My first impression of ABA Therapy as someone with PTSD

By Laura Roman-Rantz

July 28th, 2023 I had no idea what was in store for me when I applied to Triangle ABA’s Registered Behavior Technician (RBT) position early June of this year.

As I took a final glance over my resume upon submission, I could not help but notice how it highlighted many of my life’s most surprising endeavors; the first piece I ever published was written for a small exercise in my creative writing class. I remember how, in spite of the prompt being seemingly straightforward, I became overwhelmed with inspiration to share my personal struggles living with post-traumatic stress disorder (PTSD).

I was unaware of how impactful this anecdotal piece would be for the remainder of my ongoing career, as it has continuously landed me roles in social activism and creative writing again and again. None of these experiences, however, have involved working with children or clients on the spectrum, and the built-in anticipation kept me on my toes until the day I finally received a job offer one afternoon.

Not only as an RBT, but as a social media writer.

Understanding and Identifying Challenging Behaviors

Before we address challenging behaviors in children with autism, it’s essential to understand and identify the various forms these behaviors can take:

• Aggression: Physical aggression, such as hitting, biting, or pushing others can cause harm to both the child and those around them.
• Self-Injury: Self-injurious behavior such as head-banging, scratching, or pinching oneself can pose significant risks to the child’s physical well-being.
• Disruptive Actions: Behaviors such as excessive screaming, throwing objects, or engaging in repetitive actions can create disturbances in the child’s environment and disrupt daily routines.
• Noncompliance: A refusal to follow instructions or comply with requests can limit the child’s ability to participate in essential activities and learn new skills.

INITIAL FEELINGS AND THOUGHTS

I arrived at the Hillsborough Street location in a thrilling flood of emotions that I kept hidden within the summer sweat of North Carolina humidity—it was my first day working for the company, and I was starting one of my roles as a Behavior Technician in training. I was anxious to learn more about what the terms “applied behavior analysis” actually meant in regards to the clinician’s care towards clients on the spectrum. While I had experience in the field of social work as someone with access to therapeutic resources, I had little to none when it came to being the therapeutic resource that other people refer to. This change in dynamic, in combination with my lack of experience with kids, made me especially nervous. The what-if questions flooded my mind: what if I am terrible at interacting with the clientele? What if I end up being so overwhelmed in the moment that I emotionally shut down at the expense of families who need our services?

What if I am not cut out to be an RBT?

FIRST IMPRESSIONS OF ABA

I was sat down in the intake office and given a packet of information detailing the services provided by the RBT and Board Certified Behavior Analyst (BCBA). I was introduced to many concepts backed up by decades of studies in behavioral science—more particularly, the formula that many Behavior Analysts would consider the bare bones of any behavior at a given time:

1. The antecedent, or the thing that happens before the behavior
2. The behavior itself
3. The consequence(s) of that behavior, which simply boils down to what happens after the behavior occurs

I imagine the amount of other people sitting in a chair scratching their heads at the simplicity of the definition—I certainly was in the moment of it being read out loud to me. However, it soon clicked: that Friday, I observed Amber Nelms presenting ABA therapy to families and parents who—like me—were in a similar state of wondering. But unlike the technicalities that were outlined in printer ink, she presented a scenario that was all too familiar:

“Let’s say you are trying to get your child to leave their shoes at the door,” she began as she acted out her entering her home. “When you first open that door, you want to present a stimulus—in this case, it would be for you to tell your child to take off their shoes. If they do not respond, you would provide them with prompting of some kind to indicate that they need to do something with their shoes. It could be you pointing at their shoes. Maybe you take off your shoes to model what taking off shoes looks like. You could also gently push down their elbows in the direction of their shoes. Or, if needed, you could put your hand on theirs and guide them in what we would call a full physical prompt to take off their shoes whenever they come through the door.

“But once they master this skill, there’s a new challenge: the stimulus, or the thing that indicates the behavior, is not them entering through the door, but you vocalizing for them to take off their shoes. So now, you would start to engage in what behavior analysts call stimulus transfer procedure. This basically means that you transfer the stimulus from you telling them to take off their shoes to the actual act of entering through the door, which is done by removing the instructional prompt—in this case, the verbal instruction for the child to take off their shoes—slowly over time. Immediately, once they engage in that response, they get some form of reward.”

In other words, using the ABA terms discussed earlier, the stimulus in Amber’s stimulus transfer scenario would be the act of walking through the door instead of the parent telling them to leave their shoes at the door. The child’s behavior would then be to take off their shoes before consequently going anywhere else in the house.

IT’S MORE THAN JUST “THERAPY”

Upon hearing her explanation, the anxieties I felt towards the technicality of the terms waned into more recognizable circumstances whenever I left the office; like the way my pets meow and bark in anticipation whenever my husband and I arrive at our apartment door and take out our keys, because they recognize that they get to spend time with us. How my husband gets excited when he notices that gas prices are a dollar less than the inflated amount which motivates him to fill up his tank even when it is not empty. How I end up pulling out my phone whenever I notice it buzzing because I want to make sure I did not receive any urgent messages.

What’s more is that this seemingly simple concept of a “first this, then that” goes even further than I realized in other daily occurrences I experience as a result of my trauma. Like the way my anxiety elevates every time my husband and I go to bed because I may or may not experience a series of nightmares or even sleep paralysis—as a result of this, I watch videos that distract me from my own rapid thoughts so that I may fall asleep.

It is in these moments where the true intentions behind Triangle ABA’s therapeutic services presents itself still in my mind as calm lake water: that, while the RBTs and BTs implement programs that the BCBAs design to help the clients build skills so that they may live as independently as possible, they do this without trying to force neurodivergent people to be neurotypical—a mentality I wish I had experienced consistently myself when going through intense treatment. I may not be on the spectrum, but I do have a condition that will persist for the rest of my life. I know that I cannot eliminate it, but I can find ways to help me work through symptoms that interfere with my ability to carry out tasks such as leaving my apartment to take my dog out for a walk alone, meeting with a professor during office hours, or—as mentioned prior—simply being able to fall asleep at night. Nevertheless, I—as well as countless others—have encountered immense amounts of family, friends, and associates in the workplace who approach my symptoms too literally as though they could be cured–

That woman interprets the smallest gestures as personal attacks, she’s allowing these people to get to her, I don’t understand why she can’t just get over those events in her life when it’s all in her head, she just has to take antidepressants and she will be in the right state of mind again. How is that so hard?

—but the reality of these perceptions is that they completely overlook some of my strongest qualities that are intertwined with having post-traumatic stress disorder: I have a lot of empathy towards others who experience similar social boundaries. I never make judgments too quickly; I observe a new person’s behavior over consecutive periods of time and consider potential factors that either increase or decrease a set of actions they engage in. All are characteristics that perhaps would not exist now in shining prominence had I not gone through the series of obstacles that were thrown my way as a young girl—although it is true that what I went through was inexcusable, I am still very appreciative that I carry those traits in my work today.

DISCOVERING THE MISSION AT TRIANGLE ABA

I noticed a similar type of accession whenever I was assigned to other RBTs and BTs to observe how they interact with a client during their sessions. Therapists always prioritized the wellness and personal expression of their clients—this could mean that, while a demand could be placed for the client to wait for a consecutive period of time, they could occupy themselves with any kind of stimming behavior. There is never a form of judgment expressed towards the client or procedure written by the BCBA to reduce those behaviors because of how they do not interfere with the client’s ability to comply with the task. In fact, giving clients a space where they are able to express themselves freely is an ongoing conversation that happens everyday at the clinic—if BCBAs and RBTs do not have to reduce those behaviors, then they won’t, because there is no harm in what the client finds comforting or enjoyable.

Additionally, there are several sections during training that prepare future BTs and RBTs—like myself—to maintain client dignity. Most of this is outlined in an Ethics Code that is updated every year by the Behavior Analyst Certification Board, otherwise known as the BACB. They are a nonprofit organization that was created in 1998 “[…] to meet professional certification needs identified by behavior analysts, governments, and consumers of behavior-analytic services” as detailed under the about page of their website. Their primary goal “[…] is to protect consumers of behavior-analytic services by systematically establishing […] professional standards of practice[,]” which include treating clients with respect and dignity as outlined in their Ethics Code for Behavior Analysts. Much of the information provided in the Ethics Code is heavily tested in the exam for RBTs and BCBAs to obtain their official certification. If at any point an RBT or BCBA is suspected of violating these core principles that ensure the ethical treatment of a client, they are liable for their practices to be shut down while also having their license revoked.

While such core principles are written in technicality, the reality is that the members of the community at Triangle ABA are always considering the overall wellness of their clients because of how much they are concerned about providing a positive experience so that they may leave the clinic not only having developed new skills, but also feeling assured in their own self-expression.

“It’s not about reducing quirks,” Amber emphasized during one of our meetings when discussing her own mission and purpose for starting the company. “It’s about developing skills to help them be as independent as they can while also embracing their beautiful qualities.”

FINAL THOUGHTS

Looking back to when I first received that job offer, I personally feel strongly about the strength of the community’s passion; I initially applied aiming for the role of a Behavior Technician and ended up opening the email in tears to find that they not only recognized my past experience with writing and social work, but also the aspirations I have for making a positive impact for families and communities everywhere through the spirit of my own creative expressions. To see that same supportive approach and care during the application process being taught and highlighted throughout each room of the clinic is so relieving when I reflect on the numerous horrid experiences I have faced as a result of people punishing me for having more eccentricities. It makes me feel confident that—in the harsh sea of a world that subjects neurodivergent people to feeling belittled about themselves for being different—there is our little clinic nestled on Hillsborough Street, glistening brightly under the sun in the bustling city of Raleigh.

Where people are celebrated for being human.

Resources

Behavior Analyst Certification Board. (2023, June 22). Bacb – about the bacb. https://www.bacb.com/about/ Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. https://bacb.com/wp-content/ethics-code-for-behavior-analysts/

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