Empirically Validated Treatment Part II

The terms 'empirically validated' and 'evidence-based' get thrown around a lot, specifically in describing the prospects of any given medically-based treatment. ABA is no stranger to the phrasing and enjoys a prominent place on the list of such treatments--namely the top of the list. This, however, does not mean that treatments without empirical validation may not hold some evidence or use. And to much dismay,  empirically validated approaches are not always implemented successfully. In fact, even evidence based approaches can fall short due to human error.

This is part 2 of this dense and tasty brew, Mike and Dan explore the empirical validation of ABA as well as other treatments deemed 'evidence-based' by most research standards. They also take time to examine what it means to not meet such a standard and those concoctions should be consumed, if at all.

This is a stout---dark, bold with some hints of sweetness and a long finish. Take this one slow but pour bountifully, and always analyze responsibly.

All ABA on Tap brews pair well with cerebration. SO--if you are ready to enjoy the benefits of Magic Mind and boost your brain performance, please use the following link and use the discount code AOT to receive 20% off your purchase, and 56% off a subscription.
https://www.magicmind.com/aot  

Transcript

SPEAKER_02: 0:00

Welcome to ABA on Tap, where our goal is to find the best recipe to brew the smoothest, coldest, and best tasting ABA around. I'm Dan Lowry with Mike Rubio, and join us on our journey as we look back into the ingredients to form the best concoction of ABA on tap. In this podcast, we will talk about the history of the ABA brew, how much to consume to achieve the optimum buzz while not getting too drunk, and the recommended pairings to bring to the table. So without further ado, sit back, relax, and always analyze responsibly.

SPEAKER_00: 0:54

All right. And welcome back to yet another installment of ABA on Tap. Very, very glad to be here. I am your co-host, Mike Rubio, along with Mr. Daniel Lowry. Mr. Dan.

SPEAKER_02: 1:10

Good to see you and excited for part two. Part two of... Evidence and not evidence-based treatment modalities for individuals with ASD.

SPEAKER_00: 1:20

Which I think I've entitled, at this point, Empirically Validated Treatment. Let's talk about that a little bit. So empirically validated, meaning it's gone through some process of experience and observation and examination, what we might call the scientific method as part of that, some sort of replicated study with a peer-reviewed journal and results and whatnot. And hopefully you've got plenty of evidence in that empirical validation and that peer-reviewed journal article. You have enough evidence to then... Prove something. Prove that something works, that it's got predictive validity, that it's been known to, with significance, assist, for example, in terms of treatment, a significant percentage of the population or the sample that was studied. And then you've got the idea of evidence-based, which means you just have evidence, right? Yes, so an evidence-based is part of empirical validation, I would argue, as I like to say. And then you can just have evidence without empirical validation. And that might be something we talk about a little bit today in terms of things that work for people that may not actually have the science behind it. What does that mean? Are we... Steering people away from that, maybe. Are we saying, maybe that's not harmful at all? Go ahead, try it. Some gluten-free cookies, they're delicious. Everybody likes them. I'm kind of boiling that down a little bit. But we're going to cover the whole gamut. Just a quick recap, Dan. Last time, we went through a whole list of evidence-based practices. Things that... your insurance provider, your funder is probably going to be okay with. We'll talk a little bit about what that means today. Why don't you take us through that list and then kind of introduce us to the other side that we'll deal with today.

SPEAKER_02: 3:16

That's what I want to do. I've been training on this for about 10 years, and I do think I hit a little bit of the Dunning-Kruger effect of the more research I did, the more confused I got specifically regarding one of the evidence-based methodologies. So from the National Clearinghouse of... This is specifically called the National Clearinghouse of...

SPEAKER_00: 3:45

Take your time, sir. It's all good. It's all good. Google's slowing us down here. I'll whistle a little bit. You might be able to hear my neighbor practicing his bagpipe right now. I don't know if you can hear. Go ahead.

SPEAKER_02: 3:55

The National Clearinghouse on Autism Evidence and Practice. So that's what this list is from. And the 28 evidence-based practices, again, are antecedent-based interventions, augmentative and alternative communication, behavioral momentum intervention, cognitive behavioral instructional strategies. differential reinforcement of alternative, incompatible, and other behavior. Interesting that it doesn't mention high-rate or low-rate behaviors, but I'm going to go ahead and assume those are evidence-based within that. Direct instruction, discrete trial training, evidence and exercise and movement, extinction, functional behavioral assessment, functional communication training, modeling, music-mediated intervention, naturalistic intervention, parent implemented intervention, peer-based instruction and intervention, prompting, reinforcement, response interruption and redirection, self-management, sensory integration, put an asterisk by that one, social narratives, social skills training, task analysis, technologically-aided intervention and instruction, time delay, video modeling, and visual supports.

SPEAKER_00: 5:10

Now, as we made the point last time, 90% of that list is, I would say, derived from the general umbrella of applied behavior analysis. Is that fair to say? That is

SPEAKER_02: 5:24

fair to say.

SPEAKER_00: 5:25

Okay. And I want to qualify that, too. I'm not trying to boil things down too far. That's not what we're trying to do here. So the idea that... Any of these pieces procedurally or to form a certain protocol can be effective. And that's what this expansive list is saying. So maybe last time I might have intimated these are all trying to be seen as separate therapies. Maybe not. Maybe, in fact, they're just saying that therapies that involve these procedures or protocols around these procedures are going to be effective. And then, yes, these are all 90 percent of these things are procedures. that we understand as part of applied behavior analysis. So that's a good thing. It's a good thing that even within that list, there's a task analysis of applied behavior analysis so people understand what these particular procedures are, what they sound like, what they intimate.

SPEAKER_02: 6:22

So what I thought was interesting, because I was a little bit confused, because when I made my training, sensory integration was on the unproven or not evidence-based list. And according to this list, It was on the evidence-based list. So as I continue to do more research, I went to Cigna, one of the larger insurance providers, and they have their evidence and not evidence-based list. And under examples of unproven treatments is sensory integrative therapy. So now I'm quite confused if it's considered evidence-based or not evidence-based. It kind of seems like it depends on who you ask and what the research and the source is to whether sensory integrative therapy is considered evidence-based or not evidence-based.

SPEAKER_00: 7:05

Well, this always brings up the question of other disciplines like occupational therapy, for example. And we can look at that from... a medical perspective and an educational perspective. The plot thickens a little bit there, what they take care of. And then we can say that clearly occupational therapy, I would say clearly, from a medical model, is an empirically validated treatment approach, discipline, if you will. Then the question remains, what does it do specific to somebody with autism or an autistic individual? to aid them with whatever challenges they may be facing that are related to those things that occupational therapists address, which there are some things like eating, right, or feeding and chewing and swallowing, which also goes into speech and language therapy. So these are all things that are medically validated. Now, how they fall into the criteria that comprise an ASD diagnosis is maybe the question that's more important here. And maybe that's what the sensory integration part, that's where the quandary lies. I don't know. What do you think?

SPEAKER_02: 8:19

It's, man, it's tricky. And we had a nice discussion before we went on air here about how There can be a lot of good collaboration from the sensory perspective and how sensory integration is defined as taking in basically your entire surroundings and making sense of them. And how if an individual struggles with this, one of the videos I showed during my new hire training was Temple Grandin talking about how it affected her. So clearly she feels like there's some relevance from her perspective. Again, this is just one individual's perspective. Taking in all of the surroundings of the environment and again, sensory processing disorder or a sensory integration dysfunction is kind of like that traffic jam of input, meaning that there's too much or too little input getting basically too much or too little input that the body's receiving and your brain is kind of making use of. So that, you know, that does make a lot of sense. So it led us down the idea of or the discussion of what is sensory integration in relationship to ABA? Is it kind of hand in hand? Is it different? Because traditionally it was maybe looking at tactile, vestibular, and proprioceptive and how it relates to an individual's behavior. But as we were discussing, without the ABC contingency, the skills probably still aren't going to be accessed by that individual.

SPEAKER_00: 9:46

It's an interesting exercise in task analysis, right? So what an OT does, I'm not claiming to be an expert by any means on that, but in my limited experience in what... OT looks really good. We were talking about that too, right? They've got some fun things to do. And a lot of what they offer in their OT centers look like really nicely padded playgrounds, if you will. Things that kids should be doing... Naturally, to use that word loosely. during the first 24, 36 months of their lives, crawling, climbing, falling, knocking things over that don't break or things that do break, maybe at a higher rate than a parent can sustain. Now we've got a language delay. Now we're talking about autism. I'm really boiling it down there. Of course. You get my point. I guess when I refer to the first 24 months of life from a developmental perspective, we're talking about a sensory motor development, the idea that that is when all kids all human animals become a little bit troublesome you're moving around you're tall enough you're able to start opening cabinets that are low enough to the ground maybe that's where pots and pans are kept because it's low to the ground now you're banging these pots and pans and then now maybe from a developmental delay perspective you don't resolve those needs if you will from an input perspective from your environment. And so if you're seven years old or maybe from a repetitive behavior approach, you persist on those behaviors. So now you're seven or eight and you're banging these pots and pans and the topography of that behavior is going to be much more impactful to your environment. So I kind of want to put that out there just in terms of what is sensory integration. How does it happen? Because now we're talking about it from a pathology approach, right? We're looking at this from a disorder perspective, if you will. Something that we're trying to adjust to be able to take in better stimuli and sensory pieces from their environment in order to interact with their environment in a way that maybe is more socially significant. Now, to your point, just joint compressions by themselves versus joint compression and muscle activation that's happening with a child as they're pouring sand into a bucket and carrying it from one side to the other and the sand's wet so it's heavier. We overly task analyze again. How do we make those things happen knowing that, yes, kids from a motivating operation developmentally are supposed to play, Through that play, they get a lot of this sensory motor development early in their life. This sensory integration that we're talking about here then is synonymous. And the way we're talking about it now is after the fact and looking, you know, being looked at from an intervention or a needs perspective. So, you know, I've said a lot there to boil it down and I've said it here before on the tap. We use words in ABA like sensory play. And as soon as I say that, I can tell you what you're thinking about. You're thinking about bins with sand and rice and beans. And you're thinking about these things that we've defined as sensory for whatever reasons. And I'm not saying they're wrong. But I am saying we've boiled it way down. And an OT would quickly tell us that and probably make a lot of fun of us with good reason. And then we still have this open-ended question back to what you said. I haven't answered anything. I'm just going back to your question. What's the relationship, right? What's the relationship between sensory integration and behavior? And what behaviors then... put together comprise the idea of sensory integration. How does somebody know you're integrating your senses? What does that mean in terms of its action, right?

SPEAKER_02: 13:49

So I'm going to throw a wrench in this that you might not even be ready for because we didn't even discuss this before. All right, you ready? Yeah. So under the evidence-based practices and definitions... When I did mention the sensory integration, it specifically says here, and again, this is a national clearinghouse. This was an extensive 143-page study that we'll probably link in our description. Under the evidence-based, again, is ARIES Sensory Integration, ASI, and its definition is interventions that target a person's ability to integrate sensory information, visual, auditory, tactile, proprioceptive, and vestibular, from their body and environment in order to respond, organize, and adaptive behavior. All right, that's from the evidence-based list. Now, as we scroll down, there is a some evidence or limited evidence list. And that list has animal-assisted intervention, auditory integration training, collaborative model for prompt promoting competence and success. Compass is what it was or what it is called, previously called collaborative coaching. exposure therapy, massage, matrix training, outdoor adventure, perceptual motor, person-centered planning, punishment, systematic transition and education program for autistic spectrum disorder, and sensory diet. So sensory integration is evidence-based. Sensory diet is some or limited evidence-based. And that's defined as sensory-based activities integrated into routines to meet sensory needs. Thoughts on that differentiation? So I think that's kind of what you were saying, right? The sensory diet, the kind of routine integration of that might not be evidence-based in terms of basically trying to rework somebody's central nervous system or rewire them to have a more... Calm, for lack of a better term, a more comfortable existence. Maybe that's the sensory dive versus the sensory integration. But yeah, we didn't even talk about that. So what do you think as we process this live on tap?

SPEAKER_00: 16:12

So, you know, if we were having this conversation even 10 years ago, I know my opinion would have been different because of that conversation. dividing line of empirically validated, not empirically validated, or not evidence-based discussion, which I think it's convenient, right, for me as a board-certified behavior analyst to sit pretty on the empirical validation and then discount everybody else. But I think the more important, and I don't want to do that anymore, ever again, I think the more important conversation we're having here is how to separate any of these things from the idea that all of them are going to engage behaviors somehow and then we're talking about how those behaviors are contextualized into some sort of socially significant activity I guess for lack of better phrasing I'll give you the best example I can think of my three-year-old went to gymnastics this morning I would say that's chock full of sensory integration, wouldn't you? Especially from a gross motor perspective, right? Not to mention listening and observing, and there's imitation, so there's cognitive faculties engaged. And I would say that a lot of what she did today might have been something repetitive that an OT might engage a child in order to build up their core strength in a way that is now unique and super targeted, which then I would say, how is that different from us presenting an SD... a child behaving in a certain way, like engaging their core in a certain fashion, and then getting some sort of consequence to make sure they do it again, even if it's concurrent, like some sort of swing, which an OT would use, which is concurrent reinforcement for almost, well, for most children, unless the ones that don't like it and then are there at the OT to integrate that sense, right? Sure. So I guess that, you know, I... All these things are related somehow. The idea that By getting better at fine motor activity, then behaviorally a child is more prone to engage in their writing activity at school, which makes them a little bit more reinforcing as a student to their teacher, which now gets them a little bit more attention, and now they're a little bit more of a pleasure to work with and not so difficult during writing time. There's a cascading effect here. There's a collateral effect here that I think we can't separate, and then we still have to go back to the question of From an empirical standpoint, would OT by itself, any of these people that are studied in this research, can we really say that any of these individuals say with autism, they're saying, wait, you're only going to do OT. You can no longer do ABA for the study. We have to stop that. I don't know what the answer to that question is, but I doubt it. I doubt that anybody ethically is able to do that. It's either going to be you have this slew of therapies and we're adding this OT therapy or Or you just have your slew of therapies as a control group, and then that's how we differentiate, which is a perfectly fine research design. I'm not criticizing it. However, the stats would say you can't extricate the rest of those therapies that those people are taking from the results, unfortunately. Sure.

SPEAKER_02: 19:29

But you couldn't do that with any of the 28, right? You couldn't do that with DTT. You couldn't do that with...

SPEAKER_00: 19:34

Other than the fact that all of them kind of fall under the ABA umbrella. So you wouldn't have to extricate them. They all sort of converge on their own, right? I mean, and again, obviously I'm partial to ABA. This is called ABA on tap here. There's no doubt about that. But that's what I would argue there is that, yeah, that's the whole point of us having so many those pieces under the umbrella is that they all correlate back to one type of analysis, right?

SPEAKER_02: 19:59

Yeah, A-B-A-O-T,

SPEAKER_00: 20:01

right? On tap. I never realized that that's our... Yeah, we're A-B-A-O-T. We are. We are A-O-T. That's our code. Anyway, we'll get into that in a little bit. So you bring up a really good point. Thank you. What do we learn from OT, right? What stimuli do we take from them, knowing that you're a fan? You're a fan of looking at OT sessions and going, oh, that's a really good idea. Let's try that. Yeah, what... What do we take from them? What can we learn? And then are we now not practicing ABA or are we now being collaborative? Yeah, that's kind of cool. We are. And then what does that mean that that, you know, we're not traipsing into fine motor and then some insurance is going to cancel us or I don't know, you know, not want to pay for services because we're traipsing into something that doesn't belong. What you know, as you can see, there's a lot of interrelationships between what we're discussing today with just classifying something as evidence based not evidence-based, this works, that doesn't, which clearly that doesn't mean that.

SPEAKER_02: 21:13

Yeah, I think we learned a few things. At the time I wrote my training and in my sensory training, it mentioned that at the time I wrote it, occupational therapy slash sensory integration was listed as the number one favorite therapy for parents for individuals with ASD. So I think regardless of the evidence behind it, I think we can learn a lot from it because at the end of the day, we need to work with parents so that they feel comfortable with the treatment modality that their child's getting. I think two things that OT slash sensory integration, and let me preface this by saying, if you're an OT, please come on the tap. Please correct us. Inform us. Educate us. Yes, absolutely. We would love to have a vibrant discussion. One of the things that OT does is it looks fun. A lot of sensory integration looks fun. It's a lot of swings. It's a lot of movement-based activity, things that kids want to do. First, think about especially older school ABA, where it's a barren room with the IKEA table and chair that we talk about so often. So I think what OT did was they made it fun. And what ABA can do is learn about a lot of the stimuli that occupational therapists bring into situations to increase the motivation to present the ABC. Because you've always talked about the quote-unquote almost four-part continuum, right? The MO, right? Then the ABC. Well, OTs do a really good job on that MO. I've seen it. I'll use the example. Instead of basically telling a kid, okay, we're going to put puzzles on a puzzle piece or... jump up and down to hit these 10 trials. What an OT might do is have a puzzle on one side of the room and a puzzle piece on the other and a scooter board. And now let's scooter to get the puzzle or the puzzle piece and scooter back to the puzzle and we'll make it a race. And now it's fun and motivating and really focused on that MO part of that MO slash ABC. So I think that's one thing that OT does is really provide a stimulating environment, which we in ABA can learn from and continue to collaborate with OTs and collaborate with people, whether it's people in preschool or things like that, to make sure that we're continuing that transition to very stimulating environments. That's the first thing. The second thing I think OT does is they provide a parent-friendly perspective. And what I mean by that is their language isn't necessarily any easier to digest than ABA. Vestibular, proprioceptive, those are some Big words. But what they do is it almost takes the onus off of the parent. And this might be a little bit controversial, but a parent can come in and the OT works with them and they're like, oh, this child has a vestibular, you know, they're hyposensitive vestibular, hypos or hypersensitive tactile. And that's why they're doing it. So it takes the onus off of the parent. It makes it the child has or the individual that's going to see the OT has this disorder, for lack of better term. the hypo or hypersensitivity and it's a child issue. It's an individual issue versus ABA is typically going to be an environmental issue and typically going to be the parent. So we're going to put it back on the parent. So instead of saying your child's not eating whatever because they have a hypersensitive tactile palate and we're going to work with that for the kid. It's your child's Not eating whatever, because you just give your kid when they don't eat it, you just give your kid cookies all day and all your kid wants to do is eat cookies. So it kind of takes the onus away from the parent and puts it to the child, which I think people like. Right. Nobody likes to go to the doctor and have the doctor say, well, eat better and work out. They want to say, no, it's if I can give you this pill. then it'll help whatever your current condition is. And in some ways, that language that they provide is almost like a pill of how to be able to fix it versus, no, you need to fix your behavior first, which nobody wants to hear.

SPEAKER_00: 25:07

It's interesting, too, in terms of the solutions that get presented because they can work against each other. I'll tell you what I mean. So one of my favorite... One of my pet peeves, I'll say, in our field is the whole idea of oral motor input, for example. Plain and simple, you've got a kid who mouths items, right? And now you've got this idea of jewelry, for example. Genius, right? Great. At least why? Well, if you've got an older kid, they're still mouthing things, which is going to have a certain impact. But They're not mouthing everything. Maybe now they're mouthing one thing, and that's better, right, in terms of from the hygienic perspective. So then there's a question that you've solved that part of the mouthing problem. They're not mouthing multiple things. They're mouthing one thing, which could actually revert now back to this idea of sensory motor development in the first 24 months. You're learning how things feel in your tongue and your mouth as opposed to your fingers, which is connected in your brain, so you're sorting all that information out. But then the question remains is from a behavioral perspective now, how do we fade that jewelry, right? So some people would say never. Never. This is going to be a need for this autistic individual forever. Kind of gets into the masking debate. And then for us, it's going to be... Well, yes, and then it becomes a matter of, well, some people are going to... Some parents, for example, some therapists, to use that term loosely, are going to impose some sort of social etiquette on those individuals and now say, you better mask this all day. And then when you get home, you get to have your input. Versus then some people saying, no, look, I... I'm autistic, and I need to do this, and you're going to accept it. My point being is that it starts from, I think, these basic differences, not wrong or right, but where some treatments are going to be a remedy. They're going to take care of a symptom. And then we're often talking about new learning that then... doesn't just take care of the symptom, but addresses behaviorally the fundamental root. So we can work against each other sometimes. And I think that that's a... That's something important to talk about because I don't think anybody's trying to work against each other. Maybe in trying to be the ones that are right, the ones that have the solution, the be-all, end-all. The ones

SPEAKER_02: 27:38

that get the

SPEAKER_00: 27:39

insurance funding. Well, that's for sure. And we've got it. Wow, I got a little cocky there. Yeah, but I think that's an interesting conversation. And back to your point, if you're an OT or you know an OT who would otherwise be furious or maybe agree with what we're saying, we want to know more. I think that there's a lot of discussion about collaborative treatment in our medical model. I don't know that it happens as well as it could. And we've talked about that in other episodes. Maybe we'll revisit that topic as we explore other collaborations. But yeah, the notion that we shouldn't feel like we're working against each other, but just by nature of what our recommendations are, sometimes that's going to happen.

SPEAKER_02: 28:26

Yeah, so interesting. I have three different lists here, the evidence-based, the not evidence-based, and the some evidence-based, and we have sensory integration or some derivative of that in all three of those lists. Very interesting. Anything else you wanted to say about sensory integration before I move on to some of the other ones on the lists?

SPEAKER_00: 28:48

Well, I mean, I think... So I guess revisiting really quickly, I touched upon it, but just in short... what we can learn from OTs. You went over this. Trying to mimic, emulate, otherwise understand why they do what they do, and then maybe setting up our play activities from that approach. Again, that might allow us to expand and vary the notion of the sensory bin and things that clearly... We've titrated down into in terms of practice, even the idea of joint compressions that people might do intermittently or whatever it is. A lot of ABA practitioners integrate, pun intended, some of this sensory integration stuff. A lot of us older school ABA practitioners are going to talk about how, well, that's not evidence-based. But if we look at it from a plain three-part contingency, here's an antecedent or an SD, it does something to your behavior, and now I consecrate it, it can all fit in. All of it fits in. And that's going to pertain to everything we talk about from here on out. And that's sort of my goal is to try to say, it all has to fall under this contingency, which we very, very gladly use. Let's think about how to make these things useful as opposed to just getting stuck on the... Evidence or not evidence-based. unless they're downright dangerous, which I think we're going to touch upon some of those. So let's move on. So quickly, just to finish that point, if you find yourself with the rice bins and the very stereotypical sensory play items in your ABA practice, I'm here to say don't be ashamed, but I am here to encourage you, change it up a little bit. Go find some OT. Go explore the idea of how to turn up certain aspects of... what senses you're engaging during that play, and then think about why you're doing it. I think a lot of what we do is to try to calm kids. We could use sensory play to stimulate in a way that could also be conducive to learning. So that's my little soapbox. Thank you for bearing with me.

SPEAKER_02: 31:02

So what are your thoughts, Mike, on, as I look at this Cigna list, so this list provided by the insurance company Cigna, again, we will link both of the National Clearinghouse articles and the Cigna articles in the the description so that you have access to that and you can reference anything that we're talking about. There's a couple in the signal list. So we talked about sensory, which they consider is basically not evidence-based. Also, auditory intervention training is considered not evidence-based. There's a couple other ones that are on the some evidence-based list for the National Clearinghouse, but not on the signal list. So What are your thoughts there? Is it just insurance is going to try to minimize and take the least option so they have to pay out the least? Is it because there can't really be some evidence-based? Either it is evidence-based or it isn't evidence-based? What is your thoughts on why I'm seeing some on the some evidence-based list and then I go to the insurance one and it's pretty extensive on the not evidence side?

SPEAKER_00: 32:09

I think you nailed it to deny your claim. I'm kidding. No, no, I... That was kind of a bad joke. In fairness, I think we're looking at the difference between peer-reviewed university-based science, maybe, and then how that actually infiltrates or gets deployed into practice. And then, yes, money has a lot to do with it, right? So the idea that you're a provider for a certain insurance panel or you want to become a provider for a certain insurance panel and you're doing this research newfangled therapy. They're going to have to credential you, certify you. So I just think that maybe, in short, the signal list is always, or the insurance provider list, it's always going to be a few items behind the university research-based list. Just because, by the nature of... That makes sense. You have to prove it and then

SPEAKER_02: 33:01

prove it again before they're going to pay

SPEAKER_00: 33:03

for it. Absolutely. And there is consumer protection in that. And then there's also, you know, a semblance of... Fiscal frugality, if you will. That means they got to be a bit stingy.

SPEAKER_02: 33:17

All right. So going into the unproven treatments, the first one listed is nutritional supplements. And actually, before I get into nutritional supplements as the unproven treatment for ASD, let's talk about a nutritional supplement that might actually be proven either evidence-based or at least you can speak to it on your own anecdotal account.

SPEAKER_00: 33:41

I do have some evidence on this one. Thank you, sir. And what we're talking about here is magic mind. Mr. Dan, what I do is I reach into my refrigerator. I grab this little capsule here, this little bottle, little shot. It had this beautiful emerald green liquid inside before I took it down. I shake it up. I breathe deeply, and I take a drink. It's nicely chilled. It's better chilled, I would say. I drink it alongside my coffee or... Solo, I wasn't having coffee today. It was a little too late in the day. Didn't want coffee, just wanted my magic mind. Now, I got to tell you, we're recording on a different day than usual. Today, my day started early, right? By six, I hit the ground running. Getting the baby ready. Going out to do some grocery shopping. Get ready for the week. Doing a little yard work. Setting up to record for the podcast. We record. We're going through it. As we're going through it, I'm a little fatigued, right? It's already well into the afternoon. If my body's fatigued, my mind might be a little bit fatigued. But Magic Mind gives me some good, good, basic stuff. to allow me to energize my brain and really get into that flow state, man. So I can't say enough about this. It's something that is now, I'm doing it religiously for the tap. Best if I can do it three days in a row. I start really seeing these cumulative effects. And just talk about the simple things that are in there. I've got some ceremonial matcha, right? They've got a little bit of agave for sweetness, a nice, bright, clean taste. And then there's some other things that are important for you to know about Magic Mind. Citicoline, for example. Mr. Dan, tell us about that.

SPEAKER_02: 35:20

Citicoline, the benefits of citicoline are to help protect and repair cells, structure, and function of your nervous system.

SPEAKER_00: 35:27

To just get things going, get things moving again in my brain. Nothing like a little vitamin, a B vitamin complex.

SPEAKER_02: 35:37

Which is used to help relieve stress, boost cognitive performance, and reduce symptoms of depression and anxiety.

SPEAKER_00: 35:43

Now, let's say, for example, Mr. Dan, we're recording here, and as I'm editing on the desktop, I somehow make a few of the sound waves disappear. True story, folks. Dan just saw Magic Mind. Dan has seen Magic Mind work beautifully here as I'm trying to move around our editing process, and sometimes technology takes over. But Magic Mind kicked in, and it saved us today for sure. To wrap it up here, L-theanine.

SPEAKER_02: 36:09

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SPEAKER_02: 37:22

All right, and now back at you. So nutritional supplements, restrictive diets, immune gluten therapy, secretin, S-E-C-R-E-T-I-N. Chelation therapy, auditory integration training. Again, they have sensory integration therapy. I think we've beat that horse. Facilitated communication and medicines. Specifically under medicines, some that are listed are clonidine and melatonin. So let's go ahead and talk about it. Nutritional supplements. That was one that's actually on the list that I put together when I did my training. When I started, I know that was the big B12 supplement. They have specifically listed here B6 and B12. That was one that was getting a lot of play when we first started. Any thoughts on wanting to discuss that?

SPEAKER_00: 38:14

I mean, it's still around. I've recently worked with clients who were engaging and said vitamin super dose is I'm trying to remember the name, Bernie, Bernie Rimland, I believe, here in San Diego. A big proponent of that. Might have been associated with UCSD. Somebody fact-checked me on that later. But I do know that, trying to think, even like Laura Schreibman's publication, The Science and Fiction of Autism in the early 2000s, if I remember correctly, and again, if you're listening to this, please fact-check me. I remember her speaking about this vitamin therapy as something that was kind of inconclusive, meaning there seems to be some data that speaks to this having a good effect. I have to, for me personally, I have to boil it back down to that same model, right? So, excuse me. The idea that I'm a health nut which I'm not, and I get up every morning and I run six miles and I do my hydration drink and I'm having all my supplements and I'm getting on my better Joe Rogan, right? Clearly, supplements and nutritional value has a good effect on an individual like that. Exactly, yep. How then that is going to affect the... traits diagnostically related to something called autism would be the question that I would continually answer about that. So, you know, if somebody tells me, hey, we're going to stop ABA, we're just going to go on this diet, I might caution you against that. However, if I'm working with a family and they say, hey, what do you think? We're all going to get on this like supernatural food and we're all doing it and we're enjoying it. And we just tried it last night and Billy loved it. And we're stoked again, back to the idea that we're creating some access to reinforcement for everybody in that dynamic family system. Hell yeah. Go for it, man. Go do it. Go all out. And everybody enjoy it. And go on your walks and your hikes together and go do your thing. So the idea that as an antecedent now where you're creating setting events which include more of the family, which include a kid that maybe is liking the food so now they're eating more than they used to and the family's happy about that. That's a lot of harmony. There we call it reinforcement that is going to be a collateral effect of that dietary intervention. Yeah,

SPEAKER_02: 41:04

and I think the key thing you said is doing supplements, as long as they're proven FDA-approved supplements, probably not going to hurt your child. By all means. It did mention here specifically the B6, the magnesium, omega-3 fatty acids. The next thing they talked about was diets, which you kind of alluded to or

SPEAKER_00: 41:22

spoke to. Kind of goes together. I mean, I would want to say it goes together in terms of either you're eating something or certain products and leaving certain things out or you're taking some sort of powder or pill, right? Sure.

SPEAKER_02: 41:33

It mentions restrictive diets. And I do want to read the description from this one specifically, again, from the Cigna website. It does say elimination of dairy foods and gluten from a child's diet is based on the idea that ASD is triggered by digestive problems, which individuals with ASD oftentimes do have gastrointestinal and digestive problems. Again, we've talked about that and we can continue to talk about if that's the symptom or the cause. Nonetheless, it says parents of children with ASD who have food allergies or intolerance may be more likely to try this type of diet. But food sensitivities aren't proven to be more common in children with ASD than in other children. I believe we've talked probably a lot about this, but it's something to just bring up the difference between intolerances and allergies, how intolerances won't show up on an allergy test. And it's not necessarily ASD specific. Any parent should get their child an allergy test to not give them things that they're going to be allergic to. Not necessarily more prevalent in individuals with ASD than not ASD. And probably not going to hurt your kid. If you want to put your kid on a nutritionally approved restricted diet, like take away gluten, probably not going to have a harmful effect with the exception of maybe that diet's going to be limited and the child's going to want to fight not eating the things that you're presenting because they might not taste as good as the thing with gluten. But in terms of, as you've always talked about, creating awareness about food at the dinner table, creating a family construct around food and an awareness about it, probably not going to hurt. So let me pass it to you. Anything you want to elaborate on in terms of restrictive diets?

SPEAKER_00: 43:17

Well, yeah, make sure it's not overly restrictive, right? Yeah, it is. As you were speaking about this list here, it's hard not to notice how the trend wave sort of infiltrates this, right? So gluten-free, casein-free, lactose intolerance... These are things that actually a majority of the population can be seen to struggle with. And then some people choose to eliminate certain things to really control it. And then you can choose not to, right? So the idea that you have a lactose intolerance, but you really dig pizza. you know that once in a while you're going to just suffer through it because you're going to enjoy the taste of the pizza and the experience knowing that the aftermath is going to be a little tough.

SPEAKER_02: 44:11

Are you talking specifically to my

SPEAKER_00: 44:12

domestic partner? No, never. It was just hypothetical, dude. So continuing on here. Ice cream is delicious too. Yes, it is. Now, how well you are able to then manage... with your outward behavior, those interoceptive processes now, the idea that your stomach is upset, that you've got acid reflux, things that we can all relate to, how you're able to communicate that if you have a language or a communication difficulty, which can also work to allay those symptoms, the mere fact that you can look at your domestic partner and go, oh, man, I shouldn't have eaten that last whatever, right? You know, again, I really just want to outline the fact that that No, I don't believe that just changing your diet now, all of these things we're talking about in terms of diets are, in my opinion, are very curative approaches. Yep. And that's not what we're trying to do here.

SPEAKER_02: 45:11

So speaking of curative approaches, let me talk to a couple more that were on this list that were also oftentimes associated with the Dan doctors. They stole my name. That stood for Defeat Autism Now. They were pretty prevalent back in the day. There's immunoglobin therapy, and that involves giving a shot of immunoglobin IV, and it's based on the assumption that ASD is caused by an autoimmune problem. There is HBOT, hyperbaric oxygen therapy, which is based on the assumption that because HBOT is used to regenerate parts of the brain for people with traumatic brain injury or things like that, so that would be based on the premise that there is a brain injury. And there's also this one called secretin. And that, again, is an IV injection of a hormone as well. So the idea that ASD is caused by a hormone deficiency. Again, these things that are talking about cures. There's also the chelation therapy based on the idea that ASD is correlated with an increase in mercury. So taking heavy metals and mercury out of the blood. And the last one, actually, I'll just hold on to those and pass it back to you. It's really interesting. Those, so the ones that I just talked about, HBOT, immunoglobulin therapy, secretion, chelation. When we're talking about IVs and things like that, those we probably want to be a little bit more cautious of. It's not just like, you know, vitamin therapy or gluten-free diets where try it, it's probably not going to hurt. We want to be a little bit more cautious. And it's very interesting that these are coming from Very different perspectives on causes of ASD when we don't even know what the cause of ASD is yet. Thoughts on any of those?

SPEAKER_00: 46:53

Or we know that it's not one cause. Maybe is a better statement there. But to your point, yes, that is a common problem variable with everything you mentioned. The idea that... Going to a doctor to get an IV, to your point, isn't going to create any other effect in terms of how invasive that therapy is. And I think you're absolutely right. It creates an internal contradiction for us especially, knowing that as feeling good about being a standard in treatment from a medical perspective All of these treatments you mentioned are now going to speak to more endogenous processes where we're talking about the environment, which is now exogenous, external, right? So there's a complete contradiction there. I don't know anything about secretin. The idea that... The immunoglobulin therapy, I think people hold on to anecdotal data of kids. For example, when there's an immune response and they're sick and you've got these lucid moments where kids will speak more or behave better because they're dealing with their illness and they have an immune response. And I think that there's a lot of anecdotal connections between that immunoglobulin and that stuff. Um, the chelation, if I understand it correctly, and I don't know enough about it, but extracting heavy metals from your bloodstream, um, it takes a lot of work. And I've, I can just say, I'll say this much. I've never seen in my 27 years of experience, I've never seen a child emerge from that process and, uh, been impressed. Um, and then certainly felt for what they were experiencing and the aftermath. It just, Did not look fun. Did not look like they were feeling well. I'll just put it that way. Yeah, again, the notion that you're going to somehow change some internal process and maybe prepare an organism, a child, for example, to better receive or be more receptive to the stimuli in their environment, which is where we come in, that's not an illogical premise, right? I think the way I personally feel, and I think you agree, that the way these treatments present themselves, it's a little bit of snake oil here. Well,

SPEAKER_02: 49:31

it certainly can be. I think anyone should be careful when somebody says that I can cure your child. They should be real careful with that. And I'll talk about that at the end when we wrap this up, that concept of cure. I think we should be really careful. The next one here is facilitated communication. It's really interesting because I specifically remember watching a National Geographic episode on that where they taught this individual to communicate with facilitated communication. And it was presented like, oh, wow, this this individual's world is now expanded. They can communicate to the world and now they can have a reciprocal interaction with the world and everyone else can understand their thoughts. And it was really it was empowering and it was awesome. And I was I was very at the end of it, I was. I was in my feels because I was like, wow, this person after how many years is now able to express themselves. I can't imagine how good that would feel. And then to find out that it's not really evidence-based, there's either some or very little evidence supporting it. In fact, most of it came back that it was just relying on the prompter. It was interesting, and I think it goes to show too that it can be even more dangerous to... think something's working and then it's not, then just not trying it in the beginning, that would be really defeating to me. If I thought that my son or daughter was able to express themselves and to find out that there's not really evidence to show that, that would create a lot of cognitive dissonance. We do have a few more to talk about, but I will pass it to you, Mike. Anything on facilitated communication that you wanted to talk about?

SPEAKER_00: 51:10

So controversial. I've seen that... That method come in and out of the stream several times in my career and very controversial. That's the best thing I can say to start. It is unfortunate, in my opinion, that after closer examination, a lot of this ended up being smoke and mirrors. Yes, I agree with you. It would be very disheartening to be a parent and have to experience that. I'm going to qualify that in terms of the empirical validation or the idea of evidence. I was talking this week to an educator here locally, and he was inquiring me about a student in this particular environment who has CP, cerebral palsy. It's a little bit different from what we're talking about here, although we could, I'm sure, make connections, and there's certainly a lot of comorbidity. But the idea that individuals that sometimes have a paralysis are using certain technologies to assist them to communicate. And what we were talking specifically was the latency that he had to adapt to to realize how lucid this student actually was, despite their challenges. So before completely writing off facilitated communication, unfortunately, we have to do that from the science perspective. That's too bad. But in talking to this particular educator, it was really enlightening, and I know that we've had experiences like that too, where we're able to observe closely, tap into some nuance of behavior to understand its function well enough to then shape it into some more recognizable form of communication. I often, and I contend that I know all of my clients have a receptive ability. They're not... able in many situations, in most situations, to demonstrate something behaviorally that confirms for me that they understood me. And that, I think we need to be careful about that. So yes, we have to stick to the science, the method, and the idea of validity, and then we have to be careful to not use that, to wield that sword so powerfully that we eliminate everything and we miss some nuance there.

SPEAKER_02: 53:31

Well said, well said. There's a couple more that I do want to talk about. And this one I'm going to serve up to you. We'll probably need the cliff notes on this one because this one's going to be right up your wheelhouse. And I know we only have about 15 minutes left. And there's two more not evidence-based treatments that I do want to briefly talk about. So the one that is on the not evidence-based list and the some evidence-based list, depending on which list you look at, is auditory intervention training. Which is interesting because on the evidence-based list, there's music-mediated intervention. And that's defined as intervention that incorporates song, melodic intonation, and or rhythm to support learning or performance of skills and behaviors. It includes music therapy as well as other interventions that incorporate music to address target skills. That's the one that is evidence-based music mediated intervention. The one that is some or not evidence-based, depending on the list you listen to, is auditory integration training, which is systematic exposure to modulated tones resulting in changes in parent reported problem behavior. I think that might be similar to, I know when I first started, they would put some of the kids that I worked with with some headphones and play tones in different ears and try to say that that stimulated something in their brain. So I will pass it to you as we talk about auditory intervention slash music mediated therapy. To give your two cents, I imagine we will do a longer episode with a colleague of ours who is a music therapist who I'm sure will be a great asset to the tap so we can go kind of in-depth into this. But let me

SPEAKER_00: 55:09

serve it up to you. So that colleague of ours, I'm just excited to get him in here and tell him about how the stuff he does. Not evidence-based, buddy. Uh-oh. You put your guitar away. You stop singing to those kids and asking them to dance around because from a heavy work, that can't wait. Hmm, that would be interesting.

SPEAKER_02: 55:29

From an anecdotal thing, I've seen him work wonders with our kids from the music aspect.

SPEAKER_00: 55:36

Where do I start? So the first thing I want to say is Facebook would tell us that Elon Musk says, this is the way to go right here for your kid with autism. And we know what he did. So, man, if I'm a parent of a child with autism and I'm scrolling through my Facebook feed and I see this, And the headphones, and you put it on. It's classical music with different frequencies. I am all over it, my friend. All over it. Right? Easy. Why not? Absolutely. Is it going to harm your child? No. No. Are they going to get really good at wearing headphones if they like it? Heck yeah. Can you now maybe play other music through there or now do better on long car trips because they can watch a DVD in the headphones? Yes. Woo. All the good things that are going to come from this, right? Now I'm going to then break it down a little bit further. The idea that from a joint attention perspective, your auditory attention is important and therefore you need to integrate. The idea from a brain perspective, from a research perspective, perspective on the autistic brain, the little I do remember, and again, better to fact check this if anybody out there wants to pull out the articles, there is plenty of evidence to indicate that individuals with autism from a developmental perspective, their dorsal and ventral streams don't actually come together until sometime in adolescence. That is to say that for all of us as we spend the first two years of our lives integrating all our senses to that sensory motor period, there is some evidence to say that autistic individuals just don't combine those two visual and auditory streams until much later in life. So the idea that this auditory thing is going to help integrate that so that a child can better understand how he hears what he's seeing or how he sees what he's hearing, to put it that way, sure. Now let's go to our colleague, Eric. We'll name him now because he will be on the tap soon. Let's go to what Eric does in terms of now playing the guitar, modulating the volume up and down, presenting movement, having facial expressions, talking about animals and the sounds they make, counting, letters, random sounds that are important to talking. There's just no comparison to me. There's no comparison. And I think that if you want auditory auto-integration therapy, then just do circle time stuff with your kid. How much more integrated from an auditory perspective can you get? And in fact, now the circle time stuff is going to add the movement part. Now you've got imitation and motor movement and symbolic play as the wheels on the bus go round and round. With all due respect, it's a little bit more of a lazy out thing. Right. So we would put headphones on our kid and not have them respond or sing back to any of these weird tones. And we wouldn't think anything of it. But we would think a lot of just singing songs around our child, because if they don't engage now, it's a problem. Why am I singing? But I'll throw the headphones on and not care how they're responding. So. Yes, try that stuff out. Get some headphones on. Introduce your kid to other music. Get a splitter for your jack and get two sets of headphones and walk around together with headphones on. Absolutely do all those things. Do I think that that's going to make a difference by itself? Not by itself. You're going to have to expand and vary it. Would I tell people not to do it? Well, only if it's ripping you off. If it's too expensive, yeah, don't do that. Or guess what? Get yourself a pair of nice headphones and you've got a phone, you can do this yourself. It's just called auditory input. So I'm not downplaying the science. I know there's a science behind it. I know people have put work into it. I know that it's got other purposes, just like HBOT, which I didn't touch upon. But same thing. Medically, a very important Therapy in terms of delivering more oxygen to places that are injured, right? Places in your brain or anywhere in your body that has an injury. More oxygen, more blood flow to that is going to bring more reparation, right? But is autism a brain injury? Not that we're aware of. Not that I'm aware of. It's a developmental delay. Not that I'm aware of. So again, we want to be careful about the good intent of these therapies and a parent having the right to try whatever within reason and within safety parameters. They want with their child. And then there's the idea of what is it really going to do for you? And then that's where I enjoy what we do because the proof is in the pudding.

SPEAKER_02: 1:00:27

Yep. Shout out to Eric. Can't wait to have you on the tap. The last one that we'll talk about again, this one, we could probably spend a whole episode and we probably will, but we can do a short little synopsis. And then there is one that I want to wrap up on. is medicines. And specifically the one listed here under Cigna is clonidine. I don't know why they specifically picked on clonidine, but they talked about how that may be prescribed to help hyperactive behavior. So Yeah, I'll pass it to you, Mike. I think medicines is an interesting one because there is no ASD proven drug because ASD is so diverse. They're all going to be specific to target certain symptoms. And in fact, a lot of them are going to be used off label. In fact, a lot of them are used, you know, antipsychotics for people that aren't psychotics, but they notice that it helps certain behaviors. So this can be a dangerous one. Just be aware with medicines. Again, it's kind of funny. An insurance company would put medicine as a not evidence-based treatment. But nonetheless, what are your thoughts on medicines in terms of evidence, not evidence-based treatment?

SPEAKER_00: 1:01:36

I'm not a doctor. I don't play one on TV, and I didn't sleep at a Holiday Inn Express last night. I can say this. Clonidine does wonders to put you to sleep.

UNKNOWN: 1:01:50

laughter

SPEAKER_00: 1:01:53

And oddly enough, does wonders to get you going in the morning. A little half milligram of that stuff, man. I don't know the politics of why it's on that list. And then I think you said it best. I won't say anything else. Just like for the rest of us, medications address symptoms. For people with autism, there are no medications, to your point, and I will say this personally, clearly that address autistic symptoms, whatever those might be. That's actually kind of an odd phrase to say. So no intent to disparage out there. In fact, I'm saying that there, what is an autistic symptom? It might be something that is a normal emotion for any individual with a greater intensity or a lower intensity, or there's a difference in modulation that the general public is gonna notice. So I think that's the general premise. I do like to tell people, Um, You know, side effects and therapeutic effects of medications are behavioral. So the idea that if your child is hyperactive and you get them on that stimulant and they start paying more attention, well, find a way to reinforce said increased attention. Don't just let the medication be on its own, right? Same thing with side effects. The idea that your child is not paying attention, but they're chewing on their shirt. Back to the jewelry example. Yep. Find a way to manage that side effect to see if it will... side, given that you're also seeing a good therapeutic effect. So that would be my two cents there. And yeah, no, it's not going to cure anything and nor do we expect it to. And we should all know that from the beginning.

SPEAKER_02: 1:03:34

Yeah. Medications are difficult to tease away from the environment. And I will look forward to having one of my good buddies on, a psychiatrist. Mark will be on here in the next couple of episodes and I will defer to his expertise and From my experience, it's really hard to tease medications out from the environment. So let's say it's not working. Is it the medication's not working? Does it need to be a higher dose? Does it need to change? Is the environment not conducive to the medication? It's like if I lose my job and my domestic partner breaks up with me and all of a sudden I have an injury and now I'm depressed. Is a medication going to help that, or are there environmental things? So let's say the medication does help that. There's still going to have to be environmental stimuli that are presented.

SPEAKER_00: 1:04:19

So the idea that now your domestic partner comes over and you've actually cleaned your bachelor pad, she gives you some feedback for that, and that's how the medication can help. And by the way, just like Eric, when Mark is here, as soon as he starts, he finishes his spiel, I'm going to say, what do you think about clonidine? And then as soon as he starts, well, that doesn't work.

SPEAKER_02: 1:04:39

Thanks, Mark. Sigma

SPEAKER_00: 1:04:40

told us. Non-evidence-based. You should have like a button that I pushed here. Non-evidence-based. That's the way ABA used to be, actually. Absolutely. Absolutely.

SPEAKER_02: 1:04:52

And then

SPEAKER_00: 1:04:52

we've got

SPEAKER_02: 1:04:53

the evidence-based.

UNKNOWN: 1:04:55

Beep.

SPEAKER_02: 1:04:55

In wrapping up, I do want to talk about the last one on my list and just kind of a conclusion that I think is going to be pretty important. So the last one on my list is essential oils. And that's another one, just like the gluten-free diet, the vitamin therapy, auditory intervention therapy. Are essential oils going to hurt your child? No. And is lavender going to help? Well, if it helps, then use lavender. If you can put on lavender and it'll calm your kid down, then use lavender to calm your kid down. Pretty simple. The issue is sometimes these things get marketed past where they are effective and it becomes, oh, you know, essential oils will help your kid talk or spontaneously promote whatever. And now we're kind of getting into pseudoscience and it's now ending up on that not evidence-based. And I say this because, and I'll pass it to you kind of to finish up, Mike, but this is the conclusion that I wanted to have, is that as a parent with a child with ASD, Sometimes you just want to give your child all of the opportunities that you possibly can. And you're going to read research that says, you know, one parent did, you know, gluten-free case and free diet free cured my child with autism. And again, I don't even know what that means to cure their child of autism, but that's what it's going to say. Or my child did facilitated communication and now my child can express themselves. Or I did the B12 shots and now all of a sudden my child talks. As a parent, you're going to want to give your child every opportunity you possibly can within the reason to give your child the best experience with life that you possibly can. So be really, really careful when you're looking at any treatment modality, including ABA. Do your research. And that's a real scary thing to say because I feel like after COVID, everybody's saying do your own research. It's interesting. But honestly, do your research. Figure out the treatment modalities. And if they're evidence-based, that does mean there's a little bit more Evidence, for lack of a better term. There's a little bit more behind them. There is enough generality and it has been peer reviewed for enough individuals to say that it will likely be effective with your child. So, you know, that's that's where you might want to look first. Look at all of the options. But we just wanted to give you not an exhaustive, but a starting point of things that are evidence based and are not evidence based for you to look at.

SPEAKER_00: 1:07:21

It's a matter of odds, right? You're a betting man, Dan. It's

SPEAKER_02: 1:07:25

five times the points at Harris tonight.

SPEAKER_00: 1:07:27

Wow. You know, the idea that it's going to be very gratifying when you hit big on low odds, right? And so it's not to say that low odds never win. That's a good point. It's just to say that the odds are really low. So if you're doing your research and you're going to put something in your kid or on your kid, And again, it's not to say that the odds are always right. So we understand the quandary here for parents, for professionals. But there is a science to all this. There is a science to everything we do, and that's where I think we're very comfortable with what we do, with our analysis. Yeah, to your point, if we're talking about essential oils, if you're building a routine, if there is... you know, you've got this massage routine that your child likes that now you're talking to each other and you're pointing out body parts. So all the behavioral pieces that we can infuse into now a routine activity that promotes bonding between parent and child and maybe even include some learning pieces purposefully, these things don't have to work against one another. They can work very nicely together. I think just my final word is it is our contention here on ABA on tap that in that massage scenario I'm talking about it's the antecedent behavior consequence that includes that essential oil as a consequence as an antecedent you know that has an influence on that behavior but we would caution you to always analyze responsibly cheers ABA on Tap is recorded live and unfiltered. We're done for today. You don't have to go home, but you can't stay here. See you next time.