After a few weeks of working with the boy, Vance was laid off and her supervisor was fired, she says. “They were missing so much about this amazing human by just saying he was like a 3-year old,” says Vance, who now heads NeuroClastic, a nonprofit blogging platform about autism. But instead of engaging with him through movie lines, she was told by her supervisors to reward the boy with candy or cereal for following commands and completing trivial tasks, such as stacking blocks. Vance recognized that he was communicating with humor and nuance by choosing lines to recite in various situations. For example, she shadowed a more experienced RBT at the home of a 10-year old boy with autism and intellectual disability who had memorized entire movie scripts. Vance also quickly became skeptical of the kind of therapy she was being trained to deliver. No one taught her how to change diapers or adequately manage aggression, she says, which she would have found more useful.

Extra training she received from her employer - on privacy, patient rights and restraint training - did not add to her confidence. (She was diagnosed with autism herself in 2017.) But when she started accompanying another RBT on home visits, she felt unprepared, she says. Vance had spent 14 years teaching English to middle- and high-school students, and she had developed a reputation for helping autistic students. It was easy to pass: If you failed a quiz, you could just re-watch the video and take it again. She was intent on learning the material, she says, but found out later that other students cut corners, letting the videos play while they did other things and looking up quiz answers on their phones. Vance completed the online course - a series of videos followed by quizzes from a company called Relias - over a weekend. The employer paid for her to get the RBT certification, which would qualify her to deliver what many researchers consider the gold-standard autism therapy, applied behavior analysis (ABA), under supervision to these children. Instead, her employer told her the company had a backlog of autistic children and wanted her to help with that caseload. To get the supervised hours she needed for her psychology license, she had taken a job working with mentally ill adults for a company in Lynchburg, Virginia.

When Terra Vance took a course to become a registered behavior technician (RBT) in 2015, she was trying to transition from a career as a teacher to one as a psychologist.

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