Embracing A New Era In Autism Treatment

Discover new possibilities in autism treatment. Explore evidence-based therapies, advancements in research, and targeted interventions. Find hope today.

Understanding Autism Treatment

Autism treatment aims to maximize functional independence and enhance the quality of life for individuals with autism spectrum disorder (ASD). The primary goals of treatment are to minimize the core features of autism, facilitate development and learning, promote socialization, reduce maladaptive behaviors, and provide support and education to families.

Goals of Autism Treatment

The goals of autism treatment focus on improving various aspects of an individual's life. These goals may include:

It is important to note that treatment goals may vary depending on the individual's age, developmental level, and specific needs.

Current Treatment Approaches

Currently, there are several evidence-based treatment approaches that have shown effectiveness in improving outcomes for individuals with autism:

It is important to note that medication for autism spectrum disorder (ASD) aims to treat specific symptoms and behaviors rather than cure ASD or address all core features of the disorder. Behavioral therapies are often used in combination with medication for comprehensive and effective treatment.

Understanding the goals and current treatment approaches for autism is essential to provide individuals with autism and their caregivers the information they need to make informed decisions and access appropriate interventions.

Evidence-Based Therapies

In the field of autism treatment, evidence-based therapies play a crucial role in helping individuals with autism spectrum disorder (ASD) reach their full potential. These therapies are backed by scientific research and have shown positive outcomes in improving various aspects of ASD. In this section, we will explore three evidence-based therapies: early intensive behavioral treatment, applied behavioral analysis (ABA), and pharmacotherapy for behavioral symptoms.

Early Intensive Behavioral Treatment

Early intensive behavioral treatment has been found to have substantial benefits for children with autism. Research studies have shown that children who receive this treatment exhibit significant improvements in IQ, language skills, academic performance, adaptive behavior, and certain social behaviors. The outcomes of early intensive behavioral treatment have been consistently better than those of children in control groups. (NCBI)

Applied Behavioral Analysis (ABA)

Applied Behavioral Analysis (ABA) is a treatment approach based on theories of learning and operant conditioning. ABA interventions have shown positive effects for young children with autism in intellectual functioning, language development, daily living skills acquisition, and social functioning. The largest effect sizes have been observed in language-related outcomes. ABA therapy focuses on identifying and modifying behaviors to improve communication, social skills, and adaptive behaviors. (NCBI)

Pharmacotherapy for Behavioral Symptoms

Pharmacotherapy for autism primarily targets specific behavioral symptoms rather than core features of autism. Medications are commonly used to address symptoms such as hyperactivity, inattention, repetitive thoughts and behaviors, self-injurious behavior, and aggression. Risperidone and aripiprazole are two medications that have been found to be efficacious and safe in treating these behavioral symptoms in children and adolescents with autism. However, it's important to note that medication should be used in conjunction with behavioral therapies for comprehensive treatment. (NCBI)

While evidence-based therapies like early intensive behavioral treatment, ABA, and pharmacotherapy have shown positive outcomes in the treatment of autism, it's important to remember that each individual with autism is unique. Treatment plans should be tailored to meet the specific needs of each person, considering their strengths, challenges, and goals. Collaborative healthcare approaches involving a multidisciplinary team can provide the most comprehensive and personalized care for individuals with autism.

Non-Evidence-Based Treatments

While there are various evidence-based treatments available for autism, it is important to be cautious of non-evidence-based treatments that lack scientific support. These treatments may not only be ineffective but also potentially harmful. In this section, we will explore three non-evidence-based treatments: chelation therapy, Lupron therapy, and hyperbaric oxygen therapy (HBOT).

Chelation Therapy

Chelation therapy involves administering chemicals to eliminate heavy metals from the body. However, it is important to note that there is no scientific evidence supporting its effectiveness as a treatment for autism. Autism is not caused by metal poisoning, and therefore, chelation therapy is not a safe or appropriate treatment alternative for individuals with autism.

In fact, there have been reported cases of adverse events and even deaths associated with chelation therapy in children with autism. It is crucial to consult with qualified healthcare professionals and rely on evidence-based treatments to ensure the safety and well-being of individuals with autism.

Lupron Therapy

Lupron therapy, a testosterone-inhibiting drug, is not considered safe or effective for the treatment of autism. While it may be approved for other medical conditions, there is no evidence supporting its efficacy in treating autism. Moreover, Lupron therapy can have harmful side effects, including hives, difficulty breathing or swallowing, numbness, tingling, weakness, painful or difficult urination, blood in the urine, bone pain, testicular pain, and osteoporosis.

It is important to exercise caution and prioritize evidence-based treatments for autism, as Lupron therapy does not provide any proven benefits and may pose potential risks to individuals with autism.

Hyperbaric Oxygen Therapy (HBOT)

Hyperbaric oxygen therapy (HBOT) involves breathing pure oxygen in a pressurized chamber. While HBOT has proven efficacy for the treatment of certain medical conditions related to oxygen in the blood, there is no scientific evidence supporting its effectiveness in treating Autism Spectrum Disorder (ASD).

Claims suggesting that HBOT can improve the core symptoms of autism or cure the condition are not supported by scientific research. The benefits of HBOT delivered in a soft-shelled chamber are no different than with a less expensive oxygen tent or nasal cannula. It is important to rely on evidence-based treatments for autism that have been rigorously tested and proven effective.

By avoiding non-evidence-based treatments such as chelation therapy, Lupron therapy, and HBOT, individuals with autism and their caregivers can focus on evidence-based therapies that have been shown to be safe and effective. It is crucial to consult with healthcare professionals and rely on scientifically supported treatments to ensure the well-being and best outcomes for individuals with autism.

Advancements in Autism Research

As research on autism spectrum disorder (ASD) continues to evolve, significant advancements have been made in understanding the underlying genetic and biological factors. These advancements have paved the way for new therapeutic approaches that hold promise for individuals with ASD. In this section, we will explore the latest developments in autism research, focusing on genetic studies and findings, emerging therapeutic approaches, and the role of the microbiome in ASD.

Genetic Studies and Findings

Recent genetic studies have shed light on the complex genetic landscape of ASD. A study analyzing the DNA of thousands of individuals, including those with ASD, identified variants in 102 genes associated with an increased probability of developing ASD. These gene variants primarily reside in the cerebral cortex, the region of the brain responsible for complex behaviors. Another study found that a gene variant-based malfunction in oligodendrocytes, which are responsible for producing myelin, the protective sheath surrounding nerve cells, could impair brain development and disrupt nerve communication in individuals with a syndromic form of ASD.

Understanding the genetic underpinnings of ASD provides valuable insights into potential therapeutic targets. Researchers are exploring various strategies, including gene therapy and modulation, to address the haploinsufficiency effect caused by loss-of-function mutations in ASD-associated genes. Techniques such as CRISPR-Cas9 gene therapy and antisense oligonucleotides (ASOs) show promise in rescuing gene expression and ameliorating phenotypes in animal models of ASD.

Emerging Therapeutic Approaches

Alongside genetic studies, emerging therapeutic approaches are being explored to address the core symptoms of ASD and improve quality of life for individuals with ASD. These approaches aim to target specific molecular pathways implicated in ASD.

Small molecule drugs, such as mTOR inhibitors and GABAA receptor agonists, are being investigated for their potential to modulate signaling pathways and restore neurochemical imbalances associated with ASD. These drugs show promise in preclinical models and offer hope for the development of targeted therapies.

Microbiome Studies and Interventions

Recent studies have highlighted the potential role of the gut microbiome in ASD. Research has found that mice lacking a specific gene associated with ASD have an unusual population of microbes in their intestines and display social behaviors similar to those observed in individuals with ASD. When treated with specific bacteria, their social behaviors improved.

These findings have sparked interest in exploring microbiome-based interventions for ASD. Researchers are investigating approaches such as probiotics, prebiotics, and fecal microbiota transplantation to modulate the gut microbiome and potentially improve ASD symptoms. However, more research is needed to fully understand the complex interactions between the gut microbiome and ASD.

As research in the field of autism continues to advance, these genetic and therapeutic breakthroughs offer hope for the development of novel treatments and interventions for individuals with ASD. By unraveling the intricate mechanisms underlying ASD, researchers are paving the way for a new era in autism treatment that holds the potential to unlock possibilities and improve the lives of individuals on the autism spectrum.

Focus on Targeted Therapies

As research in autism treatment continues to evolve, there is a growing focus on targeted therapies that aim to address specific challenges faced by individuals on the autism spectrum. In this section, we will explore three promising avenues of treatment: the Social Communication Therapy Program, drug trials for modifying brain signals, and psychedelic compound research.

Social Communication Therapy Program

Led by Prof Jonathan Green and his colleagues, a targeted social communication therapy program is being tested in a pilot therapy project. This program is designed for babies as young as 10 months old who have an increased chance of developing autism. The therapy focuses on improving communication and brain function by emphasizing one-to-one social interactions with parents or caregivers. By providing support and guidance in understanding the child's communication style, parents can adapt their responses to foster deeper connections and improved outcomes for the child as they age [6].

Drug Trials for Modifying Brain Signals

The National Autism Project, led by Declan Murphy from King's College London, is exploring drugs that can modify brain signals in autistic individuals. The aim of this study is to improve symptoms that can cause distress, such as sensory sensitivity and irritability. By targeting sensory processing using drugs that already have regulatory approval, this research holds the potential to offer immediate treatments if successful. The goal is to enhance the quality of life for individuals on the autism spectrum.

Psychedelic Compound Research

Dr. Grainne McAlonan at King's College London is investigating the use of a psychedelic compound called psilocybin, found in magic mushrooms, as a potential treatment for autism. This research focuses on targeting the serotonin pathway in the brain, which has shown consistent differences in autism studies. By leveraging the unique properties of psilocybin, this research aims to provide personalized medication options for autistic individuals, potentially addressing specific symptoms and improving overall well-being.

As research continues to progress, targeted therapies offer hope for more personalized and effective treatments for individuals on the autism spectrum. The Social Communication Therapy Program, drug trials for modifying brain signals, and psychedelic compound research represent exciting avenues that may lead to transformative advancements in autism treatment.

Medication for Autism

While there is currently no medication that can cure autism spectrum disorder (ASD) or treat all its symptoms, medications can be used to target specific behaviors associated with ASD. It's important to note that medication should be used in conjunction with behavioral therapies for the most effective treatment.

FDA-Approved Medications

The U.S. Food and Drug Administration (FDA) has approved certain medications to specifically address irritability associated with ASD in children within specific age ranges. These medications, such as risperidone and aripiprazole, are classified as antipsychotic drugs and can help manage behaviors such as self-injury or aggression.

FDA-Approved MedicationIntended PurposeRisperidoneTreatment of irritability associated with ASD in children and adolescents aged 5-16AripiprazoleTreatment of irritability associated with ASD in children and adolescents aged 6-17

Off-Label Medication Use

In addition to FDA-approved medications, healthcare providers may also use other medications off-label to help improve symptoms of autism, even though they are not specifically FDA-approved for this purpose. Off-label use refers to the use of a medication for a condition or age group not approved by the FDA. The decision to use off-label medications is based on healthcare providers' clinical judgment and individualized treatment plans for each person with ASD.

Collaborative Healthcare Approaches

Collaboration between individuals with ASD, their caregivers, and healthcare providers is crucial when considering medication as part of the treatment plan. It is important to closely collaborate with healthcare providers to ensure the safe and effective use of any medication for ASD. Healthcare providers often start with a trial period to assess the medication's effectiveness and may need to adjust dosages or combinations to find the most suitable treatment plan.

By managing specific behaviors associated with ASD, medications can help individuals with autism focus on other activities, such as learning and communication. It is essential to work closely with healthcare providers to monitor the effects of medication and address any concerns or side effects that may arise. Organizations like Autism Speaks provide resources and support to help parents and caregivers make informed decisions regarding medication and the overall treatment of individuals with 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