Intersectionality and ABA: Balancing Harm, Survival, and Systemic Oppression
UnitedHealthcare’s recent decision to deny coverage for Applied Behaviour Analysis (ABA) claims has sent ripples through the autism community and beyond, sparking a heated debate across social media. For many neurodivergent advocates, this move was a cause for celebration, viewed as a potential blow to a practice long critiqued for its harmful effects on autistic individuals. Others, however, saw it as a troubling example of corporate cost-cutting dressed up as ethical reform, with devastating implications for families who rely on ABA as their primary, or only, form of support. The reactions have been predictably polarised, with advocates against ABA cheering its decline and many families expressing fears of being left with no viable options for their children.
ABA, a behavioural ‘intervention’ designed to teach skills through reinforcement, has dominated the landscape of autism ‘treatment’ for decades. Hailed by its proponents as the gold standard of care, it is equally reviled by many autistic people who compare its methods to conversion therapy, aimed at erasing their natural behaviours in favour of compliance and conformity. Despite growing criticism of ABA’s ethics and efficacy, the practice remains entrenched in what some refer to as the Autism Industrial Complex—a multi-billion-dollar industry that profits immensely from selling this singular vision of ‘treatment’ to desperate families. ABA’s prominence is not a reflection of universal agreement on its effectiveness but rather a testament to the power of capitalism to commodify disability under the guise of care.
Whilst it is tempting to focus solely on the harm ABA inflicts, this narrow view overlooks a critical dimension of the debate: the intersection of race, disability, and systemic inequity. For many African American families of autistic children, particularly those with high support needs, ABA represents not just a therapy but a survival strategy in a society that is openly hostile to both their race and their neurodivergence. The conversation about abolishing ABA must therefore expand to include the lived realities of these families, who face unique pressures that are often ignored in broader critiques. Without an intersectional lens, any effort to dismantle ABA risks leaving the most marginalised communities unsupported and vulnerable.
Capitalism’s Hand in UnitedHealthcare’s Decision
UnitedHealthcare’s decision to deny ABA claims is, at its core, a cost-cutting measure masquerading as progress. Whilst some may interpret this as a tacit acknowledgment of ABA’s ethical controversies or lack of scientific rigour, the reality is far less altruistic. This move has little to do with aligning autism care with best practices or prioritising the well-being of autistic individuals. Instead, it is a calculated effort to reduce expenses and increase profits in a system where financial considerations consistently outweigh patient-centred care. For a healthcare giant like UnitedHealthcare, the denial of ABA claims is not about embracing neurodiversity but about protecting their bottom line.
ABA’s commodification makes it an ideal target for such cost-cutting measures. The practice has been sold for decades as the definitive treatment for autism, bolstered by an industry that thrives on standardised, marketable interventions. It is no coincidence that ABA dominates the landscape of autism care despite mounting evidence of its ethical shortcomings and mixed efficacy. In a capitalist healthcare system, treatments like ABA flourish because they are profitable, not because they are effective. This commodification reflects a broader trend in disability services, where interventions are marketed to parents desperate for solutions, with little regard for their alignment with autistic individuals’ lived experiences or needs.
The implications of this decision extend far beyond ABA. UnitedHealthcare’s move can be seen as a test case, gauging the public and institutional response to cutting coverage for a high-profile but controversial therapy. If successful, this decision could pave the way for similar denials of other treatments with limited evidence bases, particularly off-label prescriptions that many neurodivergent individuals rely on. Whilst some may welcome the phasing out of ineffective or harmful practices, this shift is unlikely to result in the reallocation of resources to more affirming supports. Instead, it risks leaving families with fewer options altogether, further exacerbating the inequities already embedded in the system.
In this context, UnitedHealthcare’s decision is not a step towards ethical autism care but a cynical attempt to save money under the guise of reform. It highlights the dangers of a profit-driven healthcare system that prioritises cost containment over meaningful change, using the most marginalised communities as testing grounds for its cost-cutting experiments.
The “Neurodivergent Community’s” Response
The announcement of UnitedHealthcare’s decision to deny ABA benefit claims was met with widespread celebration in much of the online “neurodivergent community,” particularly among white autistic advocates. Social media platforms quickly filled with posts hailing the decision as a long-overdue rejection of a practice many compare to “conversion therapy” for autistic people. For these advocates, ABA represents not care but coercion—a form of behaviour modification designed to erase autistic traits rather than support neurodivergent needs. The collective glee was palpable, driven by years of frustration with an industry that profits from forcing compliance at the expense of autonomy and mental health.
Yet this reaction reveals more about the fragmented nature of online discourse than it does about the complexities of autism care. Social media algorithms perpetuate an insidious form of segregation, clustering content into silos that rarely intersect. “Black TikTok” and “Black Twitter” are distinct spaces, shaped by the lived experiences of African American communities and fundamentally separate from the white, middle-class autism advocacy that dominates much of the discourse on ABA. From my vantage point as a teacher in a Title 1 school, where “white moms” represent the smallest minority, these divisions are glaring. They underscore how disconnected the broader conversation about ABA is from the realities faced by families of colour, particularly African American families navigating both systemic racism and the challenges of raising autistic children.
The valid critiques of ABA as abusive and dehumanising cannot be dismissed. Its focus on compliance over connection, and normalisation over individuality, has caused significant harm to countless autistic people. But these critiques often centre white, middle-class experiences, overlooking the systemic pressures that drive marginalised families to rely on ABA despite its flaws. For African American parents, the stakes are not just about autonomy but survival. In a society where their children are disproportionately criminalised, compliance training is often seen as a necessary defence against a system that is both racist and ableist - and deadly.
What’s missing from much of the neurodivergent community’s response is an intersectional understanding of these dynamics. The celebration of ABA’s decline assumes a uniform experience of ‘autism care,’ failing to account for the unique challenges faced by families who do not share the privilege of safety or systemic support. Without this nuance, the conversation risks becoming exclusionary, leaving behind the very communities most in need of thoughtful, affirming alternatives.
What’s Missing in the ABA Debate?
The ongoing debate about ABA often fails to capture the lived realities of African American parents raising autistic children, particularly those with high support needs. Whilst many neurodivergent advocates rightly critique ABA for its harmful focus on compliance and normalisation, these arguments frequently overlook the systemic pressures that compel many families to rely on such interventions. For African American parents, the stakes are uniquely high, shaped by the intersecting forces of systemic racism, ableism, and inequities in access to alternative supports. Any conversation about abolishing ABA must grapple with these realities, or it risks alienating the very communities most impacted by its removal.
The fears African American parents face are rooted in real and present dangers. Encounters with police, social services, or even well-meaning strangers can quickly turn deadly for Black autistic individuals, whose behaviours are often misinterpreted as defiance or aggression. Research has highlighted the disproportionate risks faced by Black youth with autism in interactions with law enforcement, where misunderstandings about stimming, communication delays, or sensory overloads can escalate to tragic outcomes. The 2014 case of Stephon Watts, a 15-year-old Black autistic boy killed by police in his own home, exemplifies the devastating consequences of these societal failures. For many parents, these stories are not hypothetical—they are daily, tangible fears.
In this context, ABA often becomes a survival tool. Whilst compliance training may be harmful in other ways, some African American parents see it as a necessary evil to teach their children behaviours that could de-escalate potentially dangerous situations. It is not about erasing their child’s neurodivergence but ensuring they can navigate a world that is hostile to both their Blackness and their autism. As comedian D.L. Hughley once explained, even his wealth and fame did not shield him from the fear that his son’s autism might one day lead to a fatal misunderstanding with police. This fear is shared by countless parents, who often feel they have no choice but to prioritise their child’s physical safety above all else.
The systemic inequities that drive these decisions are stark. African American families often lack access to alternative supports, such as culturally competent therapies, community-based interventions, or even adequate public education resources. Racism compounds these challenges, limiting their ability to advocate for their children within systems that already marginalise them. Critiques of ABA that fail to consider these intersecting oppressions risk dismissing the hard choices families must make in a deeply inequitable society.
What’s missing from the ABA debate is a nuanced, intersectional lens that acknowledges the double bind faced by African American parents. They are navigating a system that offers few affirming options for their children whilst simultaneously grappling with the life-or-death stakes of raising Black autistic kids in a racist and ableist world. This is not to excuse the harm ABA causes but to recognise the systemic failings that make it, for some families, the only viable option. Until the conversation expands to address these realities, it will remain incomplete, leaving marginalised communities unsupported and vulnerable.
ABA’s Useful and Problematic Role in Marginalised Communities
Families from marginalised communities, particularly African American families, often rely on ABA as a tool to navigate a world deeply hostile to both Blackness and neurodivergence. Systemic inequities leave these families with few alternatives. Public services are frequently underfunded, culturally incompetent, or entirely unavailable, leaving parents in impossible situations where they must choose between a flawed therapy like ABA and no intervention at all. These inequities are compounded by the heightened risks that Black autistic children face during interactions with law enforcement and other systems of authority. Behaviours stemming from autism—such as stimming, delayed responses, or sensory overload—are often misinterpreted as aggression or defiance. For families fearing these misunderstandings could result in tragedy, ABA’s emphasis on compliance can appear as a necessary tool for survival.
Tiffany Hammond’s reflections on ABA and its use in marginalised communities bring to light the layered complexity of these decisions. Parents who turn to ABA are not endorsing its methods but are making pragmatic, and often painful, choices in the face of systemic failure. Compliance training, with all its flaws, becomes a way to teach children the behaviours least likely to provoke harmful responses from a society that criminalises Blackness and misunderstands neurodivergence. For many families, this choice is made not with the goal of erasing a child’s autistic identity but with the hope of protecting their lives.
However, the reliance on ABA as a survival tool does not erase its significant ethical problems. As Hammond often notes in her articles, the therapy is rooted in behaviourist principles that prioritise external control over internal understanding. It focuses on suppressing behaviours deemed undesirable or socially inconvenient, often at the expense of a child’s autonomy and emotional well-being. Many autistic individuals who have undergone ABA report long-term trauma, describing experiences of being conditioned to deny their authentic selves to conform to neurotypical expectations. The therapy’s goal of compliance over connection reflects a failure to centre the needs and rights of the individual being “treated.”
The tension between ABA’s practical utility for survival and its ethical failings highlights broader systemic issues. The prominence of ABA in marginalised communities is not a testament to its effectiveness but an indictment of the inequities that leave families without better options. As Hammond argues, dismantling ABA is insufficient if we do not simultaneously address the conditions that make it a necessary evil for so many. Without meaningful systemic change, abolishing ABA risks leaving families in an even more precarious position, without any resources to protect their children or support their growth.
The conversation must therefore shift from abolishing ABA in isolation to addressing the broader systems of oppression that sustain its use. This requires significant investment in culturally competent, neurodiversity-affirming supports that prioritise the autonomy, safety, and dignity of autistic individuals. It also demands reforms in policing, education, and healthcare to ensure that Black autistic children are no longer subjected to the compounded dangers of systemic racism and ableism. Until these changes are made, the reliance on ABA, however fraught, will remain a painful necessity for many families navigating an unjust world.
The Systemic Critique: Why Such Tools Are Needed
The continued reliance on tools like ABA underscores a much deeper issue: the hostility of the systems that govern our lives in the US. For marginalised groups, particularly African American families raising autistic children, the world is structured not for their safety or success but for their oppression. Racism and ableism work in tandem to create conditions where tools like compliance training are not a matter of preference but of survival. ABA is a symptom of these conditions, a tool shaped by a society that prioritises control and conformity over autonomy and dignity.
Policing in the United States exemplifies this systemic hostility. Its roots lie in slave patrols, designed to maintain the capitalist order by enforcing the subjugation of enslaved people. Over time, this institution has evolved only superficially, retaining its original purpose of protecting capital and enforcing systemic inequality. American police are granted a near-monopoly on violence, with laws and systems providing them with sweeping immunity from prosecution. This dangerous combination has led to countless deadly encounters, disproportionately targeting African Americans. Within the autistic community, these encounters are now receiving increased attention, as behaviours associated with autism are misinterpreted as defiance or aggression (in the US, near instant compliance with orders is a requirement when interacting with the police). The result is a lethal intersection of racism, ableism, and systemic neglect, where Black autistic individuals face heightened risks in every interaction with authority.
The over-policing of marginalised communities and systemic neglect in education, healthcare, and social services reinforce the conditions that make tools like ABA appear necessary. Families turn to compliance training not because they believe in its principles but because the alternative feels like risking their children’s lives. This is a damning indictment of the systems that should be protecting and supporting these families but instead force them to rely on interventions that prioritise survival over authenticity.
What society should be—and what it could be with systemic reform—is radically different. Imagine a world where autistic individuals, regardless of race, are affirmed in their autonomy and dignity rather than conditioned to suppress their differences. This would require a complete overhaul of policing, education, and healthcare. Police forces would no longer serve as enforcers of systemic inequality but would instead be replaced or reimagined as community-led systems of safety and accountability, stripped of their monopoly on violence. Education systems would prioritise neurodiversity-affirming practices, offering supports tailored to the unique needs of each student rather than imposing conformity. Healthcare would be universally accessible, culturally competent, and focused on holistic care rather than cost-driven interventions.
Inclusive support systems could replace tools like ABA, centring on connection, understanding, and respect for neurodivergent needs. These systems would provide families with real options, ensuring that no parent has to choose between their child’s safety and their child’s authenticity. But achieving this vision requires dismantling the racist and ableist structures that define our current systems and replacing them with frameworks built on equity, justice, and humanity (yes, capitalism has got to go for this to happen).
Until then, tools like ABA will remain a painful necessity for many families navigating a world that was never designed for their survival, much less their flourishing. The work of reimagining society is urgent—not just to abolish harmful practices but to create the conditions where such practices are never needed again.
Moving Forward: Building Better Alternatives
Moving forward, the path away from ABA and towards meaningful support for autistic individuals, particularly those in marginalised communities, requires a radical reimagining of care systems. This shift must prioritise culturally competent, neurodiversity-affirming alternatives that address the specific needs of families often left behind by existing frameworks. It also demands an honest reckoning with the economic and systemic forces that perpetuate reliance on harmful practices like ABA. At the heart of this conversation is a simple truth: society spends vast sums policing and controlling poor and marginalised communities but allocates little to truly supporting them. This imbalance is not accidental—it serves a capitalist agenda that keeps these communities in a constant state of precarity as a warning to others to stay in their place.
For families on public assistance, the situation is even more dire. Limited resources mean fewer options for therapies or supports, coupled with more frequent interactions with hostile systems like law enforcement or social services. This constant surveillance and control are by design. Capitalism benefits from ensuring that marginalised families remain on the margins, functioning as a cautionary tale to those slightly above them in the socioeconomic hierarchy. Addressing these inequities requires more than just replacing ABA—it demands a fundamental shift in how resources are allocated and how society values the well-being of its most vulnerable members.
Creating better alternatives to ABA must start with listening to the communities most affected. Community-led solutions are essential, recognising that marginalised families understand their needs better than any top-down policy ever could. Policy changes should focus on reallocating funds from systems of control—like policing—into systems of care that provide holistic, affirming supports. These could include expanded access to occupational and speech therapies, sensory-friendly public spaces, and educational reforms that centre neurodiversity - and Universal Basic Income. For families navigating cultural stigmas around autism, like those in Chinese or other collectivist communities, alternatives must also consider the social dynamics that shape their experiences. In these cases, ABA is often viewed as a tool for maintaining social cohesion, a deeply ingrained value that must be addressed respectfully in any shift towards new models of care.
Yet one of the greatest barriers to progress is the fragmented nature of the autism advocacy space. As Tiffany Hammond often observes, there is no singular “autistic community.” Instead, there are countless autistic individuals speaking, often in silos, with the loudest voices typically reflecting white, middle-class experiences. Much of the online discourse about ABA centres whiteness, ignoring the unique ways different cultures interact with autism and its associated therapies. The stigma surrounding autism in many communities of colour, including Chinese communities, highlights how little the conversation has engaged with diverse perspectives. To build better systems, advocates must make space for these voices and move beyond one-size-fits-all solutions.
Ultimately, the fight against ABA is inseparable from the fight against the societal conditions that make it necessary. Advocacy must challenge not only harmful practices but also the economic and systemic forces that sustain them. The path forward lies in solidarity: neurodivergent advocates and marginalised communities working together to create supports that affirm autonomy, dignity, and cultural nuance. This requires a commitment to equity, to redistributing resources from systems of oppression into systems of care, and to building a society where survival is no longer a privilege but a given.
Final thoughts …
ABA’s harm is undeniable, and I speak from personal experience when I say that its methods can leave lasting scars. For many autistic individuals, ABA represents a painful chapter in their lives, marked by a forced suppression of their authentic selves to fit into a world that refuses to accommodate difference. However, the systemic pressures that drive marginalised communities to rely on ABA cannot be ignored. For families facing racism, ableism, and systemic neglect, the choices are often stark: rely on flawed tools to protect their children or risk even greater harm in a hostile and unforgiving world.
This tension highlights the complexity of the ABA debate. It is not enough to condemn the therapy outright without addressing the societal conditions that make it a perceived necessity for so many. Families turning to ABA are not endorsing its principles but navigating impossible decisions in a system designed to control rather than care. True progress lies not in abandoning these families to fend for themselves but in building the inclusive, culturally competent alternatives that have long been denied to them.
Yet within this complexity lies hope. The growing discourse around ABA, though often fraught, signals a broader reckoning with the way society treats neurodivergence and marginalised communities. The critiques, the calls for change, and the push for better supports are all part of a larger movement toward equity and inclusion. This moment offers an opportunity for solidarity—a chance for neurodivergent advocates and marginalised families to come together and demand the systemic reforms that will benefit everyone.
The path forward requires courage and collaboration. It demands that we dismantle the systems of control and oppression that perpetuate harmful practices like ABA and replace them with frameworks that affirm autonomy, dignity, and cultural nuance. It calls on us to listen to the voices of those most affected, to centre their experiences, and to build solutions that reflect the diversity of their needs.
Change is never easy, but it is possible. The movement to replace ABA with affirming, holistic supports is not just about therapy—it is about reimagining society itself. It is about creating a world where no family has to choose between survival and authenticity, and where neurodivergent individuals are celebrated, not conditioned into compliance. Together, we can build that world. We owe it to ourselves, to our communities, and to future generations.