A Day in the Life of a Behavior Technician

*due to the nature of my job, names, ages, and any other identifying information has been changed in order to ensure confidentiality

7:00am. The boisterous rhythm of Cantina Band from the Star Wars soundtrack blasts in my ears. I startle awake. Why did I think trumpet-playing aliens would be a good way to start my morning? I reach my hand under my pillow to find the source of the noise. I shut it off quickly. I look over at my love peacefully snoring in a dream-filled bliss, unaware of the alarm that had gone off. I lay on my back and stare at my ceiling.

Monday. Alright. I have two clients today. I have an appointment with my BCBA at 2:30. I have at least two assignments I need to finish for school. Hm, maybe I should have chicken and rice for dinner. I should probably take the chicken out of the freezer.

I hoist myself out of bed and into the kitchen. The light streams in from my balcony door, creating a simple square of light on the floor of my otherwise dark apartment. I take out my Starlord mug and put a k-cup in my Keurig. My eyes glaze over as I watch the coffee stream into the mug. I spend about twenty minutes scrolling aimlessly through Instagram and Facebook. I check the time. 7:30am. I finish the coffee and put the mug in the sink. I tip-toe back into the bedroom and get ready for the gym.

10:00am. I sit on the couch eating breakfast. I opted out for frozen protein waffles and Nutella, you know, for balance. I check my email and write a small section of the new book I am working on. At 10:30, I grab my backpack, car keys, and work iPad and head down to the garage. I stop at the Dunkin across the street from my apartment. I know everyone there on a first-name basis. When I walk in, I’m greeted by the friendly faces of the morning crew.

“Small iced coffee with pumpkin and cream, power breakfast sandwich with no egg, and hash browns?” The employee asks. I pull my debit card out of my wallet. “You already know,” I reply. They give me my food and drink and wish me a good day. When I get in the car, I put on my favorite podcast and drive over to my first client’s house.

My first client is six-years-old and nonverbal. She has Autism Spectrum Disorder as well as a couple of other processing disorders. She is adorable, but she can get feisty. I have only been working with her for about five months, but her and I have formed a strong therapist-client relationship. I never know what to expect from her. One day she can be the perfect little angel. The next day she’ll try and throw the kitchen chair at my head.

11:30am. I take a deep breath and knock on the front door. My client’s teenage sister opens the door. She smiles at me with her eyes and runs back to her room. I walk down the front hallway and into the living room. My client is sitting on the floor with her iPad. She does not look up when I walk in the room. I set my backpack full of materials and iPad on the floor in front of her. “Hi Amanda,” I say. She looks up at me, recognizing her name, and then puts her iPad to the side. “Thank you for putting your iPad away”, I say. She gives me the signal for ‘help’, which consists of clasped hand above her head. “Thank you for saying help!” I exclaim, poking her belly. She shoots her arms down and giggles. “I can help you with the backpack.”

With a grunt, I haul the backpack over my shoulder and open it up. I rummage through the books and toys. I pull out one of her favorite books, Cinderella, and a toy Barbie doll.

“Which one are we going to work for today?” I ask. She takes the book and the Barbie out of my hands. She sets the Barbie aside and rifles through the book. I take the time she looks through the book to set up the session on my iPad. She then puts the book aside and picks up the Barbie. After a second of contemplation, she hands me the book. She gives me the sign for ‘more’, which consists of hitting her two fists together in the center of her chest. I pick up the book and say, “Okay, Amanda. Thank you for choosing the book. Before we read, we are going to do our numbers.” I take out my number flashcards and set three down in front of her. “Point to ‘one’,” I say. She picks up the card with the number 1 on it and hands it to me. “Awesome job picking up the 1,” I praise. I take the cards away and set down three different cards. “Give me the 4,” I demand. She looks over the cards for a second and hands me the card that says 5. “Oh, not quite,” I say. I point to the card that says 4. “This is four,” I correct her. Amanda furrows her brow in frustration. “Let’s try again.” I leave the card that says 4 and replace the other two distractor cards. “Hand me that card that says 4,” I demand again. She starts to pick up the card that says 10. I immediately point to the card that says 4. “This is four”, I correct her again. Amanda lets out a shriek and tears up the card that says 4. Well, now I know how today is going to go, I think.

About halfway through the session, Amanda’s mom comes down the stairs and into the living room. “Hi Elizabeth. Happy Monday,” She says cheerfully. “Happy Monday,” I reply. Amanda’s mom walks over and crouches down. Amanda leans into her mother and makes a high humming noise. “I have good news,” Amanda’s mom says. “Oh? What happened?” I ask. Amanda’s mom looks at her daughter proudly.

“So, you know how we’ve been working on building her social skills with other kids? Well, Saturday, we took her to the park. There was another little girl there with her parents. It turned out that this littler girl was deaf, and when she realized Amanda couldn’t speak she signed with her. They were nearly inseparable, Elizabeth. That was the first time Amanda made a friend on her own.” Amanda’s mom started to tear up. I could feel the pride and the relief coming from her. “That’s incredible!” I nearly shout. “That…that is amazing. Wow. That is some incredible progress from the last time you took her to the park. I am so proud of you Amanda! You made a friend!” Amanda smiled.

1:30pm. I walk out of the house and back to the car. The session was hit or miss. Amanda only threw a tantrum twice today, but they lasted about fifteen minutes each. She had also bit me at one point. I look down at my arm. There was a tiny imprint of where Amanda had decided to take a chunk out of me.

2:15pm. I make it home just in time to heat up some leftover dinner from the night before. Fifteen minutes later, I get a call from my BCBA, Susan.

“Hey Elizabeth,” Susan says, “I’m glad we could coordinate this meeting. It should only take about thirty minutes. At 3:00 make sure you go into the portal and input this time into the billing services, so you can get paid for it. Anyways, I just wanted to check in and see how you were doing?”

“I’m doing okay,” I say with a mouthful of pasta. “Amanda bit me today, which she hasn’t done in a long time. I included it in my notes from today, of course. Just took me back a little bit.” Susan was quite for a moment. “She bit you?” I take another bite of pasta. “Yeah, and it was weird because she wasn’t exhibiting any signs of frustration. I can’t pinpoint the antecedent. I was playing Barbies with her and the next thing I knew she was dangling from my arm like a piranha. I brushed her off of me and ran a smaller target because I figured it was just for attention and I did not want to reinforce it verbally.” Susan made a hm sound. “Well, that is abnormal behavior. If it happens again let me know. If it happens more than three times this week, I’ll add it back into the portal as a behavior to keep track of officially.”

“Sounds good, Susan.”

“Well, I don’t have anything to modify, target wise. I just wanted to let you know that all of the data looks really good, and she’s tracking on all of her targets and behavior reductions. I have to file my quarterly report to the clinical supervisor and insurance company. You’re doing an amazing job. Keep it up. I’ll be in for supervision on Wednesday.”

“Thank you, Susan. I appreciate it. Have a great day.”

4:30pm. I pull into the driveway of my second client’s house. He is nine-years-old, also nonverbal. He also has Autism. He is a little bit more cognitively underdeveloped. I am still teaching him the alphabet and basic numbers. I have been focusing more on his fine motor skills lately. He has difficulty gripping things like pencils and the tips of his shoelaces.

I knock on the door and wait. No answer. I look at my phone. That’s weird, I think. His dad is usually home by now. I knock on the door again. After a couple of minutes, I pull out my phone and text the BCBA for this client.

Hey, Dave. MH doesn’t seem to be home. I’ve waited about ten minutes. The house looks dark. Can you text dad and see what’s going on?

After a minute I get a response.

Hey. Sorry. I meant to tell you. MH’s grandma is in the hospital. Dad had to take him last night to the hospital. He hasn’t texted me back all day. If the house is dark and no one answers the door in the next five minutes, go ahead and go home. Don’t forget to go into the portal and cancel the session under ‘client cancellation’.

I knock on the door again. I wait another few minutes. No one answer. Oh well, I think. At least this gives me more time to work on my grad school assignments.

5:30pm. I arrive back at my apartment. I put on Netflix and open my laptop. I have two assignments to complete: a discussion board post and an article review.

“Hey, how was your day?” My boyfriend asks as he pokes his head around the corner of the kitchen.

“It was fine…Client 1 bit me today.” He walks over to me. “She bit you? Where?” I unroll my sleeve and show my boyfriend my arm. “Oh wow,” he says. “Yeah, she did bite you.” I rub my temple with my fingers. “She hasn’t done that in ages,” I say. “It came out of nowhere. I don’t know what I did wrong.” My boyfriend pulls up a chair next to me and sits down. “You didn’t do anything wrong,” he says. “Being a behavior technician is hard. It takes a very special person to do it. I definitely couldn’t do it. You’re building the foundation for these kids to developmentally succeed. Who knows where these kids would be if It wasn’t for the work you do now, even on the bad days.” I smile at him. “You’re right, what I do is important. These kids deserve just as much love and success as any ‘neuro-typical’ kid.” I turn back to my computer reminded of my purpose.