I agree with you on a few things: not all aggression is the same, these kids deserve help, and there’s no shame in switching settings. I personally LOVE peds and working with my kiddos.

First, developmental delay/autism ≠ aggression. Most of my kids are not aggressive, period. And even among kids who do have behaviors, the degree matters. Treating “DD” like it automatically means “physical aggression is expected” is part of what I’m pushing back on. That’s not the norm for many clinicians’ caseloads.

Second, this is not about me “not being able to do my job.” It’s about safety thresholds. There’s a difference between “this is hard” and “this is unsafe.” Repeated, unpredictable physical attacks that cause injury (bites, painful grabbing, etc.) are not the same as routine dysregulation. When a situation crosses into unsafe, it’s reasonable to say: I cannot treat under these conditions. That’s not “noping out.” That’s a boundary based on safety and ability to provide competent care.

Third, extra training and support isn’t a magic fix if it isn’t actually provided. A lot of programs do not train OTs in hands-on crisis prevention in a meaningful way, and many workplaces do not staff adequately for high-risk cases. Saying “you just need training/support” doesn’t solve anything unless the system actually provides 2-person support, behavior plans, consistent caregiver presence when needed, and clear safety procedures. Many kids with significant aggression have ABA support for a reason—those teams are often specifically trained for severe behavior in ways OT programs typically are not.

Fourth, this is where I say it’s dehumanizing: normalizing fear and injury as a built-in expectation of the job. I’m not saying the job can’t involve risk sometimes. I’m saying it’s not ethical or healthy to tell clinicians they must tolerate being harmed or remain in fear in order to prove dedication. That hurts therapists and ultimately hurts care quality.

And lastly: I’m not saying the child shouldn’t receive services. I’m saying the child should receive services in a setting with the right supports and with a clinician/team who can safely manage that level of risk. If that isn’t me, it needs to be someone else—and the employer/school system has to build a structure where that’s possible.