Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis

“However, first-person accounts of adults who experienced ABA [229] and even former therapists indicate that it is a very stressful procedure for the child, which in parts can be deeply traumatising—potentially leading to Post-Traumatic Stress Disorder (PTSD) [154].”

“One small study even found evidence of increased post-traumatic stress symptoms in those exposed to ABA (Kupferstein, 2018).”

“…and neurodiversity advocates sometimes describing them as traumatic, particularly with regards to use of aversives and the suppression of Autistic traits/regulatory mechanisms (Bascom, 2015; Cumming et al., 2020; Gardner, 2017; Kupferstein, 2018; Sequenzia, 2016; Stop ABA, Support Autistics, 2019).”

“First, Kupferstein (2018), published in Advances in Autism, surveyed 460 respondents in an effort to evaluate a correlation between receiving and/or having received ABAbased intervention and the prevalence of posttraumatic stress symptoms (PTSS).”

“In addition, Kupferstein (2018) found evidence of increased posttraumatic stress disorder (PTSD) symptoms in autistics who had been exposed to ABA practices, indicating that ABA practices are causing psychological harm.”

“In light of recent accusations that behavioral treatment approaches are associated with lifelong trauma (Kupferstein, 2018; McGill & Robinson, 2020), incorporating a broader range of measures could help us better understand negative experiences with ABA and provide a more compassionate rebuttal…”

“…investigating adults with ASD who participated in ABA treatments when they were young has shown increases in incidences of posttraumatic stress disorder (PTSD); this is an emerging field of research in adults with ASD and should be further investigated through long-term studies (Kupferstein, 2018).”

“The authors specifically refer to Picture Exchange Communication System approaches and Applied Behavioural Analysis (ABA) methods as informing their work—without critically contextualising the controversies, particularly surrounding ABA (cf. [105]).”

“Children who received ABA self-report serious psychological problems (Kupferstein 2018), and there are recent data indicating a link between attempts to “camouflage” behavior in autists (what we would describe as engaging in superficial change) and suicidality (Cassidy et al 2018).”

“33 Kupferstein’s study was the first to quantitatively demonstrate a potential link between ABA and PTSD. Kupferstein’s research fueled discussion about how autism and autistic traits may be stigmatized in certain forms of autism therapy, social skills training, and education programs, which may…”

“…that there has not been enough attention paid to the long-term consequences of autism treatments (Dawson & Fletcher-Watson, 2021) or the impact of behavioral techniques, in particular, on increased rates of stress disorders and compromised mental health of autistic people (Kupferstein, 2018).”

“We know that early intervention has positive effects [50,51], and our results showed that even with an age difference of one year, that is, between 3-year-old and 4-year-old children, there is a difference in the treatment effect.”

“Other concerns involve putative long-term harm from the application of ABA therapy to autistic clients (e.g., posttraumatic stress disorder; Kupferstein, 2018; but cf. Leaf et al., 2018) and even suicidality (Mitchell et al., 2021; Ne’eman, 2021).”

“This lack of information about the possible long-term consequences of early intensive ABA-based interventions on subsequent mental health, quality of life and well-being has been previously highlighted (Kupferstein, 2018).”

“Other researchers have warned of this group's possible increased rates of posttraumatic stress disorder due to ABA (Kupferstein, 2018; Sandoval-Norton & Shkedy, 2019).”

“…that the use of ABA with autistic individuals leads to increased rates of posttraumatic stress disorder (PTSD), referencing a research study by Kupferstein (2018), which found individuals treated with ABA in childhood showed higher posttraumatic stress symptoms than those not treated with the…”

“…2021, 2022; Rumball et al., 2020, 2021a, b), five reported on 4224 children (Bitsika & Sharpley, 2021; Brenner et al., 2018; Hoch & Youssef, 2020; Hoover & Romero, 2019; Paul et al., 2018), and two studies reported on the same population of 460 respondents of mixed ages (Kupferstein, 2018, 2020).”

“Throughout the implementation and promotion of the therapy, several researchers also have expressed concerns that its misuse could result in additional harm to children with ASD, including more severe stereotyping and depression (9).”

“Future studies should involve autistic adults from diverse backgrounds who report difficulty in feeling affective empathy and determine whether they may have PTSD. Longitudinal studies should investigate if autistic participants recover affective empathy following therapy for PSTD.”

“For example, Kupferstein (2018) conducted a survey of 460 respondents and claimed to find evidence of increased PTSD symptoms for autistics who had been exposed to ABA.”

“Relatedly, personal accounts of autistic self-advocates and findings from peer-reviewed studies (e.g. Kupferstein, 2018) suggest harm and trauma as a result of ABA treatment.”

“ABA and behavioral techniques from the field of ABA are emerging to be recognized as ineffective at best and abusive at worst (Sandoval-Norton & Shkedy, 2019), increasing incidence of post-traumatic stress disorder in people with previous ABA treatment (Kupferstein, 2018).”

“Unfortunately, recent literature has been published highlighting a significant portion of autistic samples experiencing posttraumatic stress from undergoing ABA treatment (Kupferstein, 2018).”

“…some people with autism have raised major concerns about highly researched standard-of-care early intervention programs, such as the potential for intensive behavioral intervention to lead to trauma and increased vulnerability for autistic people (Kupferstein, 2018; McGill & Robinson, 2020).”

“A study by Kupferstein (2018) found a correlation between exposure to ABA and post traumatic stress disorder, while Wilkenfeld and McCarthy (2020) write that ABA resembles conversion therapy and violates the fundamental tenets of bioethics.”

“A recent study in Autism (Kapp et al. 2019) points out, moreover, the pertinence of respecting these stereotypies, and another study suggests that behavioural approaches could even induce PTSD (Kupferstein 2018). objectalizaing function”, an effect of the unbinding of the death drive pushed to its limits.”

“For example, a scoping review by Novak and Honan (2019), includes Applied Behavioural Analysis, token economies, and picture exchange communication system as ‘ green light ’ interventions for autistic children, approaches the autistic community is strongly against (Kupferstein, 2018).”

“…[138], and Applied Behavioral Analysis is both well-utilized as an autistic “cure” and covered by insurance, despite sharing techniques and origins with conversion therapy [35, 139] and causing Post-Traumatic Stress Disorder in about half the individuals that the technique purports to treat [128].”

“In fact, recent criticisms from within and outside the field of behavior analysis suggest some function-based intervention procedures might be inconsistent with TIC (Kupferstein, 2018; Rajaraman, Austin, et al., 2022).”

“induce post-traumatic stress disorder (Kupferstein, 2018; McGill & Robinson, 2020) and learned helplessness, and prompt dependency (McGill & Robinson, 2020; Sandoval-Norton & Shkedy, 2019; Wilson et al.”

“Stereotypies are defined as repetitive and involuntary movements or vocalizations that persist in the absence of social consequences and are maintained by nonsocial reinforcement (Lanovaz & Sladeczek, 2011; Rapp & Vollmer, 2005).”

“For example, published critiques of ABA have described ABA as harmful (e.g., Shkedy et al., 2019), abusive (e.g., McGill & Robinson, 2020), and traumatic (e.g., Kupferstein, 2018).”

“The act of enforcement itself can be harmful (Kupferstein, 2018).”

“These critiques are found in peer reviewed journals (Kapp et al., 2019; Sandoval-Norton & Shkedy, 2019; Kupferstein, 2018), advocacy groups (Ashburn, 2021; Autistic Self-Advocacy Network, n.d., silentlyspeakingvolumes, 2020), on social media (Listen, Learn, Lead, n.d., Therapist Neurodiversity…”

“A controversial [58, 61, 88, 95] range of treatments mainly lacking rigorous empirical evidence, aside from some support for Naturalistic (NDBI) and technology based interventions [86, 87].”

“Unfortunately, professionals have questioned the effec‑ tiveness of behavioral intervention for individuals diagnosed with ASD (Kuperferstein 2018) despite overwhelming evi‑ dence to the contrary (see Foxx 2016).”

“One study suggested this was the case in for 50% of females who had undergone ABA [10].”

“Critics have falsely asserted ABA causes trauma (e.g., Kupferstein, 2018; see Leaf et al., 2018 for a response).”

“In line with this, ABA approaches can be critiqued as vectors seeking to achieve so-called ‘recovery’ from autism, something that is neither possible nor desirable and has been shown to lead to substantial mental health challenges (Milton and Moon 2012; Kupferstein 2018; Anderson 2023).”

“…à la psychanalyse étaient en outre considérées par certains analystes comme une résistance à la 14 En réalité, certaines études suggèrent l’inverse, c’est à dire le caractère dangereux de l’ABA qui engendrerait chez près d’un enfant sur deux un trouble post-traumatique (Kupferstein, 2018).”

“Irrespective of the involvement of ND people, the relative successes and failures of workplace environments and skills training programs are often conceptualized with respect to ND productivity and employment.”

“Many attribute enduring anxiety and emotional distress to compliance-based interventions that disregarded their autonomy [5].”

“Further, ABA is experienced by many recipients as harmful, able-ist, and marginalizing (Kupferstein, 2018; Shkedy et al., 2021), with many autistic advocates, professionals, and others calling for a paradigm shift toward services that are affirming, reflect autistic people’s input, and align with…”

“Third, there are emerging descriptive and anecdotal accounts suggesting that some individuals with lived experience of ABA perceived their services to be violent, dehu-manizing, and traumatizing (Anderson, 2023; Lynch, 2019; Kupferstein, 2018; Sandoval-Norton et al., 2019; Sparrow, 2016).”

“ABA has caused trauma and harm for many people when it prioritizes adherence to societal norms over an individual’s autonomy and wellbeing [30].”

“A recent movement, in opposition to ABA, has emerged from various groups that believe ABA has been harmful to clients and that autism should not be treated (Kupferstein, 2018).”

“For example, while the autism community holds that ABA is harmful for autistic people [135][116][75], this di � ers from the mainstream opinions of medical professionals [9].”

“The reductionist behavioral approaches associated with ABA and PBS have been increasingly criticized for overlooking trauma experiences of people with IDD and associated with increased risk of further harm (Kim & Venet, 2025; Kupferstein, 2018; McAllister et al., 2024; Sandoval-Norton et al., 2019).”

“In an online survey of 460 autistic adults and caregivers of autistic youth, autistic adults and youth self-reported significantly greater rates and severity of post-traumatic stress symptoms (Kupferstein, 2018).”

“…within the neurodiversity movement raise ethical concerns regarding consent and compliance within behaviour-analytic interventions, which entail iatrogenic risks impacting client agency, autonomy and mental health (Kupferstein, 2018; Ne’eman, 2021; Roscigno, 2019; Sandoval-Norton et al., 2019).”

“…these events with heightened sensitivity or interpret them distinctively, reflecting the unique challenges and perceptions associated with ASD (Haruvi-Lamdan et al., 2018; Hoch & Youssef, 2020; Connor M. Kerns et al., 2022; Kupferstein, 2018; Ng-Cordell et al., 2022; Taylor & Gotham, 2016).”

“Research links experiences in ABA to increased symptoms of post-traumatic stress disorder in Autistic adults (Kupferstein, 2018).”

“Notably, Applied Behavioral Analysis (ABA), a form of autism treatment associated with trauma symptoms in autistic people (26, 27), was created by Ole Ivar Lovaas, who was also a proponent of conversion therapy for LGBTQ people (28).”

“, 2019) or even posttraumatic stress disorder (Kupferstein, 2018) in autistic individuals.”

“The result is that ABA is either viewed as the problem (Kupferstein, 2018), as not even worth mentioning (Howlin, 2013), or as not providing enough evidence to be included in major reviews (NICE, 2016).”

“Recent discussions have raised concerns about the potential emotional impact of overly rigid or prolonged interventions, such as fatigue and distress [7].”

“Evidently, misinformation about ABA on the internet abounds and this can lead to parents being dissuaded from scientifically validated interventions usually to the detriment of their child [52].”

“In line with this consideration, an online survey was developed to investigate whether adults with autism perceived early intervention during childhood as a potential stressor (Kupferstein, 2018).”

“…researchers, clinicians) and nonprofessionals have both suggested that behavior-analytic assessment and treatment procedures may be traumatic (e.g., Kupferstein, 2018; Rozsa, 2025; cf. Rajaraman et al., 2022, and Kranak & Briggs, 2025); however, it is difficult to objectively quantify the extent…”

“…frequently made: that ABA makes autistic people unduly compliant (Kaylene, 2024); that it causes PTSD symptoms, including nightmares and flashbacks (Kupferstein, 2018); that its goal is the elimination of benign behaviors, like stimming, to make autistic people appear more “normal” (Kaylene, 2024)…”

“With new research emerging about the adverse effects of some autism interventions (e.g., Applied Behavioral Analysis; Kupferstein, 2018; McGill & Robinson, 2021), future work should directly ask about negative outcomes to provide a complete picture of a program ’ s impact.”

“Many have also raised ethical concerns about the impact of ABA on its survivors, as adults who underwent childhood ABA have reported increased Post Traumatic Stress Disorder (PTSD) symptoms after the experience (Kupferstein, 2018; McGill & Robinson, 2020).”

“Some autistics who underwent ABA therapy have reported trauma, with Kupferstein ’ s (2018) study indicating a higher likelihood of post-traumatic stress disorder among those who received ABA.”

“The indirect reference criterion was relevant for this review because a paper titled “Evaluating Kupferstein’s Claims of the Relationship of Behavioral Intervention to PTSD for Individuals with Autism” by Leaf et al. (2018) created multiple false positives in the initial search because of the inclusion of “Kupferstein…”

“…caregivers, and other professionals, including the ethics of using certain behavioral strategies (e.g., punishment, extinction) and the use of behavioral strategies to teach behaviors to have neurodivergent people appear neurotypical (e.g., Kupferstein, 2018; Sandoval-Norton & Shkedy, 2019).”

“Some autistic individuals re-ported experiencing PTSD in connection with ABA intervention (Kupferstein, 2018; McGill & Robinson, 2020).”

“However, conflicting research that explores the accounts of autistic individuals argues that CBT's behavioural component can continue the promotion of ableist behaviour modification (Kupferstein, 2018 ; Lynch, 2019; Shyman, 2016).”

“Both also have significant traumatic results; Kupferstein (2018) found that Autistic individuals exposed to ABA were 86% more likely to meet the criteria for post-traumatic stress disorder (see also Brown, 2013).”