Journal of Applied Behavior Analysis (Fall) 2020, 53, 1830–1836 NUMBER 4

Editor’s Note: Societal changes and expression of concern about

Rekers and Lovaas’ (1974) Behavioral Treatment of Deviant
Sex-Role Behaviors in a Male Child
The Society for the Experimental Analysis of Behavior and
Linda A. LeBlanc, Editor-in-Chief
Journal of Applied Behavior Analysis

In an early study in the Journal of Applied Behavior Analysis, Rekers and Lovaas (1974) evaluated
the Behavioral Treatment of Deviant Sex-role Behaviors in a Male Child. They investigated the
use of reinforcement and punishment to target non-gender-conforming behaviors of a 5-year-
old male child. This study was considered by some to be controversial and concerning, even
near the time of publication (Nordyke et al. 1977; Winkler, 1977). The concerns focused on
the ethicality of selecting non-gender-conforming behavior as a target response and the use of
punishment for this type of response, particularly at the behest of parents when the young child
was not seemingly distressed. The study has subsequently been used as empirical support for
conversion therapy creating concerns about misinterpretation of the original article and harm to
the LGBTQ+ community. This editorial reviews the concerns originally presented by Nordyke
et al. (1977) and Winkler (1977) and issues an official Expression of Concern about the various
harms that have been associated with this paper.
Key words: conversion therapy, ethics, gender non-conforming, LGBTQ+

The early volumes of Journal of Applied Behav-
ior Analysis (JABA) included many articles that
seem controversial in retrospect. For example,
the terminology used to describe participants
with intellectual and developmental disabilities
(i.e., the current professionally accepted term),
although considered appropriate at the time, is
offensive in today’s society. Even the
U.S. national organization for this population
used the term “retarded citizens” at that time,
but no longer does so. Similarly, terms such as
“mentally retarded,” “retardate,” “deviant,” and
“mentally handicapped” are no longer evident in
the pages of JABA from recent decades. As soci-
ety and its focus on inclusive and bias-free lan-
guage evolved, so has our own terminology such
that what was contextually acceptable at one
point in time is no longer acceptable today. Early
studies published in JABA also were also more
Address correspondence to: Linda LeBlanc, 1006
Dogwood Drive, Golden, CO 80401. Email:
jaba@lbehavioral.com
doi: 10.1002/jaba.768
© 2020 Society for the Experimental Analysis of Behavior (SEAB)
1830
likely than recent studies to examine the effects
of aversive consequences (Shawler et al., 2019).
As our technology and scientific literature base
evolved, so has our research and clinical practice
such that recommended practice is the use of
nonpunishment-based procedures when possible
and operating according to the principle of “least
intrusive intervention” (Vollmer et al., 2011).
There is one clear instance in which an early
JABA study was considered controversial, and
potentially unethical even at the time of publi-
cation. Rekers and Lovaas (1974) used rein-
forcement and punishment to reduce “feminine
behaviors” in a 5-year-old male child. That is,
the treatment was specifically designed to
reduce gender nonconforming behaviors at the
request of the parents. The mother was taught
to reinforce masculine behaviors and to extin-
guish feminine behaviors using social reinforce-
ment in the clinic and the father spanked the
child at home based on the results of the a
token reinforcement procedure in the home
(i.e., a certain colored card indicated that there
 Societal Changes and Ethical Concerns
had been feminine behaviors at clinic and the
child would be spanked). Although this study,
and the treatment research program on child-
hood gender problems from which it came,
were supported by United States Public Health
Service Research Grant 21803 OlAl from the
National Institute of Mental Health, other
researchers at that time still questioned the eth-
icality of selecting non-gender-conforming
behavior as a target response for modification
for a young boy.
Nordyke et al. (1977) and Winkler (1977)
each published papers that outlined significant
concerns with the rationale for targeting this par-
ticular behavior, the degree to which the study
attended to recent literature and social change,
and the ethicality of the procedures used by
Rekers and Lovaas (1974). Winkler (1977)
pointed out that some researchers (Davison,
1976; Winett & Winkler, 1972) were already
expressing concerns about the type of behavioral
goals set in that same decade, though others,
including the American Psychiatric Association
(APA) and its framework for diagnosing mental
disorders (APA, 1968), clearly felt that homosex-
uality was pathological (Bieber, 1976;
Rekers, 1977). The publication of these response
papers within a few years of the original study
provides evidence that some members of the sci-
entific community were concerned about this
issue at the time of publication.
Nordyke et al. (1977) questioned both the
rationale for treatment (e.g., relieving the child’s
suffering from social isolation and scorn,
preventing lifelong pathology, alleviating paren-
tal concern), the procedures used, and the
descriptions of the masculine and feminine sex-
roles. Nordyke et al. suggested that the earlier
study appeared “to be not only accepting but
also supporting sex-role stereotyping, thereby
failing to contribute to the solution of a larger
social problem.” The authors suggested that
concern about social isolation and scorn was a
poor rationale for targeting the child’s behavior
rather than societal change when they drew the
1831
analogy that “feminists may be scorned and iso-
lated by segments of society, and while they
may not like the societal scorn, most have indi-
cated a need for modification programs aimed
not at themselves but at the very segments of
society that set the occasions for their problems”
(p. 554). Nordyke et al. expressed concern that
Rekers and Lovaas (1974) admitted that “social
and parental pressure led them to conduct sex-
role therapy” (p. 553). For example, even Rekers
and Lovaas indicate that “society probably could
afford to become more tolerant with individuals
with sex-role deviations,” however, they suggest
that they targeted the boy’s behavior instead of
societal responses because “it is potentially more
difficult to modify society’s behaviors than
Kraig’s [the participant’s pseudonym” (p. 174).
Winkler (1977) expressed concern that the
authors made no mention of contemporaneous
changing of societal attitudes and psychiatric
opinions about homosexuality and other sexual
behavior, changing laws, and expanding gay
rights movements. Nordyke et al. suggested that
Rekers and Lovaas should have sought out other
viewpoints such as “spokespersons for lesbian
and homosexual organizations, representatives of
AABT [the Association for the Advancement of
Behavior Therapy] positions concerning homo-
sexuality, children’s rights advocates, and
others (p. 554)”.
Other studies published in JABA and other
journals targeted homosexual responses in
adults, but at the request of the distressed adult
who gave consent for the use of the procedures
(Abel et al., 1975; Barlow & Agras, 1973;
Brownell et al., 1977) rather than a minor.
Although the distress may unfortunately have
been due to societal pressures and norms, none-
theless it existed, and these individuals sought
their own treatment. Both Winkler (1977) and
Nordyke et al. (1977) expressed concern that in
the case of the Rekers and Lovaas (1974) study,
the child was not presenting with distress. The
parents were presenting with alarm at the gender
nonconforming behaviors and requesting the
1832 Linda A. LeBlanc
treatment with no apparent consideration for
the rights of the minor. Nordyke et al. suggest
that by taking only the parental point into con-
sideration, “the therapist has become the par-
ents’ agent, rather than the child’s, or society’s”
(p. 554) with potential consequences for the
field and society if behavior analysis is used to
change behavior that is questioned only by other
agents, such as parents or courts.
Nordyke et al. (1977) also questioned the
treatment procedure in which the token
(i.e., the immediate consequence for so called
feminine or masculine play) resulted in punish-
ment in the form of “timeout or a spanking by
the father” (p. 555). Nordyke et al. suggested
that the use of punishment in this instance was
also questionable in regard to new areas of
application of behavior change. Even as early as
the 1960s and 1970s, the notion of “least
intrusiveness” as a guidepost for treatment
selection was evident. Nordyke et al. suggested
that beginning with treatment procedures that
involved punishment for these behaviors,
including physical punishment from the father,
was inappropriate according to this guideline.
The publication of this study caused concern
to some in the behavior-analytic community
immediately1 in the context of the 1970’s soci-
ety even though it was federally funded and in
alignment with the status of early versions of
the Diagnostic and Statistical Manual which
designated gender nonconformance and homo-
sexuality as pathological (APA, 1968). From
the retrospective viewpoint of almost 45 years
later and today’s social context, that study
seems almost inconceivable as a scientific
endeavor. The societal change that has now
occurred and is still underway with respect to
civil rights of the LGBTQ+ community was
already beginning at the time the original study
was published. The discord between those
1 study was unethical by the standards of that
Although the publication dates for both papers are
1977, Nordyke et al. was originally submitted in August,
1975, while Winkler was submitted April, 1975.
changes and the Rekers and Lovaas (1974)
study was concerning to some contemporane-
ous researchers and is of grave concern to soci-
ety today. In addition, the expectations for
considerations of personal rights of participants
and use of less intrusive procedures as initial
treatment options were also heavily discussed in
the scientific community at that time. The Bel-
mont Report had not yet been published at
that time and the Human Subjects Institutional
Review Board (HSIRB) infrastructure that we
know today was not yet established. Today, the
HSIRB requirements for treatment research
with children specifies that there should be pro-
cedures for child assent (when obtainable) as
well as parental permission. The Rekers and
Lovaas study would seemingly never be
approved in recent decades, much less receive
federal grant funding or be published.
Multiple readers of JABA have reached out to
the present Editor-in-Chief of JABA to make
the Society for the Experimental Analysis of
Behavior (SEAB) board aware of multiple harms
that have been associated with the Rekers and
Lovaas (1974) article. These communications
led SEAB to undergo a detailed examination of
all available information and publications rele-
vant to the paper or the subsequent uses of the
paper in alignment with the Committee on
Publication Ethics (COPE) guidelines
(COPE, 2019). The actions of Retraction and
Expression of Concern were carefully reviewed to
determine whether the original study met the
established criteria for those actions. The criteria
for retraction are primarily based on clear and
defensible evidence of scientific misconduct, fal-
sification or fabrication of data, or clear ethics
violation. By today’s standards and in light of
our current scientific knowledge, the study
would be considered unethical and would not
be published in JABA. However, the available
evidence does not make it clear that the original
day. While the evidential criteria were not met
for retraction, SEAB and the Editor of JABA
 Societal Changes and Ethical Concerns
made the decision to issue an official Expression
of Concern (COPE, 2019) along with this edi-
torial to clearly outline the concerns about the
Rekers and Lovaas (1974) paper and the various
harms potentially or actually resulting from
it. This decision by a long-standing scientific
organization was reached to minimize adverse
effects associated with the use of outdated litera-
ture that was concerning to some even at the
time of publication. From this point forward,
the original article will be electronically linked
to the original response papers, to this editorial,
and the accompanying publisher’s (i.e., Wiley
Periodicals, LLC) Expression of Concern so that
the original article cannot be accessed without
awareness of the other publications that respond
to the original study.
The first clearly evident harm was to the par-
ticipant and family. A 2012 CNN story by
Anderson Cooper exposed various background
details about the family and participant as well
as the significant personal harm experienced by
the participant of that study, who eventually
died by suicide (CNN, 2012; National Center
for Lesbian Rights, 2020). The tragic details
are available to those who wish to know them
and will not be repeated here. While the sui-
cide cannot be causally linked to participation
in the study decades earlier, it is clear from the
family’s report that the experience of participat-
ing in this study was very negatively impactful
for them. This harm, regrettably, cannot be
undone and the fact that this study was con-
ducted and published in a different societal
context cannot be erased. Instead, it behooves
us to remember the past, behave differently in
the future, and speak out strongly to prevent
similar psychological harm to others.
The second evident harm is that this study
has been and may still be being inappropriately
used as evidence for the effectiveness of conver-
sion therapy (i.e., aversive conditioning of same-
sex stimuli to reverse sexual preference) resulting
in continued harm to the LGBTQ+ commu-
nity. The use of this study as support for
1833
conversion therapy seems to be related to the
first author’s (i.e., Reker) personal actions and
advocacy against the LGBTQ+ community.
The claim is unfounded from a scientific per-
spective (i.e., the study did not target responses
to sexual stimuli, the participant’s sexual orienta-
tion remained same sex into adulthood and
until his suicide) as well as reprehensible from a
human rights perspective. Following a scandal
regarding his travels with a hired male compan-
ion (Bailey, 2010; Bullock & Thorpe, 2010),
the first author resigned from the anti-LGBTQ+
organization National Association for Research
and Therapy of Homosexuality (NARTH), for
which he had formerly served as officer and sci-
entific advisor. His expertise and professional
reputation were discredited, eliminating his abil-
ity to testify in cases related to the civil liberties
of the LGBTQ+ community as he had done in
the past.
As of the beginning of 2020, 19 states have
passed laws fully banning conversion therapy
(Movement Advancement Project, 2020), par-
ticularly for minors who may be forced into the
pseudoscientific procedures by their parents
(Southern Poverty Law Center, 2016). How-
ever, in other states, studies such as Rekers and
Lovaas (1974) may be inappropriately used to
support continued implementation of conver-
sion therapy. Multiple professional associations
such as the APA (Anton, 2010), the American
Psychiatric Association (Byne et al., 2012) and
the American Medical Association (AMA,
2019) have published statements condemning
the use of conversion therapy as non-
scientifically supported. Although SEAB is not
a professional association that could publish a
position statement on behalf of the discipline
of behavior analysis, as a scientific organization,
SEAB strongly condemns conversion therapy
and is fully in opposition of pseudoscience in
all forms. However, practitioners and organiza-
tions endorsing conversion therapy continue to
cite the Rekers and Lovaas (1974) paper as evi-
dence for conversion therapy, in the absence of
1834 Linda A. LeBlanc
acknowledgement of the Winkler (1977) and
Nordyke et al. (1977) responses. Thus, the pro-
fessional critiques of the ethical issues are hid-
den in favor of a single example published over
45 years ago that was not actually an example
of conversion therapy. The linking of the early
articles and the publication of this editorial are
designed to prevent selective access to the liter-
ature as a means to support this practice.
The third source of harm is to applied behav-
ior analysts as a whole due to the false impres-
sion that may be created that this article, or the
use of conversion therapy is in any way represen-
tative of the field. As scientists and practitioners,
we should be constantly mindful of the mission,
purpose, and values of our field which focus on
using science to achieve social good. Wolf (1978)
encouraged us to fully embrace the notion of
the social validity of our interventions with
respect to the importance of our behavioral tar-
gets, the acceptability of our treatment proce-
dures, and the extent to which our achieved
outcomes result in meaningful positive changes
for those we serve. Both Sidman (1989) and
Skinner (1948) expounded upon the dangers of
coercion in every facet of society. They encour-
aged behavior analysts to use the science of
human behavior to minimize coercion in every
circumstance. This commitment to our disci-
pline’s mission is still evident in recent writings
focused on compassionate care (Taylor et al.,
2019) and understanding behavior in the con-
text of the circumstances in which it occurs
(Friman, in press). Those who are in a position
to educate others are encouraged to use this edi-
torial and this topic to educate your students
about the ethics of the original study and the
scholars who spoke out about the paper in the
1970s serving as voices for social justice. As pro-
fessionals, we cannot let our science or practice
be divorced from the values that created them.
As professors and mentors to the next generation
of scientists and practitioners, we must imbue
their professional training with the mission and
values upon which our field was founded.
Another concern is the connection between
the early paper, the authors, conversion therapy
and the unfortunate impression that behavioral
treatments focus on the use of aversive proce-
dures and are associated with conversion ther-
apy. Multiple members of the SEAB board
have encountered families with a child with
feeding problems, intellectual disabilities, or
autism spectrum disorder that delayed or wor-
ried about starting evidence-based behavioral
treatment services because of encountering
information that erroneously links this treat-
ment to conversion therapy and the perceived
use of aversives in behavioral therapy. Mistaken
impressions that delay or prevent families from
accessing effective treatments harm those fami-
lies as well as the reputation of our field.
Every behavior analyst reading JABA should
be aware that individuals may have encountered
a mistaken impression of our field based on their
exposure to the Rekers and Lovaas (1974) paper.
Those individuals might think of our field as
solely linked to autism and be unaware that
applied behavior analysis has created and is still
creating positive impacts in areas from disease
prevention (LeBlanc et al., 2020; Lombard
et al., 1991) and safety (Lehman &
Geller, 1990; Maxfield et al., 2019) to treatment
of substance abuse and unemployment
(Silverman et al., 2008; Silverman et al., 2019).
They may think that applied behavior analysis is
synonymous with the use of aversives without
realizing that there is an enormous expanse of
behavioral literature focused on refining proce-
dures to provide a plethora of positive and effec-
tive treatment alternatives. We behavior analysts
must be sensitive to the concerns that are pres-
ented by others and recognize that at least some
of the concerns may be directly or indirectly
linked to the paper by Rekers and Lovaas. We
recommend that concerned readers use this edi-
torial and Expression of Concern, and guidance
from the Behavior Analyst Certification Board®
Professional and Ethical Compliance Code for
Behavior Analysts (BACB, 2014) as professional
 Societal Changes and Ethical Concerns
motivation to represent our field with dignity,
integrity, compassion, and respect for human
rights.
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