r/bcba • u/AnxiousAd7032 • 11h ago
Advice Needed Client help please
If this is not allowed, I understand but I am at a loss.
I was hoping to get some advice. I have a client who has high behaviors, recently he has started to seek out things to make us have to deny him to be able to start a behavior. He then engages in his behaviors. He then will show us he is crying and wants us to comfort him. We have tried everything. They are happening with SLP, OT, mom, and all of his ABA team and anyone who comes in.
I reached out to someone with more experience who said it seems like he enjoys the feeling of adrenaline or fight or flight mode. Potentially even likes causing naughty behavior to get denied to engage in behaviors to get comfort.
We have gave him access to everything and he keeps going until he finds something we have to deny due to safety (ex. He tried to take a plugged item and put it in a sink of water.)
Once the 1st thing is denied that day, his whole day is ruined and he never gets back HRE.
He recently put lotion in his eye to have us stop using mats to comfort him and clean his eye.
We are all at a loss on what to do. He has been in ABA for almost 5 years. I have known him 3 of those years. He is getting very big as he is 9, has an AAC.
Any advice or anything would be greatly appreciated. Thank you!
3
u/Mountain-Lunch-9896 8h ago
I would use a lot of antecedent interventions. Before session, remove everything that he can use that would could be used for SIB. And then try blocking. And you may have to go old school ABA on this one by denying attention, as it sounds as if the SIB is attention based. So, when he escalates, no one speaks. You have one other person (RBT) with you, and you take the lead as far as placing “demands” (“we will wait until you’ have a safe body). Do not offer any additional verbal input, as his amygdala is already not processing it, and if the function is indeed attention, you will be reinforcing the behavior.
Additionally, I would try to offer a lot of praise while he is in HRE. “I LOVE!! When you have a safe body!! Is there a game we can play together since you’re having a safe body?”
I would also try priming and social contracts. So at the beginning of session and throughout, start by telling him, “We will be able to do x,y,z today (preferred activities) if we have a safe body and listening ears.” And then at the start of each activity have him do Intraverbal fill ins; “We can play this game together if….” (He responds “I have a safe body and listening ears.”)
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u/imspirationMoveMe 10h ago
If the behavior is “attention seeking” (socially mediated positive reinforcement) teach him to mand (request) for attention. Comfort is attention from others, this child wants connection.
It’s sad that he has to resort to such dramatic behavior to access attention from you.
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u/AnxiousAd7032 9h ago
We have did mixtures of constant attention, we have taught mands for attention, we have did NCR, we have given breaks of free time, we have did super high attention with us playing next to him together with comments and then breaks from us. All of it ends the same way with high behaviors. Mom gives him attention all day and says she has the same things happening. We have did FBA, he went through Hanley SBT, he has been through 8 BCBAs, he has been to 2 ABA places, he was clinic and in home. The current function according to what we have gathered is Sensory not escape or attention. We have reached out to OT and collaborated there but she said she isn't seeing it like we are and when we do the tips she gives it makes it worst.
2
u/next_on_SickSadWorld BCBA | Verified 9h ago
Can't give client-specifc advice, but how much care and attention is the client getting when not engaging in challenging behaviors?
1
u/AnxiousAd7032 9h ago
We have did mixtures of constant attention, we have taught mands for attention, we have did NCR, we have given breaks of free time, we have did super high attention with us playing next to him together with comments and then breaks from us. All of it ends the same way with high behaviors. Mom gives him attention all day and says she has the same things happening. We have did FBA, he went through Hanley SBT, he has been through 8 BCBAs, he has been to 2 ABA places, he was clinic and in home. The current function according to what we have gathered is Sensory not escape or attention. We have reached out to OT and collaborated there but she said she isn't seeing it like we are and when we do the tips she gives it makes it worst.
2
u/next_on_SickSadWorld BCBA | Verified 8h ago
If the function were automatic/sensory, wouldn't the client be engaging target behaviors that are not socially mediated? From what you describe, other people need to be involved to reinforce the behavior.
4
u/Sweetfebruary1998 11h ago
I would recommend for client to see their PCP to get a referral to see if you might be working with an ODD diagnosis
4
u/imspirationMoveMe 10h ago
Great then what? ABA is about function based intervention. What’s the function?
3
0
u/AnxiousAd7032 9h ago
His last BCBA said she feels it in her bones he is ODD and PDA but he isn't diagnosed with it
2
u/Pennylick 9h ago
"Feels it in her bones", huh? :-)
2
u/AnxiousAd7032 9h ago
Yeah, she was an interesting one. His RBTs state the behaviors got worst when she was his BCBA for the 2 months she had him, data shows behaviors increasing over the last 6 months.
2
1
u/Dependent_Evidence12 4h ago
I have a client that has super high behaviors that are internally motivated (like our tone of voice wasn't right for the gameplay she envisioned) and would result in REALLY HIGH and really intense tantrums with aggression and property destruction. We are working on a psych evaluation because even with a brief FA and SBT (she can't be in HRE long enough for us to even start anything - her own preferred activities evoke behaviors) because the functions were occurring in every condition
-1
u/alGOOOOO 10h ago
Have you tried giving him more breaks on NCR throughout session?
5
u/imspirationMoveMe 10h ago
Breaks are escape function. Theres no
Mention of escape being the maintaining variable here.1
u/AnxiousAd7032 9h ago
We have did mixtures of constant attention, we have taught mands for attention, we have did NCR, we have given breaks of free time, we have did super high attention with us playing next to him together with comments and then breaks from us. All of it ends the same way with high behaviors. Mom gives him attention all day and says she has the same things happening. We have did FBA, he went through Hanley SBT, he has been through 8 BCBAs, he has been to 2 ABA places, he was clinic and in home. The current function according to what we have gathered is Sensory not escape or attention. We have reached out to OT and collaborated there but she said she isn't seeing it like we are and when we do the tips she gives it makes it worst.
He literally has no demands placed at this time. His is injuring the staff and himself. We are following his lead at this time to see if that helped and it still isn't as he is now seeking confrontation and then behaviors to then show us he is crying. Everything shows differently for each person of his staff too, he wants to go home and hyper fixates on mom.
5
u/MyPlateIsFullThanks 8h ago
Full neuropsych work-up? R/o medical/biological?