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Autism - Support Across the Spectrum Autism - Support Across the Spectrum

Issue with Junior ABA Therapist. Am I expecting too much?

Posted by on Aug. 22, 2013 at 3:35 AM
  • 12 Replies

Hello moms,

I am new to CafeMom. I did a search and found that a lot of other moms have issues with their therapists too. I hope this doesn't sound redundant or just a rant. This is a long post, so you may skim through it if you want to.

Background:
I have a 2.5-year-old son who was diagnosed with autism. He's considered very high-functioning with few "autism characteristics." He started ABA (and speech) therapy in early July and has been progressing very well. The company providing for his ABA therapy was chosen by our local regional center (in California). The overall experience with this company has been ok with some minor hiccups. All in all, I'm just SO HAPPY that my son is progressing well and having fun (most of the time).

On his ABA team, he currently has 1 program supervisor, 1 behaviorist, 2 junior therapists, and 2 senior therapists. It has been 1.5 month and one therapist left and they added two senior therapists to the team.

Past Hiccups:
During the initial assessments, the program supervisor gave me inaccurate dates for the submission of the report. The report was eventually submitted two weeks later than what she told me.

Multiple consultation cancellations during therapy. The last time, she didn't even tell me. So it's still kind of ongoing.

Underscheduling. My son should be receiving 20 hours/week but there were four weeks that he didn't get all his hours. I only found out when there was one day one of his therapists didn't show up and I recalculated all the hours. They have made up all those missing hours in this week.

Current Issue (with Junior Therapist):
I don't dislike this  therapist as a person. I think she's a nice person. She seems to adore my son. She's a great playmate -- very energetic and doesn't mind being silly. I just don't think she knows what she's doing (at least most of the time). She's a recent college grad and have been an ABA therapist for less than a year. She started out really strong -- her playful and energetic personality was great when she was pairing with my son at the beginning. 

At the beginning, things were simpler -- getting my son to look at the person talking whenever, have him give some response whenever, having him point at whatever, etc. As things progressed, they got a bit more complicated and simply having my son perform tasks like a puppy is not enough to challenge him or teach him the right behaviors. That's how I feel the recent sessions have been, anyway.

Example 1: The therapist grabbed one of the pieces off my son's structure as he was building it, then told him to show her his tummy (identifying body parts). My son was clearly concentrating on building his structure and he was upset that she "ruined" his it. Hence, he didn't do as she requested and got marked down.

Example 2: The therapist and my son were doing a puzzle. The therapist wanted to run some programs and she chose to run "stand up." Honestly, I thought that was just stupid when you're doing an activity that requires concentration. Instead she could've ran VVI ("puh") or maintenance ("huh" for help) which would be appropriate and not make my son lose his concentration which then would make him unnecessarily frustrated. She also kept shoving puzzle pieces toward his way before he could figure out where the put the piece he already had.

Example 3: The therapist wanted to redirect my son to playing with blocks instead of the iPad. When my son began playing with the blocks, the therapist bust out her slinky and started rambling on about how cool the slinky is. My son just ignored her and her requests. 

I can't remember all the specific incidents, but here's a list of "issues" I have with her methods/approaches:

1) She ALWAYS speak in a monotonous (albeit soft and cheerful) tone with my son. It just sounds like she's always rambling on and on and on. Even my son ignores her most of the time. Hence her prompts are often hard to distinguish from her casual rambling.

2) She doesn't know how to properly redirect. She usually just picks up a toy and go on (and on) about how fun and cool it is -- my son doesn't buy any of it.

3) She doesn't know how to properly ignore "bad" behaviors. When my son climbed on to the couch, she kept repeating (in her soft and angelic voice) why he shouldn't climb and struggled to yank my son off the couch -- my son only got more fixated on the couch.

4) It's always like a flea market during session. She doesn't enforce cleaning up.

5) She doesn't give my son enough challenge. When she prompts my son to do something, she'll take anything for an answer and praise him. I don't know who is tossing who a bone. 

6) She doesn't teach my son the appropriate response in a certain situation, like when she prompts him to stand up during puzzle

7) Bombarding him with toys and activities. Once he takes up an activity, she change it up abruptly. It feels like she wants to make the call on what to play, but can't (lack of authority) -- and she would only play what SHE wants to play.

8) Overuse of reinforcers (i.e. monotonous praises and tickles). I know we're supposed to praise my son a lot when he does something whether because he cooperates or he does it independently, but I don't feel like my son cares for her praises and tickles. She does it so often, it seems like my son just tunes her out most of the time.

by on Aug. 22, 2013 at 3:35 AM
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Replies (1-10):
TheJerseyGirl
by Michele on Aug. 22, 2013 at 6:34 AM

If you don't see any real progress or just don't like her way, I would definitely find or ask for another therapist!

amonkeymom
by Amy on Aug. 22, 2013 at 12:24 PM

 I agree.  I think it's important that your therapist is someone you like and can work with who is doing what's best for your child.

Quoting TheJerseyGirl:

If you don't see any real progress or just don't like her way, I would definitely find or ask for another therapist!

 

kajira
by Emma on Aug. 22, 2013 at 1:05 PM
2 moms liked this

It sounds like she's not a good fit for your son.

As an autistic adult, that kind of person would make me want to find the nearest escape route myself. Aba therapy doesn't really work for me - I'm not a huge advocate for it - though I know some people swear by it.

I would suggest asking them to find a more suitable replacement. You have a right to stick up for your son and if it's not working... they don't mesh.

Not exactly comparing kids to dogs, but neither my children, NOR my dogs would listen to me if I made it sound like it was optional when I ask them to do something. And, I'm not mean and I'm quick to praise when my directions are followed. You just can't make something sound like a game if you want to be taken seriously.

As to the way she's trying to redirect him, I'm freaking autistic and figured out how to redirect both children and animals just from common sense and logic. It really sounds like this job may not end up being a good fit for her.

darbyakeep45
by Darby on Aug. 22, 2013 at 1:28 PM

I agree with all of these ladies above...hugs mama!

Blueluvr
by on Aug. 22, 2013 at 1:37 PM

 Maybe you should talk to her and maybe her supervisor. But her job is also to HELP him start to overcome those things. Change or switcing toys often because children with ASD become very involved/fixated on one thing. They talk alot to the children because "normally", people talk.. a lot of children with ASD dnt use their words. She gives lots of praise bc even though you may not have seen him do anything, she may have been looking for a particular response/reaction. I'm NOT in any way on her side.. maybe you could talk to her 1 on 1.. ask her why she does the things she does bc YOU dont think it helps or makes sense?  Maybe she will have a better understanding for you, explain exactly what it is. I have ABA therapist at my house at least 2 hours a day EVERY SINGLE day. She sounds like my ABA workers and they've been doing it quite a few yrs.  And at first, I didnt think what they were doing was challenging or working but INSTANTLY my son has made an AMAZING improvment I wouldnt be too concerned about the amount of hours of therapy. Some is better than NONE. But if you really feel like she's not the one for your son, you can jst leave a message with her supervisor. And let them know your concerns.. hopefully that will help. If all else fails.. maybe you could talk to the supervisor about switchin to a different company that also offers ABA services.

MomOfOneCoolKid
by Gold Member on Aug. 22, 2013 at 7:23 PM

Well, she's learning... but most of the points you make are valid. They are hard to learn in practice. Sigh. The issue is, is she willing to take advice? Thats been my bad-point with most therapists.

A couple of things I think she is doing right which you pointed out:

4) It's always like a flea market during session. She doesn't enforce cleaning up.

You want to make it about as much fun as possible. If *you* want clean up to be something he learns, then its like anything else in ABA, you start small, set the bar low, praise and ramp up incrementally so that at each step you can make sure "he will get it"

5) She doesn't give my son enough challenge. When she prompts my son to do something, she'll take anything for an answer and praise him. I don't know who is tossing who a bone. 

Praise is key. Praise everything -- no matter how small. Now, there are different levels of praise -- differential reinforcement. There is a difference b/w "good job" and "whoo-hoo! awesome! dance and sing!"

I think the biggest issue in making progress is pairing and making sure the kid is having fun.

Like I said, I think your points are valid. Honestly, your therapist sounds a lot like me. Those are the points I usually have to work at. LOL

Hopefully, she's open-minded enough to listen to them.

Jenifr
by on Aug. 22, 2013 at 8:43 PM
1 mom liked this
I've spoke with her twice and made suggestions. She was very polite. I asked her if she finds what I told her helpful at all and if it's too much information. She seemed very open-minded.

Sessions have slightly improve but my son is still yoyo'ing and whining a lot more than I think he should. Not that he has never whined or protested with his other three therapists but they were more in control of the situation and able to redirect him properly.

I can see she's trying hard but...

Regarding "cleaning up," that's something he's been doing with his other therapists so he's actually doing really good at that. I felt like this week he regressed because this therapist hasn't been "maintaining" it or rather she has a tough time finding that right moment to direct my son to clean up. We did started out setting the bar low in the beginning and he's progressed to almost independently cleaning up. It's not entirely black and white. Like there's no cleaning up if they play ball. I don't mind if they just leave the ball in the hallway or wherever. Certain activities like puzzles and Legos actually gives her the opportunity to teach him how to clean up and she misses it BIG TIME. I don't even mind if they leave it there for a while and then come back and clean it up later. I've seen how his other therapists done it. They can see opportunities that this therapist can't. They can have fun with him and also teach him the skills he needs. The sadder part is, my son isn't even having much fun with this therapist because she's so "weak" for the lack of a better word.

Regarding the praises, it's the way she praises. Her rambling probably interferes with the effectiveness of her praises and prompts -- imagine someone speaking in a monotonous voice for three hours straight. It's sort of like ohlookheresaslinkyooohsocooldoyouwantplaywithslinkyheyshowmetummyohgoodshowingmetummytickletickletickle

Thanks for responding. It helps me figure out how to better elaborate these things and hopefully I can tell the therapist better myself.

I apologize if I sound mean. I tend to sound mean when I'm just being honest and direct. Sometimes I wonder if I'm autistic myself.


Quoting MomOfOneCoolKid:

Well, she's learning... but most of the points you make are valid. They are hard to learn in practice. Sigh. The issue is, is she willing to take advice? Thats been my bad-point with most therapists.


A couple of things I think she is doing right which you pointed out:


4) It's always like a flea market during session. She doesn't enforce cleaning up.


You want to make it about as much fun as possible. If *you* want clean up to be something he learns, then its like anything else in ABA, you start small, set the bar low, praise and ramp up incrementally so that at each step you can make sure "he will get it"


5) She doesn't give my son enough challenge. When she prompts my son to do something, she'll take anything for an answer and praise him. I don't know who is tossing who a bone. 


Praise is key. Praise everything -- no matter how small. Now, there are different levels of praise -- differential reinforcement. There is a difference b/w "good job" and "whoo-hoo! awesome! dance and sing!"


I think the biggest issue in making progress is pairing and making sure the kid is having fun.


Like I said, I think your points are valid. Honestly, your therapist sounds a lot like me. Those are the points I usually have to work at. LOL


Hopefully, she's open-minded enough to listen to them.


Jenifr
by on Aug. 22, 2013 at 8:55 PM
Very good points. I need to be more clear about those things you mentioned.

RE: changing toys/activity abruptly
I understand and have been informed about ASD kids being fixated on one toy/activity. That's not quite the case. The problem is the therapist presents my son with like six different toys and activities in like less than a minute -- way too confusing and overwhelming and my son doesn't even have time to respond or react. When he takes up an activity, she'll introduce another toy/activity before the seat even gets warm -- literally like a minute or less.

RE: talking a lot
All his therapists talk a lot and it's great and really helpful to him. They model speech and break down words for him and he catches on. This therapist just rambles on and on and on in a time that sounds like she's just mumbling to herself. Like what I said in the reply to MomOfOneCoolKid: heyletsgoplayyouwanttoplaywithcaryouwanttoreadabooksitdownyouwanttoplaychaseohimgoingtochaseyouheydothisgoodjobdoingwhatidoohnicecalmbody

I'll make sure I'm more clear on these two points when I talk with her (again). Also, I apologize if I sound mean. I tend to sound mean when I'm just being direct and honest. I do find your reply helpful. Thanks


Quoting Blueluvr:

 Maybe you should talk to her and maybe her supervisor. But her job is also to HELP him start to overcome those things. Change or switcing toys often because children with ASD become very involved/fixated on one thing. They talk alot to the children because "normally", people talk.. a lot of children with ASD dnt use their words. She gives lots of praise bc even though you may not have seen him do anything, she may have been looking for a particular response/reaction. I'm NOT in any way on her side.. maybe you could talk to her 1 on 1.. ask her why she does the things she does bc YOU dont think it helps or makes sense?  Maybe she will have a better understanding for you, explain exactly what it is. I have ABA therapist at my house at least 2 hours a day EVERY SINGLE day. She sounds like my ABA workers and they've been doing it quite a few yrs.  And at first, I didnt think what they were doing was challenging or working but INSTANTLY my son has made an AMAZING improvment I wouldnt be too concerned about the amount of hours of therapy. Some is better than NONE. But if you really feel like she's not the one for your son, you can jst leave a message with her supervisor. And let them know your concerns.. hopefully that will help. If all else fails.. maybe you could talk to the supervisor about switchin to a different company that also offers ABA services.


Poisongirl98
by Member on Aug. 22, 2013 at 10:41 PM
2 moms liked this
Have you talked to her supervisor? That's the person I would talk to. That's what they're there for, that's their role-not only to supervise the program but to supervise the therapists. If she's not a good fit, she's not a good fit. I'm sure this girl is doing the best she knows how to, but she may need some better supervision.

I'm not an ABA therapist but an SLP. There have been families that don't like my style or we haven't been a good fit, and I can tell you I'm a hell of a lot better therapist 12 years later than I was a year out of grad school. Part of that was me needing to learn on-the-job experience, things they don't teach you in school, and learning how to be more assertive. Another reason was that honestly my supervisor my first year out of school was not good--and by our profession's standards I had to be supervised a certain amount per month. Admittedly I am the type who doesn't like to ask for help either though. Anyway, those first few times I got "fired" by a family I really took it personally. However now--although it hasn't happened in quite awhile--i learn from it and realize most likely we probably just weren't a good fit--it happens to every one of us.
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HippoCat
by Hadley on Aug. 22, 2013 at 11:58 PM
If it doesn't feel right get rid of her! I had to change and entire team because they were nice, but still learning. I accept that, but NOT with my kid! For some reason I didn't want to hurt their feelings or get them in trouble and then I thought "Ya know, my life is really hard right now and I have a lot of struggles with my son and these people are supposed to be making it better, but they are just making it more complicated."

Fight for your kid. Be mama bear. You will find the right people, but you have to keep at it to get the best team for you and your child.
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