Can PTSD Be Mistaken For Autism?

Discover the connections and challenges in understanding these complex conditions.

August 24, 2024

Understanding Autism and PTSD

Autism Spectrum Disorder (ASD) is a complex condition related to brain development that impacts social interaction, communication, and behavior. The term "spectrum" signifies the wide range of symptoms and severity observed in individuals with this condition. Some signs of autism may appear in the first few months of life, while others can become noticeable much later.

Children with ASD may demonstrate varying levels of intelligence and learning abilities. Some may have difficulty learning and show signs of lower than normal intelligence, while others may possess normal to high intelligence but struggle with communication and social situations. The severity of ASD can range from low functioning to high functioning, depending on the level of impairments and their impact on daily functioning.

Characteristics of ASD:

Social Interaction: Challenges in understanding social cues and forming relationships.
Communication: Difficulty in verbal and non-verbal communication skills.
Behavior Patterns: Limited and repetitive behaviors or interests.

Post-Traumatic Stress Disorder Overview

Post-Traumatic Stress Disorder (PTSD) is a mental health condition triggered by experiencing or witnessing a traumatic event. It can affect individuals of any age, including children. Symptoms may include flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about the event.

PTSD can manifest in various ways, and its effects can be particularly complex when experienced by individuals with ASD. While both conditions can lead to difficulties in social interaction and emotional regulation, the underlying causes and symptoms may differ significantly. Understanding these differences is crucial when considering whether can PTSD look like autism?

Symptoms of PTSD:

Flashbacks: Reliving the traumatic event as if it is happening again.
Avoidance: Steering clear of reminders of the trauma.
Hyperarousal: Heightened anxiety and vigilance, leading to difficulty sleeping or focusing.

Recognizing the distinctions between autism and PTSD is essential for effective treatment and support. Further exploration of the relationship between these two conditions will provide insights into their overlapping symptoms and challenges. For more information, refer to our section on autism and PTSD similarities and differences.

Prevalence of PTSD in Autistic Individuals

Research indicates that individuals on the autism spectrum are more likely to experience Post-Traumatic Stress Disorder (PTSD) compared to the general population. A 2021 survey involving 687 autistic adults revealed that approximately 44% of participants met the criteria for a PTSD diagnosis. This is significantly higher than the estimates for non-autistic individuals, where the prevalence of PTSD is around 4.5% [3].

Furthermore, studies suggest that about 60% of autistic individuals report having probable PTSD at some point in their lives, compared to just 4% of non-autistic individuals. The reasons for this increased prevalence are not fully understood. However, it may be linked to the way autism influences perceptions of danger, alongside the stigma and abuse often faced by autistic individuals.

Population Group & Prevalence of PTSD (%):

Autistic Individuals: 44%
Non-Autistic Individuals: 4.5%
Autistic Individuals (Lifetime): 60%
Non-Autistic Individuals (Lifetime): 4%

Overlapping Symptoms and Challenges

Identifying PTSD in autistic individuals can be particularly challenging due to overlapping symptoms between the two conditions. Both autism and PTSD can manifest in similar ways, such as heightened anxiety, social withdrawal, and difficulties with communication. This can lead to misdiagnosis or underdiagnosis of PTSD in autistic individuals.

Autistic women, genderqueer individuals, and BIPOC (Black, Indigenous, and People of Color) autistics are at an even greater risk of experiencing trauma and developing PTSD. Autistic women, for instance, are 1.5 times more likely to be victimized than their non-autistic peers, making them more vulnerable to PTSD after a traumatic experience.

Additionally, individuals with PTSD may develop coping mechanisms that can mimic some traits of autism, such as repetitive behaviors or avoidance strategies. Understanding these complexities is crucial for caregivers and professionals working with autistic individuals to ensure appropriate support and treatment. For more insights into the similarities and differences between autism and PTSD, consider reading our article on autism and ptsd similarities and differences.

Diagnosis and Differentiation

Understanding the differences between autism and PTSD is crucial for providing appropriate support. Both conditions can co-occur, leading to challenges in diagnosis and treatment.

Challenges in Diagnosing PTSD in Autism

Diagnosing PTSD in individuals with autism can be complex. Symptoms that may indicate PTSD can overlap with behaviors typical of autism. According to Medical News Today, a comprehensive evaluation by a psychologist is essential for accurate diagnosis. This complexity is further compounded by a phenomenon known as "diagnostic overshadowing," where the presence of one diagnosis may obscure the recognition of another.

Recent studies indicate that previously, less than 3% of autistic individuals were believed to have PTSD, a rate similar to that of typical children. However, the recognition of PTSD among autistic individuals may have been underestimated, suggesting that many may experience some form of trauma response.

Diagnosis Challenges:

Overlapping Symptoms: Symptoms of PTSD may mimic behaviors associated with autism.
Diagnostic Overshadowing: One diagnosis can prevent the recognition of another condition.
Low Recognition Rates: Historically low rates of PTSD diagnosis in autistic individuals may be inaccurate.

Differentiating Between Autism and PTSD

Clinicians face the significant task of distinguishing between autism and PTSD to ensure that individuals receive the correct support. It is possible for autistic individuals to develop PTSD and Complex PTSD (C-PTSD), similar to anyone else. Studies suggest that while autistic individuals may be at a slightly higher risk for PTSD, the reported rates remain low.

Diagnostic criteria for PTSD may not be fully sensitive to the unique presentation of symptoms in autistic individuals. As a result, healthcare professionals must be well-versed in the nuances of both conditions. Differentiating these two disorders is essential in order to provide tailored interventions.

Differentiation Factors:

Co-occurring Conditions: Autism and PTSD can coexist, complicating diagnosis.
Unique Symptom Presentation: PTSD may manifest differently in individuals on the autism spectrum.
Need for Specialized Training: Mental health professionals require training to recognize overlaps and distinctions.

For more information on how these conditions intersect, check out our article on autism and ptsd similarities and differences. Understanding these aspects helps ensure that both conditions are appropriately addressed, leading to better outcomes for individuals affected by them.

Unique Manifestations of PTSD in Autism

Individuals on the autism spectrum may experience PTSD in ways that differ from the typical presentation of the disorder. Autistic children often have more reactive nervous systems, which can lead to increased hyperactivation after experiencing trauma. This hyperarousal may manifest in several specific symptoms, including:

Increased Startle Response: Autistic individuals may be more easily startled by sudden noises or movements.
Insomnia: Difficulty falling or staying asleep can be more pronounced in those with autism and PTSD.
Anger and Anxiety: Heightened feelings of anger or anxiety can disrupt daily functioning.
Concentration Difficulties: Challenges in focusing may be exacerbated by both autism and PTSD.

Recognizing these unique symptoms is essential for timely intervention and support.

Trauma Effects on Autistic Children

The effects of trauma on children with autism can sometimes overlap with the characteristics of autism itself. Preliminary studies indicate that trauma may exacerbate existing autistic traits, leading to regression in skills, communication difficulties, and increased stereotyped behaviors.

Children on the autism spectrum may interpret questions about their trauma differently, often avoiding discussions about their experiences. Their communication challenges can hinder participation in traditional trauma-focused therapies, which require a certain level of abstract thinking and conversation skills.

Additionally, behaviors such as repetitive play and communication difficulties may emerge after a traumatic event, making it essential to differentiate between PTSD and autism. Some of these behaviors can be misinterpreted as signs of autism when they are, in fact, rooted in trauma [7].

Understanding these nuances allows caregivers and professionals to provide tailored interventions that effectively address the needs of autistic individuals experiencing PTSD. For more information on effective therapies, explore the role of virtual reality in autism therapy.

Treatment Approaches

Understanding the appropriate treatment approaches for individuals with both autism and PTSD is essential. Tailored interventions can address the unique needs of these individuals, while also considering any comorbid conditions they may face.

Tailored Interventions for Autistic PTSD

For individuals with autism experiencing PTSD, treatment often requires a customized approach. NICE guidance suggests that trauma-focused psychological treatments, including trauma-focused cognitive behavioral therapy (CBT), are effective for both adults and children with PTSD [6].

In autistic individuals, PTSD may manifest differently, leading to symptoms such as hyperarousal, which includes being easily startled, insomnia, anger, anxiety, and difficulty concentrating. Recognizing this specific form of PTSD can aid in early detection and tailored interventions.

Treatment Type:

Trauma-Focused CBT: A structured therapy that helps individuals process traumatic experiences and develop coping strategies.
Play Therapy: A method often used with children, allowing them to express feelings and experiences through play.
Autism-Specific Trauma Assessments: Tools being developed to better identify trauma-related responses in autistic individuals.

Preliminary studies indicate that addressing both autism and PTSD together can be beneficial due to the overlapping symptoms and challenges faced by these individuals.

Addressing Comorbid Conditions

It is important to recognize that autistic individuals are at an increased risk for various comorbid conditions, including substance abuse disorders. This risk is similar to that of individuals with PTSD, as substances may be used to manage a hyperactive nervous system.

Clinicians should be aware that symptoms like withdrawal from peers, rigid play, and angry outbursts may not solely indicate autism; they could be signs of PTSD, especially in children with a known trauma history.

To effectively treat individuals with both autism and PTSD, it is essential to develop a comprehensive treatment plan that addresses all relevant conditions. This may involve:

Integrated therapy sessions that focus on both autism and trauma.
Support groups that cater to the unique needs of autistic individuals with PTSD.
Continuous monitoring for signs of substance abuse and other comorbidities.

Understanding how to best support individuals with these overlapping issues can lead to more effective treatments and improved outcomes. For further insights, explore the role of virtual reality in autism therapy and how it may offer innovative solutions for managing PTSD symptoms in autistic individuals.

Support and Awareness

Recognizing Signs and Providing Support

Understanding the signs of PTSD in individuals who may also exhibit symptoms of autism is essential for providing effective support. Children who have experienced trauma, such as emotional and physical abuse, may show behaviors often associated with autism, including repetitive play and communication difficulties. These behaviors can sometimes be misinterpreted as signs of autism when they are actually related to PTSD.

It is crucial for caregivers and family members to be aware of these overlapping symptoms. Features like withdrawal from peers, rigid play, and angry outbursts could indicate PTSD, especially in children with a known trauma history. Recognizing these signs can help in providing appropriate support and interventions tailored to the individual's needs.

Behavior & Possible Interpretation:

Withdrawal from peers: May indicate PTSD rather than autism.
Rigid play: Could be a sign of trauma response.
Angry outbursts: Often misattributed to autism but may stem from PTSD.

Awareness and education about the differences between autism and PTSD can significantly enhance the support offered to individuals facing these challenges. For more insights on the similarities and differences between these conditions, check out our article on autism and ptsd similarities and differences.

Training for Professionals in Diagnosis

Training mental health professionals to recognize signs of childhood trauma is vital to avoid misdiagnosing PTSD as autism. Awareness of PTSD in children has been limited until recently, leading to symptoms being mistaken for more familiar childhood diagnoses like Autism Spectrum Disorder (ASD).

Clinicians need to be equipped with the knowledge and skills necessary to differentiate between autism and PTSD. This involves understanding the unique features of both conditions and recognizing when they may overlap. Effective training can help ensure that children receive the appropriate support they need for their specific conditions.

By fostering a better understanding of these conditions and their symptoms, professionals can provide more accurate diagnoses and improve the overall care provided to individuals with autism and PTSD. For more resources on autism and how it relates to other conditions, consider exploring topics such as is autism a trauma response? and the role of virtual reality in autism therapy.

References

[1]: https://www.canada.ca/en/public-health/services/diseases/autism

‍[2]: https://www.mayoclinic.org/diseases-conditions/autism-spectrum-disorder/symptoms-causes/syc-20352928

‍[3]: https://www.medicalnewstoday.com/articles/autism-and-ptsd

‍[4]: https://neurodivergentinsights.com/misdiagnosis-monday/ptsd-and-autism

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How To Find A Great BCBA Supervisor

Understanding the Role of a BCBA SupervisorWhen seeking autism treatment, finding the right Board Certified Behavior Analyst (BCBA) supervisor is crucial. A BCBA supervisor plays a vital role in overseeing and guiding the treatment process for individuals with autism. Let's take a closer look at what a BCBA supervisor is and why their role is essential in autism treatment.What is a BCBA Supervisor?A BCBA supervisor is a professional who has earned board certification as a behavior analyst and has extensive experience working with individuals with autism. They have completed advanced coursework, gained hands-on experience, and passed a rigorous examination to obtain their certification.Typically, BCBA supervisors work directly with individuals with autism, their families, and a team of behavior technicians or therapists. They design and implement behavior intervention plans, assess progress, and provide ongoing supervision and support to ensure effective treatment.The Importance of a BCBA Supervisor in Autism TreatmentA BCBA supervisor plays a crucial role in the success of autism treatment. Here are a few key reasons why their involvement is vital:Expertise and Knowledge: BCBA supervisors possess specialized knowledge and expertise in applied behavior analysis (ABA) and autism treatment. They stay up-to-date with the latest research and best practices, enabling them to provide evidence-based interventions tailored to the unique needs of each individual.Treatment Planning and Oversight: BCBA supervisors are responsible for developing comprehensive treatment plans based on thorough assessments. They oversee the implementation of these plans, ensuring that interventions are appropriate, effective, and aligned with the individual's goals and needs.Supervision and Training: BCBA supervisors provide ongoing supervision to behavior technicians or therapists working directly with individuals with autism. Through regular meetings and observations, they offer guidance, feedback, and training to ensure the highest quality of care and treatment fidelity.Data Collection and Analysis: BCBA supervisors monitor and analyze data collected during the treatment process. This data helps them evaluate progress, make data-driven decisions, and modify intervention strategies as necessary.Collaboration and Advocacy: BCBA supervisors collaborate with other professionals, such as speech therapists, occupational therapists, and educators, to ensure a comprehensive and integrated approach to treatment. They also serve as advocates for individuals with autism and their families, helping them navigate the healthcare and educational systems.Finding a qualified and experienced BCBA supervisor is a crucial step in the autism treatment journey. Their expertise, guidance, and support can make a significant difference in the progress and overall well-being of individuals with autism.Identifying Your NeedsBefore embarking on the search for a BCBA (Board Certified Behavior Analyst) supervisor, it is important to clearly identify your goals and needs. This will help you find a supervisor who aligns with your specific requirements and can provide the support necessary for effective autism treatment.Assessing Your Goals and NeedsTo begin, take some time to reflect on your goals for autism treatment and the specific areas where you need assistance. Consider the following questions:What are your primary goals for autism treatment?Are there any specific areas of concern or challenges that you would like the BCBA supervisor to address?What are your expectations regarding the frequency and duration of supervision sessions?Do you have any preferences or requirements regarding the location or format of supervision sessions?By assessing your goals and needs, you will have a clearer understanding of the qualities and expertise you are looking for in a BCBA supervisor.Determining the Scope of Supervision RequiredThe scope of supervision required will vary depending on the individual and their unique circumstances. Consider the following factors to determine the level of supervision needed:Experience and expertise: Are you seeking a supervisor with extensive experience in working with individuals with autism or specific expertise in certain treatment approaches?Intensity of support: Do you require intensive supervision, including frequent in-person meetings and regular feedback, or are you looking for a more flexible arrangement?Treatment setting: Will the supervision primarily take place in a clinical setting, a school, or in the home environment?Legal and ethical considerations: Are there any specific legal or ethical requirements that need to be considered, such as adherence to state or local regulations?Understanding the scope of supervision required will help you narrow down your search and find a BCBA supervisor who can meet your specific needs.By assessing your goals and determining the scope of supervision required, you will be better equipped to find a BCBA supervisor who can provide the necessary support and guidance for effective autism treatment.Finding Potential BCBA SupervisorsWhen searching for a BCBA (Board Certified Behavior Analyst) supervisor, it's important to explore various avenues to find potential candidates who can meet your needs. Here are three ways to find potential BCBA supervisors:Referrals from ProfessionalsOne effective way to find a BCBA supervisor is through referrals from professionals in the field. Reach out to your child's primary care physician, pediatrician, or any other healthcare professionals who specialize in autism treatment. They often have connections with BCBA supervisors and can provide recommendations based on their knowledge and experience. Additionally, therapists, educators, and other individuals who work with individuals with autism may also be able to offer valuable referrals.Online Directories and DatabasesUtilizing online directories and databases can be a convenient and efficient method of finding potential BCBA supervisors. There are several reputable websites and platforms that provide comprehensive listings of BCBA supervisors in your area.These directories often include information about their credentials, experience, and areas of expertise, allowing you to narrow down your search based on your specific requirements. Consider using trusted directories, such as those provided by professional organizations or autism advocacy groups.Local Autism Support GroupsEngaging with local autism support groups can be an invaluable resource for finding BCBA supervisors. These groups typically consist of parents, caregivers, and individuals with autism who share information, resources, and recommendations.By connecting with these groups, you can tap into their collective knowledge and experiences to identify potential BCBA supervisors. Attend support group meetings, participate in online forums, or join social media groups dedicated to autism support in your community. These interactions can help you gather insights and recommendations from people who have firsthand experience with BCBA supervisors in your area.By exploring referrals from professionals, utilizing online directories and databases, and engaging with local autism support groups, you can broaden your search and find potential BCBA supervisors who may be a good fit for your needs. It's important to keep in mind that each method has its own advantages, so consider using a combination of approaches to maximize your chances of finding the perfect BCBA supervisor for your situation.Evaluating BCBA SupervisorsWhen searching for a BCBA (Board Certified Behavior Analyst) supervisor, it is crucial to thoroughly evaluate potential candidates to ensure they meet your specific needs. Here are some key factors to consider when evaluating BCBA supervisors:Reviewing Credentials and ExperienceReviewing the credentials and experience of BCBA supervisors is essential in determining their qualifications for the role. Look for the following information:Credential or Experience and Importance‍‍Board Certification as a BCBA: EssentialYears of Experience as a BCBA: ImportantSpecializations or Areas of Expertise: Relevant to Your NeedsContinuing Education and Professional Development: Demonstrates CommitmentTake note of the BCBA supervisor's credentials and experience to determine if they have the necessary knowledge and skills to provide effective supervision.Assessing Communication and Interpersonal SkillsEffective communication and interpersonal skills are vital for a successful BCBA supervision relationship. Consider the following factors during your assessment:Skill and Importance‍‍Active Listening: EssentialClear and Concise Communication: EssentialEmpathy and Understanding: ImportantCollaborative Approach: ImportantA BCBA supervisor with strong communication and interpersonal skills will be able to effectively communicate goals, provide feedback, and establish a positive working relationship.Requesting References and Client TestimonialsTo gain insights into the BCBA supervisor's performance and reputation, it is recommended to request references and client testimonials. This feedback can provide valuable information about their professionalism, effectiveness, and ability to work with individuals with autism.When contacting references, consider asking questions such as:How long have you worked with the BCBA supervisor?Did they demonstrate expertise in your specific needs?How did they communicate and collaborate with you?Did they provide constructive feedback and support?Were they responsive to your concerns or questions?Client testimonials can also offer valuable perspectives on the BCBA supervisor's approach and effectiveness in delivering quality supervision.By thoroughly evaluating BCBA supervisors based on their credentials and experience, communication and interpersonal skills, and client feedback, you can make an informed decision when choosing the right BCBA supervisor for your needs. Remember, finding the right fit is crucial as the BCBA supervisor will play a significant role in guiding and supporting autism treatment.Interviewing Potential BCBA SupervisorsOnce you have identified potential BCBA supervisors for autism treatment, the next step is to interview them to ensure they are the right fit for your needs. This section will guide you through the interview process, including preparing questions, discussing their approach and treatment philosophy, and addressing availability and logistics.Preparing Questions for the InterviewBefore the interview, it's helpful to prepare a list of questions to gather relevant information and assess the suitability of the BCBA supervisor. Consider the following questions:Can you tell me about your experience working with individuals with autism and your specific expertise in this area?How do you approach individualized treatment planning for your clients with autism?What strategies do you use to address challenging behaviors in individuals with autism?How do you involve the family and caregivers in the treatment process?Can you describe a successful case or outcome you have achieved with a client with autism?Asking About Approach and Treatment PhilosophyDuring the interview, it's important to ask the BCBA supervisor about their approach and treatment philosophy. Understanding their methods and beliefs will help you determine if they align with your goals and values. Consider asking the following questions:What is your overall treatment approach for individuals with autism?How do you incorporate evidence-based practices into your treatment plans?Do you take a collaborative approach, involving other professionals such as speech therapists or occupational therapists?How do you stay up-to-date with the latest research and advancements in autism treatment?Discussing Availability and LogisticsIn addition to assessing their qualifications and treatment approach, it's crucial to discuss practical matters such as availability and logistics. This will ensure that the BCBA supervisor can accommodate your needs and fit into your schedule. Consider discussing the following points:What is your availability for supervision sessions? Are you able to accommodate my preferred days and times?How frequently will supervision sessions occur, and for how long?What is your preferred mode of communication? Are you accessible for questions or concerns outside of scheduled sessions?Do you have any geographical restrictions or limitations on the areas you serve?By asking these questions and having open discussions during the interview, you can gain valuable insights into the BCBA supervisor's approach, experience, and availability. This will help you make an informed decision when selecting the right BCBA supervisor for your autism treatment journey. Remember to take notes during the interview process to compare and evaluate the candidates effectively.Making the DecisionWhen it comes to finding the perfect BCBA Supervisor, making the right decision is crucial for the success of autism treatment. It's important to carefully consider various factors and weigh the pros and cons before finalizing your choice. Trusting your instincts and starting the supervision process are also essential steps in this decision-making process.Weighing the Pros and ConsTo make an informed decision, it's helpful to weigh the pros and cons of each potential BCBA Supervisor. Consider the following factors:ProsExtensive experience in autism treatmentStrong communication and interpersonal skillsPositive client testimonialsConvenient location and flexible schedulingConsLimited availabilityHigher cost of supervisionDiffering treatment philosophyLimited references availableBy evaluating these pros and cons, you can gain a clearer understanding of the advantages and potential drawbacks associated with each BCBA Supervisor. This analysis will help you make a decision that aligns with your specific needs and goals.Trusting Your InstinctsWhile it's important to consider objective factors when choosing a BCBA Supervisor, trusting your instincts is equally valuable. Pay attention to your gut feelings and instincts during the evaluation process. If you have a positive connection with a particular BCBA Supervisor and feel comfortable discussing your concerns and goals, it may indicate a good fit.Remember that the trust and rapport between you and the BCBA Supervisor are crucial for effective collaboration. If you have reservations or doubts about a potential supervisor, it's important to listen to those feelings and continue your search until you find someone you trust and feel confident in.Starting the Supervision ProcessOnce you have made a decision and selected a BCBA Supervisor, it's time to start the supervision process. This typically involves an initial meeting to discuss goals, expectations, and logistics. The BCBA Supervisor will provide guidance, support, and ongoing supervision to ensure the effective implementation of autism treatment plans.During this initial meeting, it's important to establish clear lines of communication and discuss any specific requirements or preferences you may have. This will help set the stage for a productive and collaborative relationship between you and the BCBA Supervisor.Remember, finding the perfect BCBA Supervisor is a process that requires careful consideration and evaluation. By weighing the pros and cons, trusting your instincts, and starting the supervision process, you can make an informed decision that sets the foundation for successful autism treatment.FAQsWhat qualities should I look for in a BCBA supervisor beyond just their credentials?It's not just about the letters after their name. Seek someone who values mentorship, understands your goals, and resonates with your approach to learning.How do I know if a BCBA supervisor will be a good fit for my learning style and career goals?Look for supervisors who take the time to understand your individual learning needs and align with your professional aspirations. A good fit goes beyond just qualifications.Is it okay to ask potential BCBA supervisors about their teaching philosophy or mentoring approach?Absolutely! In fact, it's encouraged. Understanding their approach gives you insights into whether it aligns with your learning preferences and goals.Should I consider geographical location when choosing a BCBA supervisor?It depends on your preferences and the flexibility of the supervisor. Some interactions may be in person, but many supervisors are open to virtual meetings, expanding your options.How important is it to find a BCBA supervisor with experience in my specific area of interest within Applied Behavior Analysis?It can be beneficial, but it's not the only factor. A supervisor with a broad understanding of ABA principles can often guide you effectively, even if they haven't specialized in your specific area.SummaryAs we wrap up the quest to find that perfect BCBA supervisor, remember that this journey is as much about connection as it is about credentials. It's about finding someone who not only guides you professionally but also understands your unique aspirations and learning style.So, go beyond the checklist, trust your instincts, and seek a supervisor who not only helps you grow in the field of Applied Behavior Analysis but also supports you in becoming the best version of yourself. Your ideal BCBA supervisor is out there – here's to a collaborative and fulfilling professional partnership ahead!Sourceshttps://hoomhouse.com/blog/how-to-find-a-bcba-supervisorhttps://www.iloveaba.com/2014/12/are-you-great-supervisorhttps://readysetaba.com/finding-quality-supervision-for-bcba-bcba

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