Centering Cultural Sensitivity in Applied Behavior Analysis

The National Center for Education Statistics recently reported that of the 49.6 million students enrolled in public schools across America, approximately 55% identified as members of ethnic or racial minority groups.

The sociocultural makeup of K-12 learners has changed significantly since the 1960s, when researchers laid the groundwork for what would become known as applied behavior analysis (ABA). Today, ABA is widely regarded as the prevailing therapy in autism care. However, the field has not always done enough to consider the diverse range of cultural backgrounds and practices reflected in the clients it serves. 

As a result, families of autistic children from underrepresented communities often face the dual challenge of navigating their child’s diagnosis while feeling overlooked by healthcare and therapy systems. How can ABA adapt to meet the needs of an evolving population?

A “whole person” approach

Diversity encompasses various factors and experiences. These include, but are not limited to, ethnicity, race, language, nationality, religion, age, gender, sexual orientation, ability, and socioeconomic status. Since those working in healthcare rely on building trust with patients and caregivers, a culturally sensitive approach to care is a requisite.

This is particularly relevant in the practice of ABA for several reasons. Firstly, no two autistic people are the same. Autism is more than just a set of behaviors or symptoms. It is a “whole person” condition, meaning it intersects with every aspect of an individual’s identity, from physical and mental health-related conditions to familial dynamics.

The same is true from a cultural perspective. No two families have identical backgrounds. When ABA practitioners create a treatment plan, the goal is that it reflects a child’s unique strengths, needs, and characteristics. Since treatment plans are highly personalized, they must also factor in the individual’s sociocultural context. 

Delivering care within the home

Cultural sensitivity also directly impacts the quality of care delivery, especially when ABA therapy takes place within the home. As such, it is important that ABA professionals are responsive to a client’s cultural norms. A therapist may need to consider factors ranging from dressing appropriately to taking steps to recognize or facilitate a client’s cultural or religious practices.

In addition, factors such as language, socioeconomic status, and nationality may impact a family’s access to care, something ABA practitioners must consider in order to connect clients with appropriate support. Put simply, a culturally competent approach to autism care is the only way to ensure equal access to services. 

Cultural diversity in the workplace

Prioritizing cultural diversity is also beneficial for employees. Board Certified Behavior Analyst (BCBA) and Registered Behavior Technician (RBT) retention is a well-documented issue. Working in behavior analysis can be emotionally and mentally demanding. In addition, without the proper supports in place, BCBAs and RBTs can feel overworked and undervalued. One study found that around two-thirds of early-career BCBAs were experiencing high levels of burnout.

Research suggests these effects are more pronounced among individuals from traditionally underrepresented backgrounds. In their recent article, “I’m One Person, I Can’t Be Everywhere,” Melanie R. Martin Loya and Hedda Meadan highlighted the experiences of U.S.-based bilingual behavior analysts supporting autistic children from Spanish-speaking homes.

Participants reported a range of difficulties, including facing discrimination from both clients and colleagues and feeling overwhelmed and underappreciated at work. Many shared that they were frequently asked to perform additional labor in the form of translating documentation and providing translation and interpretation for clients outside of their regular caseload. Participants recommended several steps that organizations could take to reduce the burden placed on them, including expanding access to interpretation and translation resources, as well as offering professional development opportunities focused on cultural competency.

The impact of culture on employee retention

Part of the challenge of providing culturally sensitive ABA therapy is that, at present, our field does not mirror the demographics of the broader population. Data from the Behavior Analyst Certification Board shows that, as of January 2024, more than 54% of ABA workers were white, and over 86% were female. 

Our industry relies on its ability to attract and retain qualified ABA professionals. As such, creating a culture that supports and embraces diversity, equity, inclusion, and belonging is an existential necessity. Healthcare organizations can empower employees to approach their work through this lens by providing training related to cultural sensitivity at regular intervals, starting with the onboarding process.

Organizations should maintain transparent policies to protect clients and employees from discrimination. They should also offer a clear and confidential process to report any instances of discrimination that do occur. Additionally, as the industry grapples with recruitment challenges, organizations may consider how different supports and policies — for example, extending flexibility to employees who are parents and caregivers — could reduce or remove barriers to entering or remaining in the field.

Elevating care, improving outcomes

The autism care space faces many challenges. The labor market is tight, and employee turnover is high. Meanwhile, awareness is growing about how autism can present. The CDC estimates that approximately 2.8% of children in the U.S. have been diagnosed with autism. While increased awareness is a positive development, it means more families are pursuing culturally responsive therapeutic interventions.

The practice of ABA is grounded in the ideals of person-centered care. Unless providers acknowledge every aspect of a child’s background, culture, and identity, they cannot offer care that truly reflects that child’s unique needs, wants, and strengths. The more healthcare organizations can prioritize diversity, equity, inclusion, and belonging in the workplace, the better positioned they will be to recruit and retain RBTs and BCBAs who enact these values in their work.

Embracing a culturally sensitive approach to care, outreach, and professional development can enable providers to elevate their standard of care while improving their ability to attract and retain staff. By considering the importance of culture for clients and employees, healthcare organizations can ensure that those they work with feel seen, heard, and respected. In doing so, they will help to create an environment that facilitates stronger outcomes for everyone.

Photo: Irina Devaeva, Getty Images

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