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What causes some problem behaviors to rapidly escalate in regards to severity/intensity, duration, or frequency? What is pumping these behaviors up?

I usually don't meet potential clients when problem behaviors are mild, occur sometimes, or are of low intensity. I don't hear a lot of statements like "She rarely tantrums, it's not that big of a deal.....We'd appreciate some help though. When you get around to it". Nope.

Far more often when people reach out for help it is because that annoying or frustrating problem behavior that started off small, has now pumped up into this Goliath -size problem that may or may not be occurring across settings. The behavior has become such a challenge, that it's clear professional help is needed.
The child used to tantrum, and now they tantrum AND bite. Or the child used to refuse to eat peas, now they won't eat anything green OR round in shape. Etc., etc.

So what happened? Most likely 1 of 2 things. Or 2 things (Just one can happen, or both can happen):

#1 The problem behavior was fed, and/or #2 Nothing else was.

Want me to elaborate? Well, I'm going to anyway.

Thing #1 - Problem behaviors grow or stick around based on what maintains them, or the available reinforcement . So giggling when your toddler throws a spoon during dinner, or buying your son a candy bar at the store because he started screaming....these things likely do not seem like reinforcement at the time, but if the behavior begins to increase then reinforcement is doing its magic. Here is a particularly unpleasant little chain of events I see often: The child cries when told to clean up toys, and mom or dad ignore and keep the demand on. The child flops to the ground and screams when told to clean up toys, and mom or dad ignore and keep the demand on. The child punches mom or dad in the legs when told to clean up toys, and mom or dad.....yell "No! Don't you hit me" and lecture the child and forget to keep that demand on. Uh-oh. What usually happens next in that scenario is the child has now learned that the quickest and most efficient way to get out of that dreaded clean up task is to punch mom or dad pretty hard. THIS is how super intense problem behavior can seem to appear overnight. I know its hard, but you have to be careful not to give a big reaction when your child suddenly increases the intensity of their problem behavior. We professionals see this from time to time in our therapy sessions, but we know if we "ride that wave" and just hold on, the new problem behavior likely won't stick around.

Thing #2 -  Persistent problem behaviors are trying to tell you something. It can require some detective work , but it will so be worth the effort to get to the root of the problem. Is your child trying to gain your attention? Are they hoping to avoid a challenging task? What about wanting you to give them something in a public place? This might help you when addressing problem behavior: remind yourself that underneath the behavior is a valid need. Buried underneath the tantrum, or spitting, or ear-splitting screams, your child is expressing or requesting something. The tricky part is determining what the heck that is! When problem behaviors suddenly seem to pump it up out of nowhere, think of that as your child saying, "Wow, what do I have to DO to get this need met??!". Here is another unpleasant little chain of events I see often: Mom or Dad successfully get rid of problem behavior A, and then the child begins problem behavior B. Mom or Dad successfully get rid of problem behavior B, and then the child begins problem behavior C. Mom or Dad....... are you seeing the pattern? The child keeps pulling out new variations of the problem behavior because the underlying root of the problem has not been addressed. And if it hasn't been addressed, then how can be it strengthened/reinforced so it will stick around? Learning new skills goes hand in hand with behavior reduction, because you don't just want to teach the child what to stop. You also want to teach him/her what to start.

Being careful to address thing #1 & thing #2 when evaluating problem behavior makes its far less likely you will end up in a situation where the behavior balloons up to a huge issue, seemingly overnight.
When in doubt, reach out for professional help. A qualified professional can work with you to reveal how multiple small steps along the way worked like multiple strings tying up into a huge knot, and then help create a plan to untangle that knot.

*Recommend Resource: ABA Inside Track discuss Functional Communication Training, which is a great tool for reducing problem behaviors

If you're an ABA professional then you're likely already familiar with BST (Behavior Skills Training). If you are not, here is an amazing resource link to get up to speed.

The 4 basic steps of BST are as follows: Instruction, Modeling, Rehearsal, & Feedback.
Lather, rinse, and repeat as needed.

I LOVE utilizing BST with supervisees and direct staff, but also when intensively targeting parent training. Such as with a case that has low hours, so instead of traditional therapy we utilize more of a parent coaching model.
BST is super effective, and makes you look like a genius who can teach anything to anyone. If it sounds like I'm overselling, shut up. No I'm not. BST really is that amazing.

If your parent training strategies could use some help, or aren't always super effective (particularly in producing long lasting change) then keep reading for some rock star parent training tips!

Here is each BST step explained in a bit more detail:

Instruction – You are most likely already doing this. Put simply, this is telling the parent what to do. The problem is, many professionals start and end at this step. As in, "Well I told the parent what to do like 8 times already, but they still aren't doing it!". Effective teaching should include more than just telling
Modeling – Put simply, this is SHOWING the parent what to do. I need to go beyond just putting up a visual, or walking the parent through a transition, as much as possible I need to show the parent what to do with their actual child, in the actual target situation. Meaning, if I am teaching the parent how to reduce meltdowns at Publix, then we need to go to Publix. 
Rehearsal – How often do we (I'm including myself here) forget about this step? This is one I have to remind myself to do, because my tendency is to jump in and model, but then I neglect to allow the other person to practice while I watch. If you're like me, you have already learned that skipping this step is no bueno. We all like to practice new behaviors to ensure mastery, especially complex behavior chains. And most of the things you teach to parents will meet the criteria of a complex behavior chain. 
Feedback – This last step also can be overlooked, or forgotten. I find that most of my supervisees struggle with giving immediate feedback. Meaning, tell the person what to correct while they can still change it. Don't wait until the parent has completed the entire toileting procedure with their child to tell them they did the 1st step wrong. That's extremely frustrating! It also makes it more unlikely that the parent will perform the behavior correctly when you are not around, because you just let them practice errors. Just like we do with our clients, be sure to provide both positive praise statements and corrective feedback. 

Here are a few examples of BST in action:
Behavior: Transitioning child to therapy table
Instruction: Explain to the parent exactly what they need to do. Be sure to ask for questions, and answer them fully
Modeling: Show the parent exactly how you want them to transition the child
Rehearsal: Say to the parent "Your Turn". Observe closely
Feedback: Both in the moment and once they are done, give the parent specific information about what went great and what needs improvement. Skip the jargon, or define any terms used. Also be sure to ask the parent where they need more help, or if any part is confusing

Behavior: Implementing a Manding Trial with the child
Instruction: Explain to the parent exactly what they need to do. Identify needed materials. Be sure to ask for questions, and answer them fully
Modeling: Show the parent exactly how to run a Manding Trial
Rehearsal: Say to the parent "Your Turn". Observe closely
Feedback: Both in the moment and once they are done, give the parent specific information about what went great and what needs improvement. Skip the jargon, or define any terms used. Also be sure to ask the parent where they need more help, or if any part is confusing

If BST makes parent training ridiculously easy, then its always effective all the time, right? Wrong. Here are some common parent training pitfalls I see all the time, that can hinder the effectiveness of your BST procedures - 

Common Parent Training Errors

  1. Not enough training examples: The child regularly has meltdowns at grocery stores, so you spend 2 hours inside a Publix with the parent. Whew....they should never have that problem again. Ummm, no. What about when the child has problem behaviors at Kroger, or Sams Club, or Whole Foods? Each store is different and may have differing maintaining variables, so the parent will likely need practice in each store. If this is not possible then at least during the instructions phase talk the parent through how to address the behavior across different settings.
  2. Not enough practice: Very closely related to the previous point, is letting the parent briefly jump in for rehearsal and then immediately you take over the session again. When I see this with my staff, I usually say to them: "YOU are not the one who needs to learn this. You already did that". Remember who the student is in parent training (the parent). They need lots and lots of practice under the watchful eyes of the team, on an ongoing basis. 
  3. Letting the parent practice errors: Would you let your client practice errors? No, right? Well then why would you sit back and let the parent practice errors? Errors impede learning. Sometimes staff allow this because they feel too awkward or hesitant to correct the parent. Again, would you correct your client? Then what is the difference? You are teaching the parent a new behavior, and in order to learn effectively they need error correction procedures.
  4. Failure to teach concept of Reinforcement: This is a big one. Many times when I follow up with a parent about their parent training I hear, "He/she just won't do (target behavior) when you guys aren't around!". Further digging usually reveals what the actual problem is....their child expects to contact (gasp!) some reinforcement for their behavior. Many parents do not understand this, and so they approach the child outside of therapy sessions with a complex and difficult demand, that can earn...nothing. Not surprisingly, the child immediately kicks off problem behaviors. Take the time to make sure the parent understands reinforcement is the glue that makes behaviors stick. It needs to be immediate, differential, and valuable to be most effective.
  5. Failure to select socially valid parent training goals: Yes, parent training should have goals like any other intervention. This is the #1 error I see, so I'll discuss it last. As the BCBA/supervisor do you tell the parents what their parent goals are? I hope not. Social validity basically means that the individuals/stakeholders requesting the treatment agree that the treatment is important and helpful to them. In order to do that, I have to work together with the parents to create parent training goals. This also provides opportunity to identify unrealistic goals ("I want her to always be happy"), or to help parents understand how concretely a skill needs to be broken down to intervene on it. If the parent you are working with has no input on parent goals, or refuses to participate in the goal selection process, then unfortunately, you have a bigger problem on your hands.

Bottom line: If the parents cannot produce the same, or at least similar, behavior change results as the ABA team when they are alone with their child then parent training needs to be modified. It needs to be revised, increased, or a common pitfall has not been addressed yet. The same way you wouldn't blame the learner for not learning, you shouldn't blame the parent for ineffective parent training. Review the BST guidelines, and come up with a new plan that works for the parent.

You can call it motivation, drive, desire, "the big payoff", or any other name, but Motivating Operations, or M.O., basically refers to the invisible and frantic magical fairies hidden underneath your behavior and secretly impacting why you do what you do.

For ABA practitioners, why is this such an important concept to know about, understand, and then apply nearly every day? Take a look at this example:

Example A- ABA therapist arrives at child's home for therapy session, immediately walks in to child tantrumming for popcorn and not wearing any pants. Therapist silently redirects the child away from the kitchen to the therapy room and prompts the child to put their pants on. Therapist then prompts the still screaming child to sit at the therapy table, and begins teaching. Multiple fully prompted trials later, the child earns a break. The therapist offers a choice between Legos and playing with clay. The child chooses neither. The therapist then prompts a forced choice of going outside. Outside the child is whining, irritable, and repeatedly attempts to run back into the house. The therapist blocks and redirects all attempts to go indoors, and tries several times to get the child interested in playing basketball using full physical prompting.

If this example summarized just the first 20 minutes of the therapy session, how do you think the session would go overall? Pretty not great would be my guess.
Now, take a look at this example where the therapist constantly followed or contrived the child's motivation:

Example B- ABA therapist arrives at child's home for therapy session, immediately walks in to child tantrumming for popcorn and not wearing any pants. The therapist uses this opportunity to target manding, and asks the parent to give her the popcorn. The therapist then shows the child the popcorn, models the label ("PUH- POPCORN"), and withholds the popcorn. After the child successfully mands and receives some popcorn, the therapist puts more in a baggie and says "Come with me, and you can have more!" and walks to the therapy room. The child quickly follows. Once in the therapy room the therapist takes some moments to interact and pair with the child before beginning instruction. At the therapy table, the child works well to earn more popcorn. The therapist offers a choice between juice (the popcorn likely made the child thirsty), or Legos. The child chooses juice. The therapist explains "FIRST pants, THEN juice". The child complies with putting pants on, in order to get some juice. Once in the kitchen the therapist lines up 3 kinds of juice so the child can choose which one he wants. The therapist then pours a pretend cup of juice, and gives some to a baby doll everytime the child drinks. The child laughs, and then wants a turn giving the doll juice. 

Are you seeing the differences? No? No worries, I'll point them out:

  • Successful therapists think on their feet - You will not always work with your clients in the most ideal circumstances. That's life. A big part of what I do is being able to quickly scan a situation, alter my game plan based on what I see, and then alter my game plan some more based on how the child responds. You can't get stuck in tunnel vision where all that matters are your session goals. What if materials are missing? What if its a parent training session and they aren't home yet? What if the grandparents are in town and want to watch the session? You have to roll with it!
  • Successful therapists know when to let a kid have a bad day - So you get to the home and the child is half naked and screaming over popcorn. Are they not allowed to have a bad day?? When you're angry do you always want to wear pants? I didn't think so. Don't make the mistake of arriving to the session and thinking its your job to immediately get things under control. What does the child learn from you prompting them straight into work? Why not use the real life situation unfolding in front of you to teach communication, or to teach the parents how to handle the behavior themselves? We can allll-ways squeeze in more Parent Training. 
  • Successful therapists ALWAYS think about "What does the client get out of this?"- I don't present any instruction or directive to my clients without first establishing in my mind why they should do it. Compliance for the sake of compliance is great, but just like the rest of us most of my kiddos need a reason to clap hands....or come upstairs...or walk with me. Are you just barking out orders to your clients, or are you making sure they are aware of what reinforcement waits right behind your demands?
  • Successful therapists can take the written programs and embed them into any task - This is something I spend a lot of time helping my staff improve upon, because I think it is one of the most critical things they can learn. Teaching is not just what occurs when you are reading SD's off your data sheet. Teaching can happen anywhere, anytime. Part of thinking on your feet will require that you develop the skill of making anything therapeutic. This means being able to alter your original game plan but still keep your original goals in mind. It also means doing what the child wants to do, and ninja-sleuth style sneaking your targets into it. NOT blocking the child from what they want to do and prompting them to do your thing. 
  • Successful therapists focus on relationship, more than trials: Which is more important at the end of the therapy session, that your data sheet is fully completed or that the child is calm, engaged, and excited about you returning? I can hear you saying, "Well, can I get both of those?". Mmmmm, not always no. Sometimes you may run less trials then you need to, or spend less time at the therapy table, or not even probe some of those new targets. But, you get some amazing eye contact while playing with bubbles, or the child reaches for your hand as you walk down the hallway, or you get to show the parent a better way to get the child to stay seated during lunch. Your job is far more than filling out a data sheet.

Getting this concept of motivation (I mean really getting it), and knowing how to follow/contrive motivation will help any ABA practitioner be more effective, have less aversive relationships with your clients, and lower stress or frustration when therapy sessions get chaotic

Whenever one of my staff calls me up after a session to tell me how horribly it went, after some digging and open-ended questions, what I usually hear are a series of missed opportunities to capture motivation and use it wisely. In other words, the client was definitely motivated to do some stuff....just not any of the stuff you wanted them to do. Instead of using that, the staff just implemented a lot of heavy handed prompting. 
Is the client desperately clinging to Mom? Have Mom join the session. A sibling is having a loud play date just down the hall from the therapy room? Let your client work for breaks to go join the play date. Dad is in the kitchen baking amazing- smelling- yet- totally- distracting cookies? Have the client join Dad and help cook, while also targeting fine motor (mixing), one step directions ("Get the spoon") and self-help skills (pouring a cup of milk). 

Don't fight against your clients M.O., use it!

*References/Recommended Reading:

Langthorne, P., & McGill, P. (2009). A Tutorial on the Concept of the Motivating Operation and its Importance to Application. Behavior Analysis in Practice2(2), 22–31.

"The White Book", chapter 16

Oh my(!), all have lots of questions :-)

I say this often to my staff, but I always feel like if 1 or 2 people are asking me something, its likely tons of people want to ask but just haven't yet for some reason. It's like being in a group training and no one wants to raise their hand first and say "I don't understand".

This massive, super- sized post will compile ALL of my FAQ posts and hopefully serve as a one stop shop. If you can't find your question answered here, then something is wrong with you (I'm totally kidding).

The FAQ posts below include great questions I receive from both parents and professionals. Let these FAQ posts help clear up some of those burning ABA related questions that you have pondered over, but never actually asked anyone about. OR, unfortunately you did ask someone but just didn't receive an adequate answer.

Dig in, I hope its helpful!

FAQ Parts I, II, and III
FAQ: Common Questions Parents Ask when Initiating ABA Therapy
FAQ: Massive Super Hero Post (questions about entering this field)
FAQ: Post - BCBA Supervisor Tips
FAQ: Tips for the BACB exam
FAQ: What IS ABA, After the Diagnosis...Now What?

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Therapy sessions "on the moon" will mean something different based on where you regularly work.
For me, my bread and butter is in- home services. I feel like I have been doing that since the Roaring 20's. 😉

So for ME, what pushes me outside of my comfort zone and makes me feel overwhelmed is when I go into community or school settings to work with my learners, because its a wildly different environment than what I am used to. But this could easily be a vice versa situation for someone else, if they have never worked in home.
Real life example- I have lots of hilarious conversations like this with direct staff all the time:

Therapist: "Tameika, I have a problem! I showed up for the therapy session today and the entire extended family was in town visiting and the therapy materials were scattered all over the house, they got a new dog and it peed on my shoe, and there were workmen repairing the roof and I could barely hear myself talk"

My response: " whats the problem?"

Due to my experiences, I have in my mind what is typical of working inside peoples homes and over the years I have learned how to think on my feet, and throw out plan A and grab desperately at Plan B. I do it on auto-pilot at this point. However, if you plop me down inside a chaotic daycare, or a circus-like grade 2 classroom, or an outing with my client to a crowded Six Flags, I may not be quite so cool and collected.

It's all about perspective, really.

To properly prepare staff for their role, its important to consider what their idea of "normal" is. If they are coming from a center based background, their first school based client will be a very interesting experience. Or if they have only ever worked in residential settings with adults, teaching Color ID to a tantrumming 3 year old will be kind of like...Therapy on the Moon. It will be so far outside their comfort zone and practical knowledge base as to make them feel overwhelmed, inept, and a nervous wreck.

I work with many direct staff who have an extensive background of doing one kind of thing. So while they may be amazing at doing X, if you just throw them into Y without prior preparation, it likely won't go well.

What's that you asked? How can we better equip staff to perform their job with excellence across settings?
Well I will tell you!

  1. Discuss the setting in advance, and review potential land-mines: Step 1 will definitely involve knowing the setting (which may require reconnaissance in advance by the BCBA), so the staff can get a quick rundown of what to expect from the setting. If its a classroom, how many teachers are there? How many students? Whats the daily schedule? Can we use classroom supplies or do we need to bring our own? Can we deliver tangible reinforcers inside the classroom? Can we pull the learner out for 1:1 time? How does the school feel about us going in? Do they understand how we will manage problem behavior (typically *but not always* this means we will NOT remove our client from the room just because they escalate/kick off a tantrum).
  2. Help the staff find similarities, as well as critical differences: How will data collection differ because of the environment? How will DTT time differ because of the environment? If the parents will not be present in this setting, how will the direct staff include them in treatment goals/progress? BUT, what is still the same regardless of the environment? Something I really like to drill into my staff is to finish (or return to) a teaching trial, no matter what. So if the fire alarm goes off, finish the trial. If a younger sibling runs off with your data sheet, finish the trial. If Big Bird walks in and starts passing out know what to do.
  3. Set up the environment for success (as best you can): This will take pre-planning, and collaboration with the powers- that- be at the new environment. If a classroom, is it ok for you to store therapy materials? Or do you need to bring those with you every day? If in home, do the parents know you need a set aside area to keep the program binder, flashcards, etc.? If a community setting, have you thought about a discreet way to carry reinforcers around? Where is the nearest bathroom located? What about distracting room features (like a huge window that looks onto the playground)?
  4. Promote and Praise creative thinkers: The reality is, the direct staff will spend more time in this setting by themselves than they will with their supervisor. So its critical that they have the freedom to think through problems as they pop up, disregard non ideal options, and choose an action step. Praise, and heavily model this creative thinking process for the staff. Teach them that yes, there is an action plan, but sometimes for unforeseen reasons that plan will need to be discarded. And then what? Well, then you quickly think on your feet based on your clinical knowledge, and what treatment goals are being targeted.
  5. Play Nicely: The last tip is to approach the powers -that- be with an attitude of respect and collaboration. They may not have the ABA knowledge you have, they may not fully understand your role, and they also could have different goals for the learner than you have. Maybe you are targeting problem behavior, but their main focus is on language. Or vice versa. Your role in this new environment is also part ambassador. Be sure to carry yourself professionally and ethically, and to let it be clear you are always available to offer assistance or strategies, but you also are not there to step on any toes. Its a delicate dance, and a fine line to walk, but it does get easier with practice.
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So many times in this ABA universe when we talk about CHOICE, we always talk about the individual receiving treatment. The student, client, child, etc.
What about our choices? How much in a typical day do you think about the impact your choices have on the behavior of the consumers you treat, or the children you are raising?

When I first meet new families, a common misconception I enjoy correcting is the idea that the child is completely "out of control". I hear statements like, "Well he can't help it, he has Autism", or "We know it will probably always be like this, but do you think there is any hope she might get better?". Statements like that come from a belief that problem behaviors don't involve choice, which leads to the next belief that as caregivers or treatment providers we are powerless to change behavior. Well clearly that can't be true, or there would be a lot of ABA practitioners standing on street corners with "Will write Behavior Plan for food" signs. ;-)

When you understand that your choices impact your child's choices, or your choices impact your client's choices, it opens up a dizzying amount of possibilities and potential outcomes. So make wise choices today, that will benefit you tomorrow.

*Recommended Reading: The Burden of Choice

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*Recommended post-- Writing ABA Programs

My last post on programming was really for professionals, but this one should help parents/caregivers understand the "why" and "how" of teaching new skills.

Typically with ABA treatment, intake/assessment is followed by treatment planning, which is followed by creating individualized programs, which is followed by teaching those selected programs. What's a program you ask? Basically, a program is what is being taught to the learner. If your child is receiving ABA services, they probably work on multiple programs every single therapy session.

I find that most parents/caregivers have a very vague understanding of what their child is working on and why, and how skills connect to each other. Due to this lack of understanding, some common problems that can arise include:
  • Expecting the ABA team to teach your child everything, all at the same time
  • Expecting skills to be taught in a matter of days
  • Parent gives little to no input on treatment planning/can't think of anything they want to work on
  • Confusing a "Program" with a "Target"
These are the main problems I see, although there are many more that can pop up when parents don't understand how the teaching part of ABA therapy works (yes, ABA is far more than behavior reduction!).

I always recommend to parents to ask questions, observe therapy sessions, utilize the BCBA, and review/look at the data regularly. These components are like the blueprint of the building, or anatomy of the cells of your child's treatment. If you are confused about the services your child receives, I would ask: how regularly are you viewing that blueprint? How involved are you with the anatomy of it? It took the staff and BCBA on the case extensive training, years of experience, and college coursework to have a solid understanding of what they are doing. How much harder do you think it will be for YOU to understand what they are doing?

I love to remove confusion (just call me Confusion Off) so let's address each of the common problems I see, one at a time:

  • Expecting the ABA team to teach your child everything, all at the same time - Definitely the biggest misconception I see. Intake/assessment is usually the point where the BCBA discusses goals for treatment with you. From the assessment results and this conversation, the BCBA will prioritize goals based on a variety of factors such as: goals that can replace current problem behavior, goals that are needed for daily functioning, goals that address the most pervasive developmental delays, etc. What this means in plain English is we cannot teach everything, all at the same time. It's just not possible. Plus your child would hate that. The reality is other non- clinical factors must be considered too, such as how available is the child for therapy, how many hours of therapy a week can the family afford, how many hours of therapy a week can the ABA therapist provide, etc.. When you add up all these factors and weigh the highest priority goals, this does mean that some skills may not be targeted right away. Your suggestions to keep adding new goals are not being ignored, it's likely that the things you want to add are not priority, the child already has the maximum number of goals for the moment, or new goals won't be added until performance improves.
  • Expecting skills to be taught in a matter of days - When you start climbing a ladder, do you put your foot on the 5th rung? No, right? Teaching is very similar to that. When teaching a new skill, there is this thing called a "pre-requisite skill". This means there is something the child needs to be able to do before they can move on to more complex or advanced skills. For example, many play skills require the ability to imitate. Why? Well, if I am trying to teach a young child to play with a Barbie doll I am going to do this by sitting down with them.....and playing with a Barbie doll. I know, this is complicated stuff :-) But what happens if while I am enthusiastically playing, the child just stares up at the ceiling and drops their doll? The child needs to be able to watch my play and imitate it, in order for me to teach them to play on their own. So before I can tackle play skills, I first need to work on teaching imitation. Much of ABA treatment involves these kind of careful ladder steps. We have to work our way up that ladder, which depending on the learner can take days, weeks, or even months. But its super unrealistic to assume the learner will just fly through learning new skills. Expect it to take time.
  • Parent gives little to no input on treatment planning/can't think of anything they want to work on - This may sound like it would never happen, but it absolutely does. A parent initiates ABA services, and during the intake makes statements like "I just want him to be normal", "I'm fine with whatever you think we should focus on", or "I just want her to be happy". Unfortunately, I don't have any curriculum for teaching "normal" or "happy". So in these kinds of situations what can happen is the ABA team puts together a treatment plan that is not functional for the learner. For example, the BCBA may decide the child should work on manners to improve their social skills. However the family isn't big on manners, and this is not an important goal to them. So when the ABA team is not around, who is practicing manners with the child and reinforcing this skill? Likely nobody. Which means the skill won't progress, and it probably won't  generalize. Think of the ABA team like a group of painters showing up to your home. We have our coveralls on, our paint, and our paintbrushes. But...what exactly do you want us to paint??
  • Confusing a "Program" with a "Target" - "I told you I wanted him to learn his body parts, why is he just playing with a Mr Potato Head toy?". If I did not have the knowledge I have, I would find much of what the ABA team does highly confusing.  It looks like we teach random flashcards, meaningless games, and senseless activities over and over again, that have nothing to do with the reasons parents initiated therapy. This could not be more inaccurate. Every "program" is like a menu at a restaurant. You open the menu because you want something to eat or drink. But you can't tell the waitress "I want to eat". You need to be more specific. So you read over the menu and see the hamburger section. But you can't tell the waitress "I want a hamburger". You need to be more specific. So you choose the exact hamburger, and the exact toppings and tell the waitress "I want a hamburger-well done- with no onions and extra cheese". Make sense? Bringing it back to ABA treatment: menu= overall objective, hamburger= program, specific hamburger= target. When a parent says to me "I want him to play with his brother". What I hear is "I want him to improve his social skills", which means breaking that down to improving and reducing behaviors, which means breaking that down to first learning to play with me, then learning to play with me and a peer, then learning to play with just a peer. Whew. Designing treatment is not quick, or simple. Rest assured, the issues you initially discussed with the BCBA are being worked toward, but we have to break the skill apart in order to teach it.

With any child, there will be skills that come easy and skills they struggle to learn. There will be things they should be able to do but cannot, and other things they do super early or super easily. Thats just part of being a human. It will drive you crazy if you look at your child with Autism as a collection of deficits and "not there yet's", and it will also cause you to overlook all the progress they are making right now.
Take time to appreciate those baby steps, sometimes baby steps are all we have.

*Free Resource: This simple handout helps explains common program names many BCBA's use (what the program is supposed to teach).

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*Recommended Post- The Basics: Operant Conditioning

Much of what I do does not involve teaching complicated, advanced level behavior analytic concepts to families/caregivers or educators. No, most of what I spend my time doing is simply explaining "basic" concepts over and over again. I say these concepts are "basic", because if they really were so basic would so many people not know them??? Hmmm, I think not.

One of these basic concepts is the idea of RESPONDING vs. REACTING.
Most of the common errors I see across clients, happen when a teacher or a parent quickly react to something my client is doing instead of going into robot-mode to properly respond.

What's robot-mode? I'll tell you: it's that moment where time seems to freeze and outwardly the ABA practitioner goes stone faced, stops talking, quiets their body language, gets near or away from the client (depending on what is happening), and appears to be not a tiny ounce affected by what the client is doing. The pros make it look easy, don't they?

Well, inwardly, that practitioner is thinking hard and fast. They are scanning the room to weigh potential dangers, they are automatically thinking of what they will do if the behavior escalates, they are reminding themselves what the last demand was (so they can return to it as soon as feasible), they are doing a mini-FBA to think about what led to this behavior, etc. And watching the practitioner work, it probably looks like none of this is happening. I've actually had parents comment on that before, something close to "I can't do what you all do, I can't just SIT THERE while my child is tantrumming". Oh believe me, we are not just "sitting there".

That's why I call it robot-mode....the outside is objective and mechanical and the inside is a  computer clicking along at high speed. It took me time+ time+ time to get to the point where I could do this as quickly as those amazing supervisors who were teaching me to do this. Especially if the client has a good handful of your hair, or skin, or clothes.

To put it simply, when we react to something we are usually going in emotions-first. When we respond to something we are usually going in logic- first. I have tested this theory out a bit by asking parents in the moment "Ok, now why did you just do that?" and they usually say something like "...I don't know/I wanted him/her to stop". *see note on this below
 If you ask the ABA practitioner (which I recommend) why they are doing what they are doing, there is a technique or strategy they can describe to you, with the overall goal always being to teach. This could be teaching replacement behaviors, teaching communication, teaching the child problem behavior does not = escape, etc. Responding is a thoughtful process where you generate ideas, evaluate your idea, consider the consequence of your idea, and then act.

*Note: I explained this in my Punishment post, but when people tend to emotionally react to problem behavior it is often in a highly punitive manner, or with the goal to just stop the behavior. Little thought may be given to teaching new behavior. Just another reason it is so important to be intentional about behavior change, and manage your own behavior before you try to intervene on your child's behavior. If your child gets frustrated and yells, so then YOU get frustrated and yell....what did they just learn?

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In a typical day as a BCBA working in the field, multitasking will be a very close friend. I you don't possess the skill of being able to supervise staff, carry on a conversation with a parent, write up a progress note, and open a container of blocks for the client all at the same time...then you should probably work on getting there.

It doesn't happen overnight, but with practice, diligence, and lots of organization----> you CAN be perfect.
Okay, not really :-) You won't be perfect, but you will be able to get an amazing amount of things done in short periods of time. And if there's one thing BCBA's have in limited commodity, it's time.

Over the years, I have learned this skillset the easy way and the hard way. I have watched and learned from other BCBA's that I admire, and definitely had some trial and error situations that didn't go so well.

Below are some of my top tips or strategies I regularly use to maintain my sanity, starting off with my absolute must haves: The Top 3.


* Know your limits and set your boundaries, or other people will constantly test your limits and push your boundaries
*Set working hours (I am including all the work you do at home for free) and stick to them
*Delegate whenever you can, to appropriately qualified individuals. You won't get a glittery cape for trying to be Superman/Superwoman, just a tension headache

  • Calendar/Scheduling: Keep a copy of your schedule in whatever format is easiest for you. I use an oversized wall calendar, but I also store my schedule electronically in case I need to update it on the fly. As much as you can, schedule things in advance. I usually schedule out a month at a time and I block out certain days each month as "catch up" days. This is where I turn off the phone and focus on paperwork, or if I need to schedule something out of the ordinary (like meeting a client's new speech therapist), then I always have free spots to do so.
  • Traveling Office: Formerly known as your car. Make sure when you head out for the work day that you have your car loaded up with any odds and ends you or your staff may need, such as extra pens, extra data sheets, supervision notes, clipboards, etc. I also carry a large therapy bag, which is loaded with my clipboard and feedback forms, pens, post its, highlighters, etc. 
  • Make a Supervision Binder: This is one of those tips I had to get from trial and error. It changed everything once I put it in place. Make a binder where you store all client information and important documents, such as: a map of the area (I found this most helpful when I was working in new states), client contact information, each client's schedule, recent notes for each case, To Do list for yourself, client school/daycare calendars, progress report due dates, etc. Put your supervision binder in your huge therapy bag, and carry it with you from one client to the next.
  • The To Do List: I make To Do lists of things to add to my To Do list. That is how much I love having a checklist. Before heading out for supervision sessions, make a To Do list for each client. This will help keep you on track once you are there with the client, the parent, and the staff. New things will pop up (of course), but get in the habit of saying "We can talk about that in just a second, but first let me run through this checklist". This was one of the best timesavers for me, and it helps me fully optimize my face to face time with the client when everyone is pulling me in 10 different directions.
  • Get a Nice Clipboard & Make Your Own Data Sheets: This one is the most helpful for going into schools or in the community. Places where you can't drag your huge therapy bag behind you. What I used to do is write copious notes on 50 little pieces of paper, carry that around with me, and then have the fun task of wading through that when I got home. What I do NOW, is I have a clipboard that I can store things inside. Especially when visiting a new school, always bring your ID/employee badge just in case they ask for it (stick that inside the clipboard, along with your keys and a few pens/pencils). Make simple data sheets instead of using large amounts of paper. This keeps your hands relatively free, keeps you from awkwardly asking where you can put your purse/bag, and when you don't need to take notes just tuck your clipboard under your arm, have a seat, and observe your client.
  • The Home Office: Your home work space needs to be neat, free of clutter, and use a storage system that makes sense for you. For me, I keep all my learning resources together, I keep my client files together, I keep my assessment kits together, etc. Everything has its own tub, and is labeled by category. Then inside each tub, items are stored in baggies and documents are stored in file folders. I use a similar system for my computer files, everything is divided up by category. I have categories for general resources, for insurance/billing, for employer required forms/data sheets, and each client has their own file system with identical subfolders. This way when I move quickly in between various clients, each folder is set up the same way (saves lots of time when I need to find something quickly). I also insanely love templates. So I have Client Master File templates, Supervision Feedback Form templates, Parent Training Handout templates, ABC Data sheet templates....I will stop there because we'd be here all day. When I need something, I just open up a template and edit it depending on who it is for. Saves an amazing amount of time.
  • Give Up 1-2 Hours Each Night: This tip may not be as helpful for you, depending on your schedule and how many clients you see in a day. For me, I don't see more than a few clients a day. What that usually means is I work a few hours and then I am done. Once I get home, I pull out my supervision binder, flip to each client's section, and I am looking for: program changes I need to make, reminders/emails I need to send to the team, data I need to transfer to my computer, materials that need to be purchased or made, etc. I plan this time into my schedule, and do not consider my work day done until this is completed. By adding this step, I avoid getting to the middle of my work week and staying up all night catching up on things I didn't get done earlier in the week. Or worse, spending all weekend furiously updating programs or revising data sheets before I go see the client again the next week. This was such a timesaver for me! I don't work in an office setting, but this is the equivalent of not leaving the office for the day until your desk is clear ;-)

 As your work experience and confidence grow, you will learn how you work best and what level of organization you need to stay sane. More than just the stress that comes from chaos though, its important that you as the BCBA are on top of things because ....well, everyone else on the team is expecting you to be! You are the one who is expected to remember everything, always have copies with you, and update everyone of important treatment changes. It helps to fulfill that role when you develop a system, and stick to the system.

**Resource: Some nice ideas (complete with decorative photos) for staying organized as an ABA practitioner.

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“Well, the parents on this case are a bit….high maintenance
“You definitely need thick skin to work with this mother”
“You have experience dealing with…very involved parents right?”

If you're an ABA professional, then you probably know what I mean by the phrase “That Parent”. You have been warned about those kinds of families in hushed tones, or directly felt their wrath somewhere in your career experience.

Who loves honesty? Yup, me too. So let’s honestly describe what is meant by the hushed and frantic whispers about THAT parent. 

The parents are/A parent is:

  •  Difficult to please and/or very picky
  •  Quick to complain, criticize, belittle, or insult 
  • SUPER vocal, opinionated, and in-your-face assertive
  •  Overly involved in the therapy process
  •  Frequently talks over you, or talks for so long you forget the point you were going to make
  •  Demanding (if you don’t respond to their email fast enough they start texting you)
  •  Slow with praise or compliments
  •  If there is a chain of command, they never follow it. Any small grievance gets immediately reported to the top of the company 
  •  Habitually speaks in an agitated or annoyed tone of voice (always seems upset)

Is this description ringing any bells?  

Over the years, I’ve had multiple experiences dealing with THAT parent. Some experiences were very brief, usually because the parents abruptly stopped services. Other experiences seemed to stretch out like stars against the night sky, and every day with them felt like 1,000 years.

Back in the day I used to approach these types of parents with a queasy stomach, sweaty palms, and a lovely tension headache whenever I was in their presence. They made me nervous, made me stammer over my words, or worse, left me angrily rehearsing unspoken conversations in my head of what I should have said, or how I should have responded. And of course, nothing like THAT parent to make you feel wholly incompetent and like a disgrace to your field.

Fast forward to today as I have a few things I didn’t have back then: perspective, increased maturity, and a munchkin of my own. As a munchkin wrangler, do I now understand what it’s like to be a 24-7 advocate for a child with Autism? No. Do I know what it’s like to navigate IEP’s, special education laws, inclusion classrooms, and the like? No. Have I nearly gone into bankruptcy trying to get my little one all the therapies she needs that insurance *coincidentally* won’t cover? Nope. BUT, I can only imagine what going through all of that might do to my awesome, bubbly personality. ;-)

And now we have reached my point: There is nothing wrong with being THAT parent. Not only is there nothing wrong with it, we ALL have the potential to be That parent when it comes to our children.

Even the most sweet, gentle, Happy Happy-Joy Joy parents that I work with have stories to tell me about that “one time” they acted like THAT parent. They ashamedly, or with clearly false bravado, tell me about the time they yelled at their child’s teacher, said the F word in an IEP meeting, or made the ABA therapist cry. 

For the most part, THAT parent doesn’t enjoy behaving the way they sometimes behave. They are not out to get you, and do not actually despise you. They are not intentionally trying to make your job harder, trying to get you fired, or trying to make you look bad. Actually it’s the opposite: they are more concerned about their child than about you.
 If fighting for what their child needs means you get yanked off a case, or receive regular 2 a.m. emails from them, or you have to spend 4 hours rewriting the behavior plan they didn’t like, then so be it. 

When dealing with THAT parent, it’s helpful to take a step back and switch out THAT for This:

  • This parent did not ask to be in the position they are in
  •  This parent may lack a strong support system that also gives them honest feedback on their behavior 
  •  This parent may be having marriage problems
  •  This parent may be dealing with emotional or mental health issues
  •  This parent may still be carrying guilt about previous experiences where they did NOT speak up
  • This parent may feel resentful that you can help their child in ways that they can’t
  • This parent may not have slept in days because they stay up nights worrying about their child’s future

My advice for navigating the choppy waters around THAT parent is to choose empathy over offense, to tackle problems/conflict head on and respectfully, and to know when to back off. By “back off”, I mean know when to say “Well then I can’t help you”. 

Part of being an ethical professional is being able to assess when you are not adding value to someone’s situation. If the working relationship has become more about misunderstandings and heated conversations, then how is that helping the individual receiving services? It really has nothing to do with someone being THAT parent: if what you bring to the table is not seen as valuable to the parents/family, then get out of the way for someone else who could potentially be a better fit.

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