For truly any child, the sibling relationship can be a combination of great/horrible, best friends/worst enemies, play partner/nemesis.
Anyone with a sibling knows this is the truth, especially when you and your sibling(s) were young kids.

BUT, when a child with ASD is tossed into the mix then totally normal sibling hi-jinks can take a more drastic turn.

A big concern of the families I work with is sibling interaction, or lack thereof. Usually, the issues fall into one of these categories:

- The typically developing children ignore the Autistic child, and have learned it's easier to just leave them alone
- The typically developing children fully give in to whatever the Autistic child wants, and have learned that letting their sibling bully them is better than making their sibling upset
- The typically developing child IS the bully, and has learned that their Autistic sibling won't put up much of a fight/won't stick up for themselves


As a professional, I see it as a great benefit when my clients have siblings living in the home because now I have a built-in pool of peers to reach for whenever we are targeting social-emotional or play goals. Win-win!
Usually though, the sibling relationship is so strained and broken that we can't include the brother or sister in the session until we work on sibling interaction first.

So there is the 1st tip: until the sibling relationship is repaired, just tossing the kids together to work on skills will likely not end well.

Need more tips? Okay:


  1. Step back from the problems, and focus on what you DO want to see - Are there issues with name-calling and teasing? Then you want to see respect. Are there issues with hitting or kicking? Then you want to see calm bodies. Are there issues with always having to win every game? Then you want to see playing by the rules. When it comes to behavior: focus on what you DO want, rather than what you don't want.
  2. Start small- Baby-step your way to success rather than jumping into the deep end. If your children start attacking each other 5 minutes into playing Candyland, then let's play the game for 3 minutes. Or 2 minutes. Start at a level where everyone can be successful, and gradually increase your expectations over time.
  3. Teach functional communication - Ensure that your children are able to communicate (vocally or non-vocally) what they do and do not want. Usually when functional communication is lacking, there will be lots of aggression instead. Make sure the children are taught how to communicate "I don't want to play", so there will be no need to hit, punch, or kick. 
  4. It's OK to dislike your sibling - Sometimes my clients just don't seem to like their siblings very much. Especially if the sibling is much younger. While we can't force "like", what we can do is maintain an expectation of respect. It is not okay to throw blocks at your baby sister because she's annoying. Nope.  Instead, how about taking a break from the situation, asking to wear headphones, or practicing patience and self-calming? 
  5. Remember, relationships evolve over time - This should be good news for someone! As adults, we tend to forget that in our childhood we felt differently about our siblings at different ages. This is completely normal. I have some clients I have worked with for years, and I have seen the ebb and flow in their children's relationships. From "I can't stand you!" to "I want to sit next to Erica!". This will happen. Just because your children have a terrible relationship right now does not mean it will always be that way.


Lastly, any quality ABA provider can include sibling interaction goals into the treatment plan, provide parent training to help you generalize strategies when the therapists are not around, and intentionally plan for play dates or community outings with all the siblings (basically, moving from rehearsal to a live show).






*Resources:






BCBA Position Summary: 

The primary function of the Board Certified Behavior Analyst (BCBA) is to plan, develop, and monitor a variety of behavioral support service delivery options to meet the needs of individual clients. The BCBA also consults with and teaches staff/client caregivers/team members regarding pro-active, educational, programming, and behavioral supports; develops and implements comprehensive treatment plans; and collaborates with related services providers as appropriate. The BCBA also provides direct staff supervision, and evaluation of staff performance both verbally, and in writing.

Essential Duties: 


  • Use appropriate assessment instruments and data to develop and implement teaching programs that reflect behavioral outcomes and objectives 
  • Ensure the accurate implementation of treatment plans, document contacts and observations; use professional knowledge and independent judgment to strategize continuous improvements.
  • Establish and maintain data measurement, collection, and analysis systems for clients
  • Maintain appropriate documentation and prepare and complete reports as required
  • Ensure that all treatment plans and programs comply with contract requirements, satisfy all relevant insurance certification and other expectations, and meet or exceed professional standards
  • Maintain highly organized, consistent, thorough, and systematic recordkeeping (session notes, data sheets, etc.)
  • Seek creative options for ensuring the continuity and consistency of treatment and support services across settings for the lifespan of the client
  • Develop strategies for the stability of quality services when clients experience transitions
  • Conduct structured periodic service reviews to monitor the effectiveness of treatment programs and their implementation; modify and document plan changes as needed
  • Provide staff development, training, and modeling for team members (including client caregivers) in strategies and methodologies for successful implementation of the treatment plan
  • Provide consultation regarding crisis interventions and critical incident supports; complete Incident Reports as needed 
  • Participate in Individual Education Program (IEP) team meetings for clients as appropriate; advocate for client needs in school settings 
  • Participate in professional growth activities such as conferences, classes, team meetings and program visitations; remain a lifelong learner
  •  Accept all other responsibilities as assigned.



This is a real job description for a BCBA position, and it's fairly accurate to most online job postings.

Yes, the typical day-to-day role of any BCBA will vary greatly depending on where they live, which setting they work in, the population they serve, etc. So to keep things simple and brief, I will focus on clinicians who primarily manage cases and supervise direct staff (as this is overwhelmingly what most BCBA's do).

The problem with most job descriptions (that may be written by administrative staff, not clinicians) is they leave out important details about the actual job.
I hear fairly often from people pursuing their BCBA, full of misinformed ideas about what it will be like on the other side. Or, I hear from current BCBA's who have been working in the field for years and are now burned out and exhausted because they weren't prepared for the realities of the job.

-- If you think you may be at a point of professional burnout, my 1st recommendation to you would be to stop & assess: When was the last time you felt passionate about your work? When was the last time you felt valued by leadership/your employer? Has your dissatisfaction at work started to seep into your personal/family life?
If so, please check out the resources below about dealing with burnout. It's a serious problem in many human service fields, and as BCBA's we are not immune.


While there are some great resources out there about professional burnout, my 2 cents is that clinicians would need triage to "stop the bleeding" much less if they enter the field with a realistic picture of what they're getting into. Let's prevent the bleeding, not patch it up.


Using the example job description above, I'll just sprinkle some fresh reality on top of it ;-) :


Position Summary: 

The primary function of the Board Certified Behavior Analyst (BCBA) is to plan (always planning....most clinicians are continuously monitoring the effectiveness of their interventions which requires intentional thinking about what will come next), develop, and monitor a variety (what works for Mickey will not necessarily work for Minnie, so this requires staying abreast of current research and trends within the field to best serve your clients) of behavioral support service delivery options to meet the needs of individual clients (no matter how impressive your intervention is, ultimately if social validity is low then you have more tweaking to do). The BCBA also consults with (this can be translated as 'remains available to', or in other words 'on top of your regular duties') and teaches staff/client caregivers/team members regarding pro-active, educational, programming, and behavioral supports; develops and implements comprehensive (comprehensive is key, and this is why we spend so much time planning and thinking--> the more deficits the client needs assistance with, the more comprehensive your intervention) treatment plans; and collaborates with (again, this is best translated as 'remains available to') related services providers as appropriate. The BCBA also provides direct staff supervision (it is common that direct contact with the client or with staff is billable time, but not so much the other important components of the position that still must happen), and evaluation of staff performance (this could include staff feedback, written evaluations, meeting with each supervisee monthly, or a mixture of all of the above. Again, this may not be considered billable time).



Essential Duties: 





  • Use appropriate assessment instruments (Some companies do not provide business equipment/tools for you, so you will have to purchase these) 
  • Ensure the accurate implementation of treatment plans, document contacts and observations; use professional knowledge and independent judgment to strategize continuous improvements (Being a quality BCBA requires excellent self-analysis skills....you must seek to continually improve your skillset)
  • Establish and maintain data measurement, collection, and analysis systems for clients (Some companies provide access to data management systems, others do not)
  • Maintain appropriate documentation and prepare and complete reports as required (Keeping in mind that what is required will change)
  • Ensure that all treatment plans and programs comply with contract requirements, satisfy all relevant insurance certification (Credentialing is a PROCESS, and an employer with top-quality billers is a must) 
  • Maintain highly organized, consistent, thorough, and systematic recordkeeping (As needed, you must be able to produce accurate, timely, complete client documentation)
  • Seek creative options for ensuring the continuity and consistency of treatment and support services across settings for the lifespan of the client (The 'across settings' part can  be challenging, especially for school or center based services where you don't see the client's home life)
  • Develop strategies for the stability of quality services when clients experience transitions (As the BCBA, you are responsible for successful client transition. This could include if hours decrease, if the program decreases in intensity of goals, or if services terminate)
  • Conduct structured periodic service reviews to monitor the effectiveness of treatment programs and their implementation; modify and document plan changes as needed (Everything you create as a BCBA must be open to revision as needed. Much of your time will be spent editing protocols, programs, or revising systems) 
  • Provide staff development, training, and modeling for team members in strategies and methodologies for successful implementation of the treatment plan (You must make time for this, which can be challenging)
  • Provide consultation regarding crisis interventions and critical incident supports; complete Incident Reports as needed (When working with severe behavior or populations in crisis, your employer should provide adequate training, protective equipment, and support. Also, ethically you must practice within the boundaries of your clinical competence)
  • Participate in Individual Education Program (IEP) team meetings for clients as appropriate; advocate for client needs in school settings (See why time-management skills are critical?)
  • Participate in professional growth activities such as conferences (Your employer may or may not pay for this)
  •  Accept all other responsibilities as assigned. (Pretty  much a vague and blanket statement isn't it? I would add the following reality check to this section: Accepting an insane caseload does not make you Superman/Superwoman, it will make you a very miserable BCBA. Understand that owning an ABA company does not qualify someone to actually be a good/ethical/honest employer, and hating the boss is the #1 reason why employees quit. Understand that staff turnover is scary high in this field..... there is a reason for that.  Understand that as a clinician there are many tasks you will complete that you just can't bill for. Understand that when you get home at the end of the day you likely still are not done with documentation/tasks. Understand that 'work life' may creep into your weekends too. Understand that many ABA employees report feeling underappreciated, devalued, and ignored by their employers, particularly at the RBT level.  Understand that there is a mental fatigue that comes with this type of work, and the more dissatisfied you are with your employer the more it increases. Understand that as clinician you will get frustrated by ever- changing funder requirements, and increased time-sensitive demands upon clinicians. Understand that employment offers for ABA positions often come with more strings attached than Pinocchio.... if you don't agree with something in the offer letter, do not sign it) 





*Resources:

Preventing Burnout 

Running on Empty

BCBA Burnout

Battling Burnout

Stress in the ABA Workplace

Addressing ABA Employee Turnover

Waldman, J. D., Kelly, F., Arora, S., & Smith, H. L. (2004). The shocking cost of turnover in heath care. Health Care Management Review, 29, 2–7

Griffith, G. M., Barbakou, A., & Hastings, R. P. (2014). Coping as a predictor of burnout and general health in therapists working in ABA schools. European Journal of Special Needs Education, 29, 548–558.

Gibson, J. A., Grey, I. M., & Hastings, R. P. (2009). Supervisor support as a predictor of burnout and therapeutic self-efficacy in therapists working in ABA schools. Journal of Autism and Developmental Disorders, 39, 1024–1030





Copyright T. Meadows 2011. All original content on this blog is protected by copyright. Powered by Blogger.
Back to Top