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Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis
Abstract
Purpose The purpose of this paper is to examine the prevalence of posttraumatic stress symptoms (PTSS) in adults and children who were exposed to applied behavior analysis (ABA) autism early childhood intervention. Using an online questionnaire to survey autistic adults and caregivers of autistic children, the author collected data from 460 respondents on demographics, intervention types, and current pathological behaviors with symptom severity scales. This study noted PTSS in nearly half of ABA-exposed participants, while non-exposed controls had a 72 percent chance of being asymptomatic. ABA satisfaction ratings for caregivers averaged neutral or mild satisfaction. In contrast, adult satisfaction with ABA was lower on average and also tended to take on either extremely low or extremely high ratings. Exposure to ABA predicted a higher rate and more severe PTSS in participants, but the duration of exposure did not affect satisfaction with the intervention in caregivers. Design/methodology/approach Participants were recruited for an online survey through social media networks, adult gatherings, social skills groups, and autism support groups nationwide. Adult inclusion criteria consisted of autism – diagnosed or self-diagnosed – and an age of 18 or older. A total of 460 respondents, consisting of autistic adults and caregivers of autistic children, completed an online survey. The caregiver entries (n=217) concerned 79 percent male children, 21 percent female children (male to…
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“Kupferstein (2018) reported that those exposed to ABA were 86% more likely to meet criteria for PTSD.”
From Rethinking psychological interventions in autism: Toward a neurodiversity‐affirming approach. (2025) · cites this paper as Kupferstein, 2018
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Cited by
Sorted by citations
Agency of Autistic Children in Technology Research—A Critical Literature Review
Spiel, K., Frauenberger, C., Keyes, O., & Fitzpatrick, G. (2019) · ACM Transactions on Computer-Human Interaction · doi:10.1145/3344919 · Cited by 312
“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].”
BackgroundHow much compliance is too much compliance: Is long-term ABA therapy abuse?
Sandoval-Norton, A. H., Shkedy, G., & Shkedy, D. (2019) · Cogent Psychology · doi:10.1080/23311908.2019.1641258 · Cited by 233
“One small study even found evidence of increased post-traumatic stress symptoms in those exposed to ABA (Kupferstein, 2018).”
BackgroundSchuck, R. K., Tagavi, D. M., Baiden, K. M. P., Dwyer, P., Williams, Z. J., Osuna, A., Ferguson, E. F., Jimenez Muñoz, M., Poyser, S. K., Johnson, J. F., et al. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-05316-x · Cited by 208
“…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).”
BackgroundConcerns About ABA-Based Intervention: An Evaluation and Recommendations
Leaf, J. B., Cihon, J. H., Leaf, R. B., McEachin, J. J., Liu, N., Russell, N., Unumb, L. S., Shapiro, S., & Khosrowshahi, D. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-05137-y · Cited by 226
“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).”
BackgroundInfluentialAutistic experiences of applied behavior analysis
Anderson, L. K. (2022) · Autism · doi:10.1177/13623613221118216 · Cited by 202
“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.”
Background
Metadata
- Authors
- Kupferstein, H.
- Affiliations
- Independent Researcher, San Diego, California, USA
- Corresponding author
- Kupferstein, Henny
- ORCID
- Kupferstein, Henny
- Venue
- Advances in Autism
- Publisher
- Emerald
- Published
- 2018-01-02
- Volume
- 4
- Issue
- 1
- Pages
- 19-29
- ISSN
- 2056-3868 (ISSN-L)
- 2056-3876
- OpenAlex
- W2781829914
- Cited by
- 207
- References
- 0
- Citations by year
- 2026: 31 · 2025: 42 · 2024: 32 · 2023: 32 · 2022: 27 · 2021: 19 · 2020: 14 · 2019: 7 · 2018: 3
- FWCI
- 6.41
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Advances in Autism (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- post-traumatic stress disorder, autism spectrum disorder, applied behavior analysis, early childhood intervention, PTSD prevalence, PTSD symptom severity, caregiver satisfaction, autistic adults, children with autism, caregiver stress, gender differences in autism, transgender children
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