For decades, I practiced developmental-behavioral pediatrics with a focus on coordinated care, measurable goals, and clinical accountability. I believed that if we could define a child’s needs clearly and track progress with integrity, we could build systems that honored both science and dignity.
But I now realize I missed something critical.
After reviewing the #BanABA initiative and speaking with Dr. Henny Kupferstein, I’ve come to understand the full scope of harm linked to applied behavior analysis (ABA) therapy. This isn’t just about outdated methods or billing irregularities. It’s about documented patterns of physical and psychological trauma, especially among nonspeaking autistic individuals and those who rely on AAC. It’s about a system that too often prioritizes compliance over communication, normalization over neurodiversity.
In 2016, I raised formal concerns about a specific military health care pilot program for ABA in a particular state. The large insurance contractor managing it stonewalled the inquiry. For them it was a big moneymaker, without oversight from the relevant government department. I was the one who attempted oversight after receiving a communication from Senator John McCain, Chairman of the Senate Armed Services Committee. The military branch involved labeled me as a troublemaker and forced me into learning the SBAR communication method.
Despite that, it was “good trouble,” using Representative John Lewis’ definition: when the senator and I questioned both the cost and the absence of measurable goals needed to justify continued paying for services under the pilot. The contractor considered the pilot as an entitlement to increase corporate profits only, not to help children with ASD. That obstruction may have triggered the legislature to authorize the largest ABA study ever conducted under the military health care program. But the study focused on cost-effectiveness, not trauma. I was asking about harm. About dignity. About whether we were truly helping the children we claimed to serve.
Earlier in my career, as medical director of the Autism Program at a large nonprofit organization in a Midwestern city, I routinely marked “NMG” (No Measurable Goals) in red Sharpie on therapy proposals for ABA, PT, OT, and speech that lacked clinical rigor. I was supported by the clinic director and the pediatric chairman. We weren’t rejecting therapy; we were demanding accountability. But even then, I didn’t fully grasp the trauma described by autistic adults and self-advocates.
I now recognize that ABA’s faults go far deeper than poor documentation:
A harmful focus on conformity: Many self-advocates argue that ABA’s goal of making autistic individuals appear “normal” can punish harmless traits like stimming or echolalia.
Psychological harm: Research and personal accounts suggest that behavior modification, when coercive, can cause lasting trauma and reinforce the idea that autistic ways of being are inherently wrong.
Better alternatives exist: Communication-based therapies, especially those that honor autonomy and consent, may offer more meaningful support, particularly for nonspeaking individuals who use behavior as language.
This isn’t just a clinical debate. It’s a civic reckoning.
I’ve come to understand that ABA’s widespread adoption was not driven by consensus among developmental pediatricians, but by insurance mandates, billing incentives, and a cultural push for normalization. In many cases, ABA was the only reimbursable option, regardless of its appropriateness or ethical standing. Families were cornered. Clinicians were pressured. And children were subjected to interventions that may have caused more harm than help.
So, what are the alternatives?
There are evidence-informed, dignity-centered approaches that prioritize communication, autonomy, and relationship-building over compliance:
Developmental and relationship-based models (e.g., DIR/Floortime): These approaches focus on emotional connection, co-regulation, and following the child’s lead. They support social-emotional development without coercion.
Augmentative and alternative communication (AAC) support: For nonspeaking individuals, access to robust AAC systems, paired with communication partners trained in modeling and respect, is essential. Communication is not a reward; it’s a right.
Occupational therapy with a sensory integration lens: When practiced ethically, OT can help children understand and regulate their sensory experiences without suppressing natural behaviors.
Presume competence frameworks: These approaches reject deficit-based assumptions and instead presume that every individual has the capacity to learn, communicate, and participate meaningfully, given the right supports.
Peer-mediated and naturalistic interventions: These emphasize learning in real-world contexts, often with neurotypical peers, and avoid rigid drill-based instruction.
These models are not perfect, but they are rooted in respect. They prioritize consent. They do not rely on token economies, forced eye contact, or compliance as a proxy for progress.
I now support a federal ban on coercive behavioral interventions. I believe it’s time to listen to autistic voices, not override them. It’s time to stop rewarding systems that monetize compliance and start investing in models that respect neurodiversity, autonomy, and informed consent.
This shift is personal. It’s professional. And it’s overdue.
I’ll appear on The Podcast by KevinMD to share this journey, from early objection to ethical awakening. I’ll speak not just as a retired pediatrician, but as someone who once believed that measurable goals were enough. They’re not. Not if the goals themselves are rooted in erasure.
I’ll also speak as an author. In my memoir The Quiet Architect, I reflect on the systems we build, and the ones we must dismantle. I’ve included an excerpt that documents my early challenge to ABA at the federal level, supported by Senator John McCain. That moment wasn’t just a clinical objection. It was a warning.
Today, I add my voice to the #BanABA initiative. I do so with humility, clarity, and resolve. I do so knowing that silence is complicity, and that legacy is not just what we build, but what we’re willing to unbuild.
This is my public pivot. My red Sharpie moment has become a reckoning.
Ronald L. Lindsay is a retired developmental-behavioral pediatrician whose career spanned military service, academic leadership, and public health reform. His professional trajectory, detailed on LinkedIn, reflects a lifelong commitment to advancing neurodevelopmental science and equitable systems of care.
Dr. Lindsay’s research has appeared in leading journals, including The New England Journal of Medicine, The American Journal of Psychiatry, Archives of General Psychiatry, The Journal of Child and Adolescent Psychopharmacology, and Clinical Pediatrics. His NIH-funded work with the Research Units on Pediatric Psychopharmacology (RUPP) Network helped define evidence-based approaches to autism and related developmental disorders.
As medical director of the Nisonger Center at The Ohio State University, he led the Leadership Education in Neurodevelopmental and Related Disabilities (LEND) Program, training future leaders in interdisciplinary care. His Ohio Rural DBP Clinic Initiative earned national recognition for expanding access in underserved counties, and at Madigan Army Medical Center, he founded Joint Base Lewis-McChord (JBLM) CARES, a $10 million autism resource center for military families.
Dr. Lindsay’s scholarship, profiled on ResearchGate and Doximity, extends across seventeen peer-reviewed articles, eleven book chapters, and forty-five invited lectures, as well as contributions to major academic publishers such as Oxford University Press and McGraw-Hill. His memoir-in-progress, The Quiet Architect, threads testimony, resistance, and civic duty into a reckoning with systems retreat.
