Empirically Validated Treatment (Revised)

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.

In 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_01: 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: 0:51

All right. Welcome back to ABA on Tap. I am your co-host, Mike Rubio, along with Mr. Daniel Lowery. Good to see you, Mike. How you doing, man? Good. Got a little bit of a trip up there to start. Hopefully not a sign of things to come today. We've got a doozy. We've got a doozy lined up for us. We're going to be talking about... Let me see. I usually try to guess the title here, prognosticate the title. I think we're talking about empirically validated treatments today. Does that sound right? That works. So the title will be somewhere in or around that theme. And this is going to be... I'm hoping to stir up a little bit of controversy. I know that we've got friends, colleagues, clients that we've discussed this theme with. It comes up often. Parents ask us questions about it. RBTs ask us questions about it. We've certainly developed our own opinions over our career. We've got a couple different lists of empirically validated or not empirically validated, or better yet, as looking at the slide we're going off of here, the idea of evidence-based versus non-evidence-based or not evidence-based. What do those things mean? What are those definitions? Let's start from there and then go through specific treatments, some that we might be directly familiar with, some that maybe we've learned to discourage just from others' experiences or things we've read. But all in all, just like we do here on the tab, Mr. Dan, it's about educating ourselves. Again, it's about learning more. It's about finding what brew works best. you know, works for who and how, and making sure that parents and professionals are using skills and techniques that work. So yes, we are proponents of ABA, but we are scientists first and foremost, and we're also medical providers and individuals that want to help our clients. So whatever is safe and effective, whether it's evidence-based or not, How does it help? How does it fit into the brew? Maybe a little bit of a foamy, bitter brew we've got here with a little bit of a sweetness topper. We're not calling the sweetness topper beer. We're just saying a little bit of something to enhance your experience. So I've thrown a lot at you there, sir. You're always excellent at unpacking it all for us. What's on your mind?

SPEAKER_01: 3:18

What's on my mind? Can you read the first two lines on my slide?

SPEAKER_00: 3:23

Yes, sir. There are over 150 documented and proclaimed treatments for individuals diagnosed with autism. Of those, only 27 are considered evidence-based. Now, we have a different list with some similar items, maybe a different set of statistics in terms of how many are available, how many are evidence-based. We'll deal with that now or later? I

SPEAKER_01: 3:47

was just kind of smirking because I made that slide probably almost 10 years ago now. And according to the paperwork that Regional Center sent us, now it's 28. So that list hasn't changed a whole lot since we compiled that list 10 years ago. Talk about

SPEAKER_00: 4:06

foreshadowing. Well, I mean, what does that say? Does that say... We're doing well at empirical validation as a whole.

SPEAKER_01: 4:16

It could. It could say the scrutiny or the rigor would be the term I'm looking for that it takes to get something to be considered evidence-based. It takes a while. As we get into this podcast, I thought that was interesting because I remember 27 evidence-based and 10 years later now it's 28 evidence-based methodologies. So I did some Googling, and I Googled evidence-based, and according to dictionary.com, evidence-based is defined as denoting an approach to medicine, education, and other disciplines that emphasizes the practical application of the findings of the best available current research. Mike, you want to unpack that concept of evidence-based a little bit? Wow.

SPEAKER_00: 5:04

So current research. That denotes... implies the scientific method, right? That means that something has gone through the rigor that you were talking about earlier. Somebody asked a question. I'm going to really butcher this, but I think I'll create a strong enough framework for our discussion, and maybe we come back in part two, because I know there'll be a part two of this, and get a little bit more technical about this. But somebody's put together an internal review board, maybe a human subjects committee. We've looked at, from an ABA perspective, is this now a single subject study? Is this a small group study? Is this an N of 30 or more that's going to lead to some semblance of predictive power over an inferential statistical model that now you can apply over a larger group of people or a swath of people. And then I'll skip over a whole bunch of parts and then say once you're done, What's the reliability? What's the validity of your outcomes? How are those then now replicated and or peer reviewed in terms of your data to then give it a seal of approval that not only have you found something statistically significant, you didn't fudge your numbers too, too much. Let me add a little caveat there and not to, spoiler alert here, not to diminish the value of said data. research processes. But I would also want to say that in my limited but valid experience of research experience, Grants, you know, people don't give you money for results that don't seem to work. You're always trying to prove that something works if you said it did. You sound

SPEAKER_01: 6:55

very anti-pharma COVID vaccine-y

SPEAKER_00: 6:57

right now, Mark. Whether I'm anti or not, that's the thing. No, no, but anybody can take those results. That's kind of what I'm saying. And depending on what you're objectivity can very quickly become subjective when there's money on the line, when there's a grant telling you that there's a certain amount of results, a certain set of results, a certain skew on the results. So that's really hard to get away from. So I want to say that only because just if we're talking peer review, empirically validated, obviously none of this means perfect. None of this means 100% correct all the time. And I think that's important for us to understand know to denote at the very top of this discussion but that's the best we've got if somebody if something isn't at all empirically validated or evidence-based then you're really starting off behind the game maybe i don't know some risks that you might not want to take otherwise

SPEAKER_01: 7:56

i think we run into a couple issues uh with evidence the evidence-based idea evidence-based methodology and you mentioned ABA being the single subject design, it's much more tricky and difficult with that model because you have to get a whole lot of single subject designs together to produce something with enough generality that's going to say that this works for enough kids to be considered evidence-based. A lot of original ABA was Skinner and rats and pigeons and things like that, and you have a whole lot of control over the environment when you have rats and pigeons and you can do what at the time was called experimental analysis of behavior. Now we're doing... doing it through the applied analysis of behavioral or applied behavioral analysis. And we have to consider ethics. So we're running into a lot of issues. You can't really have control groups because if something works, then the control groups like why are my kids, the Guinea pigs here. So now it's a whole bunch of single subject research. And when you have that single subject research, you do run into the issue of everybody's experience being a little bit different because since you don't have the control group, you're not able to control for the environment as much.

SPEAKER_00: 9:01

That's a great point. That's a great point. And again, so this is where the single subject design for our individual client work then does become very relevant. So again, we'll start with that idea of What I came into your household, I'm assessing your particular environment. We're no longer in a lab. We love saying from the lab to your living room here on ABA on tap with that whole metaphor surrounded here. And that's the idea is the way I utilize positive, negative reinforcement, positive, adjust the density of your reinforcement schedule. All those things are going to be single subject in terms of their individualization anyhow. I'm leaning on the empirical validity of the idea, the technology, if you will, maybe I got that right, of positive reinforcement, for example, that I know that if I can find the appropriate mode of reinforcement, that I'm going to be able to allow a desired or socially significant behavior to be emitted yet again or increase the probability of its emission such that I'm working with a parent and I can say, when that happens, make sure you're adding something to it. Or taking something away such that it happens again. What those things are, well, we can't really put that into a specific recipe, right? I think we tried. I know, you know, if I look back 20 years in my career, Whether it was the setting, the way we set up the setting, or the Ikea chair and table, the mini M&Ms for a little while seemed to be the analog to the mackerel to the little side of sardines. It was very, very animal behavior training, right? I

SPEAKER_01: 10:46

got a kid to desensitize to... public restrooms using mini M&Ms at the Target here in Mission Valley. So yeah.

SPEAKER_00: 10:53

Well, and from that, so yes, so there you go. Effective, right? Yep. And then from the progression of our model, realizing that maybe we were overusing those M&Ms, maybe not just the optics, but the humanity of our treatment was now going into this more animal behavior, non-human animal behavior. I love saying the arrogance of us with the big foreheads in the animal kingdom, but you have to take that into account, right? Because we need to make our treatment not just empirically valid or based on empirical validation. We need to make it humane and accessible and respectable and make sure that integrity is part of that, that we're really not subverting. We're not using authoritarian measures, which I would say we've absolutely been guilty of in our progression with this whole political notion of who our clientele are, that demographic, the notion of disability or inability or at the start of this, the notion of people that were otherwise institutionalized. You could see that running a great risk. I learned this word recently, from a hermeneutic perspective. Hermeneutic. Meaning, I think this refers to the study of the Bible, but the idea being you have to bring those ideas, you have to put them in their time contextually. So the notion that ABA started with much more authoritarian measures and much more of an animal behavior model, a non-human animal behavior model. Yeah, that is true. And it should be forgivable, given the progression of our science, and if you're still using a lot of those techniques. So, you know, to your point, Dan, what would be your new approach? If not M&Ms, not many M&Ms, what else would we use now to make sure that we're not bringing food into the bathroom? Or whatever else we've now learned, yeah, but many things, I'm not picking on you either. I can think of many things in my 27-year career where I go, oh, man, I wish I hadn't done that. I didn't know any better.

SPEAKER_01: 12:59

I didn't. I think the thing when we're talking about evidence-based, too, is coming back to the functional relationship. That's what ABA is all about, is looking at the functional relationship between environment and behavior. It's the third dimension of ABA, right? Analytic. So, Looking at that functional relationship between what happens in the environment and under what situation certain behaviors happen in the environment, I think that's what it comes down to when we're talking about the evidence-based as well. We see it so often that, and maybe we have a little bit of a chip on our shoulder in the ABA field, that parents will try a conglomeration of a bunch of things concurrently, right? They'll try medication, they'll try occupational therapy, they'll try ABA. They'll try a whole bunch of stuff and then it'll work. And then they'll make an attribution that one of those things is the reason that it worked. I mean, I think about it like when I get sick, right? You take certain medicine, you sleep better, you take time off of work and you eat better and you get better. And you're like, well, which one of those four worked? And we'll attribute it to whichever one we want to attribute it to at the end of the day until we do a component analysis and figure out which one works. Or maybe it was the treatment package. It absolutely could be the treatment package and none of them individually are strong enough. I think that's what's really important when we look at this evidence-based piece as we go through these evidence-based treatments is seeing if that treatment alone can stand up to to the scrutiny. Because I remember I was actually, they referenced it on a Joe Rogan podcast recently, but when I first started, Jenny McCarthy was on the big gluten-free case and free dairy-free. The gluten, it's just the gluten and that's the autism. And if we just get rid of the gluten, then the autism will go away. And that was 15 years ago maybe. And I remember almost every kid that I worked with went on that diet and it helped some, didn't help others. The point being that it didn't have enough generality and wasn't the sole part of that treatment package that you saw a behavioral enhancement with enough individuals that proved to be effective for individuals with ASD and we're finding now that that's just individuals in general that have gluten intolerances like my girlfriend has gluten intolerances not allergies they won't show up on an allergy test but she doesn't feel well after she eats gluten but you know ice cream is delicious and so is pasta so she just deals with it point being that that's That was probably part of a larger treatment package that this individual saw, Jenny McCarthy in this example, saw for her son, which by all means, if it's working, keep doing it. That's the issue with an ABA design and ABA and why it's not necessarily the most ethical. So either it was part of a treatment package that the other parts of that treatment package can be extrapolated, or the gluten-free diet did work for her kid, but over time hasn't shown enough generality to say as the sole part of that treatment package can work for substantially enough individuals with autism to say that it makes a behavioral impact substantially enough that it's going to be recommended and even covered by insurance. Because at the end of the day, if that helped, not helped, if that was the solution, then insurance wouldn't be fun in ABA because that's a hell of a lot more expensive than a gluten-free diet.

SPEAKER_00: 16:14

So I can think back... I'm going to date myself here. I don't know, before 2000, I remember going to a conference, an ABA autism conference, and one of the tables, which is weird to think about now that it was even permitted because I think ABA was not very friendly in the sandbox at that time, and it's taken us time to evolve. But I want to sort of compare. I hope I can do this effectively. Our evolution... in our accessibility and our pragmatism to the evolution of gluten-free products. And I'll explain. Back in probably 1998, 1999 at the latest, I'm in Sacramento at this conference, and I see somebody talking about gluten-casing-free products, and they're showcasing them. And I can tell you, with all due respect to those folks who I won't name, they were awful. It tasted like cardboard. We hadn't figured out They hadn't figured out how to make that gluten casing thing. And that was very specific now to people with celiac disease. And that was the association they were sort of loosely making there, that this idea of people that consume gluten or wheat products that have celiac disease often go into a response or reaction that is akin. That was the explanation back then. I don't know how that's progressed. But yeah, they were awful. And I remember having clients try this out. And for example, you know, birthday parties with gluten-casing-free cakes. You know, the flourless chocolate cake back then just wasn't that good of a thing, right? So people weren't stoked on it. And I make that comparison just kind of saying, we don't want to put all our eggs in that basket, a gluten-casing-free diet. I'll say that. But it could be one component. Just like ABA might be one component. But the difference with ABA, I'm going to say, as far as I'm concerned, maybe one difference is that ABA... ABA includes a behavioral contingency. And I think that gluten casein free diets also fall into that same contingency. So I'm going to go on the record as saying that gluten casein free diets could be one part of your behavioral contingency. It doesn't mean that it's going against the ABA. It just means that if you focus on that diet as the treatment that's going to help your child learn how to brush their teeth and go to the bathroom, that's not going to work. That's not going to work. Now, might it put your child in a better state of mind, a better state of arousal, less agitation because maybe they're not feeling bloated or uncomfortable? Yes, absolutely. Does that make them more accessible now to the learning procedures that we're lending? Of course. And I would also say that that's going to work whether it's in their schools and they're following more of an educational model. This almost makes me beg the question, what is ABA really? Can people really define it? That's very popular these days with controversial topics. What is ABA, right? People might tell us sometimes, oh, what you do is an ABA. And it's like, oh, I guarantee you it is. That's what I do. What do you mean it's not ABA? It's like you telling me I'm a neurosurgeon and just because I'm using a different kind of scalpel or retracting tool, I'm no longer a surgeon. No, I'm a behavior analyst. That's what I do. I'm not using the traditional techniques all the time. I'm not necessarily reverting to the token chart, although I like token economies, not necessarily star charts. Again, one of those... I say that because it's like the gluten-casing diet. The star chart doesn't do anything. The idea of the token economy is what helps you then parse out secondary reinforcements that you might... prolong a certain behavior toward a certain outcome, for example. So again, I think that looking at these alternative treatments and how they've progressed and seeing them as one piece of the treatment package is probably the best way for us to approach this from an implementation perspective for us as analysts to play in the sandbox better and not have to discourage parents from doing certain things unless they're really interfering with our treatment from a medical perspective. So I think that's one way to approach this is, okay, don't put it all in one basket. The gluten-casing-free diet by itself isn't going to do it. Now, is that diet if the whole family, I think I've said this here before, if the whole family's not doing it and everybody's enjoying it and now you're sitting at the table having two, three meals a day as a family and you're talking and you're interacting and you're practicing your utensil use and the etiquette parts that are relevant to your home, Well, those are all behavioral components that would be analogs, collateral pieces. The GFCF would just be the collateral piece. The rest of it would be behavioral, in my opinion. So anyway.

SPEAKER_01: 21:18

No, that's a great point about not putting all of your eggs in one basket. Because when we look at these lists, like parents are going to do, and bringing it full circle, that's the reason why we're doing this. podcast, and that's what I would always present my parents in parent groups or even my new hires and my new hire trainings to try to understand parents and where they're at, is parents are going to do whatever they feel they possibly can to give their child the best outlook and live the most independent life as possible. So if there's an article that comes up and says, give your kid this type of mac and cheese and it'll enhance their ability to communicate or something like that, a lot of parents are going to do it just because Somebody said to do it, and they don't want to later find out that it worked and then be like, well, I should have done that. So at the end of the day, yeah, I think putting all of your eggs in one basket can be a little bit dangerous if you're on the non-evidence-based side. The evidence-based side, we know that it works. Now, the question is going to be, is it the most user-friendly? Are there things that might work faster? Maybe using those supplementally, like you're saying, might increase your ability– to see these results and also understanding what results you're looking for. We had an interesting discussion with a parent the other day about kind of figuring out as a parent what you're looking for, because that's 90% of the battle. I do want to get back to what you said with the ABA piece as well and defining ABA. I think it's interesting. Sometimes I get in a slightly facetious debate with one of our esteemed colleagues about what ABA is because I'll say that I think our kids do ABA better on us than we do on them. Or your daughter probably does ABA way better on you than you can do on her. And he'll say, no, no, no, ABA has to have the analysis and has to be done in a fashion where you're looking at data and things like that. And I think that kind of gets to what you're saying of like defining ABA. What actually is ABA? Is it looking at behavior and analyzing it and coming up with conclusions? Or is it the actual we're going to look at the data and we're going to, based on the data, increase or decrease the behavior? And then we have data for the increase or the decrease in behavior and look at the interventions as a result. So I did want to touch base on that. The last thing I will say is either side of the fence that you sit on as we get into these strategies of evidence-based and not evidence-based, you brought up a really interesting point in our pre-podcast discussion of the difference between ABA conceptually, so we could call it the, I guess it was the conceptualization of behavior, and the difference with it being implemented. Like the medical model of ABA, so how it's conceptualized or theorized versus how it's implemented. Can you speak to that? Because I do think that's something that's really important to touch on before we get into the specific modalities.

SPEAKER_00: 24:15

I guess the best way I can describe that is, I mean, everything we're doing from a Scenarium perspective comes from the idea of an operant chamber. The notion that you've got full experimental control over every stimulus being presented and every consequence being presented to a given organism. We're back to talking about small foreheads or no foreheads at all, pigeons and rats primarily. So I think that when we can consider that and then the proliferation of that philosophy of that science, if you will, now extending into a practical implementation where people that aren't necessarily trained in that tradition are practitioners of that science as it serves as a medical intervention. And we start introducing, we're going to talk about PECs, I presume, in a little bit. We start introducing things like PECs that are empirically validated that do fall into, in their presentation, a three or four part contingency, but then run the risk of now being bastardized to two by two laminated squares with weird icons, which I've referenced here before. Now that becomes a medical implementation that even steps away from what the PECS people intended. And they are now one step away or one part of this idea of applied behavior analysis now mixed in with speech and language, pathology, and psycholinguistics, right? So I think that's the difference there is that you've got all these things that you know work, these no longer theories, but well, I guess things based on theory that end up with outcomes, with predictive power, right? And you are able to prove them in a lab. So it starts with this nice empirically validated science, and then you've got to take those out to a situation, like we do, that you have no experimental control over. So now you're leaning on these things that worked when you had full control, working to some extent enough that you might then get a child to admit certain behaviors that can now be directly reinforced by the environment toward their future emission. And we want those to be socially significant productive, constructive in some way, shape, or fashion, whether it's to the individual themselves or better yet, to their surroundings. So that's a lot. That's a lot to consider. I hope I answered your question. Kind

SPEAKER_01: 26:36

of, yeah. I think a lot of it comes from the conceptualization piece just comes from the use of punishment or reinforcement to use socially significant behaviors, right? Presenting of stimuli, using positive reinforcement, negative reinforcement, positive punishment, or negative punishment, contingent on the response to those stimuli will increase or decrease that behavior in the future. Now, like you brought up, PECS is one iteration of that. DTT would be one application of that. There's a lot of different applications. It's kind of like saying teaching. If we think of teaching and we think of somebody learning, we think of like a school and a desk. That is one application of teaching, but You could do yoga in a park and you could learn it and there's no desk and there's not a teacher with a chalkboard and things like that. There's somebody with a yoga mat, but they're still teaching. So there's many different ways ABA can be applied and each individual application or way of utilizing it is just one way of utilizing it. It doesn't mean that ABA is or is not that. It just means that's one representation of ABA. So I do think when we talk about that, I think that's important that we understand because when people say, oh, that is or is not ABA, well, is it using positive or negative punishment or reinforcement to consecrate a behavior? Then it's applied behavior analysis.

SPEAKER_00: 28:00

One thing I've been saying, I don't know if I said it already on the recording here or just in our pre-discussion, but Any of these things that we're discussing today, right? So we're talking about ABA as an intervention that gets recommended, as a medical intervention that gets recommended and what that looks like in its inception, the optics. And then we're talking about the science that those medical treatments are now based on. And that gets... I'm losing my train of thought a little bit here. It gets a little tricky. But the idea that... So the idea that from a three- or four-part contingency, any of these treatments that we speak about, are they presenting stimuli? You sort of referenced this earlier. Are they presenting stimuli to their clients? Are they getting behavior as a result of that stimulus? And then are they consecrating that behavior? I don't want to overgeneralize or pull too much rank here, but once you put something into that three- or four-part contingency... Are you not embracing applied behavior analysis somehow? Without getting away from that, how are you not somehow implementing the philosophy of the science of behavior?

SPEAKER_01: 29:16

So with that, while sometimes it sounds like maybe we're being a little bit defensive of like, well, you're doing what we're saying we're doing, what I think we're saying is, yeah, you're doing ABA. So if you're unhappy with the way that it's being administered... Find a different company or find a different administration of ABA. It doesn't mean that it's not working well. It means that maybe you need to find one that you vibe with a little bit more.

SPEAKER_00: 29:39

So things like escape extinction for eating or feeding problems. Sure. Okay. Is it going to be effective in getting your child to eat more? Pretty likely. That's why we would call that maybe an empirically validated treatment or protocol, right?

UNKNOWN: 29:55

Yeah.

SPEAKER_00: 29:56

Then the question that people are asking, very fairly, is, is escape extinction always needed? No, it's needed for feeding issues where maybe a child's about to get a GI tube. Was that what you need to do to expand a child's menu or food repertoire? Absolutely not, in my opinion. We would be missing if we were doing it for that reason. And I think that that's what's ended up happening from the... the medical application piece are where you think about baking and cooking, right? My three-year-old daughter can probably make a cake, right? But if I make it with her with a certain precision, of measurement, I can predict with almost 100% certainty that we're going to get a cake. But if I don't monitor the oven, we might get a burned cake. So even just that empirically validated cake recipe isn't going to necessarily give us a cake unless we do the whole process well and it's fully controlled from beginning to end. Now, if we just haphazardly put the measurements in there... We might get a cake. It might be a little loose. It might be a little dry. But we're going to get a cake. And I think that's what ABA needs to become in everybody's home. We're not going to have the power to precisely measure everything. And then if you do, which in my 27 years of practice, I've seen a lot of precision on data, for example. Well, if you're spending that much time on the data... then there is no interaction. You're not teaching. What you're doing is you're doing things to try to get data points, and that in and of itself might lead to some learning, but we've seen that it wasn't generalizable, that it was a little bit unnatural, and to our dismay, a good amount of people not saying that it was traumatic. So a lot to consider here. Should we delve into these lists really quickly and maybe get a little bit more?

SPEAKER_01: 31:48

Let's take a look into the list. The last thing I'll say with that is when we talk about the difference between the conceptual versus the application, if somebody's telling you you have to do something as an ABA therapist or a direct service or whatever, I'd be really skeptical of that because that's not within the conceptualization. That's one application of ABA. It's kind of like if I have an itch on my arm and I go to the doctor, And the doctor's like, well, we're going to have to amputate your arm. You're darn sure I'm going to get a second and probably a third opinion before I do that. And same thing with ABA. And that's just the difference. If somebody's telling you something you do or don't agree with, talk with it or talk with somebody else in the field. It may just be one application of ABA. that may or may not be a good application of ABA and not necessarily a representation of the evidence-based premises of ABA overall.

SPEAKER_00: 32:37

Well, and while you're saying that, I love that. I'm going to certainly borrow that analogy there, that amputating your arm would take care of the itch on that amputated arm, but not anywhere else on your body. You would still have an itching problem at some point. But everybody's looking for the right combination, right? Whether it's, again, that three-, four-part contingency that ABA brings or some analog– alternative, whatever treatment that goes along with that, everybody's looking for the magic potion. Yes. So while I say that, let me talk about some more magic, and then we'll get into the list of treatments. So I'm going to give everybody a bit of a magical behavioral sequence here. What I do is I take this little container. Here, Dan, you used to have a nice little green elixir. And I shake it. It's nice and cold first. It's got to be a cold container here. I shake it. I breathe. And then I drink. I saw you do that before we recorded. You did. You did. And it worked. You saw the magic. You must have seen it all come down. Felt it. You felt it. You felt the energy, the resurgence of my brain power as we started this recording here today. Now, the important part that we're going to call it proprietary, and I'm not the one that owns it, but we're going to call it proprietary, is what you drink. I didn't say drink coffee. Drink water. Drink some sort of energy drink. What you have to drink for this magical hair behavioral sequence to work, Dan, is Magic Mind. All right, all right. Let me tell you the magic ingredients within Magic Mind because those are important to think about. We're talking about two general classes of ingredients here, right? We're talking about adaptogens and and nootropics. Tell us a little bit, Mr. Dan, with your Google genius over there about these nootropics and adaptogens. What are these things? What are they considered?

SPEAKER_01: 34:29

Adaptogens are plants and mushrooms that help your body respond to stress, anxiety, fatigue, and overall well-being. So that's the adaptogen side of things. And then nootropics are are used for things like treating memory, consciousness, and learning disorders.

SPEAKER_00: 34:45

All right, so if I asked you to tell us a little bit about, or our listeners a little bit about, the lion's mane mushroom, I've been hearing a lot about this. I know that I'm ingesting it here with the magic mind. What is that doing for me?

SPEAKER_01: 34:58

Well, it could be used in including treating things like dementia, nerve damage, diabetes, preventing ulcers, again, going back to that stress piece.

SPEAKER_00: 35:07

Wow, so really lowering my stress so that my brain can function a little bit more smoothly. Allow me to remember things better as we record and we disseminate important information. I have to reach back into my memory banks to think about what we're talking about. Now, what about something really nicely sounding like ashwagandha?

SPEAKER_01: 35:25

Well, it's going to do what the others have talked about. And what have the others been? Reduce stress. Reducing stress

SPEAKER_00: 35:32

and anxiety. Which then helps me... Have a better mental state, a better flow all together. I'm seeing a theme here, sir. I'm seeing a theme. Being more in control of your thoughts. Well, now I want to say it's worked very well for me. I recommend it. Before you do, you need a little bit of a brain boost right on the spot. Or if you're taking it daily, at least three days in a row before a huge event or some circumstance where you're going to really need to get into that mental flow, let me recommend Magic Mind. So to boost your brain performance, your memory, your mental acuity, alertness, and awareness, add Magic Mind to your day today. Today simply use the link in our episode description or go to www.magicmind.com slash capital A capital O capital T. Once again www.magicmind.com slash in all caps AOT and please use discount code all capitals once again AOT to receive 20% off your purchase and 56% off a subscription. Rediscover your mental power and endurance. Shake, breathe, drink, Magic Mind. All right, sir. Thank you for that time. Let's jump right back in. Really quickly while I introduce this, I'm going off of your list with the slide here that's a few years old. We're looking on the left side of this slide here, Applied Behavior Analysis, and then under that you've got PRT, DTT, or Pivotal Response Training, Discrete Trial Training. Those are two things that even in the field people might say, well, I'm doing PRT, well, I'm doing DTT. I'm minimizing the statements there, but the notion that both of those are directly derived from applied behavior analysis. In fact, discrete trial training is attributed to LOVAS, which we'll do for our purposes here, and then PRT, which was created by people that were graduate students of PRT. that very researcher, Ivor Lovaas, out of the UCLA tradition, yet out of the conceptualization of those different approaches, people will distinguish them from ABA. So DTT and PRT, if it's fair to say, are ABA. ABA does not get fully, thoroughly expressed or encapsulated into DTT or PRT. Those are just two treatment packages based on the principles of Applied behavior analysis.

SPEAKER_01: 38:03

Yep. If you look at my slide, ABA is bold, and the other ones below, it should have been a smaller font as well because I wanted to communicate that they're all part of the larger umbrella of ABA. Let's look at these 28 evidence-based practices, which would go on the left side of my screen there, and let's talk about them in relationship to reinforcement and punishment delivery. The first one, antecedent-based interventions. It's basically delivering reinforcement or punishment before a behavior happens. Once you've figured out the three-term contingency and you've figured out some consistencies there, you do it ahead of time. And like, Mike, you've always talked about getting in front of it. And if you're saying, well, my child always does this, we probably do something before that that's very consistent as well. So changing that.

SPEAKER_00: 38:52

And I love that in the sense that... One thing we can say about applied behavior analysis is we don't change the behavior, we change the environment. Exactly. And that almost comprises fully, in many ways, an antecedent-based strategy. What are you doing to change the cues, change the notion of the availability of reinforcement, all of those things that you're doing preemptively?

SPEAKER_01: 39:15

Yep. So that one talks about delivering reinforcement prior to the behavior. augmentative and alternative communication is the second one talking about how can we get this individual to communicate so that we can deliver them reinforcement behavioral momentum intervention is the third one how do we get the behavior to happen so we can deliver reinforcement maybe we have to break it down a little bit cognitive behavioral and instructional strategies i'm not as familiar with that one so um I'll either move to the next one or pass it to you if you have anything you would like to say on that one. I wouldn't be able to speak to it well enough, so we're going to be fair and table them for a little bit. Differential reinforcement of alternative, incompatible, or other behaviors. How do we find behaviors to reinforce instead of the other

SPEAKER_00: 40:02

ones? So these are all like... little bolded paragraphs or sections of my Cooper book. These aren't... Yep. So all of these therapies are basically pointing back to, with the exception, at least for our purposes, of the cognitive behavioral piece, which still includes behavioral, but now looking more as cognition as something where, depending on your model, whether mentalistic or not, you might not want to include as part of your antecedents or consequences to behavior, but they're all really still falling into this Three, four-part contingency.

SPEAKER_01: 40:34

All of these, like you said, are chapters of the Cooper book. Not

SPEAKER_00: 40:38

even necessarily chapters by themselves. They might even just be sections. Glossary

SPEAKER_01: 40:41

terms. Yep. From the Cooper book. It's basically what these are. I'm asking you to do something. You're not doing it. So now we're at impasse. How are we going to get that behavior to occur? I'm going to need to break down my strategies and differentially reinforce other things. I'm going to have to prompt you through it. I'm going to have to change what I'm doing on the antecedent strategies. It's basically getting past this impulse and pass so we can deliver reinforcement.

SPEAKER_00: 41:07

I like the way you said that. You made me think of a school teacher, right? Like, I'm asking you to do something, you're not doing it. And that's a really good, I was going to say, where the environment is giving you a cue. But I like what you said, because what we're talking about, even when we talk about things like verbal prompts being mostly intrusive, unfortunately, that's just a... an integral part of human interaction, right? Yes, schools have school bells, but we also want the teacher to be able to say, hold on, give me a second, let me just describe something before you go off to your other class just because the bell rang. And more traditional experimental analysis of behavior, much more non-human animal models, they would be counting on those particular stimuli, which now we're humanizing, if you will. So I like that, because again even with the notion of like verbal prompts are the most intrusive but aren't they the most socially relevant too now i understand why we say that and why we have to be careful about presenting too many of those in terms of prompt dependency because now you're trying not to redirect the child verbally all the time but you're always doing it verbally so you've got to revert back to that skitter box in a sense with all due respect what other cue can you give that might give that child enough pause for you to then do something else and then come back and provide instruction. So the pragmatic implementation of the ABA is where we're getting better.

SPEAKER_01: 42:28

I heard you just snapping, which leads me to the next one. Direct instruction. A modality of teaching. Click, click. Yep, exactly. To deliver reinforcement on a more structured... Choral responding. Click, click. Yep. Discrete trial training. Another method of teaching to ensure that the individual is going to get enough reinforcement for said behavior. Exercise and movement. That's a new one that I'm not as familiar with being on this list. I'm not saying that it's not evidence-based at all. I'm just not as familiar with that. But again, another modality that might be reinforcing to these individuals, so let's include it.

SPEAKER_00: 43:06

Well, this completely contradicts, I know at the start of my career, the start of your career... Exercise and movement? Kids can't do exercise and movement sitting at a white... Ikea table and chair, Dan. Love it. And they have to be sitting down to do discreet trial. Is this exercise and movement fad and craze telling me that kids could be moving? You can't learn when you're moving, Mike. Responding to trials? Receiving concurrent reinforcement from playing? Can't do that. Clearly these crazy exercise and movement folks are saying that. I know somewhere on that list is Ikea white table and chair discreet trial training. No, it isn't. So I love that. I love that in the sense that 20 years ago, as a hoity-toity, aloof behavior analyst, I'd like to think we've all gotten better. You might look at that and go, no, no, it's got to be ABA. But no, exercise and movement can be very important stimuli to your ABA practice. Let's keep that in mind. I'll leave it at that.

SPEAKER_01: 44:07

Yeah. I mean, a lot of what occupational therapists do is ABA. Now, if they're looking at the cause of the behavior, not looking at the environmental antecedents and consequences, but looking at the cause more proprioceptive or vestibular, okay, now we're diverging a little bit. But a lot of what these people are doing is ABA, just a different medical model of ABA.

SPEAKER_00: 44:28

And what we're saying there is that from a developmental perspective, there's going to be deviations. OTs don't just work with kids with autism. They work with kids across... the human spectrum, if you will, just like we talk about behavioral pediatrics and routine behavior problems, behavior problems that all kids have, not just kids with autism. When we get to empirical validation in terms of OT as an empirically validated treatment for autism, no, it is not. However, does autism come with certain occupational fine motor or otherwise motor movement issues that an OT can address toward then remedying the traits of their autism as expressed the answer has to be

SPEAKER_01: 45:11

yes which is interesting because in the regional center program design two of the seven i think there are deficits or two of the seven areas that of target are motor right fine and gross motor

SPEAKER_00: 45:24

well and that that being very particular to the early intervention and then if we think about older kids so this is now uh

SPEAKER_01: 45:31

um

SPEAKER_00: 45:32

preventative intervention, right? So no diagnostic. And so you're referencing the early start piece. And then, so that becomes part of that program. And then as you go into insurance, some of them might challenge the fact that we can't work on physical development or that depending on what stimuli we cite for that, like pencils, now we're working on something academic that's fine motor based. So there's a lot to... Or God forbid you do it outside. Oh, we can't even... That's a whole episode in and of itself. And I'd like to get some... Actually, can we find some insurance representatives? I want to find out why outdoor stimuli aren't part of ABA, in their opinion. So we're a little bit tongue-in-cheek here with something that we dealt with recently in our personal work, in our day-to-day work about getting a denial because something on a goal alluded to being outdoors, and apparently that wasn't okay with said insurance provider, who will remain nameless at this point, just to be fair.

SPEAKER_01: 46:32

Okay. Moving on? Moving on, sir. So moving on. The next one is extinction, the removal of reinforcement. Again, it's all just reinforcement or punishment. What chapter in the Cooper book is that?

SPEAKER_00: 46:46

By the way, that Cooper book I keep referencing, it's got a really complicated title, Applied Behavior Analysis. Is that correct?

SPEAKER_01: 46:53

Third edition. Oh, thank you. Next one, Functional Behavioral Assessment. Finding things in the environment that are going to reinforce or punish an individual. Next one, functional communication training. Finding ways to teach an individual to communicate so that they can access reinforcement.

SPEAKER_00: 47:14

In all fairness, and I'm not sure, that one might not actually be a chapter, or is it? Or a paragraph. No, that one's a chapter. Functional communication. I wasn't

SPEAKER_01: 47:24

sure. That's the man's and the tax and all of that. Oh, that's no longer

SPEAKER_00: 47:28

under

SPEAKER_01: 47:28

the...

SPEAKER_00: 47:29

Oh, verbal operance. That might be verbal operance. I wonder. You're right. I do think it... You're right. I'm trying to think if it's under there. Yeah.

SPEAKER_01: 47:36

Next is modeling. So showing an individual how to access reinforcement. Music-mediated intervention, that's a new one. I think that's literally the difference between 27 and 28 in the list I had, either that one or the exercise and movement. So music-mediated interventions, an interesting one that we can talk about now or talk about more in depth later. I

SPEAKER_00: 48:00

have to say, I know that sometimes if and when I actually do exercise and movement, I often include music, which means I would be combining two therapies in that powerful little regimen of mine, huh? That's right before you do voodoo. That's

SPEAKER_01: 48:14

the third part of it.

SPEAKER_00: 48:17

Sorry, that was a little too facetious. Right. But again, as somebody who uses music all the time, somebody who often says, I think that our early start programs could be two hours of circle time if the child's engaged and they would effectively teach everything we want to teach. I would say again, love music. Thinking about it as its own therapy, that's hard, knowing that we're sort of trying to look at what is ABA and what isn't. Well, music's a stimulus. Yes. And it's going to evoke illicit certain behaviors, and it's actually very concurrent in its reinforcement, meaning as long as you like the song and it's on, guess what? It's continually reinforcing. Sure. Unbelievable. How many people have their radios on all day? I guess music is reinforcing, huh, Dan? How many people

SPEAKER_01: 49:01

play the drums when they're driving in traffic? Only me. Yes, I do tend to think of that more as a stimulus, no different than a horse or a dolphin when they talk about equine therapy and things of that nature. You're getting ahead of the list here.

SPEAKER_00: 49:17

You're going on to the other side here. You're mentioning horses and dolphins, and sometimes they say hippo, which is actually just horse therapy. I love when people are like, oh, hippotherapy. I'm like, wait, hippos now? Not just horses and dolphins? Get the whole animal kingdom in there. We've got dogs. We've got therapy dogs, for sure. No

SPEAKER_01: 49:36

therapy chickens.

SPEAKER_00: 49:37

Now, what is that?

SPEAKER_01: 49:40

Or therapy raccoons. That's a different story. That's a whole separate story, Mr. Dan. I'm going to need some evidence-based therapy. Absolutely. Next one, naturalistic intervention. Again, can you imagine that these stimuli can be presented in their natural environment, Mike? No.

SPEAKER_00: 49:58

Okay. No,

SPEAKER_01: 49:59

they have to be laminated. Oh, Mike, are you ready for the next one? I don't know. The next evidence-based methodology. So remember early school ABA. I'm going to take you back. We're going to take a little story time here. Early school ABA, you had the table and the chair. What could be in the room? What or who had to be out of the room?

SPEAKER_00: 50:23

The

SPEAKER_01: 50:24

parent?

UNKNOWN: 50:24

Yeah.

SPEAKER_01: 50:25

The next evidence-based practice is parent-implemented intervention. Can you believe that they can reinforce or punish?

SPEAKER_00: 50:37

What is the intervention that's being implemented in that particular phrase? I wonder if it's based on the principles of, wait for it, applied behavior analysis. Reinforcement and punishment, you think? Are those things part of... Applied behavior analysis? Are we sure about that? I

SPEAKER_01: 50:56

think so. Applied behavior analysis is conceptually systematic, which means reinforcement and punishment.

SPEAKER_00: 51:01

And the parents can be involved these days. So let me just say that that's very refreshing news for me because you're absolutely right. Looking back 20-plus years ago, that was literally one of the questions I remember on an intake form I used to look at and I used to wonder about that because I come from the developmental framework where parents are a pretty important part of just about everything that happens with kids. I don't think that's changed. But I remember that. Do you have a separate room in your home where we can put said white table and chair from Ikea? Oh, the cube chair was pretty popular for a little while, too. I do like the cube chairs, but that's a whole separate conversation. But yeah, it's refreshing to hear that finally what my uphill battle over the past 20 years in trying to include parents as much as I can in said interventions of ABA, I'm no longer violating the principles of ABA, but actually using something that's empirically validated.

SPEAKER_01: 51:57

Yep. I appreciate you bringing up the cube chair as well, because it seems like we're about... bashing Ikea. We're not bashing Ikea. In fact, Ikea, if you want to reach out to us as a sponsor, we're happy to sponsor you here on the tap.

SPEAKER_00: 52:09

Yep, because we'll actually just say that it's a very nice part of the EBA therapy to have a place to sit that's child-friendly, small for children, durable, inexpensive, accessible, absolutely.

SPEAKER_01: 52:20

So what does Ikea furniture come with when you buy it to figure out how to assemble it? What does Ikea furniture come with?

SPEAKER_00: 52:29

I'd say packs, but the instructions aren't laminated so it can't be. So what is it? Visual structure.

SPEAKER_01: 52:37

Look at number 28, visual supports right there. IKEA using ABA in ABA. You

SPEAKER_00: 52:45

know what's interesting about this here, and I'm completely with my full facetious hat on here, is that I'm really glad to see that because I used to use a lot of blindfolding. In my ABA therapy? Because there was no way I was going to have my kids, my sighted kids, seeing that visual supports. Those aren't part of ABA, Dan.

SPEAKER_01: 53:04

Or putting attention towards stimuli that you didn't present to them?

SPEAKER_00: 53:10

Oh, God forbid. They can see other things except the things I want them to look at. We cannot reinforce that in any way. Because if that

SPEAKER_01: 53:17

happens, then they might get a manned... that wouldn't be a percentage of opportunity because you didn't present the stimulus. That would be...

SPEAKER_00: 53:24

Listen, Dan, the world is full of linear contingencies. There's one antecedent to one behavior to one consequence. And unless you're doing that, Dan, you're not doing ABA. All right? All

SPEAKER_01: 53:34

right. So parent-implemented intervention. What else or who else had to be outside of the room when... When ABA was implemented back in the day, Mike.

SPEAKER_00: 53:46

Just about everything, other than the white table and chair.

SPEAKER_01: 53:48

So not only the parents, who else? You got me here. The siblings had to be out of the room too, right? The next one is peer-based instruction and intervention. Imagine peers being involved. So...

SPEAKER_00: 54:03

This is very enlightening for me, back to being super facetious. So now as I go back to work tomorrow, I can take the blindfold off of my clients and I can make sure that their family can be included, especially given that I'm in their home.

SPEAKER_01: 54:19

Mike, somebody's going to hear that one quote, the blindfold of my clients, and then we're going to get all sorts of ABA comments. I knew ABA was crap.

SPEAKER_00: 54:29

Listen, man, blindfolded, eating really bad cookies that are gluten-free, no visual supports, none. No sensory. Sensory deprivation tank. This is refreshing. So, yes, we're being a little bit sarcastic. We get that. But that's kind of the point, though, is that it is a little bit... Unnerving, right? When people are like, no, no, we're doing a parent-implemented intervention, not ABA. So what are you doing as a parent? What are you implementing? Antecedents and then consequences to behavior? Well, that would be ABA. I don't know what to say. Okay, let's continue.

SPEAKER_01: 55:13

Next one is actually kind of an interesting one. Prompting. Oh, no. came about figuring out, again, how we can get individuals to access reinforcement. One solution might not be the best solution, but one solution is to get them to do the behavior either by verbally getting them to do it, physically getting them to do it, providing a visual to get them to do it so they can access reinforcement. Again, comes back to reinforcement. Go ahead,

SPEAKER_00: 55:40

Mike. I always wonder... how it is parents use prompts in general. We seem to have a corner on the prompt market in ABA, and that's to say that from a naturalistic intervention or just parenting, I think parents are using prompting all the time in terms of physically supporting and or modeling through observational learning what they want their kids to do. So this is interesting to see how all of these things have become individual therapies that are empirically validated. I'm going to make a sales pitch here, Dan, okay? Let's just say that I could offer you, you could offer anybody out there, one treatment package that includes all of these. You know what it's called? I've already said it earlier. It's very difficult. Are you sure? It's called Applied Behavior Analysis.

UNKNOWN: 56:39

Okay.

SPEAKER_01: 56:39

Mind blown. Next one on the evidence-based practice. Reinforcement. Can you believe? Get out of

SPEAKER_00: 56:48

here, man.

SPEAKER_01: 56:49

Reinforcement.

SPEAKER_00: 56:50

Wait, wait, wait, wait. Both positive and negative?

SPEAKER_01: 56:53

Both positive and negative reinforcement.

SPEAKER_00: 56:56

This list is getting a little bit rogue. I know. I'm going to have to start doubting. What's the source here? What's the reference? Who are these people? This is nuts. The N-C-A-E-P. Got to watch out for those folks.

SPEAKER_01: 57:09

But again, all of these practices are either structures to set up, i.e., direct instruction, discrete trial training, naturalistic teaching, set up ways to get reinforcement or ways to get an individual to do a behavior, i.e., functional communication training, augmentative communication training, differential reinforcement. We'll talk about some more later. To exhibit a behavior to get reinforced. Now, I do think it's interesting that punishment is not listed on here because punishment is an evidence-based methodology. Now, not something that we use a whole heck of a lot, but it is evidence-based.

SPEAKER_00: 57:46

Well, and we, how do I say this? We do use it. We don't like to say we use it. We don't like the popular connotation or misconstrual of what it means outside of its ABA definition, which is simply a stimulus that follows a behavior which lowers the probability of that behavior being expressed in the future. But everybody always thinks about corporal punishment, spanking, depriving the child of something. And oddly enough, if you do too much withholding in an effort to elicit a behavior, that is more traditionally punishing as well. And when we say punishing, we mean cruel. So to your point, I think we do use punishment even in our procedures. A very popular procedure for just day-to-day parenting and time out, well, that's a punishment procedure. And if it's inappropriately implemented, it could become cruel. So I think that those two words have become synonymous. Punishment need not mean cruel. When we say punishment, we just mean something that's going to reduce the emission of a certain behavior. That's all we mean.

SPEAKER_01: 58:56

Yep. Next one, response interruption and redirection. Again, another way to get a behavior to occur, to get reinforced. Could run into issues with that, but that's on the list.

SPEAKER_00: 59:08

In all fairness, I don't know if that one's in the Cooper book, but I also haven't perused my Cooper book in the recent past.

SPEAKER_01: 59:16

Next one is self-management, which I know is in the Cooper book because it differentiates self-management from self-control, meaning that the locus of control is external, not internal. But again, teaching you ways to manage your behavior that will increase your ability to get reinforced.

SPEAKER_00: 59:31

Access reinforcement.

SPEAKER_01: 59:32

Next one is Mike's favorite, sensory integration, which can only be done in a ball pit or with a lot of lights or in a sensory room. Those are the only three places you can do anything sensory. That's right. You can't do it in circle time or in the playroom. No sensory or the sensory deprivation tank. Only in the sensory

SPEAKER_00: 59:51

room. Well, I mean, I'm thinking that I'm going to now have to... Well, the good thing about the sensory deprivation tank is that you don't have to use a blindfold in there. So that's the... That's a really good part. Yeah, so I don't know what these kids are doing otherwise, because I think that most of my clients are sensing the entire time I'm with them. So I'm not really sure what people... So in all fairness, I think that you make a really good point in terms of what this is... turned into in terms of what it means, what it looks like, just like pecs getting boiled down to laminated squares with weird icons in many ways if we're not careful. And they don't just have to be that. They can be that. But yeah, we talked about sensory stuff in the Strange Technologies episode. We could probably revisit that because another point I'll make there is that we always think of sensory as something soothing and calming. We seldom think about it as a way to... Alert. To alert, to make somebody more alert. And that's something that we could, again, we'll revisit at some point. But yes, it's consensory-based activities in terms of multimodal experiences be valuable. Yes, for all kids and people.

SPEAKER_01: 1:01:02

Yep.

SPEAKER_00: 1:01:02

Yes, absolutely.

SPEAKER_01: 1:01:04

Next one, social narratives. Interesting. I think it used to be social stories, but now it's social narratives. Again, highlighting that... just because it's not in a book saying, my name is John, I don't like to fly, when I... Want to go to Disneyland, I have to get on an airplane. Getting on an airplane, blah, blah, blah, going on. It could also be a video. It could be all sorts of different conduits to present that social narrative. It could just be a discussion of, hey, you remember you like Disneyland, right? Well, to get to Disneyland, there's an airplane, and we can talk about it as well. There can be various different formats, but nonetheless, it's a story presented to try to teach an individual how to receive reinforcement in an environment.

SPEAKER_00: 1:01:44

And if I'm not mistaken, and I might be, But I think the social narrative part also expanded the idea of the social story from the first person to now a more socially based milieu, the idea that I, Johnny, ride the airplane to go to Disneyland, and so do my mom and dad, and so does that boy over there with his family, and whatever the case may be, which I think is really important. I often like to say, somewhat facetiously, but only to help our younger professionals get out of the rut that has become the specialized materials effort in ABA treatment with autism, is all children's books are social stories. There you go. All of them. Most YouTube videos are, too. Yes. Now, if your child needs something specific to them in the first person, okay, start with that. Make sure you don't put all your eggs in that basket. Make sure you expand that concept. Make sure you vary it to include others in terms of social referencing.

SPEAKER_01: 1:02:40

My favorite is when we get the message or the email, does anybody have a social story about going to the dentist or going on an airplane? It's like, can't you all just look up YouTube? And there's endless videos. It doesn't have to be a specific story. It could be a video. It could be Multi-modal, as you would call it.

SPEAKER_00: 1:02:57

The Berenstain Bears. That's my go-to, because they've gone to the dentist, they've broken something in the house, they go through all those scenarios. And again, there's plenty of children's books out there that are just hearkening back to typical childhood experiences with some sort of social lesson behind them. I understand why people... I don't want to be critical of us being specialized in our materials, but... I do want to caution about being overly specialized and therefore exclusive, and then now you're inadvertently treating your client as autism-specific as opposed to just treating them and being with them.

SPEAKER_01: 1:03:32

That's a good point, right? Being specialized and individualized is a key component of TEACH, which is an evidence-based methodology. So your kid likes... I walked in the studio and saw your daughter today, and she had on a princess dress. She obviously likes princess. So if I can incorporate princess... dare I say icons, princess pictures, books, modality. Wands, jewelry, rings. Stuff like that. That will probably be a hit. Now, if I say every three-year-old girl, because they have, I don't know, X diagnosis, needs princess rings, now that's becoming an issue. The next one, social skills training. which is another thing that didn't really exist when we first started ABA 20 years ago. But we interviewed a couple parents recently talking about ABA, and both of them said the number one thing that they would recommend for ABA is social groups. So social skills training, super important. Also teaching kids how to seek out reinforcement from their peers. Wow.

SPEAKER_00: 1:04:40

Let me just make sure. In these social skills groups... the methods they're using. what would those methods be based

SPEAKER_01: 1:04:52

on? I'm sensing a theme here. Let's say reinforcement and punishment,

SPEAKER_00: 1:04:56

ABA. Hopefully that's the last time I'll ask

SPEAKER_01: 1:05:01

that question. We'll see. I'm having a lot of fun with it. Me too. The next one, task analysis. Somebody doesn't know how to complete a task. Well, maybe we can break it down to allow them to get reinforcement because the total task isn't getting completed. So if we break it down, they can access reinforcement If

SPEAKER_00: 1:05:19

anybody out there that's listening is specifically a task analysis therapist, can you please get in touch with us? Because I want to know what you do all day. Are you just sitting there making lists? Task analysis is certainly a part of everything we do in ABA. I would want to know... I'm going to have to Google it, right? Task analysis therapy. Teach me how to break a task down into its components. All right.

SPEAKER_01: 1:05:43

Next one, technology-aided intervention and instruction. That one I think is interesting because technology is kind of a broad term. So

SPEAKER_00: 1:05:52

they're probably referencing something electronic.

SPEAKER_01: 1:05:54

Yes, some electronic. Time delay is the next one. talking about how long should we wait before prompting an individual so they can access reinforcement. Next one is video modeling. I feel like it goes with technology-aided intervention. I'm surprised that they're separate. But video, again, shows that maybe it's not just books or us talking. People can also access reinforcement by watching videos and learn how to do things through watching videos.

SPEAKER_00: 1:06:23

I'm going to use this phrase, this term. This all seems very reductive. Again, it's like one egg, one basket. So these are all arguably, as we've been saying, parts of ABA, technologies within ABA, procedures, parts of our protocols. But somehow they're now all being listed individually as specific therapies. That's very interesting to me. Why the need to... task analyze our methods in order to create, is this more of a marketing thing? And again, this is something that I'm going to have to educate myself on a little further for future discussion. To ask that question again, what does task analysis centered therapy look like? And how is it not ABA? Well, it's considered evidence-based practices, so I don't know if there's a difference between therapy. That's a good... So these are, again, these are all practices under the umbrella of ABA.

SPEAKER_01: 1:07:19

And the last one being visual supports, which we've talked about. Again, a great strategy, very evidence-based, something that should be highly utilized, sometimes is overutilized. Again, see our strange technologies intervention. The premise here being, look, all of these 28 that we've talked about are just ways of Creating a situation so an individual can be reinforced for a behavior or breaking something down so that we can contrive a situation so an individual can be reinforced by a behavior or a structure way of setting up an environment so an individual can be reinforced by a behavior. It all comes back down to... ABA, at the end of the day, comes back down to how can we reinforce somebody for a behavior? Can we give them a different way to speak, either with augmentative communication, with functional communication, with technologically assisted communication? Do we find that they... speak more in their naturalistic environment, or if we, and by speak, I don't mean vocally speak, I mean exhibit behavior. Communicate, exactly. Again, at the end of the day, all of these evidence-based practices just come down to the application and presentation of reinforcement. We have a whole separate slide, a separate section of the slide, which we'll cover, I'm assuming, in part two of this training than non-evidence-based because I do feel like we can cover a lot of ground with that one as well. Let

SPEAKER_00: 1:08:39

me pass it back to you, Mike. Yeah, as we contemplate the next episode here, we knew this would be a two-part series. Some closing thoughts, right? So now we're going to look next time at the not evidence-based practice. And it's not to say that parents are implementing some of these things on this list. I'll give an example. We talked about the diet. And you made a really good point at the beginning in terms of attributions. One of my favorite stories is I want to teach the kid to say apple. I've got a whole bunch of things related to an apple. We're eating apples. The kid goes on medication one day. The child says apple. And the parents go, we're so glad we put him on medication. Look, he said apple. It's like, oh, man. Again, there's a lot of, and that's me being a little bit too proud there, but I think the example serves us well here. The idea that we're not saying that GFCF diets can't be part of your success. That's not, I don't think, what not evidence-based means. What we're saying is if you put all your eggs in that one basket, the idea that fixing your child's gastrointestinal problems in and of itself is going to take care of all behavioral concerns and problems you know, learning concerns? No. I'm gonna say a hard no on that. Is that to say that ABA by itself can take care of all of those things? I'm gonna say yes, but only if implemented and analyzed in a progressive and ongoing manner such that you're always making adjustments. So there's no one baking recipe. Back to that analogy, it's a lot more like cooking here. You're going to have to change the ingredients, adjust the flame, change your tools, add some sauce here, turn that off there, deglaze that pan over there. There's a lot of activity you're going to have to work through. So let's end with that. What we talked about today are things that have been lab tested. proven to work under experimental control, and then we still have to take it outside of that realm and start cooking, start brewing more appropriately for our purposes here on the tap. Any closing thoughts, sir?

SPEAKER_01: 1:10:41

No, I thought that was well said, and I'll leave the rest of my thoughts for part two. All right. Well,

SPEAKER_00: 1:10:46

go ahead and bake precisely, cook with fervor, and always

SPEAKER_01: 1:10:52

analyze responsibly. Cheers.

SPEAKER_00: 1:10:55

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.