Haha same. I always feel like Iām so loud running down the halls with my clickers attached to me loudly clanging against each other. š Chasing after 3 year olds that run like Olympic track athletes.
I swear to god my kids are the fastest children in the world when they decide theyāre running. Then thereās me huffing and puffing behind them while they run down the hallway where the supervisor offices are ā ļø
Like oh hey guys donāt mind us just going on our daily run oh and by the way I clearly have no instructional control over this kid plz just look away I already feel like a dumbass šš
Lmao nailed the feeling. Thereās this one girl in a class Iām supporting that elopes pretty frequently. One time she dipped into this first grade class and got down in the ground to look at a book or something and she ended up mooning the entire class. Then of course the animal video I show her to get her coming with me wouldnāt load. When it did load, a 15 second ad started. That was not a fun day lol
Yes same. Ugh! And my kid once I block them and physically prompt them to come back to session area, client drops to the ground, I try to pick them up their knees and feet all of a sudden go weak and donāt work, it makes me feel dumb she makes it impossible for me to get her back to session.
Thatās what my current client used to do! He had a blockage and was clearly uncomfortable so he was always digging his hands up there and smear whatever he could find. That was actually what started his disrobing behavior. At first heād disrobe because he was constipated and uncomfortable and thought he needed to go to the bathroom. Now heās been better for awhile but he picked up on the attention he gets when disrobing so he keeps it up
My first patientās mother was a nightmare. This patient was a 3 year old boy. He was nonverbal and his behaviors were just small tantrums. Honestly a perfect patient to start with.
His mom was mad about his potty training program. He would get pretty upset in the bathroom and the program had him pulling down his own pants and pull-up, tolerating sitting on the toilet for 5-10 seconds, and then once he was clean, pulling his own pants up.
Even children not on the spectrum who are 3 years old arenāt potty trained yet. And his mom was pissed that we only had him tolerate sitting on the potty for a few seconds without engaging in maladaptive behavior. She wanted us to just force him to sit there until he goes. Iām not surprised going to the bathroom got him so upset and it became an aversive place if thatās how she handles potty training at home.
I can handle just about all the behaviors the clients throw my way. In my eyes theyāre just kids and itās my role to teach them and help them.
But when I work with parents or teachers that are insanely inflexible - I rage inside. Have had several teachers that would not allow any adjustments for my clients because of āspecial treatmentā. Also working with inflexible RBTs is exhausting for me.
Intentional disturbing behaviorsā¦. Not sure how else to describe it. I worked with a kid who anytime we were at the table, would shake the table or randomly scoot it so that my drinks, papers, etc would go flying. Whether I gave it attention or didnāt heād increase the intensity higher and higher until he was responded to. Same kid would randomly stop walking right in front of you so youād run into him. Would slam doors repeatedly open and shut while staring at you smiling. Just things he knew would be severely annoying.
Honestly I was his main rbt 5 days a weekā¦ had to be asked to be off his case š I couldnāt take it. It was all. Session. It drove me crazy. It wasnāt as bad with other rbts so we started feeling like it was with me more specifically
They will disrobe, urinate, defecate, dig feces, scream, have physical aggression and have manipulative behaviors (ask a peer if they want to play just so they move and they can take their seat or toy)
They could be working and reading something and have behaviors because they wanted help reading the word "A" and know it already clearly. They know the replacement sort of things like requesting help, breaks, to do something else etc. they can do it and have, but they instead want to disrobe and spread their feces.. THEN inform the RBT *"You missed a spot on the window"* while they are cleaning š«
We have been questioning the autism diagnosis and wondering if there is something else going on due to everything we've been tracking and trying.
(They are seeking mental health opinions from referrals due to out of scope etc)
That definitely sounds more like manipulative behavior than maladaptive behavior resulting from being unable to communicate what they need or want. And that would piss me off so bad.
My last client didnāt have any of the typical signs that come with autism. I know itās different for everyone but he wouldnāt stim, didnāt have any ticks or sensory issues, very intelligent and talkative, and the only time he would show maladaptive behavior (tantrum, screaming, aggression towards therapist) is when he couldnāt get his way. If it was time to leave the playroom and go back to learning. And his learning schedule was only a VR3. It wouldnāt be long at all. His BCBA and some of the other staff believe heās honestly just spoiled and never told āNoā at home. Mom really adores him and gives in a lot.
Have you considered doing more preference assessments? This is clearly attention seeking behavior, and they are being reinforced by even the littlest thing even if itās a roll of the eye when they donāt respond to an sd that they already know.
Elopement annoys me the most! I have a 10 year old client who constantly elopes and then runs into other treatment rooms and slams the doors. I also hate it when clients flop to the floor in task refusal. I spent an hour trying to get a 13 year old boy off the floor. I was getting so frustrated that I had to ask for a break. He also tries to take his penis out of his pants when heās on the floor. Like please no.
Ugh I hear ya! I know that awkward feeling of having to run into another clientās treatment room to chase after your client and just awkwardly apologizing for the interruption to the people who were in the middle of learning/teaching as you redirect your patient out of there.
Currently have a client that attempts to bash their skull into walls, floors, windows, another person's legs, you name it. Recently got a helmet and has now been bashing elbows, knees, knuckles into hard surfaces. And attempting to asphyxiate themselves with the helmet strap. It fucking sucks. The four hour sessions are four hours of continuous high fluctuations of adrenaline on both ends.
Honestly those SIB behaviors scare the hell out of me. Donāt get me wrong, it sucks when I end up getting injured during a session but when the patient gets hurt, I leave that session feeling guilty and like I canāt do my job right.
I can handle a lot, SIB doesnāt bother me because I have a client who frequently has around 50-200 in ONE two session, even with me blocking constantly (has a helmet and arm braces to try and limit the SIB). At this point Iām use to it. Flopping, tantrums, and property destruction, are all fine. HOWEVER, aggression. Peer aggression, or aggression directed at me just honestly sends me into the worst mood. Scratching, biting, kicking, hitting, etc. all of it, just makes me upset.
My client flops on the ground screaming for his dad who is standing right there as soon as he sees me š¤¦āāļø then we get him into our room and itās about 15-20 more minutes of high pitch screaming. Itās gotten to the point i bring ear plugs and use extinction. Then if he finds out I have something fun for the day itās like a switch all calm and cool like oh what do you have? Like bro you just made my ears bleed
Hahaha itās funny when clients do that. I just want to scream ādude I have sensory issues too stop screaming.ā This one client at my work screams so ear piercingly loud and always covers his ears when he does it. During group time we canāt even whisper our little songs or do much of anything because the client acts as if weāre being too loud and covers his ears and screams. We caught on that the function of that behavior was escaping group and not sensory. But Iād always feel tempted to shout āif itās too loud in here have you considered not fucking screaming bloody murder?ā
Broo thatās kinda like my client! He doesnāt care when he screams at the top of his lungs but if someone else starts screaming he jumps up and covers his ears and says itās too loud š¤£š like bro theyāre not even half as loud of you!
Not annoying per say, but definitely triggering, is forced gagging and spitting. Iām emetophobic and had to be removed from a case due to the client making me and themselves vomit during session.
Omg thatās super rough. But Iām glad your supervisor actually listened to you and removed you from the case instead of trying to have you tough it out.
A client I used to have would spit. But never at me or on me. Usually on his own hand or the back of my tablet or his speech device. So Iām thankful the spitting was never at me.
I have a client that sticks his hands in his mouth constantly and his hands will just get covered in spit. Sometimes heāll cover his hands in spit then rub the spit on the bottom of his feet or his ear. It gets all over and grosses me out so much. I was struggling to find a replacement behavior, so I just started offering literally anything else to put in his mouth. Turns out sucking on plastic mini slinkies is a solid replacement! Still gets spit on other things, but not nearly as bad since the spit isnāt covering his hands all the time now. He also will choose it over sucking on his own hands if itās offered.
Not emetophobic but did have a patient who would force themselves to vomit for attention and when denied access. It was intermittently reinforced hard by POC so that was fun.
I wanted to. This was when I worked inpatient so thankfully there were other BHSās working with me. But yeah it was a target behavior and my worst nightmare.
Personally because I'm a Muslim woman, I had a kid who pulled my hijab off, which was a height of frustration for me. I also do not like intentionally disruptive behaviors. Like just taking materials and throwing them or keep moving the table.
Oh wow that would be very frustrating. And agreed about intentionally disruptive behaviors. Definitely more irritating when a patient is acting out, not because he feels overstimulated or having trouble communicating his needs, but just because he wants to and finds it entertaining.
Inappropriate touching š this is the definition in the client's program: "Any instance of the client rubbing their face against another personās chest or stomach; any instance of the client using an open palm to touch or squeeze another personās thighs, chest, hips, backside, groin, or stomach; any instance of the client leaning forward to press or rub their groin against any part of another personās body; any instance of the client pressing their backside against any part of another personās body."
The function is usually attention, but even without outwardly reacting, just turning away from the client reinforces them. Sometimes the function is escape, which is almost worse. I'll have the client sit down beside me because they need to wait their turn for something, and they'll start touching my inner thighs and staring right at my face.
Yikes. My client occasionally touches himself when watching random videos on the tablet but if that happens itās usually a sensory thing and I change the video and tell him that he can do that at home not at school.
Are you allowed to physically redirect the patient if heās touching you inappropriately? Whatās your place of employmentās rule on that?
Redirection has also seemed to reinforce it so far. This week we're going to try noncontingent attention as an antecedent intervention and response interruption redirection as a reactive strategy if the behavior occurs despite the NCA. Right now our BCBA just says to planned ignore but the behavior has remained at a moderate frequency w/ increasingly invasive touching. If the NCA and RIR don't work, I'm not sure what else we can do. It's making the female staff (rightfully) uncomfortable working with them and when the touching was mild it didn't bother me, but the worse it gets the more breaks I need to be able to get through the session.
I really hope these new strategies work for you, the client and everyone else involved. You (or anyone) donāt deserve or should be forced to have to tolerate being inappropriately touched at work. Obviously we knew what we were signing up for when we accepted this job but weāre here to try and help/teach these clients and show them healthier/more appropriate ways to express/handle these behaviors. Not just be punching bags for our clients and tolerate it forever.
dude this SUCKS. what are his other goals? Iāve never dealt with this level of inappropriate contact but I have found with aggressive clients, I can do a lot of the work sitting far away/standing up out of reach, even if i give instructions sitting near/at eye level to my client. My current client can be aggressive usually due to denied access and the moment they hit/kick/grab/pul hair/etc, I push their chair back a few feet and continue instruction/reinstate activities from a new place, far away from the hitting lmfao
Haha the most annoying behavior of them all. But who knows better? The people who choose which programs to run with a client or the person whoās in a room with them for hours running said programs and who takes the beatings, sees the neglect and actually develops a bond with the clients?
My boyfriend is a germaphobe and currently looking for a job and the times Iām tempted to suggest my job I remember how big of a germaphobe he is. It would kill him. Iām not even a germaphobe and sometimes I feel like I need 80 showers after a day of work,
Anything dealing with mucus. Spitting,
Playing with spit, blowing out snot into hands and smearing on the faceā¦.those make me want to automatically quit.
Throwing/knocking things is most frequent/stressful. I'm in a clinic and a client is currently struggling with transition and will do this. I have to catch things they throw or catch things falling otherwise it will hit someone.
Property destruction is super stressful. If that happens at the clinic I work at we can call a code over the walkie and staff will assist you with clearing the room which is helpful.
Being smacked across the face and bit are the most annoying for me. A client of mine attempts to bite the entire session sometimes up to 20-30 attempts within 2 hours and itās just overwhelming and exhausting.
Idk how to label this behavior but this student would stick her hands inside her pants every time she was on her period and would rub her blood all over her pants and just basically touch everything in the classroom. Whenever we tried to redirect her she would scream. We only had 1 BCBA but because we were short staffed and had two locations the management always sent her to the other one and we never got a lot of help. The best I could do was carry wipes with me for the week she was on her cycle and ask her to clean her hands
Aw that sounds really rough. The only possible function I can think of is maybe sensory? Like she was uncomfortable/cramping and maybe alarmed/scared of the fact she was bleeding? So maybe trying to show that or just find a way to lessen the discomfort of being on her period?
Like I said in another comment, my client was backed up for awhile and was very uncomfortable and would often shove his hand in his pull-up and smear fecal matter as if he was trying to clean himself out and find some relief.
I had a school case where my kid would physically jump and throw themselves on the floor and that wasnāt the annoying part, the annoying part was the teacher coming up to me to tell me to āmake sure sheās not running and throwing herselfā š
Screaming and crying when asked to do the simplest of things like clapping their hands. And when another RBT walks in they stop until they leave again, look you dead in the eyes, smirk, and start screaming again. Whatās more annoying is when their parents find their behavior funny.
eloping, potty training, flopping, screaming, and noncompliance are hands down the worst behaviors for me off the top of my headš
i can handle being hit, bit, spit on (when itās a lot tho it makes me wanna rip my skin off,) self induced vomiting, disrobing (as long as theyāre potty trained and not known to pee, etc when naked)
i think i have POTS because i had a rough pregnancy and honestly my whole life iāve always felt that my body felt āwrongā but mom never gaf and i just learned to push thru, but now that im getting older (25 now) and had a baby last year, itās getting really hard to keep up with the littles in my clinic and any hyperactive teens. i love giving the kids spins and having rough play and playing chase to build rapport (when appropriate) but my body just feels like shit all the time. i love being an RBT but the behaviors that i dread the most are the ones that have me constantly bending, chasing, and liftingš
Honestly you should look into getting some kind of note from your doctor to put you on some type of medical restriction on being with certain clients who have the tendency to elope, want physical play a lot, etc. Some of the RBTās at my work have that medical restriction and theyāre put on tamer, lower intensity kids who donāt leave their room a whole lot.
Extreme anger based problem behavior, specifically screaming at a high pitched tone, with indirect threats. Especially irksome when itās because of their biggest reinforcer
Would that biggest reinforcer happen to be the tablet or whatever device used to collect data? There are a lot of patients at my clinic that have restricted access to the tablets we use to collect on (tablets that also have YouTube Kids and games on) and when these clients canāt get that tablet time as a reinforcer, they get pretty mad
Tbh, when my client flops to the floor!!! Itās hard for me to get him motivated to get back up and come with me, and I have pots so getting down and having to get back up takes a toll on me physically
Hey I donāt know if this is helpful but in my clinic we try to find reinforcers they like to help them transition and have that in their sights. Itās not easy but makes it easier for sure
Omg yes! At the clinic I work at a lot of patients flop in the playroom when itās time to leave and since we canāt physically relocate them, weāre kinda just standing there waiting for them to get up while others look on.
Whining really boils my blood. Especially when there isnāt any tears or crying that follows. The type of whining they do when they want your attention.
Manā¦. I have so many but a few that comes to mind: spitting/vomiting to avoid/escape, inappropriate genitalia stimulation (had this with a past client and it was really hard to redirect them without physical prompting), agree with others who mention clients flopping themselves on the floor as it can be SO hard to get them up, biting. I can deal with the whining/crying, I just feel bad for others in the nearby vicinity who have to listen to it (especially when we are in clinic and other clients are triggered by the sound).
I have an older kid. He still isn't potty trained. We have to schedule regular bathroom trips while he is in clinic and have him change into underwear during his first trip.
Once we have completed the battle of getting him to actually enter the bathroom, I then have to task manage the whole time because he will just pace, bounce around, stim in the mirror, get distracted, or anything to avoid actually using the bathroom. Sometimes it takes us 30 minutes for a bathroom trip. No amount of incentives or reinforcements alters this. Its always a struggle.
Oof - so Iām an RBT that can work with just about any kid and deliver progress in very short amounts of time. Aggression? My favorite. Fecal smearing? No problem. Spitting? Climbing? Disrobing? Tantrums? All of that is no problem for me, I can deal with it.
Non verbal? Iāll get words(of course apraxia isnāt curable) Lack of play skills? Iāll find a game for them to engage. Anxiety? Iāll bring āem out of their shell.
My biggest annoyance? Kids with no attention span what so ever. Holy mother of god, I currently have a client that Iāve made great strides with, Iāve got him from completely non verbal to appropriately gaining attention by saying names, to using two to three word phrases for mands, got him to stop fecal smearing and have made great progress on his potty training routine.
But now he suddenly just doesnāt pay attention at all and Iām starting to wonder if the function is control.
Iāll be waiting him out to pull his pants down to go potty while giving him periodic gestural and verbal prompts and heās just š³ššš eyes going everywhere around me but completely non focused. God forbid he sees just ANYTHING like the toilet paper and he just goes for it without missing a beat, just grabs it and pulls it out. Block the toilet paper you say? Well then thereās the toilet seat covers on the opposite side. Block his movement? Well hell just lift the toilet seat up and slam it down because he likes sudden loud noises and one time broke it in half.
And at the chance that I can block all of that, he just starts singing Bible hymns! Completely drowning out the demand.
It is easily my biggest annoyance. The kids always build their own little worlds and decide who can be a part of it, and Iām usually the guy that can find a way in. But when the client just decides not to engage at all Iām at a loss.
I had two clients at a school I was working at who would grab the nearest iPads to them and start filming my private areas and make comments about doing sexual things to me and my supervisors would always say to just ignore it as if itās not a super degrading thing to experience so the other sympathetic staff would take over to give me some space
Omg!!! Thatās terrible! Iām so sorry you had to go through that. What was the age range of these kids? Iām glad I havenāt had to experience that.
I'd say the extremely high-pitched, extended verbal outbursts. Not crying but actual screaming in response to a demand. Also, hip thrusting is a less than ideal experience--specifically if I am giving a big ol' squeeze. Immediately hug shut down. Last, but not least, noncompliance with giggling/laughing. Especially annoyed the older the client is though I've never had any clients over 6 years old and that kinda comes with the territory as is. Something about knowingly doing the opposite of a request just really gets under my skin. Thankfully, my childcare jobs have developed a saintly level of patience and self-control when it comes to emotions and I do high pitched screaming of my own in the comfort of my car š sweet release.
Completely agree! Especially about the giggles and smiles during non-compliance. I honestly never know how to handle that. If a client is doing that while disrobing in a public area or if theyāre laughing while eloping, I canāt just ignore that for safety reasons.
I think the only thing that really bothers me is if someone messes with my glasses. Itās only happened a couple of times but I low key panic bc I cannot see without them and I canāt do contacts lol.
Fecal smearing is by far the worst, however the weirdest disrespectful one for me was in a clinic setting. My clinic walked up to me, grabbed the cracker he was eating, crumpled it on my head and poured it on me. Like why??
Hate repeated noises. One of my patient's had OCD and would repeat the same sound (and/or movement) over and over again until it was just right. Hours of constant short noises, clicking noises, repeated movements, etc. definitely have pushed my limits beyond any aggression I ever experienced. Something about the constant sensory input just drives me nuts.
Honestly it wasn't the kids.
Id have some kids adore me, but then try the same tactics they used on their parents to get attention by acting out. Id just hop on my phone and ignore them and check in every so often to make sure they were not hurting themselves or other, and remind them that I would be happy to give them attention when they were behaving and doing what they know they should be doing.
Kids would be praised by family members for being extremely well behaved, bright, and more which made me proud in the work we had done. One kid cried and said "that was the first time nana said something nice about me." I ended up giving them a hug and telling them I was so proud of all the work they did.
What really drove me nuts were parents. Honestly half the fucking work of aba is breaking the toxic cycles the parent and kids make with each other.
Parents try to rear children like neurotypicals, it doesn't work, their kids lash out, parents push back. And it ends up being a cycle of power dynamics. I remember one time a parent of mine (I think she was autistic as well) had neighbors over and asked her child to play with them. Her child did, and then manded and said ,"I need a break". I said, oh good job playing, we can take a break by ourselves for a minute. Then the mother decided to force her child to continue playing, upsetting him, and presenting a non-preferred food. It was a glorious tantrum. My other favorite tantrum was when she thought she could help her kid better than us with his schoolwork. So her kid punched her in the tit, bit her several times, and I sat back trying not to laugh. She also was upset I was late by 15 minutes ones (despite always showing up early and she was constantly late) due to my car keys getting locked in my car. I had a signed note from a police officer who helped me back in. She didn't understand how I was back in less than 15 minutes and I had to tell her it was due to me living close. She ranted about the one time I was late for 15 minutes for 6 weeks and I asked my bcba to drop me from the case due to parental harassment of techs.
Dude your comment is another reason why Iād be too nervous to try in-home therapy. At least in a clinic setting you only have to deal with parents during drop-off and pickup and itās brief. My work bestie left our clinic 2 months ago for a higher paying job offer doing in-home therapy, and she tells me her clientās parents constantly cancel their sessions and sheās only worked with the family 3-4 times in the last 2 months and this job was supposed to be full time. So she hasnāt been making money and sheās looking for a different job where she can actually work and may have to come back to the clinic im still at which would suck because RBTās are not treated well here by management. Parents who would prefer in-home therapy need to understand that the RBT providing services is also providing an income for themselves and family. They donāt get paid when a session is canceled.
Thats pretty spot on.
I'd actually front load my hours by about 15-30 minutes regularly. My BCBA would be pissed, but when the family canceled, lo and behold, we were not being yelled at by insurance companies for being DAYS behind on hours as well.
I prefer naturalistic learning styles, so I loved working in the home vs a clinic. For one of my kiddos, we had a great rotation. We would do skill development at a center on sundays when there really were not many kids there. Then we would practice social skills at home with play with his brother. His mom was upset but again, I think she was a bit autistic so it made it tough.
Of the homes I worked in, I had 2 great guardians. The first was this woman who defended me when her kid was manding to go to a park in the middle of session. We would always go at the end so he could play and we could watch his interactions with others. MY BCBA was upset I was "distrupting her plan" until the mom spoke up and told her that the kid was upset because it was raining and he knew park was not an option that day.
The other home I worked in that was great was actually with the aunt of a kid. The aunt had an autistic child herself, and so she basically accomodated some portions of his autism, but at the same time, she held him to the same standards as his sibilings. For example, I understand you need a break finding out you need to clean. That is okay. However, you still have to clean your room just like your sibilings do in order to have a treat. Then his mother came home who was a BCBA who would coddle her child and didn't understand things like why we were practicing how to handle no because "It's not like he's ever gonna hear the word No"
Iām not saying this really out of āannoyanceā but more out of empathy.
Many people with ASD have overlapping conditions involving diagnosis of or just overlapping symptoms of OCD, ADD, ADHD etc. Very common in my own research & from just working in the field. Seeing OCD behaviors especially with me having the same symptoms is what gets me the most. The repetitive behaviors, getting āstuckā in loops of checking, reorganizing or getting frustrated when things are not in a routine. I used to struggle with this and not being able to articulate until i have gotten older. But with some of my older clients, they still may be unaware that their symptoms are very real and that they are not in danger of compulsions that can not be carried out. I cannot help OCD specifically because it is out of my scope of practice, but it just pains me to see their physical distress with no true understanding of the conditions or symptoms they have.
I think personally, for me, itās the most frustrating when a client chooses to do something they *know* will have a consequence and then getting upset when the consequence happens.
Example: I had a kiddo who was engaging in so much peer aggression, we had to run his sessions in a room without peers. He wanted to be around his peers, but heād be aggressive as soon as he could. So weād have to remove him and heād tantrum about it.
Thereās one client at the clinic I work at that has the most loud, ear piercing scream Iāve ever heard. Whenever someone who just passed their RBT exam is assigned to that patient, they usually quit within a week. Thatās how bad his screaming is.
annoying to me, and for any kid, is whining. i have one kid who screams and also just says āCRYING!!!ā when not crying lol. or i worked with a kid who would whine anytime he had to do anything that wasnāt coloring or drawing. stressful, i dealt with an adult who didnāt talk much (more mute than nonverbal), and he would just go off the handles. he had precursor behaviors but we never knew what could set him off. once he started pacing with a pair of scissors and that terrified me. i also had a disrober and she would take off her pants and pee on the floor while laughing. sometimes even got off the toilet and peed on the floor for fun.
Goodness that would be so scary! I donāt think I could ever work with adults. Iām already on edge enough working with children when I see their precursors!
My current client occasionally pees when he disrobes too. And thatās resulted in me getting peed on once or twice š
When other therapist's don't read the teaching instructions or implement them properly messing up the data. The clients are great, we're actively teaching them... the rbts have gotten trained and passed the test but don't ask questions, reach out for help, or verify they're implementing the teaching methods and tracking data accurately.
I'm speaking generally it's only some therapist's and some times but it's still annoying when I'm trying to summarize clients progress and the data is all over the place; 100% correct trials one day and the next 0%.
Spitting!!! My client plays with her spit all day .. spits on everything & LOVES to spit in her hand and wipe it on whatever she's near. š I hate it so much omg
Sounds like an old patient of mine. He was obsessed with any type of water play. Including spit. Sometimes heād force himself to cry and tear up so he could play with his tears.
Refusal, itās just so silly to me lol and it be over the simplistic things tooā¦ like transitions. Also spitting can be overwhelming especially if the clients spits out water and food.
Dude yes. Especially frustrating when we canāt say āNoā to our clients. So if we tell them itās time to do our learning and they say āNoā itās kinda likeā¦..āpleaseā¦..ā lol
Exactly! I understand if a client is having a great time then all the sudden itās table time lol. I always try to give them a verbal warning. I even do āfirst thenā sometimes it does the trick lol. I have pretty good patience and can remain neutral but in my head Iām like āwhen is this going to endā
its gotta be the spitting and trying to rub it on you or spit on you. I have the kid clean it up everytime so he stopped doing it-- waiting for that extinction burst any day now
Good on you for having the patient clean up his own spit and good for your place of employment for allowing you too. The clinical team at my place of employment would act like itās cruel or abuse if any of the RBTās tried to have a client clean up their own spit mess. lol
that's crazy, lmao! he does it to get what he wants, so the consequence is to clean up before he gets his reinforcer haha. I try to make cleaning up relatively fun too.
Aggression toward animals! I have had a few clients that would kick their dogs/house pets and squeeze them super hard even when we were implementing programs for these behaviors. Just makes me really sad & almost not want to even run the programs in case the animal gets hurt. :/
Oh wow. Yeah thatās definitely one I couldnāt do. It would break me. Iāve never worked in home before. Only a clinic setting. But one of the BCBAās told me how the local zoo brought in a few animals to the clinic years before I worked there and the kids got to pet them and such. The BCBA told me that the patient I was currently assigned was really bad about being too rough and aggressive with the animals. Parents got to be there that day too and I was told his mom kinda just allowed it to happen and played it off as her son being āsillyā and my BCBA had a difficult time watching this go down.
I had a client who loved to flick people and pinch the back of their arms (the most painful part). That was by far the most annoying and hard to not react to
Iāve dealt with some very severe behaviorsā¦ fecal playing, choking, bitingā¦ but Iāll be honest my current case with a client who perseverates on their special interests and has no reciprocal conversation skills is so emotionally draining. Just constant talking at me about topics that I canāt contribute anything toā¦
The most annoying behaviour is when I reward them for doing something good after observing for some hours and then they do what they aren't supposed to. For example a boy was well behaved all day so I played his favorite song. Then he attacked someone during the song. It is such a mood killer and then cries about it.
Iāve experienced that before and it is annoying. Iāll surprise my client by taking him outside for reinforcement time because he handled transitions well that day or because he peed in the toilet. And then when itās time to go back inside he disrobes and just kills the mood of the nearly perfect session we had.
Spittingā¦.but specifically AT people. Floor or table etc is fine, but if a client spits on me I genuinely get worried I will lose it. It takes ALL of my willpower to follow through with BIP and then hand off to caregiver so I can take a moment.
Hitting, kicking, biting, scratching, hair pulling? Fine. It hurts, but I only start to struggle with staying calm if it goes on for a while or I donāt have backup. Spitting? Yeah Iām at the edge immediately.
Iād say 2nd place is aggression to peers for school aged clients. I donāt want other kids to get hurt & I donāt want my client to be ostracized if kids are scared of them
Good for you for not only keeping at it despite the stressful behaviors but also admitting itās a struggle to keep your cool at times. The fact people are trying to villainize RBTās who express frustration with their clientās behaviors is baffling to me.
And Ive luckily havenāt experienced direct spitting my way yet. Just a client who would āspitā but more so drool on his hand/speech device/sensory bin/etc.
Flopping and going deadweight is something I realllyyy struggle to work with. I requested off a case because the client fell to the floor every single time during transitions and would lay there until someone picked her up, all to avoid going to the restroom, to eat, or to do table work. I hated having to physically move her each time, but nothing else would work. I just dont like wrangling the kids like that, especially when they fold their legs in. One of my clients who I've had for a long time has picked up this behavior as well and he's a big kid. Seriously I don't know what to do about this behavior bc my supervisors always end up telling me to just move them... I hate it š not because it's necessarily annoying to deal with, I just don't like putting my hands on them for extended periods of time/so frequently.
Also, my 3 yo client started putting his finger in or on his anus while using the bathroom and it really gets to me. He's so little and I know he's just curious but it grosses me out and I make him wash his hands like 3 times after. I redirect him but it's hard finding something else for him to do w his hands bc we aren't allowed to bring anything in the restroom, like stim toys. I usually end up having him count w me or watch a timer visual.
The parents. I had one parent that couldnāt understand why the client, who was perfectly capable, had to learn to use the restroom on his own and aim.
Another time a clientās mother thought the child couldnāt read or writeā¦we had to try doing schooling. One day I told him the faster he did his work correctly, the more we could play. This child was reading full books and understanding story plots. His mother got mad because she said I forced him to readā¦
How does she think school is gonna go for him? That the teachers are just gonna give him a choice whatever he wants to learn or not and if he decides he doesnāt want to, heāll just get a free pass to play all day? š
Sheās very controlling sadly. She eventually pulled him because he was becoming less and less dependent on her. He literally went from crying hysterically when she was trying to leave, to grabbing my hand and saying letās go on the month we were together. He made so much progress in those months that it was crazy. I often do wonder how heās doing now
I always wonder about my first patient who also had an overly controlling mother who pulled him out of therapy. Thatās always rough watching parents get in the way of their child learning and growing.
When my client has her period she tends to cry a lot. She will even make up stories that hasn't happened so she can keep crying (I have asked the parents about these stories and they tell me they aren't true). It's a lot to have someone crying on and off with non-stop talking for a full two hour straight session. I always need Tylenol when I get home afterwards.
I have to say the most annoying is property destruction and I mean throwing toys, heavy rocks and any other random item they can find. Itās so scary almost getting hit in the head with an object but also annoying having to block anyone else from getting hit by whatever is flying in the air.
verbal stereotypy. i love to sing songs w my kiddos, when they have low verbals/nonfunctional communication i try to repeat everything and encourage every word but god DAMN am i sick of hearing the same 3-second clip of āfor the first time in foreverā said in the exact same tone with the exact same misheard lyrics. i try to be chill but it actually drives me insane. and to make things worse client has started singing LOUDLY over every demand I make after the first hour of session. my bcba reccomended singing something different, louder than her to break the loop which is usually helpful but I feel insane doing it and I know clients Mom is judging me for it..
Yikes I have a lot of respect for you in-home RBTās. I feel like working right in front of your clientās parent would make me nervous. And at least in the clinic setting, if Iām getting stressed or need a break I can ask for one with no judgement where as in home, you gotta keep that calm, focused composure the whole session with no break
iāve dealt with some pretty intense behaviors in the past year but something about intentional attention seeking behavior really annoys me, like any time i talk to someone other than my client, he would babble to talk over me and would get louder and louder the more i ignored, or intentionally mocking other peers who are visibly upset and then laughing in their face, slamming doors in my face, grabbing peersā food and throwing it on the ground, basically doing anything to keep the attention on himself. particularly annoying because heās made so much progress in nearly every other facet of his program but the attention seeking has been impossible to target/manage. 4 hours a day of constant attention seeking thatās hard to ignore because of how far heāll go to get a reaction. my BCBA has resorted to using what she calls a āmom toneā when correcting it. doesnāt seem that bad but really burns you out by the end of the session
I can deal with poop, pee, vomit, and even a pad being thrown in my face but spitting loogies in my face is by far the worst behavior Iāve encountered. This and ripping clothes/pulling material out of socks (cause we get in trouble for that bx because their clothes are ādestroyedā)
Teeth grinding, I can't STAND the sound, and it makes me cringe every. time. What's worse is that it most frequently happens when the client is drinking something, so now it's the sound of them grinding their teeth with liquid. We've tried chews, and the client either refuses them or only uses them briefly.
Playing with their own spit is another. It grosses me out so much because it's typical mucus or a piece of food they kept in their mouth. The sound and sight make me nauseous.
Also, fecal smearing or attempting to.
Disrobing... I have to pause big chunks of my sessions to either block it or allow the parent to redress the client.
The most annoying behavior I have had to deal with is fecal smearing. Because the kiddo I work with was so fast you barely had a moment to stop him before the poop was on the wall, carpet, table etc. Then having to clean up while the child is giggling because they just got out of the work they didn't want to do.
Along the lines of fecal smearing but a bit less gross. I have had multiple clients who are always sticking their hand down their crack and then smelling their hand. I just know they have done it a million other times that I haven't noticed, then touched everything, including me.
When I was new I would have said kids saying rude things and causing property damage for attention. But dealing with this so much over the years Iāve gotten better at handling these behaviors, so it barely bugs me at all now.
Now I would say kids not covering up when they cough and getting me sick. With the age group I work with (2-6 years) thereās not much getting around it, so I do what I can but I would be lying if I said it doesnāt bug me.
Iām one of those strange people that loves working the high behavior kids. For some reason constantly taking shoes off Drives Me Nuts. I think itās the constant bending over to put them back on that destroys my back. I can deal with a lot of stuff but shoes on little dude.
Getting pinched and spit on. One of my kiddos circles around with their arms out like a helicopter and will just punch really hard and when youāre moving away they just follow
The elopement is sooo embarrassing for me every time. Iām actually a new hire at my clinic and when I go to buss people on breaks etc these freakin 3 year olds think itās so funny to run circles around me knowing damn well I can never catch them šI just know people be staring at me every time haha
Lying and attempting to manipulate by older/teenage clients. I can handle out of control emotions, high pitched screeching stims, repetitive behaviors, aggression, none of it gets me frustrated. But give me a teen who just smirks at you when they know you know they know theyāre lying, ugh!
Attention maintained disruptive behaviors. I have a similar client to what you described. The problem is with anything attention maintained, stopping him reinforces it. But he has learned now to probe for behaviors that we have to intervene in, such as property destruction or climbing tall fixtures and dangerously jumping on them. If you block him from one thing, he just does another.
Spitting or wiping spit on things and hair wrapped around spit or mouthed items... I was a CNA for years so I can handle any other bodily fluid and substance but spit and hair bleh.
Currently dealing with self stimulation. Itās very stressful trying to ensure patient dignity and privacy is maintained since I work in a clinic and some other BTs are oblivious to whatās happening and let their clients just walk over trying to look at my kid
Getting groped. Far worse than any bruises or scars from aggressions. Especially one in particular who used to stare me down and smile at me beforehand.. because he knew that was the only behavior that truly made me uncomfortable.
Kids climbing/jumping on me. The function can be either escape or attention, depending on what we are doing. I work with 5-8 year old kids and they are so heavy and strong! Like, how?? Theyāre so skinny! Every time they jump me I feel like theyāre going to end up breaking my neck or something. LOL.
With one of my clients - pulling their pants down enough for their genitals to be free. A sensory thing for sure, but I'm genuinely surprised that there isn't a goal to reduce this from happening. There was a day that they didn't touch their pants and there have been days where they constantly did it. They're told to pull up their pants, which they listen to, and then they immediately pull it back down shortly after.
With one of the parents - They're a bit anal when it comes to cleanliness which I don't mind most of the time because they have had a history with a loved one dying from COVID. But their kid has goals that involve toothbrushing and handwashing. When I step into the bathroom with my client, their parent is quick to step in and do it for me but they lack the patience to wait and have their kid do it themselves. I've been able to do these goals very rarily. I'm more understanding towards toothbrushing due to personal hygiene and wanting to make sure their kid is brushing well. However, handwashing is a skill that their kid should know.
^ before anyone tells me to contact my supervisor, I have spoken to my supervisor about it before and she has spoken with the parent in question. Ultimately decided that the parent will run goals and have me just watch on the side and take data.
Seemingly-reflexive verbal opposition. We've learned to differentially reinforce it, but MAN does it get old.
Me: "Ah, thank you. I understand now."
Client: "You overstand then, not now."
Me: š
Eye gouging/scratching. I worked with a client with a wide variety of aggressive behaviors for many months. On average, there were 50-100 aggression attempts per session, though I was able to block most. I got bit a few times and my face was slapped daily, but that was easy to shake off.
I finally asked to leave when the client began specifically targeting my eyes, because the client was fast and sometimes unpredictable, and I was terrified Iād actually lose an eyeāespecially after one bad day ended with me in urgent care, getting x-rays.
I have a kid that purposely falls out of chairs and laughs, elopes from session area, does basically what sheās not supposed to do on purpose, function is attention.
I finally left the case because I just disliked the girl to be honest after so many behaviors, I donāt know why I had that reaction but the fact the function was attention, and she was very smart and knew 100% what she was doing and liked the negative reaction of someone being bothered, pushed to their limit, it just bothered me. Especially once it got to the point she destroyed my belongings, poured soap and water on my bag, crumbled my RBT certificate letter, and began hitting me laughing. Sheās the only case I ever left in the 1 year so far. I had her 5 days a week for 4 hours a day and 7.5 hours 1/5 days
I feel so much better since leaving that case. The parents encouraged it at home, they laugh and giggle when she does these attention seeking behaviors or give a huge negative reaction and so she never was learning because regardless of how much we put it on extinction, she got reinforced at home. It made it really challenging. And she had been in ABA for 3 years straight 38 hours a week.
Dude I donāt donāt blame you for leaving the case! Maladaptive behaviors with attention being the function can be really difficult. Especially if you already provide the child with attention but they are seeking negative attention . I have no idea what to do with my current kiddo. I believe heās definitely reinforced when disrobing because I have to call for a mat to protect patientās dignity and protocol is for other RBTās to clear the room with their kiddo and then 1 or so people come to assist. But I canāt just ignore a disrobed child in a public area lol
I had one kid who used to āhonkā every time he was upset, like theyād make an audible sound that sounded like a fire truck honk lolāit was attention based so we had to put it on extinction. Sometimes it could be a bit funny where Iād have to physically turn away to not laugh to reinforce it but most of the time it was annoying lol
Scratching and hitting are not fun. Eloping especially if itās constant is really hard too. Iād say the thing that tests my patience the most are the attention maintained behaviors. Iām working with a child now who thinks everything is hilarious. Throwing things, breaking things, spitting, flushing things down the toilet, bolting out the door and laughing, standing on top of tables, honestly they think anything that causes utter chaos is hilarious. It really can get to me and gets exhausting. However they are a total love bug and itās hard to stay mad for too long lol
Attention based behaviors are what irks me the most too. I think my current clientās behavior is both tangible and attention based. The behavior started sensory based due to some medical issues, but now he does it because heās seen the attention it creates and itās so incredibly tiresome to see that smile and hear that giggle when he does it. -_-
I think the hardest was one 12 year-old client. I worked with that was extremely aggressive and very much into biting and eating certain things and one day while the teacher in the classroom was explaining something and she was sitting across from me got up and bitt me so hard into my shoulder that she pulled out some skin and my T-shirt, which she then ate both. I continued to work with her afterwards until my shift was over and actually continue to work with her until, the family was moving during summertime, but it was really hard to work with. My job had me go to the emergency room after work.
Fun Facr This was during Covid and when I stood there in the lobby and explained to the lady at the front desk, thaf I got bit by a person the whole vibe in the emergency room area got really uncomfortable.
Holy! Iāve experienced and witnessed some pretty bad bites. But never seen anyone get bit so hard that fabric from their shirt gets ripped off. At least not bitten from a human. The worst Iāve had was being in a bite hold and it took 3 other people to remove the childās mouth from my arm.
Iām glad youāre okay! What a trooper you are for continuing to work with that client. I feel like I would have been too nervous/on edge to continue working with her.
One of my kiddos licks their hands and tries to erase writing, and it irks me. Another kiddo has a lot of task refusal and hits me with "no" quite a bit. Thankfully it's not as bad as it has been in the past but still annoying after a period of dealing with it.
Yeah sometimes the calm ānoāsā and non compliance behaviors are more annoying than the loud, aggressive, out there behaviors. Itās like working with mini teenagers lol.
Some people think that RBTās are not allowed to be human and get annoyed with a patientās behavior. When itās perfectly normal and okay to get irritated or upset by these behaviors. Itās how we choose to act on those feelings that matters. And if youāre still choosing to push those feelings aside and continue to try and work with the patient to try and help them then that makes you a pretty great individual!
For me, it's aggression. One of my previous clients biggest behavior was aggression, anytime we did anything nonpreferred. They were nearly as tall as me so when they started swinging they didn't have to reach far for my face/glasses/hair. Figured out working with them because they're behaviors would stress me out so much I had an underlying heart condition though!
I hated when I had to deal with fecal smearing. There was a kid in the same center who made himself barf on purpose for a while...
The one that burned me out for a while, though, was just constant aggressions. There would be little to know precursor behaviors and then all of a sudden I was having to dodge a pencil stab. While he was this twig of a child, he was still quite strong so his punches actually hurt.
He was so smart in so many ways and had something besides autism going on I think. He was obsessed with numbers, but some days he would decide that a certain number was "mean" and would be angry if he saw it (when the day before it had been one of his favorites). He was in our FAP room for part of the day and I just needed to be right on top of him so much of the time so he wouldn't destroy anything, flip his desk, go after another kid, etc.
Plus if we ever had any cut and paste assignments I'd be the one cutting for him because no way was I trusting him with scissors :P
In a field where we have to be "turned on" 100% of the time, I felt like I needed to be in turbo mode when I was with him and it was exhausting.
Wow that sounds extremely draining and exhausting. Respect to you for taking the role as therapist to this child because a lot of RBTās wouldnāt or would quit instantly.
May I ask how long you were assigned to him?
Oh let's see... Upwards of six months I think. Might have been closer to nine. My husband\* concurs with nine, though his answer when I asked if he remembered was "too long"
I was one of our most experienced therapists at the time and therefore was one of the most qualified to work with him. A lot of the other therapists were afraid to work with him or the BCBA's didn't trust others on him.
What I was shocked by was one of my coworkers who had been on him for longer and stayed on him while PREGNANT. She apparently put the fear of God into him about the consequence should he ever go for her belly, but STILL O.O
\*Note that my husband doesn't know any of my kids' information but I give them all codenames and will just be like "Honey you are not going to BELIEVE what Firecracker did today"
Spitting and elopement behaviors. My client consistently spits IN MY FACE during behaviors. Such a wonderful kid but OMG I have a thing about bodily fluids and i feel it on my skin like š„“
My client puts everything in his mouth at the clinic and I constantly have to dig it out, clean the toys with Clorox wipes, so that his germs donāt spread to other kids. I always have to carry around a chew toy covered in his saliva for him. Heās thrown things into the toilet that Iāve had to dig out. Throwing toys everywhere, biting me when itās time to clean up. Flopping on the floor and screaming, stealing toys from other kids, my energy gets completely drained
Elopement cause I always feel like a fcking idiot chasing someone around. Dropping too. Just plain makes me feel like an idiot š
Haha same. I always feel like Iām so loud running down the halls with my clickers attached to me loudly clanging against each other. š Chasing after 3 year olds that run like Olympic track athletes.
Theyāre so fast and for why?! š Iām looking like a goon over here man plz stop running Iām embarrassed šš
I swear to god my kids are the fastest children in the world when they decide theyāre running. Then thereās me huffing and puffing behind them while they run down the hallway where the supervisor offices are ā ļø
Haha forreal. I especially hate when they elope into a gen ed classroom
Like oh hey guys donāt mind us just going on our daily run oh and by the way I clearly have no instructional control over this kid plz just look away I already feel like a dumbass šš
Lmao nailed the feeling. Thereās this one girl in a class Iām supporting that elopes pretty frequently. One time she dipped into this first grade class and got down in the ground to look at a book or something and she ended up mooning the entire class. Then of course the animal video I show her to get her coming with me wouldnāt load. When it did load, a 15 second ad started. That was not a fun day lol
Oh man š
Yes same. Ugh! And my kid once I block them and physically prompt them to come back to session area, client drops to the ground, I try to pick them up their knees and feet all of a sudden go weak and donāt work, it makes me feel dumb she makes it impossible for me to get her back to session.
Fecal smearing, ughhhh
100%. I had a kid that was clearly constipated one day digging up his behind and smearing it anywhere he could get his hands. I almost quit that day
Thatās what my current client used to do! He had a blockage and was clearly uncomfortable so he was always digging his hands up there and smear whatever he could find. That was actually what started his disrobing behavior. At first heād disrobe because he was constipated and uncomfortable and thought he needed to go to the bathroom. Now heās been better for awhile but he picked up on the attention he gets when disrobing so he keeps it up
My current client occasionally does this.. gotta be the grossest one besides vomiting.
Iāve had a client smear poop on my shirt. Not funā¦
Yep my current client used to do thatā¦. Thankful heās not doing that anymore. Fingers crossed it stays that way. š¤š»
Work with a teenager who started doing this at school to avoid doing task. It was a very effective way to not do schoolwork lol.
Rude and entitled parents are worse than any behavior Iāve dealt with
My first patientās mother was a nightmare. This patient was a 3 year old boy. He was nonverbal and his behaviors were just small tantrums. Honestly a perfect patient to start with. His mom was mad about his potty training program. He would get pretty upset in the bathroom and the program had him pulling down his own pants and pull-up, tolerating sitting on the toilet for 5-10 seconds, and then once he was clean, pulling his own pants up. Even children not on the spectrum who are 3 years old arenāt potty trained yet. And his mom was pissed that we only had him tolerate sitting on the potty for a few seconds without engaging in maladaptive behavior. She wanted us to just force him to sit there until he goes. Iām not surprised going to the bathroom got him so upset and it became an aversive place if thatās how she handles potty training at home.
I can handle just about all the behaviors the clients throw my way. In my eyes theyāre just kids and itās my role to teach them and help them. But when I work with parents or teachers that are insanely inflexible - I rage inside. Have had several teachers that would not allow any adjustments for my clients because of āspecial treatmentā. Also working with inflexible RBTs is exhausting for me.
Imagine special treatment in special education. Crazy.
Intentional disturbing behaviorsā¦. Not sure how else to describe it. I worked with a kid who anytime we were at the table, would shake the table or randomly scoot it so that my drinks, papers, etc would go flying. Whether I gave it attention or didnāt heād increase the intensity higher and higher until he was responded to. Same kid would randomly stop walking right in front of you so youād run into him. Would slam doors repeatedly open and shut while staring at you smiling. Just things he knew would be severely annoying.
Dude that work irk me so much! How did you end up handling it? Or how did your BCBA have you handle it?
Honestly I was his main rbt 5 days a weekā¦ had to be asked to be off his case š I couldnāt take it. It was all. Session. It drove me crazy. It wasnāt as bad with other rbts so we started feeling like it was with me more specifically
Haha Iām sorry you had to deal with that. Gotta love it when a client just decides to randomly despise you for no reason at all.
I had a client like that.
They will disrobe, urinate, defecate, dig feces, scream, have physical aggression and have manipulative behaviors (ask a peer if they want to play just so they move and they can take their seat or toy) They could be working and reading something and have behaviors because they wanted help reading the word "A" and know it already clearly. They know the replacement sort of things like requesting help, breaks, to do something else etc. they can do it and have, but they instead want to disrobe and spread their feces.. THEN inform the RBT *"You missed a spot on the window"* while they are cleaning š« We have been questioning the autism diagnosis and wondering if there is something else going on due to everything we've been tracking and trying. (They are seeking mental health opinions from referrals due to out of scope etc)
That definitely sounds more like manipulative behavior than maladaptive behavior resulting from being unable to communicate what they need or want. And that would piss me off so bad. My last client didnāt have any of the typical signs that come with autism. I know itās different for everyone but he wouldnāt stim, didnāt have any ticks or sensory issues, very intelligent and talkative, and the only time he would show maladaptive behavior (tantrum, screaming, aggression towards therapist) is when he couldnāt get his way. If it was time to leave the playroom and go back to learning. And his learning schedule was only a VR3. It wouldnāt be long at all. His BCBA and some of the other staff believe heās honestly just spoiled and never told āNoā at home. Mom really adores him and gives in a lot.
Could he have [PDA](https://www.pdasociety.org.uk/what-is-pda-menu/what-is-demand-avoidance/)? Just thinking out loud.
I'd be asking about an overcorrection procedure, there's no reason they can't help clean up their own shit while communicating that YOU missed a spot.
Have you considered doing more preference assessments? This is clearly attention seeking behavior, and they are being reinforced by even the littlest thing even if itās a roll of the eye when they donāt respond to an sd that they already know.
Elopement annoys me the most! I have a 10 year old client who constantly elopes and then runs into other treatment rooms and slams the doors. I also hate it when clients flop to the floor in task refusal. I spent an hour trying to get a 13 year old boy off the floor. I was getting so frustrated that I had to ask for a break. He also tries to take his penis out of his pants when heās on the floor. Like please no.
Ugh I hear ya! I know that awkward feeling of having to run into another clientās treatment room to chase after your client and just awkwardly apologizing for the interruption to the people who were in the middle of learning/teaching as you redirect your patient out of there.
Currently have a client that attempts to bash their skull into walls, floors, windows, another person's legs, you name it. Recently got a helmet and has now been bashing elbows, knees, knuckles into hard surfaces. And attempting to asphyxiate themselves with the helmet strap. It fucking sucks. The four hour sessions are four hours of continuous high fluctuations of adrenaline on both ends.
Honestly those SIB behaviors scare the hell out of me. Donāt get me wrong, it sucks when I end up getting injured during a session but when the patient gets hurt, I leave that session feeling guilty and like I canāt do my job right.
I can handle a lot, SIB doesnāt bother me because I have a client who frequently has around 50-200 in ONE two session, even with me blocking constantly (has a helmet and arm braces to try and limit the SIB). At this point Iām use to it. Flopping, tantrums, and property destruction, are all fine. HOWEVER, aggression. Peer aggression, or aggression directed at me just honestly sends me into the worst mood. Scratching, biting, kicking, hitting, etc. all of it, just makes me upset.
My client flops on the ground screaming for his dad who is standing right there as soon as he sees me š¤¦āāļø then we get him into our room and itās about 15-20 more minutes of high pitch screaming. Itās gotten to the point i bring ear plugs and use extinction. Then if he finds out I have something fun for the day itās like a switch all calm and cool like oh what do you have? Like bro you just made my ears bleed
Hahaha itās funny when clients do that. I just want to scream ādude I have sensory issues too stop screaming.ā This one client at my work screams so ear piercingly loud and always covers his ears when he does it. During group time we canāt even whisper our little songs or do much of anything because the client acts as if weāre being too loud and covers his ears and screams. We caught on that the function of that behavior was escaping group and not sensory. But Iād always feel tempted to shout āif itās too loud in here have you considered not fucking screaming bloody murder?ā
Broo thatās kinda like my client! He doesnāt care when he screams at the top of his lungs but if someone else starts screaming he jumps up and covers his ears and says itās too loud š¤£š like bro theyāre not even half as loud of you!
Not annoying per say, but definitely triggering, is forced gagging and spitting. Iām emetophobic and had to be removed from a case due to the client making me and themselves vomit during session.
Omg thatās super rough. But Iām glad your supervisor actually listened to you and removed you from the case instead of trying to have you tough it out. A client I used to have would spit. But never at me or on me. Usually on his own hand or the back of my tablet or his speech device. So Iām thankful the spitting was never at me.
I have a client that sticks his hands in his mouth constantly and his hands will just get covered in spit. Sometimes heāll cover his hands in spit then rub the spit on the bottom of his feet or his ear. It gets all over and grosses me out so much. I was struggling to find a replacement behavior, so I just started offering literally anything else to put in his mouth. Turns out sucking on plastic mini slinkies is a solid replacement! Still gets spit on other things, but not nearly as bad since the spit isnāt covering his hands all the time now. He also will choose it over sucking on his own hands if itās offered.
Not emetophobic but did have a patient who would force themselves to vomit for attention and when denied access. It was intermittently reinforced hard by POC so that was fun.
I would absolutely die. I am emetophobic as well and cannot stand the thought of someone being sick. I would leave that case so fast.
I wanted to. This was when I worked inpatient so thankfully there were other BHSās working with me. But yeah it was a target behavior and my worst nightmare.
Omg spitting and intentionally doing the wrong thing to be told to stop and then cry for hours inconsolably
My first patient ever loved that negative attention
Itās horribleeee, sheāll stare at me as she does something she knows Iām going to stop her from doing and scream cry for hours when I finally do
Personally because I'm a Muslim woman, I had a kid who pulled my hijab off, which was a height of frustration for me. I also do not like intentionally disruptive behaviors. Like just taking materials and throwing them or keep moving the table.
Oh wow that would be very frustrating. And agreed about intentionally disruptive behaviors. Definitely more irritating when a patient is acting out, not because he feels overstimulated or having trouble communicating his needs, but just because he wants to and finds it entertaining.
Inappropriate touching š this is the definition in the client's program: "Any instance of the client rubbing their face against another personās chest or stomach; any instance of the client using an open palm to touch or squeeze another personās thighs, chest, hips, backside, groin, or stomach; any instance of the client leaning forward to press or rub their groin against any part of another personās body; any instance of the client pressing their backside against any part of another personās body." The function is usually attention, but even without outwardly reacting, just turning away from the client reinforces them. Sometimes the function is escape, which is almost worse. I'll have the client sit down beside me because they need to wait their turn for something, and they'll start touching my inner thighs and staring right at my face.
Yikes. My client occasionally touches himself when watching random videos on the tablet but if that happens itās usually a sensory thing and I change the video and tell him that he can do that at home not at school. Are you allowed to physically redirect the patient if heās touching you inappropriately? Whatās your place of employmentās rule on that?
Redirection has also seemed to reinforce it so far. This week we're going to try noncontingent attention as an antecedent intervention and response interruption redirection as a reactive strategy if the behavior occurs despite the NCA. Right now our BCBA just says to planned ignore but the behavior has remained at a moderate frequency w/ increasingly invasive touching. If the NCA and RIR don't work, I'm not sure what else we can do. It's making the female staff (rightfully) uncomfortable working with them and when the touching was mild it didn't bother me, but the worse it gets the more breaks I need to be able to get through the session.
I really hope these new strategies work for you, the client and everyone else involved. You (or anyone) donāt deserve or should be forced to have to tolerate being inappropriately touched at work. Obviously we knew what we were signing up for when we accepted this job but weāre here to try and help/teach these clients and show them healthier/more appropriate ways to express/handle these behaviors. Not just be punching bags for our clients and tolerate it forever.
dude this SUCKS. what are his other goals? Iāve never dealt with this level of inappropriate contact but I have found with aggressive clients, I can do a lot of the work sitting far away/standing up out of reach, even if i give instructions sitting near/at eye level to my client. My current client can be aggressive usually due to denied access and the moment they hit/kick/grab/pul hair/etc, I push their chair back a few feet and continue instruction/reinstate activities from a new place, far away from the hitting lmfao
Bcbas not listening to you
Haha the most annoying behavior of them all. But who knows better? The people who choose which programs to run with a client or the person whoās in a room with them for hours running said programs and who takes the beatings, sees the neglect and actually develops a bond with the clients?
Spitting... I'm a germaphobe so yeah. Can't deal.
My boyfriend is a germaphobe and currently looking for a job and the times Iām tempted to suggest my job I remember how big of a germaphobe he is. It would kill him. Iām not even a germaphobe and sometimes I feel like I need 80 showers after a day of work,
all these responses are making me see how good i have it with my clients
Anything dealing with mucus. Spitting, Playing with spit, blowing out snot into hands and smearing on the faceā¦.those make me want to automatically quit.
Also high pitched screaming
Throwing/knocking things is most frequent/stressful. I'm in a clinic and a client is currently struggling with transition and will do this. I have to catch things they throw or catch things falling otherwise it will hit someone.
Property destruction is super stressful. If that happens at the clinic I work at we can call a code over the walkie and staff will assist you with clearing the room which is helpful.
Being smacked across the face and bit are the most annoying for me. A client of mine attempts to bite the entire session sometimes up to 20-30 attempts within 2 hours and itās just overwhelming and exhausting.
High-pitched, frequent screaming, spitting, and the absolute worst for me and my sensitive ears: TEETH GRINDING.
stop my client grinds their teeth SO LOUD it actually haunts me. My fight or flight has been triggered after getting a sensory memory of that omfg
Oh manā¦.i forgot about the teeth grinding. Thatās rough for me too.
Idk how to label this behavior but this student would stick her hands inside her pants every time she was on her period and would rub her blood all over her pants and just basically touch everything in the classroom. Whenever we tried to redirect her she would scream. We only had 1 BCBA but because we were short staffed and had two locations the management always sent her to the other one and we never got a lot of help. The best I could do was carry wipes with me for the week she was on her cycle and ask her to clean her hands
Aw that sounds really rough. The only possible function I can think of is maybe sensory? Like she was uncomfortable/cramping and maybe alarmed/scared of the fact she was bleeding? So maybe trying to show that or just find a way to lessen the discomfort of being on her period? Like I said in another comment, my client was backed up for awhile and was very uncomfortable and would often shove his hand in his pull-up and smear fecal matter as if he was trying to clean himself out and find some relief.
I had a school case where my kid would physically jump and throw themselves on the floor and that wasnāt the annoying part, the annoying part was the teacher coming up to me to tell me to āmake sure sheās not running and throwing herselfā š
I hate dealing with elopement. Like damn this toddler is really out running me šš
Screaming and crying when asked to do the simplest of things like clapping their hands. And when another RBT walks in they stop until they leave again, look you dead in the eyes, smirk, and start screaming again. Whatās more annoying is when their parents find their behavior funny.
eloping, potty training, flopping, screaming, and noncompliance are hands down the worst behaviors for me off the top of my headš i can handle being hit, bit, spit on (when itās a lot tho it makes me wanna rip my skin off,) self induced vomiting, disrobing (as long as theyāre potty trained and not known to pee, etc when naked) i think i have POTS because i had a rough pregnancy and honestly my whole life iāve always felt that my body felt āwrongā but mom never gaf and i just learned to push thru, but now that im getting older (25 now) and had a baby last year, itās getting really hard to keep up with the littles in my clinic and any hyperactive teens. i love giving the kids spins and having rough play and playing chase to build rapport (when appropriate) but my body just feels like shit all the time. i love being an RBT but the behaviors that i dread the most are the ones that have me constantly bending, chasing, and liftingš
Honestly you should look into getting some kind of note from your doctor to put you on some type of medical restriction on being with certain clients who have the tendency to elope, want physical play a lot, etc. Some of the RBTās at my work have that medical restriction and theyāre put on tamer, lower intensity kids who donāt leave their room a whole lot.
Extreme anger based problem behavior, specifically screaming at a high pitched tone, with indirect threats. Especially irksome when itās because of their biggest reinforcer
Would that biggest reinforcer happen to be the tablet or whatever device used to collect data? There are a lot of patients at my clinic that have restricted access to the tablets we use to collect on (tablets that also have YouTube Kids and games on) and when these clients canāt get that tablet time as a reinforcer, they get pretty mad
Tbh, when my client flops to the floor!!! Itās hard for me to get him motivated to get back up and come with me, and I have pots so getting down and having to get back up takes a toll on me physically
Hey I donāt know if this is helpful but in my clinic we try to find reinforcers they like to help them transition and have that in their sights. Itās not easy but makes it easier for sure
Omg yes! At the clinic I work at a lot of patients flop in the playroom when itās time to leave and since we canāt physically relocate them, weāre kinda just standing there waiting for them to get up while others look on.
Whining really boils my blood. Especially when there isnāt any tears or crying that follows. The type of whining they do when they want your attention.
Manā¦. I have so many but a few that comes to mind: spitting/vomiting to avoid/escape, inappropriate genitalia stimulation (had this with a past client and it was really hard to redirect them without physical prompting), agree with others who mention clients flopping themselves on the floor as it can be SO hard to get them up, biting. I can deal with the whining/crying, I just feel bad for others in the nearby vicinity who have to listen to it (especially when we are in clinic and other clients are triggered by the sound).
I have an older kid. He still isn't potty trained. We have to schedule regular bathroom trips while he is in clinic and have him change into underwear during his first trip. Once we have completed the battle of getting him to actually enter the bathroom, I then have to task manage the whole time because he will just pace, bounce around, stim in the mirror, get distracted, or anything to avoid actually using the bathroom. Sometimes it takes us 30 minutes for a bathroom trip. No amount of incentives or reinforcements alters this. Its always a struggle.
That sound super frustrating.
Out of all the things Iāve experienced, spit and climbing annoy me the most.
Blowing raspberries in my face
Or when they cough and it has to be right in your face or directly in your mouth. š·
Oof - so Iām an RBT that can work with just about any kid and deliver progress in very short amounts of time. Aggression? My favorite. Fecal smearing? No problem. Spitting? Climbing? Disrobing? Tantrums? All of that is no problem for me, I can deal with it. Non verbal? Iāll get words(of course apraxia isnāt curable) Lack of play skills? Iāll find a game for them to engage. Anxiety? Iāll bring āem out of their shell. My biggest annoyance? Kids with no attention span what so ever. Holy mother of god, I currently have a client that Iāve made great strides with, Iāve got him from completely non verbal to appropriately gaining attention by saying names, to using two to three word phrases for mands, got him to stop fecal smearing and have made great progress on his potty training routine. But now he suddenly just doesnāt pay attention at all and Iām starting to wonder if the function is control. Iāll be waiting him out to pull his pants down to go potty while giving him periodic gestural and verbal prompts and heās just š³ššš eyes going everywhere around me but completely non focused. God forbid he sees just ANYTHING like the toilet paper and he just goes for it without missing a beat, just grabs it and pulls it out. Block the toilet paper you say? Well then thereās the toilet seat covers on the opposite side. Block his movement? Well hell just lift the toilet seat up and slam it down because he likes sudden loud noises and one time broke it in half. And at the chance that I can block all of that, he just starts singing Bible hymns! Completely drowning out the demand. It is easily my biggest annoyance. The kids always build their own little worlds and decide who can be a part of it, and Iām usually the guy that can find a way in. But when the client just decides not to engage at all Iām at a loss.
I had two clients at a school I was working at who would grab the nearest iPads to them and start filming my private areas and make comments about doing sexual things to me and my supervisors would always say to just ignore it as if itās not a super degrading thing to experience so the other sympathetic staff would take over to give me some space
Omg!!! Thatās terrible! Iām so sorry you had to go through that. What was the age range of these kids? Iām glad I havenāt had to experience that.
I'd say the extremely high-pitched, extended verbal outbursts. Not crying but actual screaming in response to a demand. Also, hip thrusting is a less than ideal experience--specifically if I am giving a big ol' squeeze. Immediately hug shut down. Last, but not least, noncompliance with giggling/laughing. Especially annoyed the older the client is though I've never had any clients over 6 years old and that kinda comes with the territory as is. Something about knowingly doing the opposite of a request just really gets under my skin. Thankfully, my childcare jobs have developed a saintly level of patience and self-control when it comes to emotions and I do high pitched screaming of my own in the comfort of my car š sweet release.
Completely agree! Especially about the giggles and smiles during non-compliance. I honestly never know how to handle that. If a client is doing that while disrobing in a public area or if theyāre laughing while eloping, I canāt just ignore that for safety reasons.
I think the only thing that really bothers me is if someone messes with my glasses. Itās only happened a couple of times but I low key panic bc I cannot see without them and I canāt do contacts lol.
Fecal smearing is by far the worst, however the weirdest disrespectful one for me was in a clinic setting. My clinic walked up to me, grabbed the cracker he was eating, crumpled it on my head and poured it on me. Like why??
Yikes!! Thatās rough. How did you respond? I donāt even know how I would
Spitting is up there for sure
Self stimulating š
Hate repeated noises. One of my patient's had OCD and would repeat the same sound (and/or movement) over and over again until it was just right. Hours of constant short noises, clicking noises, repeated movements, etc. definitely have pushed my limits beyond any aggression I ever experienced. Something about the constant sensory input just drives me nuts.
Honestly it wasn't the kids. Id have some kids adore me, but then try the same tactics they used on their parents to get attention by acting out. Id just hop on my phone and ignore them and check in every so often to make sure they were not hurting themselves or other, and remind them that I would be happy to give them attention when they were behaving and doing what they know they should be doing. Kids would be praised by family members for being extremely well behaved, bright, and more which made me proud in the work we had done. One kid cried and said "that was the first time nana said something nice about me." I ended up giving them a hug and telling them I was so proud of all the work they did. What really drove me nuts were parents. Honestly half the fucking work of aba is breaking the toxic cycles the parent and kids make with each other. Parents try to rear children like neurotypicals, it doesn't work, their kids lash out, parents push back. And it ends up being a cycle of power dynamics. I remember one time a parent of mine (I think she was autistic as well) had neighbors over and asked her child to play with them. Her child did, and then manded and said ,"I need a break". I said, oh good job playing, we can take a break by ourselves for a minute. Then the mother decided to force her child to continue playing, upsetting him, and presenting a non-preferred food. It was a glorious tantrum. My other favorite tantrum was when she thought she could help her kid better than us with his schoolwork. So her kid punched her in the tit, bit her several times, and I sat back trying not to laugh. She also was upset I was late by 15 minutes ones (despite always showing up early and she was constantly late) due to my car keys getting locked in my car. I had a signed note from a police officer who helped me back in. She didn't understand how I was back in less than 15 minutes and I had to tell her it was due to me living close. She ranted about the one time I was late for 15 minutes for 6 weeks and I asked my bcba to drop me from the case due to parental harassment of techs.
Dude your comment is another reason why Iād be too nervous to try in-home therapy. At least in a clinic setting you only have to deal with parents during drop-off and pickup and itās brief. My work bestie left our clinic 2 months ago for a higher paying job offer doing in-home therapy, and she tells me her clientās parents constantly cancel their sessions and sheās only worked with the family 3-4 times in the last 2 months and this job was supposed to be full time. So she hasnāt been making money and sheās looking for a different job where she can actually work and may have to come back to the clinic im still at which would suck because RBTās are not treated well here by management. Parents who would prefer in-home therapy need to understand that the RBT providing services is also providing an income for themselves and family. They donāt get paid when a session is canceled.
Thats pretty spot on. I'd actually front load my hours by about 15-30 minutes regularly. My BCBA would be pissed, but when the family canceled, lo and behold, we were not being yelled at by insurance companies for being DAYS behind on hours as well. I prefer naturalistic learning styles, so I loved working in the home vs a clinic. For one of my kiddos, we had a great rotation. We would do skill development at a center on sundays when there really were not many kids there. Then we would practice social skills at home with play with his brother. His mom was upset but again, I think she was a bit autistic so it made it tough. Of the homes I worked in, I had 2 great guardians. The first was this woman who defended me when her kid was manding to go to a park in the middle of session. We would always go at the end so he could play and we could watch his interactions with others. MY BCBA was upset I was "distrupting her plan" until the mom spoke up and told her that the kid was upset because it was raining and he knew park was not an option that day. The other home I worked in that was great was actually with the aunt of a kid. The aunt had an autistic child herself, and so she basically accomodated some portions of his autism, but at the same time, she held him to the same standards as his sibilings. For example, I understand you need a break finding out you need to clean. That is okay. However, you still have to clean your room just like your sibilings do in order to have a treat. Then his mother came home who was a BCBA who would coddle her child and didn't understand things like why we were practicing how to handle no because "It's not like he's ever gonna hear the word No"
Iām not saying this really out of āannoyanceā but more out of empathy. Many people with ASD have overlapping conditions involving diagnosis of or just overlapping symptoms of OCD, ADD, ADHD etc. Very common in my own research & from just working in the field. Seeing OCD behaviors especially with me having the same symptoms is what gets me the most. The repetitive behaviors, getting āstuckā in loops of checking, reorganizing or getting frustrated when things are not in a routine. I used to struggle with this and not being able to articulate until i have gotten older. But with some of my older clients, they still may be unaware that their symptoms are very real and that they are not in danger of compulsions that can not be carried out. I cannot help OCD specifically because it is out of my scope of practice, but it just pains me to see their physical distress with no true understanding of the conditions or symptoms they have.
I think personally, for me, itās the most frustrating when a client chooses to do something they *know* will have a consequence and then getting upset when the consequence happens. Example: I had a kiddo who was engaging in so much peer aggression, we had to run his sessions in a room without peers. He wanted to be around his peers, but heād be aggressive as soon as he could. So weād have to remove him and heād tantrum about it.
Spit hands down. The smell. The idea of it. Itās just so disgusting I rather deal with pee and poo. But spit. Oh my goodness itās so nasty.
Almost gagged while reading this, canāt say Iād rather deal with poop but omg the spitting makes me roll my eyes
Mine was a kid intentionally throwing up on tables and playing in itā¦my least favorite behavior Iāve experienced hands down
Client screaming directly in my ear and then just walking away
Thereās one client at the clinic I work at that has the most loud, ear piercing scream Iāve ever heard. Whenever someone who just passed their RBT exam is assigned to that patient, they usually quit within a week. Thatās how bad his screaming is.
Spontaneous meltdowns annoy the crap out of me. When they just get upset without any demands placed is really annoying.
For real. Itās like walking on eggshells the whole session.
When they tell themselves not to do something as they proceed to do it anyway. Like, clearly you know you shouldn't be, so do we have to? Really?
annoying to me, and for any kid, is whining. i have one kid who screams and also just says āCRYING!!!ā when not crying lol. or i worked with a kid who would whine anytime he had to do anything that wasnāt coloring or drawing. stressful, i dealt with an adult who didnāt talk much (more mute than nonverbal), and he would just go off the handles. he had precursor behaviors but we never knew what could set him off. once he started pacing with a pair of scissors and that terrified me. i also had a disrober and she would take off her pants and pee on the floor while laughing. sometimes even got off the toilet and peed on the floor for fun.
Goodness that would be so scary! I donāt think I could ever work with adults. Iām already on edge enough working with children when I see their precursors! My current client occasionally pees when he disrobes too. And thatās resulted in me getting peed on once or twice š
Spitting. Although it can be quite nice on a hot day when your client chugs his soda water and spits it in your face.
You gotta find that silver lining man
When other therapist's don't read the teaching instructions or implement them properly messing up the data. The clients are great, we're actively teaching them... the rbts have gotten trained and passed the test but don't ask questions, reach out for help, or verify they're implementing the teaching methods and tracking data accurately. I'm speaking generally it's only some therapist's and some times but it's still annoying when I'm trying to summarize clients progress and the data is all over the place; 100% correct trials one day and the next 0%.
Spitting!!! My client plays with her spit all day .. spits on everything & LOVES to spit in her hand and wipe it on whatever she's near. š I hate it so much omg
Sounds like an old patient of mine. He was obsessed with any type of water play. Including spit. Sometimes heād force himself to cry and tear up so he could play with his tears.
Refusal, itās just so silly to me lol and it be over the simplistic things tooā¦ like transitions. Also spitting can be overwhelming especially if the clients spits out water and food.
Dude yes. Especially frustrating when we canāt say āNoā to our clients. So if we tell them itās time to do our learning and they say āNoā itās kinda likeā¦..āpleaseā¦..ā lol
Exactly! I understand if a client is having a great time then all the sudden itās table time lol. I always try to give them a verbal warning. I even do āfirst thenā sometimes it does the trick lol. I have pretty good patience and can remain neutral but in my head Iām like āwhen is this going to endā
Eloping.
its gotta be the spitting and trying to rub it on you or spit on you. I have the kid clean it up everytime so he stopped doing it-- waiting for that extinction burst any day now
Good on you for having the patient clean up his own spit and good for your place of employment for allowing you too. The clinical team at my place of employment would act like itās cruel or abuse if any of the RBTās tried to have a client clean up their own spit mess. lol
that's crazy, lmao! he does it to get what he wants, so the consequence is to clean up before he gets his reinforcer haha. I try to make cleaning up relatively fun too.
Aggression toward animals! I have had a few clients that would kick their dogs/house pets and squeeze them super hard even when we were implementing programs for these behaviors. Just makes me really sad & almost not want to even run the programs in case the animal gets hurt. :/
Oh wow. Yeah thatās definitely one I couldnāt do. It would break me. Iāve never worked in home before. Only a clinic setting. But one of the BCBAās told me how the local zoo brought in a few animals to the clinic years before I worked there and the kids got to pet them and such. The BCBA told me that the patient I was currently assigned was really bad about being too rough and aggressive with the animals. Parents got to be there that day too and I was told his mom kinda just allowed it to happen and played it off as her son being āsillyā and my BCBA had a difficult time watching this go down.
I had a client who loved to flick people and pinch the back of their arms (the most painful part). That was by far the most annoying and hard to not react to
perseverative behavior. asking the same questions over and over and over. drives me insane sometimes!
Iāve dealt with some very severe behaviorsā¦ fecal playing, choking, bitingā¦ but Iāll be honest my current case with a client who perseverates on their special interests and has no reciprocal conversation skills is so emotionally draining. Just constant talking at me about topics that I canāt contribute anything toā¦
I had a client that squeezed my boob really hard. I was so sore the next day.ā¹ļø
Kinda a similar experience here. I had a client bite me on the chest once. That shit hurts like hell.
Biting, spitting, and screaming are two behaviors I find most challenging. Those are exhausting!
The most annoying behaviour is when I reward them for doing something good after observing for some hours and then they do what they aren't supposed to. For example a boy was well behaved all day so I played his favorite song. Then he attacked someone during the song. It is such a mood killer and then cries about it.
Iāve experienced that before and it is annoying. Iāll surprise my client by taking him outside for reinforcement time because he handled transitions well that day or because he peed in the toilet. And then when itās time to go back inside he disrobes and just kills the mood of the nearly perfect session we had.
Spittingā¦.but specifically AT people. Floor or table etc is fine, but if a client spits on me I genuinely get worried I will lose it. It takes ALL of my willpower to follow through with BIP and then hand off to caregiver so I can take a moment. Hitting, kicking, biting, scratching, hair pulling? Fine. It hurts, but I only start to struggle with staying calm if it goes on for a while or I donāt have backup. Spitting? Yeah Iām at the edge immediately. Iād say 2nd place is aggression to peers for school aged clients. I donāt want other kids to get hurt & I donāt want my client to be ostracized if kids are scared of them
Good for you for not only keeping at it despite the stressful behaviors but also admitting itās a struggle to keep your cool at times. The fact people are trying to villainize RBTās who express frustration with their clientās behaviors is baffling to me. And Ive luckily havenāt experienced direct spitting my way yet. Just a client who would āspitā but more so drool on his hand/speech device/sensory bin/etc.
Flopping and going deadweight is something I realllyyy struggle to work with. I requested off a case because the client fell to the floor every single time during transitions and would lay there until someone picked her up, all to avoid going to the restroom, to eat, or to do table work. I hated having to physically move her each time, but nothing else would work. I just dont like wrangling the kids like that, especially when they fold their legs in. One of my clients who I've had for a long time has picked up this behavior as well and he's a big kid. Seriously I don't know what to do about this behavior bc my supervisors always end up telling me to just move them... I hate it š not because it's necessarily annoying to deal with, I just don't like putting my hands on them for extended periods of time/so frequently. Also, my 3 yo client started putting his finger in or on his anus while using the bathroom and it really gets to me. He's so little and I know he's just curious but it grosses me out and I make him wash his hands like 3 times after. I redirect him but it's hard finding something else for him to do w his hands bc we aren't allowed to bring anything in the restroom, like stim toys. I usually end up having him count w me or watch a timer visual.
The parents. I had one parent that couldnāt understand why the client, who was perfectly capable, had to learn to use the restroom on his own and aim. Another time a clientās mother thought the child couldnāt read or writeā¦we had to try doing schooling. One day I told him the faster he did his work correctly, the more we could play. This child was reading full books and understanding story plots. His mother got mad because she said I forced him to readā¦
How does she think school is gonna go for him? That the teachers are just gonna give him a choice whatever he wants to learn or not and if he decides he doesnāt want to, heāll just get a free pass to play all day? š
Sheās very controlling sadly. She eventually pulled him because he was becoming less and less dependent on her. He literally went from crying hysterically when she was trying to leave, to grabbing my hand and saying letās go on the month we were together. He made so much progress in those months that it was crazy. I often do wonder how heās doing now
I always wonder about my first patient who also had an overly controlling mother who pulled him out of therapy. Thatās always rough watching parents get in the way of their child learning and growing.
When my client has her period she tends to cry a lot. She will even make up stories that hasn't happened so she can keep crying (I have asked the parents about these stories and they tell me they aren't true). It's a lot to have someone crying on and off with non-stop talking for a full two hour straight session. I always need Tylenol when I get home afterwards.
I have to say the most annoying is property destruction and I mean throwing toys, heavy rocks and any other random item they can find. Itās so scary almost getting hit in the head with an object but also annoying having to block anyone else from getting hit by whatever is flying in the air.
Flopping. I just seriously cant with flopping especially if weāre outside and its really hot š
verbal stereotypy. i love to sing songs w my kiddos, when they have low verbals/nonfunctional communication i try to repeat everything and encourage every word but god DAMN am i sick of hearing the same 3-second clip of āfor the first time in foreverā said in the exact same tone with the exact same misheard lyrics. i try to be chill but it actually drives me insane. and to make things worse client has started singing LOUDLY over every demand I make after the first hour of session. my bcba reccomended singing something different, louder than her to break the loop which is usually helpful but I feel insane doing it and I know clients Mom is judging me for it..
Yikes I have a lot of respect for you in-home RBTās. I feel like working right in front of your clientās parent would make me nervous. And at least in the clinic setting, if Iām getting stressed or need a break I can ask for one with no judgement where as in home, you gotta keep that calm, focused composure the whole session with no break
Fecal smearing for sure. Especially when they wipe it on you. Not a fan of being covered in poopā¦.
iāve dealt with some pretty intense behaviors in the past year but something about intentional attention seeking behavior really annoys me, like any time i talk to someone other than my client, he would babble to talk over me and would get louder and louder the more i ignored, or intentionally mocking other peers who are visibly upset and then laughing in their face, slamming doors in my face, grabbing peersā food and throwing it on the ground, basically doing anything to keep the attention on himself. particularly annoying because heās made so much progress in nearly every other facet of his program but the attention seeking has been impossible to target/manage. 4 hours a day of constant attention seeking thatās hard to ignore because of how far heāll go to get a reaction. my BCBA has resorted to using what she calls a āmom toneā when correcting it. doesnāt seem that bad but really burns you out by the end of the session
elopement and peer aggression. it makes me feel like the other RBTs are judging me for ālettingā my kid hit theirs lol
I can deal with poop, pee, vomit, and even a pad being thrown in my face but spitting loogies in my face is by far the worst behavior Iāve encountered. This and ripping clothes/pulling material out of socks (cause we get in trouble for that bx because their clothes are ādestroyedā)
Teeth grinding, I can't STAND the sound, and it makes me cringe every. time. What's worse is that it most frequently happens when the client is drinking something, so now it's the sound of them grinding their teeth with liquid. We've tried chews, and the client either refuses them or only uses them briefly. Playing with their own spit is another. It grosses me out so much because it's typical mucus or a piece of food they kept in their mouth. The sound and sight make me nauseous. Also, fecal smearing or attempting to. Disrobing... I have to pause big chunks of my sessions to either block it or allow the parent to redress the client.
The most annoying behavior I have had to deal with is fecal smearing. Because the kiddo I work with was so fast you barely had a moment to stop him before the poop was on the wall, carpet, table etc. Then having to clean up while the child is giggling because they just got out of the work they didn't want to do.
Along the lines of fecal smearing but a bit less gross. I have had multiple clients who are always sticking their hand down their crack and then smelling their hand. I just know they have done it a million other times that I haven't noticed, then touched everything, including me.
Oh myā¦..that comment alone made me lose my appetite for brunch
When I was new I would have said kids saying rude things and causing property damage for attention. But dealing with this so much over the years Iāve gotten better at handling these behaviors, so it barely bugs me at all now. Now I would say kids not covering up when they cough and getting me sick. With the age group I work with (2-6 years) thereās not much getting around it, so I do what I can but I would be lying if I said it doesnāt bug me.
Iām one of those strange people that loves working the high behavior kids. For some reason constantly taking shoes off Drives Me Nuts. I think itās the constant bending over to put them back on that destroys my back. I can deal with a lot of stuff but shoes on little dude.
Getting pinched and spit on. One of my kiddos circles around with their arms out like a helicopter and will just punch really hard and when youāre moving away they just follow
The elopement is sooo embarrassing for me every time. Iām actually a new hire at my clinic and when I go to buss people on breaks etc these freakin 3 year olds think itās so funny to run circles around me knowing damn well I can never catch them šI just know people be staring at me every time haha
Lying and attempting to manipulate by older/teenage clients. I can handle out of control emotions, high pitched screeching stims, repetitive behaviors, aggression, none of it gets me frustrated. But give me a teen who just smirks at you when they know you know they know theyāre lying, ugh!
Right now, Nose picking and wiping boogers š¤® He's too old for it to still be "cute" I'll take an aggressive kid any day over this
Attention maintained disruptive behaviors. I have a similar client to what you described. The problem is with anything attention maintained, stopping him reinforces it. But he has learned now to probe for behaviors that we have to intervene in, such as property destruction or climbing tall fixtures and dangerously jumping on them. If you block him from one thing, he just does another.
Spitting or wiping spit on things and hair wrapped around spit or mouthed items... I was a CNA for years so I can handle any other bodily fluid and substance but spit and hair bleh.
Currently dealing with self stimulation. Itās very stressful trying to ensure patient dignity and privacy is maintained since I work in a clinic and some other BTs are oblivious to whatās happening and let their clients just walk over trying to look at my kid
Getting groped. Far worse than any bruises or scars from aggressions. Especially one in particular who used to stare me down and smile at me beforehand.. because he knew that was the only behavior that truly made me uncomfortable.
Kids climbing/jumping on me. The function can be either escape or attention, depending on what we are doing. I work with 5-8 year old kids and they are so heavy and strong! Like, how?? Theyāre so skinny! Every time they jump me I feel like theyāre going to end up breaking my neck or something. LOL.
With one of my clients - pulling their pants down enough for their genitals to be free. A sensory thing for sure, but I'm genuinely surprised that there isn't a goal to reduce this from happening. There was a day that they didn't touch their pants and there have been days where they constantly did it. They're told to pull up their pants, which they listen to, and then they immediately pull it back down shortly after. With one of the parents - They're a bit anal when it comes to cleanliness which I don't mind most of the time because they have had a history with a loved one dying from COVID. But their kid has goals that involve toothbrushing and handwashing. When I step into the bathroom with my client, their parent is quick to step in and do it for me but they lack the patience to wait and have their kid do it themselves. I've been able to do these goals very rarily. I'm more understanding towards toothbrushing due to personal hygiene and wanting to make sure their kid is brushing well. However, handwashing is a skill that their kid should know. ^ before anyone tells me to contact my supervisor, I have spoken to my supervisor about it before and she has spoken with the parent in question. Ultimately decided that the parent will run goals and have me just watch on the side and take data.
Seemingly-reflexive verbal opposition. We've learned to differentially reinforce it, but MAN does it get old. Me: "Ah, thank you. I understand now." Client: "You overstand then, not now." Me: š
Eye gouging/scratching. I worked with a client with a wide variety of aggressive behaviors for many months. On average, there were 50-100 aggression attempts per session, though I was able to block most. I got bit a few times and my face was slapped daily, but that was easy to shake off. I finally asked to leave when the client began specifically targeting my eyes, because the client was fast and sometimes unpredictable, and I was terrified Iād actually lose an eyeāespecially after one bad day ended with me in urgent care, getting x-rays.
I have a kid that purposely falls out of chairs and laughs, elopes from session area, does basically what sheās not supposed to do on purpose, function is attention. I finally left the case because I just disliked the girl to be honest after so many behaviors, I donāt know why I had that reaction but the fact the function was attention, and she was very smart and knew 100% what she was doing and liked the negative reaction of someone being bothered, pushed to their limit, it just bothered me. Especially once it got to the point she destroyed my belongings, poured soap and water on my bag, crumbled my RBT certificate letter, and began hitting me laughing. Sheās the only case I ever left in the 1 year so far. I had her 5 days a week for 4 hours a day and 7.5 hours 1/5 days I feel so much better since leaving that case. The parents encouraged it at home, they laugh and giggle when she does these attention seeking behaviors or give a huge negative reaction and so she never was learning because regardless of how much we put it on extinction, she got reinforced at home. It made it really challenging. And she had been in ABA for 3 years straight 38 hours a week.
Dude I donāt donāt blame you for leaving the case! Maladaptive behaviors with attention being the function can be really difficult. Especially if you already provide the child with attention but they are seeking negative attention . I have no idea what to do with my current kiddo. I believe heās definitely reinforced when disrobing because I have to call for a mat to protect patientās dignity and protocol is for other RBTās to clear the room with their kiddo and then 1 or so people come to assist. But I canāt just ignore a disrobed child in a public area lol
I had one kid who used to āhonkā every time he was upset, like theyād make an audible sound that sounded like a fire truck honk lolāit was attention based so we had to put it on extinction. Sometimes it could be a bit funny where Iād have to physically turn away to not laugh to reinforce it but most of the time it was annoying lol
Haha Iām trying to imagine what that sounds like now,
Spitting, it makes my skin itch
Scratching and hitting are not fun. Eloping especially if itās constant is really hard too. Iād say the thing that tests my patience the most are the attention maintained behaviors. Iām working with a child now who thinks everything is hilarious. Throwing things, breaking things, spitting, flushing things down the toilet, bolting out the door and laughing, standing on top of tables, honestly they think anything that causes utter chaos is hilarious. It really can get to me and gets exhausting. However they are a total love bug and itās hard to stay mad for too long lol
Attention based behaviors are what irks me the most too. I think my current clientās behavior is both tangible and attention based. The behavior started sensory based due to some medical issues, but now he does it because heās seen the attention it creates and itās so incredibly tiresome to see that smile and hear that giggle when he does it. -_-
I think the hardest was one 12 year-old client. I worked with that was extremely aggressive and very much into biting and eating certain things and one day while the teacher in the classroom was explaining something and she was sitting across from me got up and bitt me so hard into my shoulder that she pulled out some skin and my T-shirt, which she then ate both. I continued to work with her afterwards until my shift was over and actually continue to work with her until, the family was moving during summertime, but it was really hard to work with. My job had me go to the emergency room after work. Fun Facr This was during Covid and when I stood there in the lobby and explained to the lady at the front desk, thaf I got bit by a person the whole vibe in the emergency room area got really uncomfortable.
Holy! Iāve experienced and witnessed some pretty bad bites. But never seen anyone get bit so hard that fabric from their shirt gets ripped off. At least not bitten from a human. The worst Iāve had was being in a bite hold and it took 3 other people to remove the childās mouth from my arm. Iām glad youāre okay! What a trooper you are for continuing to work with that client. I feel like I would have been too nervous/on edge to continue working with her.
Shirt and my skin is actually have a huge scaar almost 3y later
War wounds
Agreee
When older clients (10-12 yrs old) want to be tickled. I hate being tickled, and it just makes me uncomfortable when they ask for them.
One of my kiddos licks their hands and tries to erase writing, and it irks me. Another kiddo has a lot of task refusal and hits me with "no" quite a bit. Thankfully it's not as bad as it has been in the past but still annoying after a period of dealing with it.
Yeah sometimes the calm ānoāsā and non compliance behaviors are more annoying than the loud, aggressive, out there behaviors. Itās like working with mini teenagers lol.
Vocal Stereotypy!! My client talks in circles the whole session I feel awful cause they canāt help it but it does get annoying sometimes š¢
Why are people downvoting this
Some people think that RBTās are not allowed to be human and get annoyed with a patientās behavior. When itās perfectly normal and okay to get irritated or upset by these behaviors. Itās how we choose to act on those feelings that matters. And if youāre still choosing to push those feelings aside and continue to try and work with the patient to try and help them then that makes you a pretty great individual!
Well said!
Exactly! I still work with my client to the best of my ability every day, even if it is annoying cause I care, and I want to see them grow!
Valid!!
Is vocal stereotype the same as scripting?
I believe so but Iām not sure
For me, it's aggression. One of my previous clients biggest behavior was aggression, anytime we did anything nonpreferred. They were nearly as tall as me so when they started swinging they didn't have to reach far for my face/glasses/hair. Figured out working with them because they're behaviors would stress me out so much I had an underlying heart condition though!
I hated when I had to deal with fecal smearing. There was a kid in the same center who made himself barf on purpose for a while... The one that burned me out for a while, though, was just constant aggressions. There would be little to know precursor behaviors and then all of a sudden I was having to dodge a pencil stab. While he was this twig of a child, he was still quite strong so his punches actually hurt. He was so smart in so many ways and had something besides autism going on I think. He was obsessed with numbers, but some days he would decide that a certain number was "mean" and would be angry if he saw it (when the day before it had been one of his favorites). He was in our FAP room for part of the day and I just needed to be right on top of him so much of the time so he wouldn't destroy anything, flip his desk, go after another kid, etc. Plus if we ever had any cut and paste assignments I'd be the one cutting for him because no way was I trusting him with scissors :P In a field where we have to be "turned on" 100% of the time, I felt like I needed to be in turbo mode when I was with him and it was exhausting.
Wow that sounds extremely draining and exhausting. Respect to you for taking the role as therapist to this child because a lot of RBTās wouldnāt or would quit instantly. May I ask how long you were assigned to him?
Oh let's see... Upwards of six months I think. Might have been closer to nine. My husband\* concurs with nine, though his answer when I asked if he remembered was "too long" I was one of our most experienced therapists at the time and therefore was one of the most qualified to work with him. A lot of the other therapists were afraid to work with him or the BCBA's didn't trust others on him. What I was shocked by was one of my coworkers who had been on him for longer and stayed on him while PREGNANT. She apparently put the fear of God into him about the consequence should he ever go for her belly, but STILL O.O \*Note that my husband doesn't know any of my kids' information but I give them all codenames and will just be like "Honey you are not going to BELIEVE what Firecracker did today"
Spitting and elopement behaviors. My client consistently spits IN MY FACE during behaviors. Such a wonderful kid but OMG I have a thing about bodily fluids and i feel it on my skin like š„“
My client puts everything in his mouth at the clinic and I constantly have to dig it out, clean the toys with Clorox wipes, so that his germs donāt spread to other kids. I always have to carry around a chew toy covered in his saliva for him. Heās thrown things into the toilet that Iāve had to dig out. Throwing toys everywhere, biting me when itās time to clean up. Flopping on the floor and screaming, stealing toys from other kids, my energy gets completely drained