Managing Facial Grimacing In Autism

Discover effective strategies for managing facial grimacing in autism.

Understanding Facial Expressions in Autism

Individuals with autism often experience challenges in understanding and expressing emotions through facial expressions. Research has shown that individuals with autism spectrum disorder (ASD) and high levels of autistic traits (ATs) may have impaired detection of happy facial expressions, which can contribute to their difficulties in creating and maintaining social relationships.

Challenges in Emotion Recognition

A comprehensive analysis of 39 studies involving a total of 684 autistic individuals and 674 controls revealed that individuals with autism are less expressive than controls. They make expressions less frequently and fleetingly and are less likely to unconsciously mimic others' looks or use their expressions to facilitate social interactions. However, they are capable of producing smiles, frowns, grimaces, and other expressions of similar intensity and size to controls.

Autistic individuals also respond equally quickly to stimuli such as strong odors [2].

The differences in facial expressions between autistic individuals and neurotypical individuals are more pronounced for spontaneous expressions than for prompted ones. As individuals with autism age and have higher intellectual functioning, they may develop compensatory strategies for producing more typical facial expressions [2].

Impact on Social Interactions

Research has shown that individuals with ASD and high levels of autistic traits (ATs) have impaired detection of happy facial expressions. This difficulty in recognizing and interpreting positive emotions can hinder their ability to engage in social interactions effectively. The impairment in detecting happy expressions may contribute to the challenges autistic individuals face in creating and maintaining affiliative relationships.

Individuals with autism produce smiles, frowns, grimaces, and other expressions of similar intensity and size to those without autism. However, they make expressions less frequently and fleetingly, and they are less likely to unconsciously mimic others' looks. This reduced expressiveness can make it challenging for others to interpret their emotions accurately.

Understanding the challenges individuals with autism face in recognizing and expressing emotions through facial expressions is crucial for caregivers and therapists. By recognizing and addressing these challenges, appropriate interventions and support can be provided to help individuals with autism navigate social interactions more effectively.

The Connection Between Autism and Tics

Tics, including facial grimacing, are quite common in individuals with Autism Spectrum Disorder (ASD). Studies have shown that up to 80% of individuals with ASD experience some form of motor or vocal tic. Let's explore the prevalence of tics in autism and the types of facial tics commonly observed.

Prevalence of Tics in Autism

Tics are frequently observed in individuals with autism, with studies indicating that approximately 80% of individuals with ASD experience some form of motor or vocal tic. Furthermore, about 22% of those diagnosed with autism also exhibit symptoms of tic disorders, such as Tourette syndrome and chronic motor tic disorder. This demonstrates a significant connection between autism and tics, emphasizing the need for effective management strategies.

Types of Facial Tics

Facial grimacing is a common type of tic observed in individuals with autism. The manifestation of facial tics can vary depending on factors such as age, gender, and cognitive abilities [4]. Some examples of facial tics include:

  • Eye blinking: Rapid or repetitive blinking of the eyes.
  • Nose wrinkling: Involuntary wrinkling or twitching of the nose.
  • Lip smacking: Repetitive pursing or smacking of the lips.
  • Jaw movements: Excessive clenching or shifting of the jaw.
  • Tongue movements: Protrusion or licking of the tongue.

These facial tics can disrupt daily activities and social interactions, impacting the quality of life for individuals with autism. Understanding the types of facial tics commonly associated with autism is crucial for caregivers and therapists in developing effective strategies to manage and support individuals with autism.

By recognizing the prevalence of tics in autism and understanding the different types of facial tics, caregivers and therapists can work towards empowering individuals with autism to manage their tics effectively. Through tailored treatment approaches and supportive interventions, it is possible to enhance the well-being and overall quality of life for individuals with autism who experience facial grimacing and other tics.

Factors Contributing to Facial Grimacing

Facial grimacing is a common manifestation observed in individuals with autism. Understanding the factors that contribute to facial grimacing is essential for developing effective strategies to manage and support individuals with autism.

Neurological Associations

Research has shown that facial tics, including grimacing, can be associated with other neurological disorders frequently co-occurring with autism spectrum disorder (ASD), such as obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD). These neurological associations highlight the complexity of the condition and the need for comprehensive intervention approaches that address multiple symptoms and challenges.

Role of Stress and Anxiety

Stress and anxiety often play a significant role in the development and exacerbation of facial grimacing in individuals with autism [1]. Individuals with autism may experience heightened levels of stress and anxiety due to challenges in social interactions, sensory sensitivities, and difficulties in communication. Tics, including facial grimacing, may occur as a response to stressors or anxiety-provoking situations.

It is important to note that each individual with autism is unique, and the factors contributing to facial grimacing may vary. It is crucial to assess and understand the specific triggers and underlying causes for each individual to develop personalized interventions and support strategies.

To effectively manage facial grimacing and support individuals with autism, a holistic approach is necessary. This includes addressing the underlying neurological associations, managing stress and anxiety, and providing appropriate behavioral therapies and medication options when appropriate. By understanding these factors, caregivers and therapists can develop tailored strategies to empower individuals with autism and help them lead fulfilling lives.

For more information on strategies for managing facial grimacing and supporting individuals with autism, please refer to the section on Strategies for Managing Facial Grimacing and Supporting Individuals with Autism.

Treatment Approaches for Facial Tics

When it comes to managing facial tics, including facial grimacing in autism, a combination of treatment approaches can be effective. These approaches typically involve a combination of behavioral therapies and medication options.

Behavioral Therapies

Behavioral therapies have shown moderate-to-large treatment effects in reducing tic symptom severity among individuals with Persistent Tic Disorders (PTDs) and Tourette's Disorder (TD). One commonly recommended behavioral therapy is habit reversal therapy. This therapy helps individuals identify triggers for their tics and develop competing responses to decrease tic frequency.

By increasing awareness of the tic and providing alternative behaviors, habit reversal therapy can help individuals gain more control over their facial grimacing and other tics.

Medication Options

Medication can also play a role in managing facial tics related to autism. Neuroleptics, such as risperidone, pimozide, and aripiprazole, are commonly prescribed to control tics. These medications work by altering the effects of brain chemicals that regulate body movements [4]. It's important to consult with a healthcare professional to determine the most appropriate medication and dosage for an individual's specific needs.

It's worth noting that treatment approaches may vary depending on the individual's symptoms and specific diagnosis. Other treatment options, such as deep brain stimulation and cannabis-based medications, are being explored but have limited evidence supporting their effectiveness for facial tics.

To support individuals with autism and their caregivers, it's essential to provide a comprehensive approach that includes not only treatment for facial tics but also addressing other symptoms and challenges associated with autism. This may involve virtual autism therapy, sensory interventions, and support programs such as ABA classes for parents and aba parent training goals examples.

By understanding and implementing a holistic approach, caregivers and therapists can empower individuals with autism to lead fulfilling lives and manage their facial grimacing and other challenges effectively.

Strategies for Managing Facial Grimacing

Facial grimacing in individuals with autism can be challenging to manage, but there are strategies that can help reduce its occurrence and impact. Two key approaches for managing facial grimacing are stress management techniques and intervention methods.

Stress Management Techniques

Stress and anxiety often play a significant role in the development and exacerbation of facial grimacing in individuals with autism. Tics, including facial grimacing, may occur in response to stressors or anxiety-provoking situations. Implementing stress management techniques can help reduce the occurrence and severity of facial grimacing. Some effective stress management techniques include:

  • Deep breathing exercises: Encouraging slow, deep breaths can help individuals with autism regulate their emotions and reduce stress levels.
  • Mindfulness and relaxation techniques: Practices such as meditation, guided imagery, and progressive muscle relaxation can promote relaxation and alleviate anxiety.
  • Physical activities: Engaging in physical activities, such as exercise or sensory play, can help release tension and reduce stress.
  • Visual supports: Visual schedules, social stories, and visual reminders can assist individuals with autism in understanding and managing stressful situations.

By incorporating stress management techniques into daily routines, caregivers can provide individuals with autism the tools they need to better cope with stress and minimize facial grimacing.

Intervention Methods

In addition to stress management techniques, several intervention methods can be employed to manage facial grimacing in individuals with autism. These methods aim to reduce tics and improve overall functioning. Some commonly used intervention methods include:

  • Behavioral therapy: Behavioral therapy, such as habit reversal therapy, is often recommended for managing facial tics, including grimacing, in individuals with autism. This therapy helps individuals identify triggers for their tics and develop competing responses to decrease the frequency of tics.
  • Medication: In some cases, medication may be prescribed to help manage facial tics that interfere with social interactions, schoolwork, or daily activities. Medications can help reduce the severity and frequency of tics, although they may come with potential side effects. It is important to consult with a healthcare professional to determine the most appropriate medication options for each individual.
  • Service dogs: Exposure to service dogs has shown promise as an intervention method for individuals with autism. These dogs can provide a sense of calm and security, alleviate anxiety and stress, and indirectly improve social interaction skills.

It's important to note that intervention methods should be tailored to each individual's specific needs and preferences. Consulting with professionals, such as therapists and healthcare providers, can help determine the most effective intervention approach for managing facial grimacing in individuals with autism.

By implementing stress management techniques and utilizing appropriate intervention methods, caregivers can play a vital role in helping individuals with autism manage facial grimacing. Understanding the impact of stress and anxiety, along with providing support and guidance, can empower caregivers to make a positive difference in the lives of individuals with autism.

Supporting Individuals with Autism

When it comes to individuals with autism, understanding and supporting their unique needs is essential. This is particularly true when it comes to facial expressions, as individuals with autism often experience challenges in understanding and expressing emotions through facial cues. Recognizing the importance of this, caregivers and therapists play a crucial role in providing the necessary support.

Importance of Understanding Expressions

Research has shown that individuals with autism spectrum disorder (ASD) may have impaired detection of happy facial expressions, which can contribute to difficulties in creating and maintaining social relationships. Autistic individuals may have difficulty recognizing and interpreting positive emotions, which hinders their ability to effectively engage in social interactions.

This impairment in detecting happy expressions may be a contributing factor to the challenges they face in developing affiliative relationships.

It's important for caregivers and therapists to understand and recognize these challenges. By being aware of the difficulties individuals with autism may face in interpreting facial expressions, they can provide the necessary support and create an environment that fosters effective communication.

Role of Caregivers and Therapists

Caregivers and therapists play a vital role in supporting individuals with autism and helping them navigate the complexities of facial expressions. Here are some ways they can provide valuable assistance:

  • Education and Awareness: Caregivers and therapists can educate themselves about the unique challenges faced by individuals with autism in understanding and expressing emotions through facial expressions. This knowledge can help them develop strategies to effectively communicate with and support individuals with autism.
  • Modeling and Teaching: Caregivers and therapists can model appropriate facial expressions and teach individuals with autism how to recognize and interpret different emotions. This can be done through visual aids, social stories, and role-playing activities.
  • Creating a Comfortable Environment: Caregivers and therapists can create a comfortable and safe environment that encourages open communication. This includes maintaining a calm and non-judgmental demeanor, allowing individuals with autism to express themselves without feeling pressured or overwhelmed.
  • Individualized Approaches: Each individual with autism is unique, so caregivers and therapists should tailor their approaches to meet the specific needs of the individual. This may include using visual supports, implementing social skills training, or incorporating ABA therapy techniques to address facial grimacing.

By understanding the importance of facial expressions in communication and actively supporting individuals with autism, caregivers and therapists can empower them to navigate social interactions more effectively. With patience, empathy, and the right strategies, individuals with autism can develop their communication skills and thrive in their interactions with others.

References

[1]: https://www.abtaba.com/blog/facial-grimacing-in-autism

[3]: https://carmenbpingree.com/blog/tics-and-autism-whats-the-connection/

[4]: https://www.crossrivertherapy.com/autism/facial-grimacing-in-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