| Kupferstein (2018, 2020) argued that autistic adults who experience posttraumatic stress disorder (PTSD) do so because they had received applied behaviour analysis when they were young children | There was no causal argument in the Kupferstein study. The study investigated scoreable stress symptoms in participants who received any autism early childhood intervention (implying autism diagnosis). The data reporting indicates a significant correlation between the ABA-exposed group and the severity of their reported stress symptoms. Correlation is not causation |
| Kupferstein did not ask respondents to verify their clinical autism diagnosis | This was not a clinical study so clinical data was not relevant to the survey, and clinical diagnostics were not determined based on the data collected from participants. What evidence do they have that autism research conducted without clinical records would be invalid? This is an industry standard, much like surveying queer people, and indigenous people, and not asking them for proof of their queerness or indigenous status. Given the financial and clinical barriers in getting an autism diagnosis (Ardeleanu et al., 2024), the enabling of self-identification is essential |
| Nor did her analysis differentiate between those who were clinically diagnosed and those who self-identified as autistic | Conducting a study exclusive to clinically diagnosed people would seriously restrict the generalisability of the findings beyond those privileged to be able to access diagnosis. It is highly unlikely that individuals would self-identify as autistic unless they felt they were autistic and the nature of autism is such that most will have undertaken extensive research into the characteristics of autism. Results of research with self-identified autistic adults have been found to be “very similar to the results of adults with a formal diagnosis of autism” (Overton et al., 2024, p. 689) |
| Autistic adults as well as parents of autistic children appear to have been asked to respond to exactly the same 26-question survey | The survey was identical but with contextual modifications. For example, adults were asked if they believe they met their therapy goals, while caregivers were asked whether they believe their child met the therapy goals |
| It is also unclear whether the responses from non-autistic parents were related to their own stress symptoms or those of their children | The questions were carefully worded to avoid any risk of parents reporting their own stress symptoms |
| Conclusions drawn from her survey appear to be based on responses from seven participants | The conclusions were drawn from responses from 460 participants. |
| Kupferstein did not evidence that her participants had a formal clinical diagnosis of PTSD. Instead, she merely asked participants about some stress symptoms and then asserted that they had this very serious clinical mental health disorder | The purpose of this study was to determine if early childhood intervention recipients who reported severe stress symptoms on a survey would likely be diagnosable with PTSD in a clinical screening, as the survey used the same questions a clinician would use. There was no assertion of a “serious clinical mental health disorder” to any of the survey participants |
| There was no formal assessment of any traumatic life events that may have taken place after any early childhood intervention | Kupferstein used an industry standard instrument. We recommend development of a specific instrument for future research into the risk of ABA-based interventions for autistic people causing trauma to minimise any issues around the adequacy of instrumentation |
| Since Kupferstein neither requested clinical evidence nor elucidate the level of training of service providers who may have provided early intervention (NB, most of her participants were not diagnosed/self-identified until they were at least in their mid-20s), we cannot say for sure that what may have been provided would have been in line with ABA as described by Baer and others since then | We agree that one cannot be sure whether the interventions would have been in line with ABA as described by Baer et al. (1968, 1987) and others. However, it does not appear to be standard practice for behavioural researchers to confirm compliance with the Baer, Wolf and Risley principles so in this regard Kupferstein’s study is no different from the behaviourist academic literature |