BCBA for autism: Why aggression in autistic children happens

If you’ve ever sat in a doctor’s office watching your child’s medication list grow longer and longer, each new pill added to fix a side effect from the last one, you know exactly the moment I’m talking about. Our son Michael has seizures and has been on four different anti-seizure medications over the years and more than once, a med change made him more aggressive, not less. I used to think that was just “how he was.” It took working with a real BCBA for autism, not a guess and check approach to help me understand that so much of what looks like “just autism” is actually the body sending a signal we haven’t learned to read yet. That’s the conversation I had with Glenn Carter, a BCBA for autism with over 15 years of experience and honestly, it changed how I think about my son’s bad days.

Key Points:

• Why is my autistic child so aggressive? Often it’s not “just autism” medication side effects, sugar crashes, allergies, weather sensitivity, poor sleep or lack of exercise can all be driving the behavior underneath.
• Before changing any medication, track the behavior with something as simple as a calendar with stars on bad days. Bring that data to the doctor instead of just describing “how things are going.”
• Structure matters more than people think. Too much unstructured “leisure time” can actually make behavior worse. Some kids and adults do better with more work, routine and visual completion of tasks.
• Community access isn’t all or nothing. The right “dose” is different for every person and it can change over time, consistency beats intensity.
• Hope is not naive. Services, science and understanding are all improving. The behavior you’re dealing with today is not a life sentence.

Why Is My Autistic Child So Aggressive?

This is the question that keeps parents up at night and Glenn’s answer surprised me even after years of doing this. He told a story about a 10 year old on a “cocktail” of medications, one drug prescribed to manage the side effect of another drug which caused its own side effect. And needed its own medication. Nobody had stopped to ask the most basic question: Why is this child on medication in the first place?

For that child the answer was aggression. So Glenn had the family start tracking real data at home and at school to get an honest baseline. When they brought that information back to the doctor, the doctor was able to start peeling medications away one at a time. Eventually, that child was medication-free, aggression and all, because the actual behavior had been addressed instead of managed with more pills.

That’s not always the outcome. Sometimes medication is the thing that changes everything for the better. Glenn’s seen kids with ADHD go from unable to focus in class to thriving, once the right medication was found. The difference isn’t “medication good” or “medication bad.” It’s whether anyone is actually measuring what’s happening.

The uncomfortable truth Glenn pointed out. Doctors are often working off of parent stories. “How’s everything going?” “Oh, fine.” That’s not data that’s a mood. If you want real change, you need something as simple as a calendar where you start the bad days and leave the good ones blank. For sleep, track bedtime. The time they actually fell asleep and whether they woke up rested. It sounds too simple to matter. It’s exactly what doctors need.

What Does a BCBA for Autism Actually Do?

I get this question a lot from other parents, so it’s worth pausing on. A BCBA (Board Certified Behavior Analyst) isn’t just someone who tells your kid to sit still or stop hitting. A good BCBA for autism does something closer to detective work, they look at behavior as information, not just a problem to shut down. Glenn’s whole approach with that 10 year old on the medication cocktail is a perfect example: Instead of accepting “this is just how he is,” a BCBA for autism asks why the behavior is happening, builds a way to measure it and works alongside doctors, nutritionists and parents to actually change the underlying cause. That’s the difference between managing a symptom and understanding a person.

What Else Could Be Driving the Behavior? Nutrition, Exercise, Allergies and Sleep

Once you start looking past medication, a whole world opens up. In our house, we learned the hard way that sugar was a huge trigger for Michael. A big sugary breakfast meant a spike and then a crash and the crash always came with worse behavior. Swap that for protein or something with a slower release and his whole day evens out.

Then there are allergies. Michael was allergic to strawberries as a little kid and the more he begged for them (and got them, because he loved them so much), the more agitated he became. At our program, J13, we’ve seen adults react to seasonal mold and pollen behavior changes when the weather turns and if you don’t know to look for it, you’ll just think they’re having a “bad day” for no reason.

Exercise matters too. On days Michael gets real physical activity walking, hiking, basketball his aggression drops noticeably in the evening. And all of that feeds into sleep. A good night’s sleep, driven by the right nutrition and enough physical activity during the day, makes him easier to be around the next day. Just like it does for the rest of us.

Glenn put a name to all of this that stuck with me: hypersensitivity. Are they hypersensitive to sugar? Changing weather? To pollen? He made the point that autism as a diagnosis is a big, sloppy bucket the way Rett’s disorder used to be lumped in with autism until they found the genetic marker that separated it out. Someday, some of what we call “autism behavior” might get its own name entirely. For now, we’re stuck figuring it out ourselves, one variable at a time.

How Do You Build the Right Daily Structure for an Autistic Child or Adult?

Here’s where Glenn said something that reframed a lot for me: some people are given too much leisure time. “I don’t know what to do with you, so go watch the show again.” Reading the same Dr. Seuss’ book for the 8,001st time isn’t enrichment, it’s a placeholder. Michael, for example, actually does better with more work and structure than with unstructured “fun” time. He loves the visual completion of a task folding laundry, closing the dishwasher, seeing something done. That satisfaction is real and for him, it beats free time.

The flip side is just as true for other kids, some genuinely need more downtime, more chance to develop real interests, whether that’s expanding their library of favorite books or making a puzzle a little more challenging. Glenn’s advice: figure out your own child’s cadence. Some people need to be pushed toward more productivity. Others need to be given permission to just enjoy something without getting “better” at it like an adult coloring book or a golfer whose handicap never moves but still loves every round.

How Much Community Involvement Is Actually Healthy?

At J13, we get our crew out into the community up to three days a week and I’ve wrestled with whether that’s the right amount for everyone. Glenn’s answer: there’s no universal number. Some people thrive once a week. Some could do more. And that number can change what’s right today might not be right in six months or a year.

He connected this to something we all watched happen with kids during COVID the ones who lost those small, everyday social interactions struggled more when they got back into the world. For a lot of kids with disabilities, something similar happens by default, because survival mode as a parent (just getting groceries, just getting dinner made) often means fewer chances to be out in the world. Getting back into community as an adult takes deliberate, repeated effort, but the payoff, Glenn says, is real: people start recognizing staff, staff start recognizing them and community actually starts to form. Consistency, even at a modest dose, beats sporadic big outings.

What Do You Do on the “Grouchy” Days?

One of the most useful reframes Glenn offered: don’t think in days. Think in hours. If your child wakes up grouchy, that doesn’t mean the whole day is shot, it means you need a different plan for the next hour or two. Maybe that’s coffee, maybe it’s a slower start, maybe it’s swapping the hardest activity to later. Once they warm up, you shift back to the normal plan. It’s flexible, it’s responsive and it’s honestly a lot less overwhelming than trying to fix an entire day.

Is There Really Hope If My Autistic Child’s Behavior Never Seems to Change?

This is the part of the conversation that stuck with me the most. Glenn talked about the idea of “yet” your child can’t communicate effectively yet. They can’t climb yet. It’s not denial, it’s just honesty about where things stand right now with the door left open for what’s next.

Glenn’s point was simple: The field is not standing still. The quality of services, the technology and our understanding of what’s possible keeps expanding. Just because the answer isn’t here today doesn’t mean it won’t be here tomorrow. And even with all the hard days, there is a good life to be built here for your child and for you.

What You’ll Learn From This Episode

• Why a “medication cocktail” often needs to be questioned instead of just managed
• A simple way to track behavior data that doctors can actually use
• How sugar, allergies and weather can mimic or worsen “autism behavior”
• Why is too much unstructured leisure time backfire
• How to figure out the right amount of community involvement for your child
• A better way to handle “grouchy” days think hours, not days
• Why “yet” is the most important word in a parent’s vocabulary

Notable Quotes

• Glenn Carter (01:15): “It really starts with the first question for the parents. It’s like, ‘Hey, why are they taking medication? What are you trying to change?'”
• Glenn Carter (02:53): “I think the biggest flaw in the practice of prescribing medication is that it’s often reliant on parent stories to the doctor of how things are going.”
• Glenn Carter (06:06): “I think one of the things about the diagnosis of autism is that it’s a very sloppy diagnosis. It’s more of a big bucket catchall.”
• Mike Carr (10:24): “Just because they’re going to be less problematic, it’s easier to put them all in a campus environment or a farm environment away from a community. That doesn’t mean that’s ideal.”
• Glenn Carter (13:38): “The question is, what is the dose of healthy access to the community?”
• Glenn Carter (17:23): “Don’t think in days, think in hours. This is what we do for the next two hours.”
• Glenn Carter (19:06): “There’s an element of humor that you have to have that actually this situation can get worse. And the inverse is even more true that this can get better, nothing is forever.”
• Glenn Carter (19:54): “There is a good life here. There’s a real opportunity for a good life.”

Resources & Links

• J13 – Mike Carr’s community-based day program model for adults with autism and complex needs, focused on real community integration.
• Autism Labs – The weekly podcast series where this conversation originally aired, featuring parents, professionals and BCBAs discussing autism support.
• Howdy Homemade – A community organization referenced in the conversation, whose founder Tom coined the “yet” mindset discussed in this episode.
• 512bcba@gmail.com – Direct contact for Glenn Carter, BCBA, based in Austin, Texas.
• BCBA (Board Certified Behavior Analyst) – A credentialed professional who designs and oversees behavior intervention plans; a good first call if you’re trying to untangle behavior, medication and environment.

Timestamped Outline

• 00:05 Recap and introduction to part two with Glenn Carter, BCBA
• 00:51 The impact of anti-seizure medication changes on aggression
• 01:15 The medication “cocktail” story and how data changed the outcome
• 04:27 Nutrition, allergies, exercise and sleep as behavior drivers
• 06:06 Why autism is a “sloppy diagnosis” and the value of parent intuition
• 07:31 Building a “cloudy day plan” and working with helping professionals
• 08:27 The risk of too much unstructured leisure time
• 10:24 How much community involvement is “good enough”?
• 15:29 Both parents bring insight recognizing and listening non-verbally
• 17:23 Handling grouchy days hour by hour, not day by day
• 19:06 Final thoughts on hope, “yet” and building a good life

FAQ’s:

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Transcription:

Mike Carr (00:05): Welcome back everyone for part two of our conversation with a real BCBA, Mr. Glenn, or Glenn Carter, who’s been doing this for over 15 years. If you didn’t watch our first episode, I encourage you to go back to last week’s episode and watch our conversation. Today we’re going to continue talking about interventions for those who require more support, or those in combination where you’ve got someone with lower support needs interacting with someone with higher support needs. Where we ended last session, I’d like to pick up today with the impact of medications. I’m thinking about our son in particular. He has seizures and is on four different anti-seizure medications, and we’ve changed those a lot over the years because some seizure medications created more aggressive behavior. He seemed more agitated, more stressed. Even though we tried a lot of interventions, that behavior really didn’t change. So we ended up going with a different mix, and his behavior moderated. Glenn, do you have any stories or examples like how does an awareness of medications, or what other professionals and therapists and medical doctors recommend, and mixing things up, have a positive impact?

Glenn Carter (01:15): I remember once working with a 10 year old who was on a cocktail of medications, a cocktail where this medication caused a side effect, so they added a medication for that side effect, which caused its own side effect, so they added another medication for that. I remember thinking, “Whoa, whoa, whoa guys, this is so much. What are we doing here?” It really starts with the first question for the parents: “Why are they taking medication? What are you trying to change?” In this case, it was simple: he used to be aggressive. So we said, let’s start the story again: we want to keep aggression low, close to zero, maybe once every six months. We worked with the parents to take data both at school and at home, so we had accurate measures of his aggression. Then we brought that information back to the doctor and said, “Here’s the baseline on this cocktail this is where we’re at.” With that information, the doctor was able to say, “Let’s take this one out first and see what happens.” We went through that process iteratively until that learner was medication-free because the original reason for the medication, the aggression, was gone, and we didn’t need medication anymore. That’s one extreme example of going from a full cocktail to nothing. But I’ve also had plenty of experiences, especially with ADHD, where a kid’s ability to focus in class was a real struggle, and once they were given the right medication, it was like, “This kid doesn’t need extra support anymore this genuinely changed their life.” Their ability to focus and do what was being asked of them was fixed.

I think the biggest flaw in how medication gets prescribed is that it often relies on parent stories told to the doctor. The doctor asks, “How’s everything going?” and the parent says, “Oh yeah, fine” and that’s not really useful information for the doctor. The number one rule, if you’re trying to make changes to medication, is to identify exactly why the medication was prescribed in the first place, and then develop some kind of simple measure. If it’s for aggression, use a calendar star the days there was aggression, leave it blank when there wasn’t. That immediately communicates something real to the doctor. If it’s for sleep, track bedtime, what time they actually fell asleep, and whether they woke up normally just a simple check, check, X, check. That communicates far more than a vague conversation.

When it comes to medication, I do defer to what the doctor says. But as you work in this field, you start to notice that some doctors are more liberal with prescriptions and some are more conservative. As you develop your practice, you can help parents find a doctor whose philosophy matches what the family wants. It’s about matching the family’s comfort level with the right doctor, and giving that doctor good measures of how things are actually going.

Mike Carr (04:27): That’s really helpful. I want to talk about a few other things you’ve had experience with: nutrition, exercise, allergies, and sleep. With our son, nutrition matters a lot if he eats a lot of sugar, which he did before we knew he needed a low-carb diet, it jacks him up and then he crashes, and that affects his behavior. But if he eats a decent breakfast, something with a moderate release of energy or protein instead of a sugar hit, his behavior is more normal throughout the day. We also discovered allergies mattered. When he was little, he was allergic to strawberries. He wanted strawberries constantly, and the more he ate, the more agitated he became, even though he loved them. We have guys at J13 right now who, when the weather turns, react to rising mold and pollen levels they have an allergic reaction, but they can’t articulate that. You just notice their behavior changes, and you can connect that to the weather. Exercise matters too on days Michael gets a lot of exercise, that mitigates his aggression. All that stress gets worked out through walking, hiking, running, or basketball, and he’s calmer in the evenings. And as a result, he sleeps better, and a good night’s sleep makes him easier to deal with the next day like it does for all of us. What gives him good sleep is exercise, the right nutrition, and knowing his triggers it’s a combination of everything. Medication is absolutely worth looking at, but even if medication feels handled, that doesn’t mean everything is handled. Any experiences or suggestions on those four areas?

Glenn Carter (06:06): You can put all of those under the umbrella of being hypersensitive to changing weather, to pollen, to sugar. One of the issues with the autism diagnosis is that it’s a very sloppy diagnosis, a big catchall bucket for things we haven’t been able to tease apart yet. Rett’s disorder used to be included under the autism diagnosis, until they found a genetic marker that separated it out as its own condition. I believe, long term, that’s what will happen with autism as a whole piece will get pulled out and identified as their own distinct things. But that’s the future; we’re in our current reality. I think as parents and Mike, this has been lovely to watch in you your understanding of your own child goes far beyond anything a therapist has. Sometimes you understand what he’s communicating in ways I never will, even having known Michael a long time. There’s nothing like a parent’s understanding of their own child.

Once you’ve identified a pattern, say they always struggle on cloudy days there are two things you can do. First, lean on other professionals, like nutritionists, who have specific expertise in that area. Second, ask: how do we change the day based on these patterns? Almost like having a “cloudy day plan” versus a “non-cloudy day plan.” That might sound silly, but it’s what we all already do. We wear a jacket when it’s cold and shorts when it’s warm. We’re already adjusting our behavior to the weather; it’s just that for some people, that adjustment needs to be far more dramatic.

On exercise I think everyone benefits from it; if you’re human, exercise is good for you. But something I’ve been reflecting on a lot with J13 is the balance between leisure time and work time. Some adults with intellectual disabilities are given too much leisure time “I don’t know what to do with you, so go watch the show again,” or “go read that Dr. Seuss book you’ve read 8,000 times, read it an 8,001st time.” Sometimes we give people too much unstructured leisure. And sometimes it’s the opposite “you have to work, you have to do chores, you have to help the family.” I think everyone has their own healthy cadence between leisure and productivity. With Michael, I actually think he benefits more from work. He’s more sociable and happier doing chores and completing tasks than doing things we’d call “fun” but that he doesn’t actually find as fun as other people might.

So I think it’s about understanding your child’s cadence for some, that means more productivity; for others, more downtime, and developing their genuine interests. Maybe it’s expanding the library of books they enjoy, or making their puzzles more challenging. And for some people, it’s not about getting better at an activity at all, it’s just the value of doing it. Adults doing coloring books might never “improve,” but they find it relaxing. Golfers with a handicap of 14 for a decade are staying in the same place, and that’s fine, because the activity itself has value. I think that’s worth reflecting on: is this leisure activity fine as it is, or does it need to evolve? It’s not just “how do I stop the hitting” it’s “how do we build a good life?”

Mike Carr (10:24): That’s such an important point, and I’m not sure there’s consensus on it. At J13, we try to get our crew out into the community every day and you could argue that’s not optimal for everyone. Every parent wrestles with the question: when is good, good enough? Our belief for most of our folks, including our own son Michael, is that we always want him challenged and growing, no matter his age, because there’s something innate in people that wants challenge and accomplishment. But there’s also room for leisure, and if a sequence of leisure activities works well and stays consistent, why change it? We want our folks out in the community, like neurotypical people are, even those with level three autism or complex needs shouldn’t be isolated just because it’s easier to manage. It might be simpler to keep them in a campus or farm setting away from the community, but simpler doesn’t mean better. We get them out, used to being around neurotypical people, having fun, mixing and mingling that feels healthier. Then we combine that with the right amount of leisure and enough structure, which is different for everyone.

Glenn Carter (12:13): One thing I’ve noticed about the jobs Michael likes is the visual completion. He doesn’t want to be told something is done, he wants to see it. Same with the dishwasher he loves closing the cabinets once everything’s put away. That visual reinforcement is powerful for him. On the question of how much community time is right I think about children who grew up during COVID and lost those small everyday social interactions, and how much harder school became for them afterward, because they hadn’t gotten to experience the world in a healthy way. Unfortunately, that’s also true for many children with disabilities during their early years. Challenging behavior can make it genuinely difficult to bring them into the community. So much of parenting becomes survival mode: “I need to get groceries, so Michael stays home while I grab what I need for dinner.” That can be a lot of childhood, and it takes deliberate effort to bring kids back into the community. By adulthood, there’s an inherent value almost a Maslow’s hierarchy kind of value that all humans get from community access. The question becomes: what’s the healthy dose? Once a week? Seven times a week? Somewhere between those numbers is right for each person.

At J13 right now, we do up to three days a week, and for most people that’s healthy. Some could probably do more, and for some, twice a week or even once a week is exactly right. People also change what works today might shift in six months or a year, and it’s important to stay responsive rather than treating community access as something you check off a list. We take people to a climbing gym on a varying schedule, and the ones getting the most out of it are the ones going most regularly. Ironically, climbing has a sharp learning curve. It’s genuinely hard to learn how to move your body that way. So starting once a week or once every two weeks might be exactly the right starting point, but to become a confident, regular climber who enjoys harder holds, you need that regular practice. And something else happens with regular community involvement: you start to recognize the staff, and they start to recognize you. That’s how a community actually gets established, showing up at the same place, at regular intervals, again and again.

Mike Carr (15:29): You mentioned a keyword here that also came up a couple of weeks ago with Howdy Homemade “recognize.” To recognize what your child needs, you have to listen and that doesn’t just mean listening to what they say out loud, since we’ve already talked about non-verbal listening. Parents do have an intuitive feel for this, and I think in most cases, dads should defer to moms, because moms tend to be more closely connected to the kids.

Glenn Carter (15:57): I disagree.

Mike Carr (15:58): Tell me why.

Glenn Carter (15:59): Especially if the child is male, I think a dad can see the male perspective really well.

Mike Carr (16:06): I like that.

Glenn Carter (16:07): I wouldn’t discredit any parent’s experience. Even if you were the parent who had to work overtime to pay for services, while the other parent stayed home and focused on the day-to-day even in that role, you’ve still gone through the experience of parenting them. And ultimately, no one will love your child more than you will. To simply defer all your knowledge to the other parent isn’t right you have something important to say too. I think the healthy thing is speaking to one another not about who has more or less information, but about seeing where you’re both at and what your perspectives are. That leads to better conclusions.

Mike Carr (16:59): So let’s give both parents credit for having insight into their kids, and also acknowledge that you do need to listen even non-verbally to understand what your child wants and where they’re at. On a “cloudy day,” you might follow one protocol, and on a different kind of day, another. “Cloudy” is just an analogy; it could be waking up grouchy or grumpy, which calls for a “grouchy day protocol,” because that mood usually isn’t going away quickly.

Glenn Carter (17:23): With that grouchy protocol, don’t think in days, think in hours. Ask: what do we do for the next two hours? The next hour? It’s easy to throw the whole day away instead of recognizing how long the difficult moment actually is. If they wake up grouchy, maybe you need a couple of hours to give them coffee, whatever helps them wake up and then return to the normal schedule.

Mike Carr (17:41): That’s important, because the day’s schedule can be very fluid. If they wake up grouchy, you might start with different activities, and as they warm up and become happier and more engaged, you can shift back to more challenging tasks. Having that flexibility in your child’s program or with the therapists working with them to roll with the punches sounds obvious, but it’s often hard to implement. That’s something we try to do at J13, individualized not just to the person, but almost hour by hour, based on what’s going on and which group works well together.

The last thing I wanted to end on and I think you share this belief is a word that Tom, the founder of Howdy Homemade, and his partner Jeff used a couple of weeks ago on the podcast: “yet.” Your child can’t climb yet. They can’t communicate effectively with you yet. There’s always a reason for hope, no matter how difficult the behavior is or how little sleep mom and dad are getting. With the right therapy and the right programs, things will probably get better. It may take a while, but they often do improve. What final thoughts do you want to leave parents with, when it comes to that idea of “yet” and hope?

Glenn Carter (19:06): It reminds me of a soccer manager in England whose team was playing badly and losing a lot of games. A reporter asked him, “It can’t get worse than this, can it?” And he responded, “It can.” There’s an element of humor you have to hold onto. This situation can get worse. But the inverse is even more true: it can get better, because nothing is forever. One thing I’ve seen throughout my career is that the quality of services keeps expanding, and our understanding of technology and what’s possible keeps growing. Just because the answer isn’t here today doesn’t mean it won’t be here tomorrow. And I think that’s something we can always rest on. Working with the adults at J13, I see real proof that there’s a good life here, a real opportunity for a good life. Sometimes I look at them and think, “I’m a little jealous you’ve got it figured out, you’ve got buddies, you’ve got interests, you get to do fun things.” It’s about anchoring yourself to the goal of building a good life for your child. And often, it does work out that way because I have struggles in my life too, we all do. But if you can help your child build a good life, regardless of any disability, I think you can rest well as a parent.

Mike Carr (20:23): Well, Glenn, thank you so much for your time today. If people want to get in touch with you and learn more about your background and BCBA experience, where can they go?

Glenn Carter (20:32): The simplest way is my email, 512bcba@gmail.com. I’m based in Austin, so if you’re an Austin family, I’m currently providing services and would love to connect. Otherwise, Facebook is a great way to reach me. My name is spelled with two Ns, G-L-E-N-N Carter, C-A-R-T-E-R. I’ve got red hair, so I don’t think there are too many other Glenn Carters to confuse me with.

Mike Carr (21:00): Awesome, Glenn thanks again, and to everyone watching, we hope you have a wonderful week. Come back next week for another episode of Autism Labs. See ya.