A Day in the Life of an ABA Therapist in the Field

The author is an Advanced Line Therapist in Milwaukee, Wisconsin. Applied Behavior Analysis (ABA) is a science which works to increase and decrease targeted behaviors in people. Intensive ABA therapy is a method of treatment for children affected by Autism Spectrum Disorder (ASD). His job presents unique challenges, yet he knows that he is helping his clients lead more fulfilling lives. He finds the work infinitely interesting, though physically demanding and exhausting.

My job is going from house to house within the Milwaukee suburbs doing one-on-one ABA therapy with kids who are on various areas of the autism spectrum.

Each child has six to nine people working with them on a team. The people the child sees most frequently are the line therapists, of which there is an average of four per team. The line therapists are trained to be robotic with the children and use simple cause and effect techniques to determine how to manage the child’s challenging behaviors. For example, most of the programs that we do are administered at “table time”. To begin table time, you are instructed to say “come here” or “it’s table time”, one time only. If the child does not come, the therapist must silently stand up and manually guide them to the table, kicking and screaming as they may be. Consistency is key in this line of work.

Most (full time) line therapists average seven hours per week with four kids, give or take, approximately 40 total hours when you factor travel. When I talk to other line therapists and tell them I do upwards of thirty four one-on-one hours per week I usually get a look of amazement, because they understand the demanding nature of the job.

My usual day consists of three shifts of two to three hours, yet by the time the first shift is over I often feel like I’ve just spent a 10-hour day in the sun (which I know because I used to work 10-hour days in the sun). Following this, and travel time, I find myself arriving at a three-hour afternoon shift already beaten and battered (sometimes quite literally). Part of the challenge to my job is remaining positive, partially because some of the kids are so seriously challenged, and partially because by the time I’ve gotten to that last house chances are I’m on your third cup of coffee and my mind is placed solely on the comforts of your own room. Throughout my time with the company I have realized that the child learns best when they perceive you as fun, and enjoy spending time with you. I am a naturally animated person who unashamedly participated in theater in high school, so I know how to access the extra energy even when I’m already burnt out.

I am an advanced line therapist. Which means I’ve been on the child’s team for a while and have the ability to help train new staff. The longer I’ve worked with ABA therapy, the more I’ve learned about the business side of managing a  service like this one. Turnover is high. More frequently, the position of advanced line therapist is merely relied on by management to complete time consuming paperwork such as data sheets and progress notes in an efficient manner. My position is overseen by seniors, supervisors, and leads. These people make up the members of the child’s team. I’m a recent college graduate, so I don’t have specialty training in therapy or in working with kids on the autism spectrum. While I did have to go through training before beginning my work, the company I work for employs somewhere around 500 people and I am completely replaceable. If I commit to this positi0n long term, there are opportunities for advancement, and I find the work rewarding enough that I may stick around. Despite the exhausting nature of the daily work, it’s rewarding to see kids improve in the way they’re able to interact and express themselves.

Every child has different needs. The rules can be bent or broken depending of the circumstances surrounding each child. For example, I am on the team of one child where we do programs on the floor (as opposed to the table) in context with our play. With this child, there is no determined beginning or end to “work time” as we might call it. With each house you need to go through a mental tally chart in your mind of all the conflicting needs of the child as well as the expectations of family. The day becomes a mental game of whack-a-mole regarding which technique to use while managing a particular behavior.

The work is endlessly interesting. One of the kids I work with engages in a screeching and wandering behavior when undesired things take place. An example of such an event is the internet going out, or the loss of a toy animal. He will put his hands on his ears, protrude an under bite, and stomp his feet widely as he paces around the living room screeching at a tight wavelength. I assume the wavelength of the sound is tight because it is high pitched and rattles the eardrums when done properly by the child. His goal during this bout seems to be hitting this particular wavelength, and using his imagination to escape the situation. Our senior therapist’s behavior plan includes us blocking the wandering behavior so that the child literally cannot wander. The screeching, on the other hand, seems to be a deeper seeded issue. We usually try to give the screeching child incompatible behaviors, like telling the child to say things (such as “I don’t like that”), because you cannot screech when you are talking. We also have many teaching programs in place regarding the use of language.

Overall, my work is challenging, and deeply rewarding. I see the kids make great strides each day. O.K., sometimes it’s just baby steps, but progress is progress and every step counts. I’m working on adjusting my expectations and I’m looking forward to where this experience takes me.

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