ABA Lessons: Ditch the Bad Therapist

ABA Therapy: Applied Behavioral Analysis (recommended treatment for children with autism)

Read my page on ABA therapy and how it applies to our unique situation.

When I first started this particular blog series, I had grand dreams of sharing all sorts of valuable lessons about ABA therapy.  I imagined all of the amazing ideas I would learn about how to work effectively with my three three year-old son diagnosed with ASD and how blogging about it would help, not only me, but other parents out there.

It hasn’t worked out so well.

I haven’t been blogging much valuable insight about ABA therapy because the therapists we’ve worked with haven’t given us much.  ABA Lesson #2 goes into more detail about the issues we’ve had; it’s been disheartening and frustrating, to say the least.

Though I should say former company we’ve been working with because we cut ties as of yesterday.  I couldn’t feel more relieved.  It all came to a head after Friday’s session.

After our last team meeting, I thought we had hashed-out all of our concerns and had a game plan.  One of our biggest concerns was the back-to-back therapy sessions on Thursdays and Fridays, meaning we would have therapists in our house for four hours and Big C wouldn’t get a nap.  I was very explicit about this being a concern, and I was reassured that the second session would take on the form of a “play session” where Big C and the therapist would socialize through a series of board games.  I was still a little worried, but I thought we’d give it a try.

That is not what happened.  At all.

Here’s a prime example of why some students grow to loathe school.  They get stuck with a shitty teacher who lacks intuition or empathy.

***

The second therapist shows up at the house for the second session and seems a little surprised by the reminder of a “play session.”  I also remind her of my concerns about overtaxing Big C, and that  he seems a little extra tired today.  Unprepared, she hasn’t come with any games, so I have to give her a crash course on how to play Hungry, Hungry Hippos, a favorite game of his we have.

The session take place in our home office, as usual.  It has a glass door, so I can “sneak a peek” if I want, but we keep the door closed to keep my 15-month old out (he’s always interested in what big brother is doing!). The session begins about 4:25 pm with a promise that “we’re going to play and have fun today, buddy!”

First lie.

She starts running drills.  He moves through them fairly quickly, but it is quite evident he is a little wound up, which is actually a sign that he is tired.  It’s the mania before the crash.  The therapist attempts a game of Hungry, Hungry Hippos, but she screws up repeatedly (seriously, it’s not hard) which flusters Big C immensely.  After only one game (which takes, literally, a minute) she puts it away and goes back to “table time” asking him to do a series of tasks for rewards.  Today’s rewards are cheese, Craisins, and iPad time.

She never comes back to any games.  So much for a “fun” session.

By 4:50 pm, twenty-five minutes in, I can hear the meltdown begin.  I am frustrated because he should have had a break already. That was something repeatedly discussed, but I don’t go into the room because I recognize he needs to work through the tantrum before seeing me.

It isn’t until hours later, when I watch the video of the session (something I insisted on a week prior) that I learn what I describe next.  Had I known sooner what was actually going on in there, I would have intervened sooner.

Basically, I feel like I am watching my son suffer a sort of mental torture.  I’m not exaggerating.  She makes promises and doesn’t keep them.  She makes demands: “Touch the table, go ‘Ba!”, match the red card, find the circle, touch your nose, what’s this boy doing on this card, blah, blah, blah,” running drill after drill, then not making good on the promise for a break.

Big C tells her early on, “I’m tired.”  I am so proud.  He is using his words instead of simply having a meltdown.

She doesn’t care.

“Do this (another random, out-of-context task), then you can have a break.”

Lie.

Big C tells her, “My butt hurts.”  He wiggles around and tries to stand, but she restrains his seat so he can’t.

“You just have to work through it.”

Are you kidding me?

He keeps trying to put his head down.

“Put your head up.”

He closes his eyes.

“Open your eyes.”

He starts flailing his arms, getting more and more agitated with every passing second.

“Hands down.”  She grabs his arms and places them on the table.

He starts to get angry.  “Don’t touch me!”   Good for you, buddy.  Tell her what you want.

She ignores him.  She continues to poke and prod him until he is literally sobbing.

“What do you want to work for?  Do you want to work for cheese?  Do you want to work for water?”

Work for water?!?  

“I want my Mommy!”  He has already told her this repeatedly, but it falls on deaf ears.  He tries to get up, but she won’t let him.

“You have to work for it.  Do this.” She taps her nose.

“No!”

“Do this.” She taps her nose again.  After a few more times, he does it.  He wants her to stop and is smart enough to know it is the only way to make it stop.

But it doesn’t work.  Instead, she says, “Do it nicely.”

My three year-old son is completely exasperated at this point.  He has no idea when the end is in sight.  I sure as shit don’t, and frankly, I don’t think the therapist knows either.  She seems to have completely lost herself.  It’s like she’s trying to break him.

And she does.  At this point, he is going through all of these crazy motions, tapping the table, touching his nose, putting his hands down, matching colors, describing actions depicted on cards, all with snot and tears dripping down his face.

Finally, after 45 minutes, he is allowed a break.  He runs out of the room and collapses in my arms, sobbing.

And the therapist has the gall to tell me she has no idea what set him off.  Even though he told her he was tired, he told her his butt hurt, he told her he wanted to see him Mommy.  Even though he completed every task she asked, even though she kept lying to him, promising him a break that would seemingly never come.  And she couldn’t tell me what “set him off.”

Oh, and she also warns me he may have a scratch on his arm from when she was restraining him.  Yes, you read right.  And, sure enough, he has a small, bleeding scratch.  Thankfully a Jake and the Neverland Pirates band-aid is a cure-all.

I tell her the session is over and to please leave.

Our goals have been very explicit with our so-called ABA “team.”  Teach him how to manage his aggression, and teach him how to interact positively with his peers.  How did this session help to reach those goals?  No one can seem to tell me how.

I am so sorry, Big C.  I am so, so, so sorry.

***

So I guess I have learned some valuable lessons so far.  Don’t just assume that if a person is a BCBA (Board-Certified Behavior Analyst) that he or she is necessarily quality material.  Sadly, you sometimes have to learn that truth the hard way.

I would like to end by saying this post isn’t meant to put down ABA therapy.  I certainly hope my experience was merely a bad one and not representative of what ABA therapy should look like.  I’m quite sure there are amazing therapists out there (and I plan to pursue them), but I cannot deny the bitter taste this bad apple has left us with.

 


~Chaos Contemplated (for now)

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22 thoughts on “ABA Lessons: Ditch the Bad Therapist

  1. I know nothing about ABA therapy and how it’s supposed to work but what you describe sounds utterly wrong, unhelpful and counterproductive. Well done you for insisting on the videos that enabled you to find out what was going on and make the right decision. You probably feel pretty bad right now for putting him through this, but if you weren’t so on the ball he would still be going through this so I think you should feel pretty good about some excellent parenting. And I take everything back I said before about the therapists getting paid because they know what they’re doing, from over here it looks like that this lot get paid because parents are desperate enough to trust them despite them not knowing what they’re doing. Good luck going onwards and upwards.

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    • Oh, thank you so much for the vote of confidence! I was thinking the same thing too about the library story time. I have a pretty good sense of what he needs, so I just need to do that. I’d still like to find a professional to guide me with a more effective behavior management plan, so I hope I am able to find someone who is quality, or at least a program I could follow. At least now I know what I don’t want! 🙂

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  2. My heart breaks for both of you for having to go through that. What a horrible experience and good for you for advocating and standing up for your son. I hope you can find a much better therapist who will respect your son as a person and help him meet the goals you have decided upon. Hugs, momma.

    Liked by 1 person

    • Thank you so much. I have to tell you it’s been just over a week and my son is already so much happier. The extreme mood swings are gone. Now, he’s just his usual mood-swingy self. 🙂 Yay!

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  3. A 45-minute session without a break is too long for a 3-year-old with NO learning challenges. Further, that woman demonstrated bullying behavior. Unsurprising that she was attracted to a field and specialty where she believed her victims to be less able to stand up to her, or complain articulately to others.

    Your son did an impressively mature job handling an abusive and stressful situation–credit to him and you. As others said, he will get past this one bad session. And you learned from it.

    Well-written post. Sorry you both had the experience, though.

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  4. First things first, I want to apologize for the horrific representation of my field. This is tragic situation at best….I promise you, we are not all like this, and there are a good portion of us who genuinely care for the children we work with. If you are still scouting for tutors / BCBAs, I’d like to offer a few tid-bits of wisdom in the hopes that it helps you find a suitable therapist in the future.

    Don’t be afraid to ask questions about company policy when it comes to maladaptive behaviors. In the time that I have spent working with children on the spectrum professionally, and personally, I have never used restraint during a meltdown unless the exhibited behavior was harmful to the child, or other children around them. I might block a hit when the hitting is frequent, but even that doesn’t go beyond placing my forearm in the way of my vital body parts. One client I worked with would literally pull clumps of hair out of my head when certain stimuli were presented; this could be as simple as the door opening unexpectedly. After I wiggled my hair out of her hands, I would prompt her to ask for a squeeze (light compression massages can be reinforcing/relaxing for some children on the spectrum.) When she did, I would massage her hands, and she would come back down. Until then, the only thing that I would do was block her access to other children (stand between her and other children), and withhold direct attention; no eye contact, no vocals, no facial expressions where possible.

    A 45 minute DTT session is far to excessive for anyone, much less a three year old on the spectrum. The token economies are supposed to be catered to the child’s ability to ensure that the child can achieve them, and get their breaks, then thinned once mastery criteria is met. This gives the kid a chance to readjust, and the therapist the chance to record the data. If the DTT session went that long, and your son understood the Sd, then this tells me one of two things; 1) The therapist wasn’t implementing the token economy correctly, if at all, or 2) the reinforcement plan wasn’t proportionate….To be honest, when a kid knows the color red, they know it, and they get frustrated when they feel like they are being dumbed down. When we can see a child is clearly that upset, we can usually get a couple of low demands that the child can do without much effort to earn their break. It also tells me that the therapist specifically is aversion. If these kids aren’t waiting at the door for us to show up, something is very wrong. ABA is in itself supposed to be fun, or have exciting elements to it to offset the more tedious work. We shouldn’t be above singing and dancing during potty training, or playing in the sand for functional communication training. Take your ques from your kid; if they run to the door, or get excited when someone is there because they think it’s their therapist……You’ve got a winner. We have to make it fun, otherwise they won’t get anything from it. That brings me to another point; the first 15 minutes of the session should be on the kids terms. One on one with the therapist, hanging out, doing what they want to do so that the two have a chance to pair. This helps increase the child’s compliance using less aversive, and painful means. (I don’t recommend using just the ipad though. Vary reinforcement so it stays reinforcing. To much focus on one reinforcer can cause maladaptive behavior as well)

    It is unfortunate, but DTT is apart of the beast, but we can do it fast, and get it over with quickly, and when break time is earned, we really need to knock that reinforcement out of the park. We can also teach a lot of that information in natural settings, so that when we do have to go through DTT, they are prepared for it. Let’s say that the kid has a goal to label body parts, I might run around with them outside and say something like “I’m going to tickle your belly”, and then I tickle their belly. Most children like to be tickled, so this established the connection between tickle, belly, and the request together so they begin to request it. After that, we might work towards generalization; tickle belly, tickle knees, (though not in one session, depending on the child’s care plan) Later during DTT, I could point to their belly and say “What is it?”. When the child says “Belly” then we give them praise, tickle them, whatever the case may be.

    Don’t be afraid to tell us we need to keep our nails down too. We have a responsibility to keep ourselves groomed to prevent our kids from getting scratched. We literally have your kids in our hands. You have every right to demand a professional

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    • Jessica,

      Thank you for sharing your first-hand experiences with ABA as a therapist. What you described is exactly what I was expecting should happen, not what I got from our former therapist.

      It is comforting to hear that ABA can be a wonderful and rewarding experience. At the moment, my son (in addition to daycare) is attending a special-needs preschool offered in our district, general ed preschool (which the staff at the special needs preschool attend), and 30 mins. of OT and Speech back-to-back once a week. This is a lot, BUT he is enjoying all of it and wants to go, so it feels right. We tried another ABA company for a short stint, not for DTT, but for parent training, but found it overwhelming and a little unproductive, especially considering our son’s already-busy schedule. ABA isn’t lost forever in my mind, but it’s on the back burner as we try these new methods to assist my son.

      Thank you again for sharing. I love learning about this world, as it helps me understand my son’s world a little more.

      Take care, and good luck to you as continue providing positive experiences with therapy! 🙂

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  5. Oh, such a vivid post – I know how you must’ve been feeling watching that video and seeing all of the great communication and clues your smart boy was giving to this therapist who was repeatedly ignoring him. We’ve gone through the good and the bad as well with ABA therapists and methods – it has been a great asset to teach my son language, but has at times also caused damage and stress. I hope you’re finding some better providers – we’ve taken nuggets of wisdom from ABA methods to use in our daily interactions and learned we could dismiss the parts that felt demeaning or wrong for our family. We’ve been lucky to find therapists who see him as a person first (not an experiment or a dog needing to be trained), and every day, I learn to listen to how he communicates (instead of always insisting he communicate the way that we speak). You are doing a great job, because you already knew the things you needed the team to do – and you quit them when they clearly weren’t the right match. It took me a lot longer to learn it was OK to get rid of therapists who weren’t the right ones.

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  6. I could have written this post. It sounds like our kiddos struggle with the same things and I was looking for exactly what you were when we started ABA about 4 months ago. After a particularly awful 3 hour session that turned into 5 hours and the complete destruction of his bedroom, we fired the therapist. It was a wake up call for us in general. I had a meeting with all the supervisors and reminded them that I could care less about whether he knew what a baboon or an armadillo was. I needed support in his aggressive behavior, safety cues, functional skills that are difficult due to sensory issues, and appropriate social communication. I also reminded them that he is a very active three year old that needs physical breaks not just iPad breaks. They told me that he was so bright that he was blowing through all the programs but still not being compliant enough to work on those issues. Huh?
    Anyways, six weeks later, we just stopped ABA all together. I know he’s a handful, but I don’t believe that breaking his spirit is the way to teach him the social skills he needs. I so desperately wanted the help (especially with the exhaustion of having a newborn), I put aside my mommy instincts and allowed it to go on way too long.
    Now I’m back to the search for help but in the meantime, I am recognizing what an amazing little kiddo I have and why I fight so hard to get him the tools he needs.

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    • Wow, you definitely could have written this post! I am so sorry you had to go through this as well; it was a rough time and you have a newborn in the mix, so I can only imagine. Your instincts sound dead-on though. You already know exactly what your kiddo needs; it’s just a matter of finding people who can help you help him. I have found a lot of luck with my area’s special needs preschool. They have been life changers for us. They seem to get him and treat him with respect. I hope you are able to find someone who does the same for your son. You and your family deserve it! 🙂

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  7. I work as a TSS (I work under a BSC, carry out the treatment plan goals and work most closely with kids and parent), and from reading this, it sounds like my position would probably have been at home with kiddo. This sounds like hell, for you and your little man. I am so sorry you had to deal with that. When I come into a home, I brief with my parents and families how the kiddo has done during the day, how theyre doing and if there is anything we can do during session. This session was an absolute mess! Ive never done any DTT…I feel it’s pointless even if I was told it was going to be part of sessions! I was reading this going “why…..why…..WHY?!?!?” Ive had sessions where my kiddos are tired, we do only the fun things, and take longer breaks. 45 minutes was insanity, especially at 3! I dont make my older kids deal with that nonsense. NO need to make things harder on kids and selves!

    Liked by 1 person

    • Alison, I appreciate you taking the time to comment and for validating my feelings! I also think it’s important for other parents to know that there ARE effective therapists out there (it sounds like you’re one of them!), so we should never settle for something we feel in our gut is wrong. Best of luck to you and your line of work! 🙂

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  8. I stumbled across your blog tonight and as an ABA therapist myself, I was horrified. I am so sorry that you and your son had to go through that. I have been a therapist for a few years now and I am always shocked to hear about experiences like this because they are so vastly different from how I have been taught to conduct ABA sessions. I’m glad your kicked that therapist to the curb. As Jessica said in a comment above, ABA therapy should be fun for the child.

    I’m lucky to have a supervisor who gives her therapists a lot of trust and encourages us not to do anything we don’t think is right or don’t feel comfortable doing, even if it is written in their programming. I hate the idea of forced eye contact and stopping harmless stimming that is clearly enjoyable or comforting for the child, so I don’t do that. I also don’t believe in absolute compliance, which your old therapist clearly did. It is important to have instructional control, but the idea that a child should happily do whatever you said immediately is ridiculous to me. If a child is crying or looks distressed over an activity or instruction I give them, they are communicating to me that I need to do something differently. In the case of your son, I would have praised him for telling me he was tired and let him have a break immediately. I always teach children how to ask for a break or for me to make a change, whether it’s with their words, with visuals or with signs. The children I work with are so much happier and are more motivated when they have a sense of control.

    I know some therapists and ABA experts who are more traditional and like to follow all the rules to a T would shake their heads at opinions like these, saying that by not following through with every instruction I am sending the message that rules don’t need to be followed. I have never had too many problems though and find that when children feel valued and respected, they are motivated to do activities and follow instructions. It is difficult to find the right balance of following the guidelines of ABA and keeping in mind that every child you work with is an individual with their own thoughts and feelings. I’ll admit that I do slip up sometimes and get too caught up in the rules and procedures of ABA. That is why I’m so thankful for parents like you and adults who recall reasons they hated ABA as a child because it helps keep everything in perspective for me. I too have days where I’m tired, hungry, unmotivated and just want to see my mom, just like your son and all the children I work with. I always try to remember not to hold the children I work with to a higher standard then I hold for myself. Many therapists, myself included, sometimes forget that their clients will have good days and bad days, just like everyone else in the world, and that it is okay to ease up on protocols to fit their needs.

    All that said, I do believe in ABA and have seen children make huge gains because of it, but in cases where the therapy was done in such a way that is respectful to them. The children I work with who are around you’re son’s age at the time of this horrific incident that happened to him typically have 2 hour sessions 2 – 3 times a week, which seems to be plenty for them. Any more and they would be worn out and stop enjoying it! It’s not nearly the recommended number of hours/week of ABA, but it’s what works best for them and their parents. No wonder your son was tired after back to back sessions (not to mention the 45 minutes spent at the table at once…).

    I didn’t realize that this would turn into such a long post! Good for you for being an advocate for your child and I wish you all the best! I hope I was able to shed a bit of light on the not so horrible side of ABA. If you ever look into it again I hope you have some luck in finding therapists who are better suited to your son 🙂

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  9. That sounds exactly like a typical day at my house with my four year old these days. (We have ABA in home five days a week, 2 1/2 hours a day.) I’ve been contemplating leaving ABA and was looking for other parents who were concerned with it as well and that’s how I found your blog. I am so glad I read this because now I know its not just me. I’ve voiced my concerns to our BCBA and our therapist that comes to the house every day is not happy with us right now. I really think I’m going to leave ABA because I don’t feel that this is just your and my story, I think this is the way of ABA or so I’ve been told by our BCBA and have witnessed from the company we’re with now and at a Center in another state. When our son was first diagnosed and we found out about ABA we thought that was the only way to go, but the longer we’re with it and the more I learn from other parents and autistic people the less I approve of it. Your story isn’t over the top, it’s not abuse or anything like that, it’s just -not right- and that’s what I’ve been looking for…another parent that has the same feelings about the same kind of thing happening to their child. Thank you for sharing your story. I think I’ve made my decision.

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    • I’m so happy reading my post helped confirm your own intuition. You can never go wrong with a mother’s instinct!
      Just so you know, I wrote this piece about two years ago now, and I don’t regret the decision to leave ABA. What we have found best for our son are social skills classes, both private and those run in his school. They have also taught me how to engage and interact with him so I have learned how to find consistency.
      I wish you and your family all the best as you continue to help your son find success and happiness!

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