Rad N Bad: The Other Side of the Table — Ethical Failures, Compassionate Care, and Consumer Realities in ABA

What "The Other Side of the Table" Asks Behavior Analysts to Do

Rad N Bad opened this episode with a dare to the field. The hosts are both behavior analysts. They noted that we say the right words now. We say assent (saying yes to the plan). We say compassionate care. We say social validity (goals the family actually wants). The harder question is whether we act on them.

Sean Yocum named a double standard. When a family says ABA helped, we accept the story. When a family says ABA hurt, we ask for details. What kind of ABA was it? When did it happen? Was that even real ABA? Those questions can be fair. They can also be a fast way to end our own discomfort.

The show's format backs the point up. The hosts did not debate their guest. They asked, restated what they heard, and gave her the last word. Kim Lambert, a mother from North Carolina, spent more than five years navigating ABA services for her son. The rest of this page is her account, and what the hosts drew from it for the field.

Listening does not require agreement, but it does require enough humility to accept that someone's experience. Can challenge what we believe without us immediately trying to make that discomfort go away.

From the talk — Sean Yocum & Michael Carrero

When "Trust the Process" Takes the Place of Informed Consent

One phrase shows up again and again in her story: trust the process. She heard it when her son was put out of daycare in the first weeks. She heard it when every session ended in a long meltdown at home. She heard it four and five years in. It came paired with lines like this is a marathon, not a sprint.

Sean turned that into a consent question. Informed consent (agreeing after the facts are explained) means a family knows the plan and can decline it. She said plainly that she never had that. Her whole idea of ABA came from a packet handed to her at a diagnosis visit. The packet said ABA was the standard of care. Nobody told her what the work would look like.

So the phrase did two jobs at once. It filled the space where an explanation belonged. It also framed her questions as impatience. That gap is a consent problem, plain and simple. The test is not whether you used the word consent. The test is whether she had enough information to say no.

What are we actually asking a parent to do?

From the talk — Sean Yocum & Michael Carrero

Hours as the Condition for Access: 30 a Week or No Funding

She was told Medicaid would only fund two amounts: 15 hours a week or 30 hours a week. Nothing in between. She was also told she could keep 30 hours only if she kept her son out of public school. Public school would drop him to 15. That was presented to her as the bad outcome.

So she homeschooled him and kept 30 hours a week. Her reason was not a clinical one. She needed to work. She needed him to sleep. She needed a few hours a day when she was not his hands-on caregiver. She said she had to go along with their demands because she needed the care.

Hear what that does to a dosage decision (how many hours per week). Hours stop being clinical judgment. They become the condition for staying in services. A plan is supposed to fit the client's needs. The family is supposed to truly agree to it too. A quota set by a funding story fails both standards. If your intake script ties access to a minimum, that is not a scheduling habit. That is coercion (pressure that removes real choice).

So what I got is you were told your child needed 30 hours of ABA a week.

From the talk — Sean Yocum & Michael Carrero

"We Don't See That Behavior Here": Goal Selection Without the Family

Her son's hardest behaviors happened at home, early in the morning and at bedtime. The clinic's answer was that they did not see those behaviors, so they could not work on them. Her answer was simple: then come to my house. The behaviors did not stop existing because the clinic was a quiet box with one adult per child.

Meanwhile the goals were small and borrowed. She described trial after trial of touch the blue square. What she needed was her son eating something besides one snack food. Using the bathroom. Staying dressed when he got upset. She said the plans looked cookie cutter, as if every child had to do the same ten things. Mothers compare notes, and the plans all looked alike.

She also pushed back on a goal that clashed with her family. Her son hears please as a question, and a question can be answered with no. In her house a direct request works better. She got years of pushback on that one. Caregivers are supposed to help choose the goals, not just watch them get picked for them. Her values were handled as an obstacle instead.

The turn came when a new analyst asked what she wanted for her son. She had no answer. The family was in survival mode. That question, plus her presence in sessions, changed the work. The clearest example is the dishwasher. Nine items he already knew how to put away. The first session took almost three hours of screaming. The next took ninety minutes. The next took five. Then they had her give the instruction, and he did it. Hitting targets on their goals had changed nothing. Hitting targets on hers changed her life.

Treatment plan can tell me a goal is mastered, but it can't tell me whether the goal mattered to your family

From the talk — Sean Yocum & Michael Carrero

Abrupt Endings: Staff Changes and Discharge Without a Plan

The endings in her story were abrupt. An analyst she trusted was pulled off the case with no notice. She found out by texting about a nine o'clock meeting that morning. A director called back to say the person no longer worked there and she could not contact them. She never spoke with another analyst at that company again.

When she asked for her discharge paperwork, she was offered six more months of parent training instead. She had to fight to get a record she had every right to. Earlier, a front-line therapist (the person running daily sessions) vanished after nearly two years with her son. He was not allowed to say goodbye. She called that cruel, and it is hard to argue with her.

It got worse during a crisis. She called a crisis line herself. She called the company and was told this was not in their purview. She agreed that was technically correct. Her point was the coldness. Nobody offered to sit with her or help her make calls. There's supposed to be a plan for transitions and for ending services. A good handoff names who takes over, what carries forward, and when. It also plans a goodbye for the client.

I never was given transition things.

From the talk — Kim Lambert

Why Families Do Not Tell You the Truth

Here is the part that should land hardest. She said families do not tell us the truth. Not all of it. They leave out the worst nights out of embarrassment. They worry the professional will judge them. They worry about something worse: that a report gets made and someone calls child services.

So families manage their image instead. She described needing to look presentable enough to be helped. Parents tell each other the real story. They do not tell the analyst, the therapist, the speech provider, or the pediatrician. Then we build a plan on the edited version and call it collaboration.

Mike Carrero said that fear should frustrate every clinician who hears it. You cannot treat the elephant nobody will name. What changed it for her was ordinary contact. She sat at the kitchen table and ate lunch with the therapist, every day, for two years. Boundaries still matter, and she said so herself. But a rule against accepting a cookie does not build trust. Steady, unhurried presence does.

That's not collaboration because that's just performance.

From the talk — Sean Yocum & Michael Carrero

What Compassionate Care Looked Like Once It Finally Worked

The second half of her story is the part worth copying. The new team required her in the room. She objected at first. She said she did not need therapy, they were there for her son. They held the line, and that was the shift. The work moved into her kitchen, her mornings, and her real routines.

Her son was brought into the conversations too. He got to disagree. Some hard things still had to happen, but he was no longer talked around. That is assent in practice, not in a policy binder. She pointed to a three year old saying no through a speech device (a tool that talks for them). No means no.

One small moment still stands out to her. She broke down in a meeting during a health scare. The analyst asked if she was okay. Then the analyst offered a plan: pause new programs for a week, hold what they had, and take a breath. Within two years of that kind of care, the family graduated from services. Her son became independent in self care. He entered public school without incident and rode the bus all year. He went to a camp with no special supports. Now he talks about college.

And it was so validating to know that our family was important enough to be taken care of.

From the talk — Kim Lambert

The Screens She Gives Parents Before They Pick a Provider

She gets asked for provider advice all the time in parent groups. Her screens are practical. If intake never asks about siblings, values, or what matters to you, keep looking. If the clinic will not let you inside the building, walk away. She knows privacy rules and paperwork exist. She also knows tours can be arranged when a provider wants to arrange them.

Her other screens are just as blunt. You should be able to read the goals written about your child. You should be able to get the whole record whenever you ask. You should raise a concern once and see it handled. She asked for four weeks to have one therapist moved off the case. She was not heard, and her son got hurt.

One signal deserves its own line. Picture two, three, or four hour meltdowns after every session, for a year. That is not normal. Something is wrong with the plan. That is not proof the work is simply hard. She is not against ABA. She is against bad ABA, and she has now seen both. The difference in her house was a team that treated the whole family as part of the case.

You should be able to be allowed to sit in on sessions.

From the talk — Kim Lambert