The Deep Impact of
Applied Behavior
Analysis for
Children with
Autism Spectrum
Disorder
Keywords: good life, ethics, pervasive developmental
disorder not otherwise specified (PPD-NOS), autism,
early intensive behavioral intervention (EIBI)
I
f applied behavior analysis (ABA) works
as claimed by Furman and Tuminello (2015),
then both Schlinger (2015) and Potter (2015)
agree that ABA could, in principle, be an aid for
solving many more problems than just those as-
sociated with autism spectrum disorder (ASD).
Does ABA work for children with ASD as Furman
and Tuminello claim? Schlinger believes that ABA
can, in fact, solve developmental and behavioral
problems associated with ASD for some children
to the point that those children might flourish in
the Aristotelian sense. On the other hand, Potter
does not believe that ABA can, in fact, elevate
children with ASD to the level of Aristotelian
flourishing.
Schlinger may be predisposed to agree with Fur-
man and Tuminello because he is a Board-Certified
Behavior Analyst and has probably seen the results
that ABA can produce not just for children with
© 2016 by The Johns Hopkins University Press
Todd M. Furman and
Alfred Tuminello, Jr.
ASD, but also for a wide range of people afflicted
with developmental and behavioral problems. Be-
cause preaching to the choir wins no new converts,
Potter’s doubts and criticism are the focus here.
Before responding to Potter’s objections, some
self-disclosure is in order. The genesis for Furman
and Tuminello (2015) was not to show a connec-
tion between Aristotle’s concept of flourishing,
Autism, and ABA per se. Rather, the prime motiva-
tion was to shed light on the fact that ABA can fa-
cilitate tremendous results for a sizable percentage
of children with ASD—results that would count
as a good life by most any metric.
Instead of proposing a new metric for a good
life, and having to defend it as well, Furman and
Tuminello used the somewhat familiar and strenu-
ous notion of a good life as offered by Aristotle.
The choice of Aristotle’s rubric was somewhat
capricious then. Hence, a full defense against Pot-
ter’s objections will not be mounted, except for
where she has underestimated the deep impact that
ABA can have on children with ASD—where the
accomplishments of children with ASD that have
been treated with ABA are on par with those of
normally developing children.
272  ■  PPP / Vol. 22, No. 4 / December 2015
Being Prudent:
A State of Mind
Potter believes that the key element of Aristo-
telian flourishing is the virtue of prudence (phro-
nesis) (Potter 2015, 265). Prudence is the ability
to reason correctly about what sort of actions and
goods lead to human flourishing. But prudence
is not contained in just the ability to reason cor-
rectly about what sort of actions and goods that
lead to human flourishing. The prudent person
must internalize the goodness of said judgment
and actions—she must feel the rightness of the
prudent goods and acts and these feelings must
factor into her motivation to act as such; other-
wise there is just the appearance of prudence but
no true prudence.
The problem Potter has with Furman and
Tuminello’s (2015) claims of children with ASD
flourishing as a result of an early intensive be-
havioral intervention (EIBI) with ABA is this. She
believes that ABA may allow children with ASD
to model appropriate (i.e., prudent) behaviors
but not feel them in the appropriate way (Potter,
264). For example, a child might go through all
of the appropriate external motions of friendship
toward another child, but if she does not feel the
friendship, there is no real friendship; there is no
virtue of friendship in place. Hence, Potter asks,
Is there anything more to ABA training than de-
veloping a skill set by which people with ASD can
cope better in the world? Do persons with ASD
ever achieve a normal emotional life? The answer
to both questions is an emphatic yes.
Evidence for the Deep Impact
of ABA
The Studies
Furman and Tuminello (2015) pointed to
research (Cohen, Amerine-Dickens, Smith 2006;
Lovaas 1987; Sallows and Graupner 2005) that
showed that children with ASD that receive an
EIBI using ABA may achieve normal levels of
functioning. What may not have been so obvious
was the fact that the normal levels of functioning
included the emotional component Potter doubts
to exist in children recovering from ASD. How-
ever, the true impact of ABA becomes clear when
considering the details of some longitudinal studies
of EIBIs using ABA on children with ASD.
In follow-up examinations, Sallows and
Graupner (2005) reported that 34% of children
with ASD that received an EIBI using ABA no lon-
ger meet the criteria for ASD as measured by the
Autism Diagnostic Interview-Revised assessment
tool (Sallows and Graupner 2005, 428). To be
perfectly clear, the Autism Diagnostic Interview-
Revised focuses on assessing three main areas:
stereotyped behaviors, communication skills, and
most important, given Potter’s concerns, social
interactions. In this light, Sallows and Graupner
(2005) found, in aggregate, that 34% of the chil-
dren studied came to communicate, behave, and
interact socially at the same levels achieved by
normally developing children.
Zachor, Ben-Itzchak, Rabinovich, and Lahat
(2007) used the gold standard for ASD assessment,
the Autism Diagnostic Observation Schedule, to
compare pre- and post-EIBI interventions using
ABA. The Autism Diagnostic Observation Sched-
ule is an interactive assessment tool that constructs
social situations in which four domains of ability
are assessed: language and communication, re-
ciprocal social interaction, play, and stereotyped
behaviors. Zachor et al. (2007) discovered that
20% of the treated children moved off of the au-
tism spectrum; 20% no longer qualified as autistic.
McEachin, Smith, and Lovaas (1993) discov-
ered an even greater percentage of children that
had been diagnosed with ASD that had been
normalized after their EIBIs with ABA. The as-
sessment instruments used by McEachin et al.
to measure intellectual, social, and emotional
functioning were the Wechsler Intelligence Scale
for Children-Revised, The Vineland Adaptive
Behavior Scales, and the Personality Inventory
for Children.
Results such as these have some researchers
working on defining the finishing line of recovery
from ASD (Granpeesheh, Tarbox, and Dixon
2009; Helt et al. 2008).
Simply because a child that was diagnosed with
ASD no longer meets the criteria for ASD does
not mean that such a child will flourish in the Ar-
 Furman and Tuminello / Applied Behavior Analysis for ASD  ■ 273
istotelian sense. After all, as Potter (2015) points
out, the standard for flourishing in the Aristotelian
sense is very, very high and requires a bit of good
luck as well (e.g., health and wealth) to every fully
reach it. But what can be said, based on results like
those reported by Sallows and Graupner (2005)
and Zachor et al. (2007), is that a significant per-
centage of children can overcome ADS to have just
as much of a chance at flourishing as a normally
developing child. And this fact is unknown by far
too many people.
One note concerning Potter’s doubts about the
appropriate mental lives of children with autism is
in order. As Schlinger (2015) points out, psychol-
ogy qua behaviorism really started to become a
real science and show tangible results when it jet-
tisoned mentalism. Hence, the behaviorist is not
going to give much credence to Aristotle’s demand
that certain sorts of mental states accompany
prudent actions for the person to be prudent and
flourish. According to the behaviorist, the appro-
priate actions are all there is for assessing prudence
and flourishing. Behaviorists are unapologetic
epistemological externalists.
Anecdotal Evidence
In agreement with Sherman (1989), Potter
rightfully claims that, according to Aristotle, we
cannot live well (i.e., flourish) as social beings
without proper emotional engagement with oth-
ers. Potter wonders aloud whether children with
ASD will ever be able to
be afraid, for instance, or to be confident, or have
appetites, or get angry, or feel pity and in general have
pleasure or pain… [in general, to have these] feelings
in the right times, about the right things, toward the
right people, for the right end, and in the right way.
(Potter 2015, 265)
Personal experience says, yes they can. Peter
Parker (not his real name) was diagnosed at the
age of 4 with ASD and an EIBI was put into
place shortly thereafter. The EIBI consisted of
year-round ABA on the order of 20 to 40 hours
per week.
Even with Peter Parker’s intervention on its
way, it seemed dubious to Peter Parker’s parents
whether Peter would ever learn to read or write,
initiate a conversation, have friends, understand
social mores, and so on. Fast forward to five years
later. Peter is finishing second grade in a regular
classroom earning all As and Bs. Peter has friends
and Peter gets happy, mad, sad, proud, and so on
at the right times, about the right things, toward
the right people, for the right end, and in the right
way, as much as any other second grader. Peter fits
in so well now that he received an award, voted
on by his peers, for exemplary citizenship. Because
of his EIBI using ABA, Peter has just as much of a
chance at Aristotelian flourishing as the next kid.
Conclusion
All hope is not lost for children with ASD.
With an appropriate intervention, a significant
number of children with ASD can be normalized;
a significant number can flourish just as much as
any other child might.
Society is in possession of a great power—the
Board-Certified Behavior Analyst. Let us hope that
society lives up to its corresponding responsibility
and uses Board-Certified Behavior Analysts to the
fullest extent possible.
Acknowledgment
The authors thank the journal referees for their
thoughtful and helpful comments. We also profited
greatly from conversations with Dr. Charlotte
Carp, Dr. Cam Melville, Dr. Tracy Leper, Dr.
Hanno Bulhof, and Dr. Cheryl Ware, and from the
moral support of Andrea Furman and Katie Blum.
References
Cohen, H., M. Amerine-Dickens, and T. Smith. 2006.
Early intensive behavioral treatment: Replication of
the UCLA model in a community setting. Develop-
mental and Behavioral Pediatrics 27, no. S1:45–55.
Furman, T., and A. Tuminello. 2015. Aristotle, autism,
and applied behavior analysis. Philosophy, Psychia-
try, & Psychology 22, no. 4:253–61.
Granpeesheh, D., J. Tarbox, and D. R. Dixon. 2009.
Retrospective analysis of clinical records in 38 cases
of recovery from autism. Annals of Clinical Psychia-
try 21:195–204.
Helt, M., E. Kelley, M. Kinsbourne, J. Pandey, H. Boor-
stein, M. Herbert, and D. Fein. 2008. Can children
with autism recover? If so, how? Neuropsychology
Review 18:339–66.
274  ■  PPP / Vol. 22, No. 4 / December 2015
Lovaas, O. I. 1987. Behavioral treatment and normal
educational and intellectual functioning in young
autistic children. Journal of Consulting and Clinical
Psychology 55:3–9.
McEachin, J. J., T. Smith, and O. I. Lovaas. 1993. Long-
term outcome for children with autism who received
early intensive behavioral treatment. American Jour-
nal on Mental Retardation 97:359–72.
Potter, N. N. 2015. Doing right and being good: What
it would take for people living with autism to flour-
ish. Philosophy, Psychiatry, & Psychology 22, no.
4:263–5.
Sallows, G. O., and T. D. Graupner. 2005. Intensive
behavioral treatment for children with autism: Four-
year outcome and predictors. American Journal on
Mental Retardation 110: 417–38.
Sherman, N. 1989. The fabric of character: Aristotle’s
theory of virtue. Oxford: Clarendon Press.
Schlinger, H. D. 2015. Behavior analysis and the good
life. Philosophy, Psychiatry, & Psychology 22, no.
4:267–70.
Zachor, D. A., E. Ben-Itzchak, A. Rabinovich, and E.
Lahat, E. 2007. Change in autism core symptoms
with intervention. Research in Autism Spectrum
Disorders 1:304–17.

About the Authors
Todd M. Furman is Professor of Philosophy at
McNeese State University and on the editorial
board of the journal Teaching Philosophy. Aca-
demic interests include epistemology, philosophy
of religion, critical thinking, and ethics. Todd
Furman is currently working on a book, Honor
Among Thieves: An Exploration of Ethics in Poker
and the World Beyond. He can be contacted via
e-mail at tfurman@mcneese.edu.
Richard G. T. Gipps is a Clinical Psychologist pro-
viding psychotherapy for the University of Oxford
and in private practice. His special interest is the
philosophical understanding of, and psychoana-
lytical psychotherapy for, schizophrenic psychosis.
He can be contacted via email at richard.gipps@
admin.ox.ac.uk.
William E. Greenberg is Psychiatrist-in-Chief of
Beth Israel Deaconess Medical Center. He served
as Residency Training Director at Beth Israel Hos-
pital, Boston from 1987 to 1994 and of the Har-
vard Longwood Psychiatry Residency from 1994
to 2011. He is Assistant Professor of Psychiatry at
Harvard Medical School. Dr. Greenberg recently
published “Changes in Residency Training over
the Past Quarter-Century: Reflections of a Long-
time Program Director” in Academic Psychiatry.
He can be contacted via email at wgreenbe@
bidmc.harvard.edu.
Mona Gupta is a Consultation-Liaison Psychia-
trist and Researcher at the Centre Hospitalier de
l’Université de Montréal. She is also Assistant
© 2016 by The Johns Hopkins University Press
About the Authors  ■ 333
Professor in the Department of Psychiatry at the
l’Université de Montréal. Her areas of academic
interest are in bioethics and the philosophy of
psychiatry. Dr Gupta is widely published on the
subject of ethics and evidence-based medicine
in psychiatry. Her research monograph on this
topic was published by Oxford University Press
in 2014. She can be reached via email at mona.
gupta@umontreal.ca.
Aaron J. Hauptman is a Child and Adolescent
Psychiatry Fellow at New York University. He is
interested in adult and pediatric neuropsychiatry.
Two recent publications include “The Differential
Diagnosis and Treatment of Catatonia in Children
and Adolescents” co-authored with Dr. Sheldon
Benjamin and forthcoming in The Harvard Review
of Psychiatry and Neuroscience and “Neurosci-
ence of Morality for the Mental Health Practitio-
ner: A Review” published in Psychiatric Times.
Ginger A. Hoffman is Assistant Professor of Phi-
losophy at St. Joseph’s University in Philadelphia,
Pennsylvania. She received her PhD in philosophy
from MIT, where her dissertation focused on the
ethics of antidepressant treatments, and her PhD in
neuroscience from Yale University, where her dis-
sertation investigated the basic biology underlying
the mechanisms of antidepressant treatments. She
researches and teaches in philosophy of psychiatry,
neuroethics, feminist philosophy, philosophy of
mind, and applied ethics. Her recent publications
include: Hoffman, G. A. 2013. Treating yourself
as an object: Self-objectification and the ethical
334  ■  PPP / Vol. 22, No. 4 / December 2015
dimensions of antidepressant use. Neuroethics
6:165–78, and Hoffman, G. A., and J. Hansen.
2011. Is Prozac a feminist drug? The International
Journal of Feminist Approaches to Bioethics 4,
no. 1: 89–120. She can be reached via email at
gingerahoffman@gmail.com.
Ian James Kidd is an Assistant Professor at the
Department of Philosophy, University of Notting-
ham. His research interests include the experience
and value of illness, the nature of a religious life,
and philosophical virtue theory and intersects
philosophy of illness, philosophy of religion, and
history of philosophy. He can be contacted via
email at ian.kidd@nottingham.ac.uk.
Robert S. Kruger is a Clinical Child Psychologist
with a private practice in Westport, Connecticut.
He received his undergraduate degree in psychol-
ogy from Columbia University and his doctorate
from Yale University. He was a postdoctoral fellow
at Yale in psychiatric epidemiology studying the
prevalence of childhood psychiatric disorders, a
postdoctoral associate at Yale in psychology study-
ing the effect of violence on television on children,
and a postdoctoral fellow in philosophy at Yale
studying philosophy of mind and phenomenology.
He has been a Clinical Instructor in Psychiatry at
Yale and Cornell. His most recent work has been
on clinical theory in the diagnosis of autism. He
can be contacted via email at drrskruger@gmail.
com.
Nancy Nyquist Potter has published extensively
in the interdisciplinary field of philosophy and
psychiatry, as well as in feminist ethics and po-
litical philosophy. Her current research is on the
connections between theories of knowledge and
ethics, with special attention to nosological and
diagnostic issues, and on the relationship between
voice, silence, and uptake, in particular for patients
living with mental illness. Her last book-length
publication was a critical analysis of borderline
personality disorder (Oxford University Press,
2009) and her newest book, The Virtue of Defi-
ance and Psychiatric Engagement, is forthcoming
2016 (Oxford University Press). She can be con-
tacted via email at nancy.potter@louisville.edu.
Henry D. Schlinger, Jr., is Professor of Psychology
at California State University, Los Angeles. He is
the former editor of The Analysis of Verbal Behav-
ior and The Behavior Analyst and the author of
three books, including A Behavior Analytic View
of Child Development. Academic interests include
basic learning processes, schedules of reinforce-
ment, child development, conceptual issues in
behavior analysis and psychology, and verbal be-
havior. Recent publications include: “What would
it be like to be IBM’s computer, Watson?” The
Behavior Analyst, 2012, 35, 37–44, and “Behavior
analysis and behavioral neuroscience” Frontiers
in Human Neuroscience 17 April 2015. He can
be contacted via e-mail at hschlin@calstatela.edu.
Anastasia Philippa Scrutton is a philosopher with
particular interests in religion, emotion, and psy-
chiatry. Some recent publications include “Can
being told you’re ill make you ill? A discussion
of psychiatry, religion, and out of the ordinary
experiences” in Think: Philosophy for Everyone
(forthcoming); “Suffering as potentially transfor-
mative: A philosophical and pastoral consideration
drawing on Henri Nouwen’s experience of depres-
sion” in Pastoral Psychology, 2015, 64.1, 99–109,
and “Divine passibility: God and emotion” in
Philosophy Compass, 2013, 8.9, 866–74. She can
be reached via email at t.scrutton@leeds.ac.uk.
John Swinton is Professor in Practical Theology
and Pastoral Care in the School of Divinity, Re-
ligious Studies, and Philosophy at the University
of Aberdeen. He has a background in mental
health nursing and healthcare chaplaincy and has
researched and published extensively within the
areas of practical theology, mental health, spiri-
tuality and health and the theology of disability.
He is the Director of Aberdeen University’s Centre
for Spirituality, Health and Disability. He can be
reached at j.swinton@abdn.ac.uk.
Alfred Tuminello Jr. is a Board-Certified Behavior
Analyst and Director of the McNeese Autism
Program. He has engaged in research designed to
further the knowledge of best practice procedures
for individuals with self-care difficulties, including
eating aversions, and medical regimen compliance
difficulties. He may be contacted via email at atu-
minellojr@mcneese.edu.
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