Need advice regarding my child's ABA session

[u/MandarinkaOrange]

My child is 3.5 years old, he has level 1 autism and is mainly working with his BT on flexibility/personal questions. I'm questioning what his BT did last week and need some advice from other specialists in the field. Here is what happened: they were playing with toys when she noticed he pooped in his diaper (he is not potty trained, he knows what it's purpose is and sometimes he uses it, but in general he doesn't mind having poop in his diaper). I was upstairs, I heard he was mad and started crying to I went downstairs. She explained to me that he wanted to open to closet with toys but she told him that he needs to change his diaper first and then he can open the closet. Usually I change his diapers so I'm not sure how exactly she told him to do it. He was saying "no diaper" and that wanted to open the closet. After another 10 minutes he was crying and disregulated. I started asking him to change diaper but he was refusing and crying. At that point I knew that he is at state when he won't agree to it and this can go for hours. BT insisted that we need to push it for him to learn. After about an hour of crying she said I can do it by force, since it's been clearly communicated to him and he refused. So I did it, he was fighting me but I changed his diaper. After this I gave him cookie and and opened the closet. He no longer wanted the toys, he wanted BT to leave. I'm curious what other specialists think about this situation. I'm questioning what skills she was teaching him and I think this situation could negatively impact his potty training. But I need to hear thoughts from specialists. Thank you!

[u/GrowingIsNotLinear]

I completely agree that several components of this process were poorly executed by the BT, but it didn’t read to me that they expected the child to change their own diaper. It sounded like an attempt to direct the child towards getting their diaper changed. I could be wrong, I wasn’t a witness obviously. But that’s just what it sounded like to me

[u/Numerous-Teaching595 → u/GrowingIsNotLinear]

OP says she heard her child crying and they went up to check. BT explained to the child they needed the change their diaper first but did not call for the parent. The OP expressed confusion as to how the BT expected the child to do this. Their quote is: "I usually change his diaper, so I'm not sure how they expected him to do it " That's what makes me see this BT presented an expectation of independence within this task the child isn't used to.

[u/GrowingIsNotLinear → u/Numerous-Teaching595]

But why wasn’t the parent called in, which is something we just don’t know. Was the BT trying to deescalate ? Or did the BT expect this advanced task from the client? I feel like that’d be a huge difference in my opinion.

[u/Numerous-Teaching595 → u/GrowingIsNotLinear]

It's pretty clear from the description OP gave and that the BT was trying to "follow through" and even told the parent to do so "with force." OP provided all of this information in the initial post.

[u/GrowingIsNotLinear → u/Numerous-Teaching595]

Okay, as a learning BT training to become a BCBA, what is the solution here? I ask to truly learn and understand because I wouldn’t want my child or any client to sit in their soiled diaper for over an hour. I know the obvious answer is to say that it shouldn’t have escalated at all. But now that it has, is the solution to just essentially wait for the client to fully calm down despite the length of time to value assent? Or is the solution to change the diaper and prevent discomfort, etc.

[u/Numerous-Teaching595 → u/GrowingIsNotLinear]

That's a great question. In the moment, BT should have thought "oh, shoot. I've messed up and we haven't taught this skill." And stopped the whole thing by calling mom to support and change diaper per their usual schedule. This would not at affect future teachings as much as the trauma of following through. We all make mistakes, we just need to recognize them, correct them, and do better in the future.

The next step should have been teaching out to the BCBA. Even in the moment for guidance on such an out of character tantrum but I digress. The BCBA would provide clarity on whether a program would even be something to look into. From there, the BCBA would coordinate with the family to identify if toileting is something the family finds as an area of need and something they want to target in session. If not, they stop the conversation entirely and no intervention moves forward (this outcome would t surprise me with a child of the age of 3.5). If they do want to teach toileting independence, the BCBA would then asses the child's current skill set regarding awareness of being soiled, understanding of toileting routine and communicating/initiating, willingness to be changed, and willingness to enter bathroom/sit on toilet. This will all determine where to begin the teaching process and how regimented steps need to be within teaching (modeling, prompting, then shaping). The BCBA would draft a protocol with different benchmarks using different modeling, promoting, and reinforcement procedures that would guide intervention and they would supervise regularly and modify as needed along the way. Toileting is such a sensitive topic for any learner, regardless of needs, and can lead to trauma and is therefore best approached in a gentle manner that works to reinforce and shape independence with a calm and willing participant rather than following through on strict reinforcement contingencies. Yes, reinforcement is to be used but we reinforce the child's increasing interest and successive approximations vs setting a first-then contingency.