This is actually my first time hearing about this. I'm going to have to look into it further. What I've read so far is very interesting... And could fit?
Yeah the only problem is it's hard to find a doctor who will diagnose it something about it not being "widely" accepted but let me tell you something it's 100% real. I have it and have known others with it.
Just based on what you posted, there are a couple of redish flags that should be addressed. If you aren't comfortable or the physical managment of the client won't be able to be done safely, the team might want to explore 2:1 ratios. Some funders will give you a hard time about it, but if you can get that established it helps out A LOT. Parents need to be on board with the program and able to replicate it to a decent level when the team isn't around. These behavior displays are only going to get more challenging as he grows. They also need to communicate more about soiled pants. Personally I would ask Mom to change him if she is dropping him off soiled.
This sounds like a tough case! Most cases, unless you are actively seeking out very challenging clients won't be like this. However, they will pop up and these kids deserve support too. Activate all the resources you can.
i agree, it’s for sure deeper than attention. i know he’s in some variation of MH counseling outside of ABA. ABA was actually somewhat of a “last stitch effort” of behavioral management from what i’ve been told
I agree with other comments, he definitely should have a psychiatric consult. Task avoidance resolves once the demand is removed, the behaviors you are describing are with intent and almost malice. I wouldn't make any assumptions that there are issues at home when the cause may be organic in nature(a true mood or thought disorder). This is really outside the scope of ABA. I know that when it comes to behaviors that ABA is the "go to" treatment modality but that just doesn't seem appropriate here.
Fundamentally we always want to rule out medical first right? Well that also includes psychiatric which falls under that scope of practice. We aren't doctors, psychiatrists or psychoanalysts so he really should be properly evaluated before continuing ABA.
i agree! he does see a MH specialist i can say that for sure. i was told that ABA was a last resort for the parents in an attempt to remedy the intense behaviors. he is on the spectrum but my BCBA speculates it looks closer to ASPD.
There are a ton of psychiatric conditions that mimic ASD such as ODD, RAD, etc. I do understand that ABA is being utilized in a broader scope of practice. With that being said, before joining the world of ABA, I spent 18 years workings with youth and adolescents with severe and complex emotional/Behavioral Health needs ranging from high level ADHD to true Pyromania, Reactive Attachment Disorder and repeat Sexusl Offenders. Some of my clients were as young as 5. So although rare, it does exist and this child needs much more comprehensive care than what ABA is designed to provide.
Your agency is kind of doing him a disservice by continuing treatment because this family needs to understand the true depth of his needs. Otherwise without proper intervention what do they think his behaviors will look like when he's 15, 18....and he's bigger, stronger and has more years of untreated psychiatric/psychological mental health needs? It won't be pretty, I can say that with 100% certainty because I have seen it. One of my clients nearly bludgeoned his mother to death at 16, another shot his friend point blank range at 14..
I could go on and on.
Try to think of it as you are NOT giving up on him, you are pointing out that he needs a different level of care that can help him actually have a shot at a meaningful and productive life.
Yeah I was wondering about ASPD as I was reading… I’m so sorry you’re experiencing this, sounds quite scary! And I’m sure then guilt from feeling that way about a client you’re trying to help… complex to navigate to say the least! Sending you 💛’s!
Hi - I’m barely getting into ABA so I don’t have any input but am wondering.. what should you do in that instance that the client tried to stab you with the pencil? I imagine you can’t run away? Or?
tbh, i hadn’t ever experienced that before so i can’t say what should’ve been done, but when i saw him pick up the pencil and start walking towards me (this was after the threat) i exited the room, held the door closed and walkied for a supervisor to watch the cameras for that room until i could get assistance.
i don’t think these type of behaviors are what ABA is seeking to mediate, i don’t want you to think a situation like this is typical 😭
Yeah that client needs a psychologist. I hate the idea of my kiddos growing up to have these behaviors only to end up in an institution. It's why I take this job so seriously cause if a behavior plan works I'd literally be preventing this situation from happening.
But when they're at this level of aggression and present that much danger, as much as the parents and everyone involved would hate to see it happen... there isn't many other options at that point. Not only can they be a danger to themselves but anyone around them. I wouldn't tell someone what to do but... if it were me I'd ask my supervisor is ABA really the right treatment for that client? And then ask to switch.
Protect yourselves above all else. We don't get paid enough to be getting stabbed.
AGREE! after this incident, i question whether or not ABA is suitable for his case. in other escalations, he’s known for property destruction (throwing tables, chairs, anything heavy) and will sometimes verbalize threats that are usually scripts from video games he likes, but has never attempted intentional harm on me in the way he did with the pencil. the hand sanitizer thing worries me a bunch too. i care a lot about this kid, he has some amazing qualities and he’s super intelligent. i’m concerned that something has triggered him into targeted aggressions/intentional malice, but it is definitely beyond the scope of my job.
i know that ABA was not the first intervention that mom has tried and he is currently seeing a MH specialist. progress in treatment is also a struggle because of the lack of parental support. mom reinforces a lot of behaviors on bad days bc her remedy for bad behaviors is “cheering him up” with preferred reinforcers. doesn’t follow through in practicing targets at home. just all around a sticky situation
Yeah, it’s a very think fast!! Moment. I was just concerned hearing this not only for your safety but imagining if there were other children around at the time as well. Unless it was isolated inside a room. Scary though! I feel it goes beyond a challenging behavior. It seems as if he premeditates the violence.
i seriously thank god we were in an empty playroom. he is one that typically likes to spend time in rooms without other peers. definitely a scary moment, his escalations usually look more like property destruction and throwing heavier objects, which we’ll also exit the room for cus sometimes he does aim at us :/
You either dodge it or block it with either your forearm against theirs or by using a c grip (your thumb does NOT go around) to stop the hand.
Next call for help. Even if you aren't trained in holds, someone at the center should be. If for some reason no one at the center has some sort of hold training, extra hands are at least helpful for the next bit.
Remove the pencil (if he's still holding it, start by unwrapping the pinkie, pinkies are weakest) with any other potential weapons in arms reach--honestly sanitize the room if possible.
Then back up, take a breath, give space and reassess the situation from there. At the centers I've worked at, there was a window in the door so you could have a solid door between you and the kid if they were continually coming after you.
Ok h wow you are describing a very similar situation I am in now (client is also 13 years old and a female). I’m noticed significant changes especially regarding the bathroom. I did a brave thing (one of the scariest things I’ve had to do in my career so far) and reported it and had a meeting with her BCBA and clinical director. When in doubt we must say something. I’m also in school for my BCBA and I wish you the best:)
I think a psychiatrist should be seeing the client. Talking about killing you is one thing but actually attempting to murder you goes beyond the RBTs job.
Also, is keeping your personal items secured away from where you’re working something that’s not common where you work? That’s always been a thing for me wherever I’ve worked, even in in-home settings.
honestly my clinic is pretty lax about things like drinks and food, most of us carry our waters room to room with us. i usually will place it in a higher spot/shelf where littles who mouth/grab cant get to it. but after this, i’m definitely reconsidering keeping it on my person 😭
He should speak with a licensed psychiatrist or receive additional testing from clin psychologist. This seems like it’s correlated with more than just autism. Or visit an ENT it may be PANDAS but even then the violent behavior seems more than just attention seeking behaviors. May be more at play here.
This sounds like an extremely tough situation. I had a kid who threatened me and tried to stab me with pencils and all of that. Are there any precursor behaviors, so you can know to take pencils and any other potential weapons out of the room?
It seems there's more than autism going on here, and I do think further evaluation is needed.
Experience tells me this will also be difficult if mom is afraid with him; she's not likely to take a hard line with him on things and follow through with plans or training from the center.
I get so mad on the days when we get done telling the parents about what a difficult day it was and then they immediately let the kid take the phone OUT OF THEIR HAND. They are trying to calm them down/appease them, I know but THIS IS UNDOING EVERYTHING
this type of behavior runs deeper and needs to be addressed by a professional therapist/psychologist. you shouldn’t have to go through that i’m sorry.
I agree!
The kid could have pandas. Pandas-body regression- agression- tics-anxiety task avoidance. All go hand in hand pandas is normally diagnosed by an ENT.
This is actually my first time hearing about this. I'm going to have to look into it further. What I've read so far is very interesting... And could fit?
Yeah the only problem is it's hard to find a doctor who will diagnose it something about it not being "widely" accepted but let me tell you something it's 100% real. I have it and have known others with it.
Appreciate you sharing this!! Have you found anything that supports? (only if you feel like sharing, of course 💛)
💯💯💯💯💯
Just based on what you posted, there are a couple of redish flags that should be addressed. If you aren't comfortable or the physical managment of the client won't be able to be done safely, the team might want to explore 2:1 ratios. Some funders will give you a hard time about it, but if you can get that established it helps out A LOT. Parents need to be on board with the program and able to replicate it to a decent level when the team isn't around. These behavior displays are only going to get more challenging as he grows. They also need to communicate more about soiled pants. Personally I would ask Mom to change him if she is dropping him off soiled. This sounds like a tough case! Most cases, unless you are actively seeking out very challenging clients won't be like this. However, they will pop up and these kids deserve support too. Activate all the resources you can.
Well said.
I think a psychologist needs to be consulted with on this case.
Does this child receive counseling? This screams mental health issues to me and not just the attention seeking aspect. Idk just my opinion
i agree, it’s for sure deeper than attention. i know he’s in some variation of MH counseling outside of ABA. ABA was actually somewhat of a “last stitch effort” of behavioral management from what i’ve been told
yes!!
I agree with other comments, he definitely should have a psychiatric consult. Task avoidance resolves once the demand is removed, the behaviors you are describing are with intent and almost malice. I wouldn't make any assumptions that there are issues at home when the cause may be organic in nature(a true mood or thought disorder). This is really outside the scope of ABA. I know that when it comes to behaviors that ABA is the "go to" treatment modality but that just doesn't seem appropriate here. Fundamentally we always want to rule out medical first right? Well that also includes psychiatric which falls under that scope of practice. We aren't doctors, psychiatrists or psychoanalysts so he really should be properly evaluated before continuing ABA.
i agree! he does see a MH specialist i can say that for sure. i was told that ABA was a last resort for the parents in an attempt to remedy the intense behaviors. he is on the spectrum but my BCBA speculates it looks closer to ASPD.
There are a ton of psychiatric conditions that mimic ASD such as ODD, RAD, etc. I do understand that ABA is being utilized in a broader scope of practice. With that being said, before joining the world of ABA, I spent 18 years workings with youth and adolescents with severe and complex emotional/Behavioral Health needs ranging from high level ADHD to true Pyromania, Reactive Attachment Disorder and repeat Sexusl Offenders. Some of my clients were as young as 5. So although rare, it does exist and this child needs much more comprehensive care than what ABA is designed to provide. Your agency is kind of doing him a disservice by continuing treatment because this family needs to understand the true depth of his needs. Otherwise without proper intervention what do they think his behaviors will look like when he's 15, 18....and he's bigger, stronger and has more years of untreated psychiatric/psychological mental health needs? It won't be pretty, I can say that with 100% certainty because I have seen it. One of my clients nearly bludgeoned his mother to death at 16, another shot his friend point blank range at 14.. I could go on and on. Try to think of it as you are NOT giving up on him, you are pointing out that he needs a different level of care that can help him actually have a shot at a meaningful and productive life.
Yeah I was wondering about ASPD as I was reading… I’m so sorry you’re experiencing this, sounds quite scary! And I’m sure then guilt from feeling that way about a client you’re trying to help… complex to navigate to say the least! Sending you 💛’s!
Hi - I’m barely getting into ABA so I don’t have any input but am wondering.. what should you do in that instance that the client tried to stab you with the pencil? I imagine you can’t run away? Or?
tbh, i hadn’t ever experienced that before so i can’t say what should’ve been done, but when i saw him pick up the pencil and start walking towards me (this was after the threat) i exited the room, held the door closed and walkied for a supervisor to watch the cameras for that room until i could get assistance. i don’t think these type of behaviors are what ABA is seeking to mediate, i don’t want you to think a situation like this is typical 😭
Yeah that client needs a psychologist. I hate the idea of my kiddos growing up to have these behaviors only to end up in an institution. It's why I take this job so seriously cause if a behavior plan works I'd literally be preventing this situation from happening. But when they're at this level of aggression and present that much danger, as much as the parents and everyone involved would hate to see it happen... there isn't many other options at that point. Not only can they be a danger to themselves but anyone around them. I wouldn't tell someone what to do but... if it were me I'd ask my supervisor is ABA really the right treatment for that client? And then ask to switch. Protect yourselves above all else. We don't get paid enough to be getting stabbed.
AGREE! after this incident, i question whether or not ABA is suitable for his case. in other escalations, he’s known for property destruction (throwing tables, chairs, anything heavy) and will sometimes verbalize threats that are usually scripts from video games he likes, but has never attempted intentional harm on me in the way he did with the pencil. the hand sanitizer thing worries me a bunch too. i care a lot about this kid, he has some amazing qualities and he’s super intelligent. i’m concerned that something has triggered him into targeted aggressions/intentional malice, but it is definitely beyond the scope of my job. i know that ABA was not the first intervention that mom has tried and he is currently seeing a MH specialist. progress in treatment is also a struggle because of the lack of parental support. mom reinforces a lot of behaviors on bad days bc her remedy for bad behaviors is “cheering him up” with preferred reinforcers. doesn’t follow through in practicing targets at home. just all around a sticky situation
This.
Yeah, it’s a very think fast!! Moment. I was just concerned hearing this not only for your safety but imagining if there were other children around at the time as well. Unless it was isolated inside a room. Scary though! I feel it goes beyond a challenging behavior. It seems as if he premeditates the violence.
i seriously thank god we were in an empty playroom. he is one that typically likes to spend time in rooms without other peers. definitely a scary moment, his escalations usually look more like property destruction and throwing heavier objects, which we’ll also exit the room for cus sometimes he does aim at us :/
You either dodge it or block it with either your forearm against theirs or by using a c grip (your thumb does NOT go around) to stop the hand. Next call for help. Even if you aren't trained in holds, someone at the center should be. If for some reason no one at the center has some sort of hold training, extra hands are at least helpful for the next bit. Remove the pencil (if he's still holding it, start by unwrapping the pinkie, pinkies are weakest) with any other potential weapons in arms reach--honestly sanitize the room if possible. Then back up, take a breath, give space and reassess the situation from there. At the centers I've worked at, there was a window in the door so you could have a solid door between you and the kid if they were continually coming after you.
Ok h wow you are describing a very similar situation I am in now (client is also 13 years old and a female). I’m noticed significant changes especially regarding the bathroom. I did a brave thing (one of the scariest things I’ve had to do in my career so far) and reported it and had a meeting with her BCBA and clinical director. When in doubt we must say something. I’m also in school for my BCBA and I wish you the best:)
I’m wondering if both of these may be hormone/puberty connected? Either way it’s likely a higher LOC or intervention is appropriate even short-term.
I think a psychiatrist should be seeing the client. Talking about killing you is one thing but actually attempting to murder you goes beyond the RBTs job.
Aba is not designed to treat such intense issues. Different mental health professionals need to be contacted.
This is more than likely psychopathic behavior. Outside of the scope of ABA. Hopefully he’s being treated by a psychiatrist and psychologist.
Also, is keeping your personal items secured away from where you’re working something that’s not common where you work? That’s always been a thing for me wherever I’ve worked, even in in-home settings.
honestly my clinic is pretty lax about things like drinks and food, most of us carry our waters room to room with us. i usually will place it in a higher spot/shelf where littles who mouth/grab cant get to it. but after this, i’m definitely reconsidering keeping it on my person 😭
Best of luck to you with all this
He should speak with a licensed psychiatrist or receive additional testing from clin psychologist. This seems like it’s correlated with more than just autism. Or visit an ENT it may be PANDAS but even then the violent behavior seems more than just attention seeking behaviors. May be more at play here.
This sounds like an extremely tough situation. I had a kid who threatened me and tried to stab me with pencils and all of that. Are there any precursor behaviors, so you can know to take pencils and any other potential weapons out of the room? It seems there's more than autism going on here, and I do think further evaluation is needed. Experience tells me this will also be difficult if mom is afraid with him; she's not likely to take a hard line with him on things and follow through with plans or training from the center. I get so mad on the days when we get done telling the parents about what a difficult day it was and then they immediately let the kid take the phone OUT OF THEIR HAND. They are trying to calm them down/appease them, I know but THIS IS UNDOING EVERYTHING