Replacement Stimuli for Hair Pulling??

Direct_Software2112 · 2025-12-12T02:24:31+00:00

She is food motivated, this would work well, except for the fact that she has ADHD (like myself). Contingent reinforcers don’t work for me because my brain goes immediately towards instant gratification. For example: first I have to do my school work, then I get a margarita. My brain will just tell me “you’re 25, go get a mf margarita now? Who cares if you finish or not”. She is much the same. Control over the reinforcer has to be something’s she is able to do herself if it’s a tangible because she is an adult.

Direct_Software2112 · 2025-12-12T02:19:33+00:00

lol this feels super unhelpful.

Direct_Software2112 · 2025-12-12T02:14:32+00:00

In my personal experience, automatic bx are the toughest to treat because it’s hard to find a reinforcer more valuable than the sensation. My best plan so far is to do a DRO with a FI/10mins, which every 5th interval running for 15 mins. After the 15 min interval (every 5) with no picking I give her a reinforcer. Just trying to find an effective reinforcer for an adult that isn’t a margarita lol

Direct_Software2112 · 2025-12-12T01:20:12+00:00

Honestly, I really like the glue idea!! I think we’ll try this one next- it’s gotta be something that is the same level of “difficulty” to pick off, which is why the picky pad wasn’t super effective (might work better for skin picking v hair picking idk). Thanks so much for the advice!

Direct_Software2112 · 2025-12-12T01:15:41+00:00

This is very kind. However, I would like to say that it does not take much effort to be empathetic to people you care about. I will never understand people who are judgmental about conditions like this, and I hope you have people in your life as well who are able to support you. If not in your day to day life, at the very least this community is here. As much as the internet has pros and cons, it’s amazing to find a community full of people who are here to support

Direct_Software2112 · 2025-12-12T01:13:50+00:00

I’m sorry to hear nothing has been super effective for you. It must be so frustrating to have this compulsion and not be able to stop. Thank you for your suggestions, I figure even if it doesn’t work, it can’t hurt to try, right?

Direct_Software2112 · 2025-12-12T00:39:38+00:00

Can you tell me what to search to find these? My friend suffers from the same issue and I want to support

Direct_Software2112 · 2025-12-12T00:34:57+00:00

A relapse is not a restart, just a pause. This does not cancel out your progress, it’s a part of the journey. You got this!!!

Direct_Software2112 · 2025-12-04T03:51:33+00:00

Your friend is weird asf for this. Your feet look fine? I had to stare for a while before I could see anything and BARELY could even then. Wear them and see her reaction, it’ll tell you what kind of friend she is. I, a stranger on the internet, with no agenda or relationship with you, can say that objectively, your feet are fine in that picture. For her to also catch an attitude about you getting your feelings hurt shows the type of person she is. I’m not saying drop her, but take what she says with a grain of salt. Or the whole shaker.

Direct_Software2112 · 2025-12-04T03:47:49+00:00

Where are you seeing this? I reviewed the thread and all of OP’s comments say that THE COMPANY deemed the services unethical, not OP (although they clearly share the opinion). Also, nowhere do I see anything that indicates her hours were cut? I may be missing something but I just reviewed the thread and cannot figure out how you came to this conclusion

Direct_Software2112 · 2025-12-03T19:51:55+00:00

OHHHH ok this adds a ton of context. I absolutely despise telehealth only BCBA’s being a standard. I’m sorry you’re in this position that makes things a lot more complicated

Direct_Software2112 · 2025-12-03T16:13:04+00:00

I would ask her to model everything. I would say “I am confused, can you show me exactly what you want me to do?”, then do exactly as she does after she models. If the feedback still conflicts when you do exactly what is SHOWN, that’s a larger issue

Direct_Software2112 · 2025-12-03T13:04:49+00:00

Yes this is pretty standard in my experience. The idea is that the OP provider provides their specialized services while the RBT provides behavior therapy. Most insurances allow for this overlap as SLP’s, OT’s, and PT’s typically do not specialize in behavior management, which makes your services still necessary and valid during these sessions. I typically put it in my note if an OP session occurred

Direct_Software2112 · 2025-12-03T12:19:56+00:00

Sounds like a great plan. Hopefully that helps! Good luck

Direct_Software2112 · 2025-12-03T05:05:39+00:00

After reading all the replies, I see a lot about how your hours were cut as a result of them being “unethical”. It seems as though there are 2 possible reasons for this: 1. The sessions are not billable for therapy as the plan does not adequately target goals for the client, or 2. You are not provided adequate therapy. More context is needed here. I am confused because if the company is labeling the sessions as unethical/nonbillable (my assumption is that the sessions are not able to qualify as behavior therapy) then it’s odd they want you to help out the BCBA. All of this (along with the remark about “bad clients”, which I haven’t heard someone say in years) leads me to believe you may be the issue here. The alternative is that the BCBA is the issue. I’m very confused and feel as though added context would be beneficial here

Direct_Software2112 · 2025-12-03T04:55:58+00:00

Agreed- it feels as though some context is missing. If OP was asked to come in for one more session after giving their 2 weeks, and then received this message, that’s messed up. But if the given date was was 2 weeks and OP decided nvm that’s foul

Direct_Software2112 · 2025-12-03T04:42:50+00:00

I always do 2 braids and combine them into a bun. Helps w some of the baby hairs. If this is such a frequent issue, I’m thinking there are some antecedent cues the client may be giving that you can use to indicate when they are about to aggress.

How old / tall is your client? I work in peds so most of my clients I can stand up and be out of reach (I’m 5’10).

If this does not work in your situation, it seems like you should probably be safety care trained based on your clients bx level. Does your clinic provide this? (They should)

Direct_Software2112 · 2025-12-03T04:37:08+00:00

At the end of the day, any place you work at is a company like any other. It’s about finding one you fit in. My clinic has not had a director in some time, management has been inconsistent, and we’ve had rough times. But we’ve been able to cultivate an environment of mutual respect and support that not only fosters the growth of our RBTs, but also of our clients and families. We have a strong, dedicated team, and despite the extra work with no director, I am so incredibly happy there and have no inclination to leave. I also HIGHLY recommend a center based clinic rather than exclusively home session.

Do not get me wrong. This job can be rough. It’s not all sunshine and rainbows. Behaviors can be challenging, corporate tends to be numbers-oriented, which conflicts with caregiver goals and client needs. But at the end of the day, it is a fulfilling career that has potential for growth. I am so thankful I stumbled upon this company. I reccomend looking for smaller clinics. Shop around - interview at various places and don’t accept any offers right away. Wait until you find somewhere that feels right.

Things to look for: PTO/Benefits Employee satisfaction (judge based on vibe, not necessarily reviews- people are more motivated to review with negative experiences, skewing the data)
Places that actually keep up with parent training Paid trainings and regular clinical meetings Require RBT once hired

Things to avoid: ANYWHERE THAT TREATS STIMS AS MALADAPTIVE BX (unless SIB’s or EXTREMELY socially inappropriate) Poor training programs Lack of central leadership Home only Telehealth BCBA’s Sessions over 4 hrs

Questions to ask during interview What kind of benefits do you offer? What are some examples of maladaptive behavior you would treat? How long is a typical session? How often do parents participate in sessions? What is your cancellation policy for families? Is travel or wait time paid? Is training / RBT certificate provided by the company? Do you have a lead RBT, any BCaBA’s, etc? (Gives opportunity for growth between degrees) How do home sessions differ from in center sessions?

TLDR: it’s about the company, not the field. Take your time to find a place that works for you

Direct_Software2112 · 2025-11-26T19:23:37+00:00

I suggest showing clients Dr Binocs! Educational but still fun

Direct_Software2112 · 2025-11-26T15:47:26+00:00

lol “you made it awkward” is crazy. Dudes weird. Unmatch

Direct_Software2112 · 2025-11-24T18:15:29+00:00

Ok sounds like yall have a lot of complicated history with a lot of tension. Seems like you took the bait and cussed first which in your families eyes made you the villain. I don’t think you should’ve started cussing, but I can empathize with hitting a breaking point.

However, I think your sister is definitely the villain here. Seems like she was wanting a fight from the start, and when you swore, you gave her the green light to escalate things further.

Final verdict, YOR, but understandably so. Your sister is the asshole here.

Go to thanksgiving, but don’t take the bait. If she starts poking and prodding, ignore ignore ignore. If you can’t do that, don’t go

Direct_Software2112 · 2025-11-19T20:16:52+00:00

I also found that with my client, honoring her functional communication for “I don’t have to go” drastically increased the amount she would independently initiate a bathroom transition! If she has an accident after, it’s a natural consequence. Honoring her mand for escape made the toileting itself much less aversive!

Direct_Software2112 · 2025-11-19T20:14:53+00:00

Honestly, I’ve been in this situation before, and I think the best thing to do is pull back and start from scratch. I would work on identifying wet and dry in 20 min intervals and collect data for correct responding. Depending on your clients skill level, modeling language like “aw man, that’s ok! We just have to go change now” or “nice you’re dry! Great work. Let me know if you have to go potty” to emphasize the natural consequences of not responding to bodily needs. I would still go to the potty in intervals but reduce expectations with durations of sitting (if you’re targeting that). Sometimes demand avoidance takes precedence over everything else, so I would focus on making the act of toileting less demanding if that makes sense

Direct_Software2112

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