"A sprinter body is built for speed and power while the marathoner is built for long, slow endurance" From www.livestrong.com article 




If you supervise/manage ABA cases for any period of time, you will start to notice a phenomenon I like to refer to as sprinters and marathoners.

Sprinter clients are often SUPER excited and energetic about starting services, and just want to hear about your success stories. When you first meet them, you will probably think "Wow! What a great family, I can't wait to start working with them". Sprinters are often the "1, 2, 3, ... Magic!" people.

Marathoner clients aren't quite so dazzling upon first meet. They are happy to start services, yes, but they may be more cautious or skeptical. They might point blank ask you about some alarming ABA information they read online. They may admit they aren't fully sold on ABA. They might quiz you or question your expertise in a way that makes you a bit uncomfortable.

Just like the tortoise & the hare, looks can be deceiving here. Time and time again, I watch sprinter clients start out strong and then fizzle out or hit that dreaded wall. Maybe their child got kicked out of *another* daycare, or the biting behavior from years ago came back, or toileting turned out to be harder than anticipated. When the path begins to veer or curve and obstacles pop up, sprinters start to slow down, or might just come to a stop. Followed by completely disengaging from the therapy process. 
Meanwhile, my marathoner clients often start off slow or bumpy, but they keep a steady and consistent pace, even when things get crazy hard. They understand that therapy is a tiring, ongoing, up and down journey, and not so much a race.


ABA Supervision

Being an BCBA/ABA supervisor means you have a role that you cannot execute alone. The caregiver/parent being on board is critical in order for you to do your job. All the typical supervision duties (assessment, evaluation, program writing, coaching/training, data based decision making) require parent input, parent approval/consent, or parent implementation when the treatment team is not around. Once sprinters burn out and collapse, it will affect the entire team. 

Parental disengagement (the "checking out" process) can lead to staff burnout, supervisor burnout, inconsistent treatment gains, resurgence of problem behaviors, and could put the BCBA supervisor in an unethical position (see ethical guideline 2.15d). It is the ethical obligation of the BCBA to ensure that the client is benefiting from treatment. If parental disengagement is preventing that from happening, then that's a serious problem.

Sprinters

Not sure what a sprinter typically looks like? Here are some common characteristics:
     Over the top excited at the start of services/only expect good things from therapy, view the team as all-knowing experts, unrealistic expectations of treatment, overly attached to staff/wants to develop friendships, give little input/ask minimal questions of the team (“Whatever you think is best”), avoids talking about or facing child’s deficits, avoids discussing the future/planning for long term goals, minimizes or downplays problems or issues, overly confident in their own abilities to execute techniques, approaches treatment like let’s throw stuff at the wall and see what sticks, cannot tell you why they chose ABA/low commitment to the process, overly focused on the end of the race or The Finish Line

1 or 2 of these characteristics does not necessarily equal a sprinter. It's the combination of multiple characteristics, combined with telltale signs of parent burnout or lack of commitment that reveal a sprinter.


Marathoners

Not sure what a marathoner typically looks like? Here are some common characteristics:

     Has an appropriate level of fear or skepticism at the onset of services, maintains realistic goals, asks probing or challenging questions of the treatment team, openly voices their opinion/will tell you when they don’t agree, comfortable setting both short and long term goals, may be involved in multiple treatments but understands that ABA requires high commitment, wants to participate in therapy/asks to be trained, openly admits to struggles or difficulty implementing the techniques, asks treatment team to help them advocate in other settings, rooted in reality vs focusing on a future day when everything will be fine, celebrates small successes or the baby steps of progress

     1 or 2 of these characteristics does not necessarily equal a marathoner. It is the combination of these characteristics, combined with consistency when the treatment team is not present that reveal a marathoner.


Action Steps

As the BCBA/supervisor it is common to want to blame yourself when a parent suddenly disengages, checks out, or begins to actively derail/resist the treatment process. This blame isn't just non-helpful, it could lead you to a place of frustration and burnout. 

What is key, is putting strategies in place to prevent sprinter issues rather than trying to react to them once they're already happening. Think antecedent interventions: what are procedures that can be implemented right from the start to help prevent a case from falling apart gradually, or suddenly. 

Procedures like:

  • Company policies such as careful screening/ interview of new clients, an intake process that clearly outlines parent expectations, a parent involvement policy (one that is actually enforced, not just written on a piece of paper), well trained staff who can recognize signs of burnout in the parent, and supported clinicians who are equipped to set the parents up for success.
  • Always view the parent as a vital part of the treatment team. If the parent bursts out of the gate at a sprint, only to collapse shortly thereafter, then the whole team needs to help get that parent back up and on their feet. This is everyone's problem to help solve.
  • At every phase of treatment, continue to review anticipated response effort and commitment levels with the parent. For example, when I introduce behavior plans or implement toilet training protocols I make it very clear to my clients that we are about to roll up our sleeves and work hard. I don't sugarcoat or minimize the increase of effort they are about to enter into, because I don't want that to be a nasty surprise.
  • Lastly, know when to terminate services. Termination is not a dirty word. It may just be the best choice for the client, particularly if due to persistent parental non-adherence to treatment. If any gains or successes are only demonstrated when the treatment team is around (aka behavioral contrast), then is that really effective treatment? I don't think so. 



This is somewhat of a Quote of the Day post, because it's going to be short and sweet.



I get a lot of emails from people all over with questions related to ABA services. Questions like "My daughter is doing XYZ at school, what do the teachers need to do", or "How do I (write/create/make) a (behavior plan/program/staff training)", or "My client's aggression is increasing, how do we stop that", etc.

The problem with questions like these, is they can't be accurately answered in a cut and dry manner. That's not how this works.
ABA therapy is crockpot cooking, not a microwave.

BUT, all hope is not lost. There is a way to discover that good ol' ABA magic, that actually will be helpful for your child, client, or student. The 3 steps below will help guide any of your ABA therapy related decision making, without sacrificing treatment quality. Guide, not completely resolve. Taking the time to complete these steps will point you in the right direction, not completely remove the need to consult with a BCBA.


  1. Carefully assess the recipient of treatment: What is the individuals age....how does their environment impact the behavior of concern...what is the setting where treatment will occur...what training level do the staff/parents currently have...is the individual on medication...what impact does the medication have on the behavior of concern....what impact does the individual's diagnosis (if there is a diagnosis) have on the behavior of concern...is the individual currently accessing ABA services....and on, and on and on. This step cannot be skipped. Its critical to evaluate the whole person, not just their behavior.
  2. Review what has already been effective: Professionals refer to this as literature review. This means to look for evidence based strategies, treatments, and therapies, that have been demonstrated effective for the behavior of concern. If that all sounded really confusing and complicated, this website should be a helpful start --ASAT.
  3. Putting it all together: I bet you didn't even notice that you just completed an assessment/evaluation, which led you to a hypothesis, which led you to data. Impressive, right? No really, that was the point of steps 1 and 2. Behavior does not occur in a vacuum, so you first need to gather information about the individual, then examine their environment, then become familiar with what has already proven effective, and then put it all together: create an individualized plan of action. This is why ABA professionals cannot answer "What should I do?" kinds of questions, because its impossible for us to complete steps 1 and 2 if we don't know you.


*Recommended Reading on Parental Involvement:

The Role of Caregiver Involvement in ABA Therapy
Parents: We Need You
Common Questions Parents Ask When Initiating ABA Therapy


I get asked lots and lots of questions by parents when we begin the therapeutic relationship, but if I sorted all those questions into 2 main categories they would be:
"How do I teach my child" and "How do I reduce behaviors".

That's it.

 All of the questions I get can be boiled down to 2 essential questions, that pretty much every parent raising a child with special needs (or any child, really) wants to know.
I can boil it down even more than that. These 2 questions are really getting at: "While you guys are working with my child and implementing treatment/therapy, what am I supposed to be doing?".

THAT is the $1,000,000 question.
To that question I say: You are supposed to be learning.

The typical parent I work with is not an educator, child expert, or a Behavior Analyst. Behavior change is not common knowledge, unfortunately. Much of what I teach parents initially seems counter-intuitive, illogical, or just downright weird.
 For children without any diagnosis or disability, parenting is hard enough. I can't imagine how much harder this process must be when your child learns/develops in unexpected ways, you need a team of professionals to help your child, but that team of professionals knows a LOT of information that you do not know.

That must be insanely hard.

So what's a parent to do? Well here is what NOT to do: open the door to let the therapy team in the house, disappear for the duration of the session, open the door to let the therapy team out of the house. Or: drive your child to the treatment clinic, sit in the waiting room, drive your child home from the treatment clinic. Or: drop your child off at school, pick your child up from school, only talk to the teacher at parent-teacher conferences.

None of those scenarios will help you learn anything about your child's treatment or therapy. But for a long time in this field, these scenarios describe what I saw. I saw parents briefly when I entered or left their home. I saw parents briefly at the start of the day at the clinic, or at the end of the day at the clinic. Quite non-surprisingly, these parents always reported a slew of challenges and issues outside of therapy sessions that the therapy team just didn't see.

This is also why many professionals struggle with parents participating in therapy sessions...its not something they are used to. Not all parents are involved with treatment, so for some ABA professionals it feels odd or accusatory when a parent starts asking questions about treatment.


I am huge on parent involvement and parent coaching, I strongly believe that if the people who hired me do not do the heavy lifting alongside me, then there's no point in me being there.

To the parent reading this: Now that you know what you are supposed to be doing while your child is receiving treatment (Learn), you may be wondering how exactly to do that? Glad you asked.


  1. Ask questions - Parents don't ask me nearly enough questions, and I remind them of this all the time. The team of professionals you are working with have spent a long time accumulating knowledge, as well as applying it to a variety of individuals. In other words, they may know a thing or three. It is in your best interest to ask questions about anything that concerns or worries you. Let me clarify that just a bit, I don't mean questions like "What will he be like at 22" or "Will she ever get married or go to college". The ABA team are not fortune tellers. I mean questions about treatment, goals, behaviors, etc.
  2. Do your research - I know, data and journal articles are not fun to everyone. By research, I don't mean you need to complete a dissertation on Behavior Analysis. What I mean is, do you actually understand the treatment your child is participating in? Do you know what ABA is, and what it is not? If your child has an IEP, are you familiar with IDEA? If your child receives speech therapy, how much do you know about ASHA? If you are signing your child up for therapies you barely understand, then how will you determine if the therapies are being implemented correctly?
  3. Read the documentation....All the documentation. Yes, I'm serious. - We can tell when you do not read our documents, whether its the report, the behavior plan, the programs, the handouts, etc. The questions you ask or the strategies you implement make that quite obvious. If you have not read the behavior plan then how can you possibly implement it? You can't. Which will lead to problem behaviors not improving, or worse yet increasing over time. If what the professionals are giving you to read looks like hieroglyphics, then you can absolutely ask them to translate that stuff into simple words! Or better yet, schedule a meeting to go over the documentation together.
  4. W-A-T-C-H - I usually start easing the families I work with into participation by having them just join the therapy sessions, to silently watch. This accomplishes multiple things at once: the parent gets to see the quality level of the staff, the child gets used to mom/dad being in the room but not rescuing them, and the parent gets to see how we teach skills. Observing the therapy sessions or treatment is an invaluable tool that will yield out so much important information. I do school observations all the time. Just by observing my kiddos at school, I can tell the quality of instruction, the social temperature of the room (how accepting are the other kids), and what is maintaining problem behaviors. If you do 1 thing this week to participate more in your child's therapies, please sit and watch the therapists work with your child. It's the best way to learn.
  5. Ask more questions! - After you observe the speech, OT, or ABA session, or go into the classroom to observe your child at school, you should have lots of questions. Ask those questions. Watching is great, but actually understanding what you just saw is even better.
  6. Talk to the treatment team as if they work for you, because they do - The treatment team is there to help your child, and to a greater extent, to help your family. That means they are accountable to you. Do you feel like they are doing their job? Are they meeting your expectations? Is your child improving? Can you say that your household is benefiting from the intervention, not just your child? If not, its time to have a conversation with the treatment team.
  7. Expect, no--->require professionalism and respectful communication - You have a right to ethical treatment from qualified professionals. Read this post if you need more clarity on that. This one is important: unethical, unqualified, non-professionals are not likely to implement intervention in a way that will actually help your child. I just don't see that ever unfold that way.
  8. Tell us when you don't think treatment is working - If you don't think the behavior plan has changed anything, tell that to the BCBA. It's important for us to know when you do not see the benefit of treatment (we call this social validity). As the person who requested our services, you should be the main supporter of our services. So if, for any reason, you have a problem with the way treatment is being implemented then we need to know that. I can't answer a question the parent does not ask, and your treatment team cannot make modifications you do not request. Parent raised issues help professionals discover problems, become aware of blind spots, or shift our perspective.



References:

Briesmeister, J. M., & Schaefer, C. E. (2007). Handbook of parent training: Helping parents prevent and solve problem behaviors (3rd ed.). Hoboken, NJ: John Wiley & Sons.

Crone, R. M., & Mehta, S. S. (2016). Parent training on generalized use of behavior analytic strategies for decreasing the problem behavior of children with autism spectrum disorder: A data-based case study. Education & Treatment of Children, 39(1), 64-94. Retrieved from https://search.proquest.com/docview/1776150175?accountid=166077

Lafasakis, M., & Sturmey, P. (2007). Training parent implementation of discrete- trial teaching: Effects on generalization of parentteaching and child correct responding. Journal of Applied Behavior Analysis, 40, 685-689.





Disclaimer: The information in this post is intended to be a general guide to composing a behavior intervention plan. Behavior plans must be an individualized, needs-specific process. As a parent or professional, please avoid “paint -by -number” guides to writing behavior plans. Various funding sources or employers may have different requirements for behavior plans, so trying to stick too closely to a formula definitely wont help you. 

I didn't intend for my first post on Behavior Plans to be a 2-parter, but recently I have become aware that many people could use assistance with writing up plans for how to intervene on behaviors. Including newly certified BCBA's :-)

I also know that BCBA's are not the only people writing these things. If you are an Educator, Program Director, Counselor, Mental health professional, etc., and you came here looking for some tips for behavior plans then I hope to be helpful.

Before I can be helpful though, let's just clear up a few things:


  • A behavior plan is not what you think it is. During your first step of selecting target behaviors and determining function (if that was not your first step, start over), you should have come up with some hypotheses of what's maintaining the problem behavior. In other words, what is the function? So think of the behavior plan as just a written Function Based Intervention. Truly, that's all it is. People get intimidated or lost in embedding graphs, language style, sections, headers, etc., when what is most important is connecting function --->to---> treatment. The skills of selecting target behaviors, measuring behavior, analyzing data, and creating specific strategies are required in order to write up an effective behavior plan. So if you do not possess these skills or any behavior analytic knowledge, or have no access to a BCBA who can consult with you, then you likely are not the ideal person to be writing up a behavior plan. And here's my next point-----
  • Everyone who has responsibility for creating behavior plans, is not necessarily a BCBA. If a non- BCBA is in the position of creating a behavior plan they can still choose to do so in an ethical manner, with evidence based recommendations, and under the close guidance of a BCBA when needed.  I  recommend consulting with a BCBA/seeking out assistance before trying to go it on your own. As explained in the previous tip, simply writing something down on paper does not a behavior plan make. If the goal is to reduce or modify behaviors with long lasting effects, then its imperative the author of the behavior plan has behavior analytic knowledge/access to a BCBA.
  • The behavior plan is not for you. As a Supervisor and Consultant, I spend a good amount of time critiquing and editing other people's behavior plans. A common mistake I notice is writing a "limousine" level plan, that will be handed off to "bicycle" level staff. By that I mean if you are working with entry level staff who received minimal training, you cannot/should not write some 12 page and highly technical intervention for them to follow. Particularly if the funding source does not allow for you to follow up with the staff to supervise, train, and support them. Don't set the staff up for failure.

With those tips out of the way, consider the following a helpful cheat sheet for any professional who has anxiety about creating behavior plans. Like any other behavior analytic strategy, behavior plan writing is a skill that will take time to learn and enhance. Between this post and the Part I, you should be good to go.


 Be patient with yourself, and when in doubt always review the literature (Behavior Analytic journals, that is). Reading what others tried and found effective, will help you develop a knowledge base of how to approach problem behaviors. Good luck!


First Things First: Summarize the Functional Behavior Assessment or Functional Analysis results (those beautiful graphs), describe the client, and identify the plan author. This will vary depending on where you work, but usually there will be some table or chart at the top of the plan that covers most of this information. Below that, there will be some type of summative data of the selected behaviors (baseline data), and possibly a brief summary of how the behaviors were measured.
What’s the Problem?: Don't forget to clearly and objectively define each behavior selected for intervention, aka this is where the Operational Definition goes. Common mistakes I see in this section are an entire list of problem behaviors (which will lead to a bulky and highly challenging behavior plan), vague descriptions of the behavior, and subjective terminology. For example: "Sally has tantrums whenever she gets mad at someone". Who is someone? What does "get mad" look like? What does "get mad" NOT include? If a stranger could not read your plan and know what the problem behavior looks like, then the definition is not clear enough. 
Get to the WHY: Function is the name of the game. If you have written up behavior plans that make no mention of why the problem behavior occurs, you have absolutely missed the mark. All recommended interventions should be based on the function, so without identifying the function there is no behavior plan. Again, language used in this section should be clear, objective, concise, and behavior analytic. If you don’t know how to write using behavior analytic terms, then you should be consulting with a BCBA as you create the plan.
Set Goals: Is the behavior going to decrease in frequency? Duration? Severity? Is it going to be replaced completely? Clearly spell out the expected goals for the problem behavior, in order to modify the plan over time. Behavior plans are not intended to be in place for eternity. As problem behaviors reduce/improve, the plan should be regularly updated based on mastery of behavioral goals.
Get to the HOW: This is the section where you connect function to treatment. Example, “Mickey Mouse’s aggression is maintained by escape/avoidance, therefore here is how to a) teach other methods to request escape, and b) no longer reinforce escaping tasks”. The how section includes both before and after strategies (Antecedent & Consequent strategies), and if necessary: the Crisis Plan.
DANGER: Crisis Plan time---Are any of the behaviors dangerous, intense, or potentially harmful? Keep in mind, even mild level dangerous behaviors (like breath holding for 5 seconds) could possibly worsen due to the Extinction Burst. A crisis plan should be included if problem behaviors are, or could become, harmful to the individual, property, or another person. Ethically, the staff/parent must be trained on the crisis plan and the crisis plan should include evidence based strategies.
Remember the Audience: If the behavior plan will be handed off to a parent, a layperson, or minimally trained staff/non-ABA staff, then this should set the tone of the plan. Avoid jargon, give clear examples, and be prepared to train the staff on implementation of the plan. Even highly trained or credentialed ABA staff often need assistance with implementing behavior plans, so your job is not done once you put a plan in writing. Writing the intervention down does not mean people will magically follow it.
Copy & Paste = Bad: Behavior plans (like skill acquisition programs, prompt levels, etc.) should be individualized to the learner/client, as well as follow the procedures outlined by the employer or funding source. This means that if you work at ABC school in Texas, you should not be copying behavior plans from the XYZ school in Virginia. That just isn’t how this works. Behavior change is highly specific, and also the people implementing the plan will influence how the plan is written. Doing a quick internet search will yield many results of sample behavior plans, but do remember that a sample is only a starting point. The hard work of literature review, reading over the ethical guidelines, discussing possible interventions with appropriate stakeholders, and considering the needs of the individual, all need to happen in a systematic manner.



I get lots of requests for information from people outside of the field of ABA, like speech therapists, educators, psychologists, social workers, etc. Which is surprising, but pretty cool.


There are many, many professionals who regularly come into contact with BCBA's, and would like to learn more from these BCBA's, but are not quite sure the best way to do so.
Trust me, I understand: sometimes the way BCBA's speak or behave can be confusing to people outside of the field. In our defense, most of us spent our days talking to other ABA professionals and so our ability to collaborate across disciplines or to explain concepts simply can get rusty.


Print out and share the handout below with anyone you think could benefit from this information, or maybe had a previous negative experience interacting with a BCBA.
ABA conferences and journal articles can be daunting if you are not in this field, so the best way to learn about ABA is to chat up the BCBA. So please allow me to help make that chat easier!




*Free Handout: Knowing What to Expect From a BCBA





Maladaptive - Incomplete, inadequate, or faulty adaptation; unsuitably adapted or adapting poorly


I had a colleague once who brought to my attention that our supervisees seemed to love to throw around the word "maladaptive" in their reports. It had almost become like a buzzword for saying "inappropriate". Like, "maladaptive tantrum behavior" or "maladaptive social functioning". My colleague's response to this was genius, IMO, and changed the way I view this word: Maladaptive to who?? 
As in, the client's tantrums are maladaptive...to who? The client's toy throwing is maladaptive...to who??? Certainly not the client.

See, the word maladaptive implies that there is something defective, or wrong, about the behavior. However, to the person engaging in the behavior it is very much serving a purpose and meeting a need.

So if I am 4- year- old little Tara and I cannot readily communicate, I now have to come up with some other way to get what I want. Oh I know, how about screaming? If screaming leads to adult attention, followed by accessing things I want, then how exactly is my screaming maladaptive?

Before throwing around buzz words, or using overly technical language to sound impressive, try thinking through what you really mean to say when describing behavior.

The irony is I think it's extremely "adaptive" to come up with a method to be understood. ;-)
Kids are so much smarter than we give them credit for, whether or not we like what they choose to do.

Clearly, when I think of "reinforcing" I think of doughnuts.

Positive reinforcement has lots of precise definitions, but a very simple way of understanding it is: why you do it again.

After buying your wife roses once, why do it again?
After visiting an exclusive spa, why do it again?
After having 1 bite of delicious ice cream, why do it again?

We do something again, because of reinforcement. Something reinforced, or strengthened, our behavior to drive us to repeat the behavior seeking to contact that same reinforcement.

Whether you came to this blog as a parent or professional, we all should a common goal of seeking to build upon or expand reinforcers.


Reinforcement is the reason why my clients learn what words like "Match", "Sort", or "Give me" mean. It's why they choose to use language rather than hit me when I upset them. It's also why you got up and went to work today, and why you answer a ringing telephone.

For most of the kids I work with, when I first meet them they have minimal reinforcers. They often spend their time wandering around the home, making noises or sounds, engaging in repetitive behaviors that adults quickly redirect, and being heavily dependent upon other people to make fun things happen.

Through intervention combined with valuable systems of reinforcement, these same kids learn to:

- request desired items or activities, instead of angrily crying until someone figures out what they want
-replace harmful behaviors with hobbies, skills, or leisure activities
-let someone know when an activity is boring, or when they just don't want to do it anymore
-get another person to engage with them, play with them, or talk to them


It's very easy to focus solely on teaching skills or reducing problem behaviors. These things are important. Highly important. But a life is not built upon performing skills, or keeping your hands to yourself.
If someone went to your home and removed every activity or object you find reinforcing (cell phone, coffee, laptop, a good book, etc.), you probably would not want to live in that home anymore. It might start to feel more like a prison or jail, than a home. Okay....so think about how a child with special needs may feel when they have so few reinforcers that they are allowed to contact, or know how to request. Sounds like a pretty dull life, doesn't it?

Intervention should be about more than just fixating on deficits, it should also look to improve overall life functioning. I know for my life, my reinforcers are pretty darn important to my overall satisfaction, mood, and temperament. I'm guessing it's the same for your life.

Building a history of reinforcement, builds an enriched life. As you are working on teaching your child, student, or client to tie their shoes, say "please", or complete math problems, I'd also suggest systematically working to increase their reinforcers, which improves quality of life.






*Suggested Reading: "The Hidden Curriculum for Understanding Unstated Rules in Social Situations for Adolescents and Young Adults"

The hidden curriculum can be defined as those invisible and unspoken rules of  society/community that we are all expected to follow, and often face negative reactions for failing to follow.

Examples? Sure:

*During checkout, the cashier may ask if you found everything ok. It's a way of being polite. They do not expect you to say "No, I couldn't find milk, eggs, flour, or lemons. Come help me find them"

*It's fine if a toddler on a plane is loudly singing the ABC song to himself. If he's still loudly singing 10 minutes later, his parents will start getting some very angry looks from other passengers 


*Do not ever get onto an elevator and stand with your back to the door, directly facing the other people on the elevator


*When you see a "free samples" sign, it is fine to take one. It is much less fine to take 5

*Any look towards another person that exceeds a few seconds is considered "staring". People may make an odd face at you if you don't break off the stare when they catch you



And on, and on, and on.

Teaching play skills? Sure, we have a program for that. How about language? Not a problem. Toileting? Of course. But the difficulty with teaching hidden curriculum is in its very unclear shades of gray. If typically developing adults have a hard time navigating invisible social waters, then how well do you think a child with Autism will do?

I think another difficulty with teaching in this invisible domain of social skills, is trying to do so within a structured therapy session. Social skills don't always fit into neat boxes, or a jam-packed therapy session from 2-4. To work on these areas of gray we need to go OUT THERE.
Out there is simply into the child's community, where they live, work, play, or attend school. It is often through being out and about with my clients that I see areas of deficit I was previously unaware of, and think to myself "Ooooo, we need to work on that".

Yet another difficulty with teaching in this invisible domain is that the wrong answer is not always obvious. Just think of someone you know who is a bit abrasive or loud. At social gatherings, you can see other people giving each other the side eye, obsessively checking their watch, or clearly saying lies to leave a conversation with that abrasive or loud person. But does the person seem to notice those cues? Not always, no. Unless someone plainly says "Hey look: you are shouting and spraying spit on my shirt, and you're also kind of ignorant and boring. I don't want to talk to you anymore", that person may never truly understand how others perceive them. And it's unlikely that will happen, because it would be extremely rude to tell someone that! So the person does not get the blunt feedback they need, because to give that blunt feedback would make the other person seem abrasive and rude.


Social skills are difficult. Like, Jenga difficult.





So what can be done?


  • Realize that this invisible area of social development will not magically descend upon your child like fairy dust. It will likely need to be taught, very intentionally, and with lots of generalization/real life examples.
  • Don't expect it to be easy, or simple. It won't be.
  • As much as you can, expose your child to same age peers. I spend a lot of time at work watching kids interact, and the results can be hilarious. Kids say things adults would never say, but that kids with poor social skills need to hear. Like: "Oh my GOSH you already said that like 4 times! I don't care".
  • Evidence based strategies such as video modeling and social strips/social stories can be particularly helpful to break down complex social skill instruction, particularly if the learner has the communicative and cognitive ability to follow a story.
  • Stop being so nice to your child. I'm not saying be a jerk, but the honest feedback your child gets on the playground won't exactly be dipped in sugar first. Practice giving in the moment feedback when your child interrupts someone, stands too close, or smells like they need a shower.
  • If you are already receiving ABA therapy services, ask if social groups are an option.
  • Make sure your child understands that social rules are a complicated matter. Almost every social rule has an "except when...." caveat. This is not a concept that will be helped by black and white thinking; flexible thinking will be key.


For more information about Hidden Curriculum, look for the publications of Brenda Smith Myles



Photo source: www.pinterest.com


There are many reasons why I stop working with clients: sometimes they move, they lose their funding, they improve to the degree they no longer need for my services (oh happy day!), or for personal reasons the family needs to take a break from treatment services. Then there is another category of why people quit therapy, it's like that dark, wooded area in the back of the park that no one likes to talk about.

Sometimes clients halt treatment because they started ABA services expecting Happiness, and instead all they got was Therapy.

Maybe you are a parent who tried ABA therapy for your child, but to your surprise, the child cried a lot. Or their behaviors grew worse. Or tantrums grew more severe. You probably thought to yourself, "Hey! What's going on here? This is not what I signed up for". Actually, it is.

Now's a good time for a disclaimer:

"Therapy" is a treatment intended to help alleviate symptoms of, or to relieve the more debilitating impact of, a particular issue, challenge, disorder, or disease. Therapy is not synonymous with being treated poorly, being treated unethically, or being convinced you need something that you really don't need. If you had bad, poor, or horrific experiences with therapy, it's likely that was not actually therapy, rather it was some unethical and harmful service being sold to you as a therapy. 

End disclaimer.


Now that we have a solid definition of therapy, what should parents realistically expect when initiating any new therapy (occupational therapy, speech therapy, ABA therapy, mental health counseling, etc.)?

*Difficulty - Therapy is difficult because areas of deficit are being targeted. The very things selected to work on are things the client either cannot do, or cannot do well.
*New challenges - By its very nature, therapy must challenge the client. If therapy does not push/challenge the client, then that is not real therapy.
*Resistance - All the science geeks: you know that every action has an equal and opposite reaction, right? Okay, so what happens when a therapist challenges the client in an area that is already weak? It's called resistance. Or the ABA team may refer to it as, problem behavior.
*Commitment Requirement - ABA therapy is not a free sample at the grocery store, or a trial sized bottle of shampoo. You get out what you put in, and commitment is required for progress to stick around. Canceling sessions, starting sessions late, continuing to reinforce problem behavior, or comforting the child through a tantrum, will all have an impact on the overall effectiveness of treatment.


Do you see happy in that list? No. 
Does that mean I'm saying therapy is all bad, all the time, and you and your child will hate it? Definitely not. 
But what I am being very intentional in saying is that the GOAL of therapy is not "happy". The therapy team will develop many treatment goals (and that process should include you as the parent) designed to improve quality of life, and quality therapists do strive to be fun, engaging, exciting, animated, and playful so that therapy sessions are reinforcing. What we do not strive to do, is keep your child happy all the time. There will be sessions with tears, or tantrums, or angry throwing/ripping of therapy materials. This does not shock us as treatment professionals, nor should it shock you as the parent. 

Treatment is hard. Treatment will take you out of your comfort zone. Treatment will push your boundaries. Treatment will impact the whole household, not just the child receiving therapy. Significant gains must be accomplished through significant amounts of work. The therapist will work hard, you the parent will work hard, and your child will work hard. If this is sounding unreasonable to you, or unacceptable, then it's likely therapy is not a good choice..... And that is okay. 

What's most important is knowing the reality of therapy, what it is and is not, before you jump into it.


Photo source: www.tombruetttherapy.com


Photo source: www.linkedin.com, www.chicagotribune.com

*Recommended post: Professionalism


Confrontation is not a bad word, but it sure makes people UN-comfortable.

As BCBA's/therapists/ABA professionals, the need to confront an issue is pretty much a job requirement.
If you're a RBT, you may find yourself needing to confront your BCBA. If you're a BCBA, you may need to confront a parent of a client.

None of us are really exempt here, unless you are totally cool with people walking all over you. If that's fine with you, then I wish you the best of luck and you can stop reading now.


For the rest of us, part of being a professional will involve having to resolve conflict or disagreement with other people in a respectful way. As in, having to arrange a sit down meeting between THAT parent and the ABA team over issues that have been simmering for weeks. Yeah.....super not fun.

No one really told me pre-certification that a big part of my job would be conflict resolution, but it kind of is. On a regular basis. Not just when things completely fall apart, but longgg before they reach that point.

I've learned from experience that the way you approach resolution can either guarantee a disaster or help prevent one. Here's what I mean:

To confront, means to face up to or deal with a difficult situation or problem.

To establish and maintain boundaries, means to mark or designate a dividing line; to clearly set a limit.


Wow. Those definitions make things pretty clear. It's a far more effective use of your time, not to mention less stressful, to focus on communicating your boundaries, than to ping pong from one confrontation fire to the next.


So as a professional, how do you establish and maintain boundaries to avoid reaching a place where you now must confront someone? By thinking through the following:

Where do I draw the line as an individual professionally, both personally (unique personal preferences) and ethically?
Once I have decided on my "boundary lines", which of these will I die for? (translation: which boundaries are the most critical)
How am I doing at clearly informing people about my boundaries?
Do I let people know when they have crossed a boundary (follow up: Then how will they know??)?
When someone repeatedly crosses a boundary I have made clear, how do I resolve the issue calmly and quickly?
If someone repeatedly crosses my boundary, is the problem with my boundary? Is the problem with me? Or is the problem with them?

Over the years, I've had angry and tight-lipped confrontations with supervisors, employers, supervisees, and parents/caregivers of clients. I have also clearly explained my boundaries, and then quickly alerted someone when they crossed/stepped on one. I much prefer the latter.
Especially for an ongoing relationship, like a supervisor you work with across multiple cases, it's better to win the relationship than to win the argument.

Just to name a few examples, as an ABA professional it's important to define for yourself where your boundaries are regarding:


  • Types of clients you will serve
  • Schedule/Availability (desired work load)
  • Training/Learning preferences
  • Communication/Correction preferences (this one is a biggie)
  • Opportunities for promotion/raises/recognition
  • Multi-disciplinary collaboration
  • Dealing with uninvolved or resistant consumers/clients
  • Creating that work/life dividing line; Maintaining balance



Instead of spending energy on very impressively worded (we do love our jargon, don't we?) confrontations, choosing to have a respectful discussion about boundaries moves you closer to maintaining the relationship.
If people don't want to work with you, even if you won the argument you definitely lost the war.


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