Models of Disability--Make That Change

In this brewing session, despite a wealth of choices, Dan and Mike focus on the basic ingredients in looking at a medical model in comparison to a social model. As behavior analysts, it's easy to see the stakeholder as the principal agent for change, and overlook our impetus for changing behavior, the surrounding environment. Models of disability take this as their basic kernel for debate. As is the final resolution in most binary discussions, Mike and Dan agree that it's not one model over the other, it's both models working in collaboration. This session delineates the 'pros' and 'cons' of each model as they relate both past and current perspectives on the notion of disability.

This is a big brew--bold with a lot of flavors to explore. It may preset bitter at first, but please do wait for the finish as it is satisfying. It's been a long day and you need to unwind with a good brew. This is the one for you. Sip slowly, breathe easy and always analyze responsibly.

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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_02: 0:54

All right. Welcome back to yet another installment of ABA on Tap. I am your co-host Mike Rubio along with Mr. Daniel

SPEAKER_01: 1:12

Lowry.

SPEAKER_02: 1:20

We're both on the tail end of some sort of weird cold. I don't know if I'm developing an allergy. I know you had a cold. So we're going to ask for forgiveness in advance here as we start the podcast because I am certain there'll be some throat clearing and some coughing that we'll have to contend with.

SPEAKER_01: 1:38

Hopefully, I don't sound too froggy. Our first client, when I would lose my voice, would get upset at me when he got upset and he would call me frog man and go, ribbit, ribbit. So hopefully, I'm not sounding too froggy today.

SPEAKER_02: 1:51

Which really speaks to theory of mind. He was trying to antagonize you, I'm pretty sure. So he knew that that maybe bothered you a little bit. And here you are remembering it. I don't know how much it bothered you. You seem to be reminiscing about it. Kind of getting nostalgic,

SPEAKER_01: 2:07

if you will. So it's Mike Rubio and Frogman today.

SPEAKER_02: 2:09

Mike Rubio and Frogman. And again, I might be breaking out into these random coughing fits. So I do apologize in advance. And we'll try to control the board here to make it a more pleasant experience for the listener. Mr. Dan, I say this often. I like to hype it up a little bit, but we really do have a very dense topic today, I feel. And I'm going to be on it. There's our first throw clear. I like it. I like it. I'm going to just have to be very candid and transparent about this. This is a topic that's a little bit scary for me. I think from a social perspective, it's just so dense and it stands... There's a lot of prospective or potential controversy to be had, which I never shy

SPEAKER_01: 2:53

away from. I was going to say, that's never something you shy away from. Never

SPEAKER_02: 2:55

something I shy away from. Absolutely not. However, I'm going to be very honest and say that I feel a little bit undereducated on this particular topic. Now, that's to say that... Well, let me just introduce it. We're going to be talking about models of disability today. And in just a few seconds, I'll pass it over to you because I think you're more well-versed on this topic. And I do like that exchange here on the tap. You brought this to the table today, so you're going to be driving most of it. But I wanted to clarify, I don't feel well-read or versed in the topic. I do feel like I've got experiential content expertise on the topic. And I'm going to think, I'm going to lean on my developmental background, again, on this, because I feel that that child-directed approach is something that has helped me stay modern, even with these new concepts in treatment. I remember a little shout-out to our colleague Rosa When I was bringing this more child-directed approach to the table, she was bringing the assent-based approaches, for example, to the table, which not that we're going to be talking about assent. Well, we will talk about assent a little bit today, I'm sure. But again, it really highlighted for me, okay, I need to get more educated on certain topics like models of disability. And at the same time, kind of rest on my laurels based on the more client or child-directed approach that I take really allows me that freedom to consider a more authoritative, a more collaborative approach to my treatment. So I feel lucky that that's always been the case, at least I think it has been. And then at the same time, I'm looking forward to educating myself a little further today here as we record, learning from you, sir. And then, yeah, I did a little bit of reading and quick research before we started. I didn't want to overly educate myself because I want to be... I like my vulnerability today. I want to be... a little less informed as we explore this topic and maybe make some mistakes. Maybe that'll get some of our listeners to reach out and correct us on some of those things, which I really enjoy. I like to, when we interface with the listeners. But yeah, Models of Disability, Dan, please get us launched here. I know there's a lot of ground to cover. Again, I think it's going to be one of those quick hours where we find ourselves starting to talk, and then before you know it, we're at the 55-minute mark or something. Yeah.

SPEAKER_01: 5:23

Yeah, so as we go through this models of disability, like Mike said, this isn't terminology that we had even really been exposed to before this parent brought it up to us. So if anybody has questions, would like to debate something, has an alternate point of view, or wants to further clarify, please, please, please get in touch. We would love to have you on the tap so we can educate ourselves as well as the rest of our listening public and get this model and get these thoughts out there so that they can be discussed and debated in an intelligent and constructive manner. So please, please reach out to us because it's something that is new to us that we'd like to bring to the table and our audience and expand on. So without further ado, we were interviewing a couple parents that we had worked with for a presentation that we're doing. on kind of ABA from a parent's perspective, and one of the parents brought up the idea and the differentiation between the medical model of disability and the social model of disability, and kind of where autism fits into that on the medical side of things, and as a result, where the locus of therapy should be, maybe how it should be implemented, and I guess for lack of better terms, how we could even look at our objectives of therapy. So breaking it down, and then I'll pass it back to you, Mike, is the social versus the medical model. So the medical model, to my understanding of what she explained to me, is the idea that somebody has either a sickness or a disability or something that needs some medical intervention. And typically speaking, in the medical model, the person who has that sickness or disability. Now, I'm not calling autism a sickness. What I'm saying is people that receive medical care, whether it's physical, they might have a sickness, behavioral, emotional, it doesn't necessarily have to be sickness. Nonetheless, that person is going to be the locus of medical care. You go to the doctor because you have a cold, they're not going to say, hey, let me talk to your wife. They're going to prescribe the medication for you because you came in with the sickness or If you're having some mental or emotional struggles and go see a psychologist or a psychiatrist, they're going to focus on you and your cognition and how you can reframe things. Certainly looking at how the environment plays into that, but at the end of the day, you're the one that's going to get the therapy because it is your... disability, your cognitive construction of the world, or your sickness, if it's a medical cold, it's kind of funny that we're doing that as we're both either coming into or out of colds, that needs the remedy. So that's the medical model. This person...

SPEAKER_02: 8:14

Something's wrong with me. Yes. I've got a virus. I've got an illness. I've got a disorder. I'm going to get a lot into semantics today because I think it's important. That's the way I think of things. But to sort of sum up, the medical model says, here's the patient something is deficient, disordered with them. There's an illness or something of that sort.

SPEAKER_01: 8:38

Yep. And again, just to reiterate, we're not saying ASD is a virus or anything like that. We're saying just in the medical scheme, that's why people come to a doctor or a mental health professional.

SPEAKER_02: 8:49

So I guess just to interrupt quickly, this gets tough for me because I'm very keen on words. Disorder, disability... What would ASD then be considered under the medical model, would you say?

SPEAKER_01: 9:05

Under the medical model, so technically it's considered a developmental delay, right? Okay, there you go. So delay or disability might be another.

SPEAKER_02: 9:15

Disability, and that's an interesting word because disabled literally meaning not able to. All right, let's hold on to that from the medical perspective. Now, that can get a little controversial, again, because it could seem... exclusive. The medical model can seem a little bit harsh. We're going to make sure and try to keep that even keeled and keep it very general. I don't think the The medical model is necessarily trying to say something's wrong with you, you're not, but as people, as a society, if we're not able, if we're not careful how we apply that notion, then yes, it could become exclusive, it could become discriminatory, all those things that we're trying to avoid.

SPEAKER_01: 9:57

Yes, and I'm also excited to have my buddy Mark on here in the near future who's a psychiatrist who can provide more insight into this, but yeah, that's the medical model, right? Somebody has, we could even call it some symptoms that they're coming for a symptomology, right? And what that medical model is going to do is it's going to look for clusters of symptoms that seem similar, like, hey, a cough and a runny nose and whatever might be a cold or a virus or a sinus infection. And once they're able to label that level of symptomology, they're able to then provide treatments for those clusters of symptoms.

SPEAKER_02: 10:34

Okay, so moving forward, the idea is... So to be cautious here... the notion that the medical model can say, I can address those symptoms. I can make those symptoms go away. I can differentiate those symptoms. That's going to be an important theme for us to keep in mind.

SPEAKER_01: 10:53

Correct. Yes. And from the behavioral side, no two people, no two symptoms are going to be exactly the same, right? If we were to take something that's medically diagnosed, whether you were to take down syndrome or schizophrenia or bipolar or depression, no two people are going to present the exact same symptomology, right? But what if with enough of the symptoms presented and a close enough relationship between them, they then can get a diagnosis, a label, and once they receive that label, then there's certain treatments that have been prescribed and in most cases on the medical model, evidence-based, medically proven to work for a certain label, which is then taking one step back, a certain cluster of symptoms.

SPEAKER_02: 11:41

Right, right. Again, I don't want to get too overly philosophical or conceptual here, but it is important for us to think about that from the medical model. Correct. I want to make that symptom go away. How we interpret that socially speaking, from a more socially significant approach, that's where the danger lies, I would say. The idea that I'm going to fix you or make something go away or restore something that's deficient in you back to what the norm says, right? And again, I'm so nervous about this just because I know I'm talking out of my lane here in many ways. But I do think it's important for us to think about that because that's where I think we get in trouble currently is this idea that I'm going to restore you from this deficiency toward now this milestone, for example, that you missed developmentally. You're not using words, right? So the only way to help you is to make you use words to communicate.

SPEAKER_01: 12:39

Yeah. So I think that's where we'll go with the medical. Let me just talk about the social and then we'll expand on both of them. Sounds good. So the medical model, somebody comes with symptoms, gets a label or a diagnosis, and then there is treatment for those symptoms for that individual. The social model is a little bit different. It says that each person is their own individual and society is set up to accommodate for certain individuals within kind of a bell curve, a certain spectrum, what we say, of individuals that society is designed to accommodate for. So let's say, I don't know, society is designed to accommodate for people that have legs to be able to drive, right? That's what society, pretty much every car, I think initially probably had a gas pedal, right? And then over time, people looked and said, there's also individuals who don't have legs or the ability to use their legs. Are we able to accommodate for that? The societal model or the social model would say that the individual doesn't need to change. We're not going to address that individual. What we're going to do is address how society is constructed around that individual, right? So there's kind of two models of the disability. Do we treat and address the individual, or do we treat and address the way society is orchestrated around that individual? That's kind of my understanding. Let me pass it back to you on the definitions before we get into each specific one. One way

SPEAKER_02: 14:15

that... One, I guess, approach that has helped me try and understand this better, and it actually creates other questions. We like to do that here on the tab, right? Not just find answers, but create more questions. The notion of a physical disability makes this a little bit easier for me. Okay, so let's take the notion of a wheelchair. Medically speaking, somebody is paralyzed, for example, from the waist down. They cannot walk. That is... So they're walking, their mobility is impaired, which creates a disability in terms of their walking. Access, yeah. And in society now, for many years, we've done pretty well. We've gotten better at creating access for somebody who... would need to roll into, using a wheelchair, roll into a physical location, navigate around a physical location, ambulating, if you will, by way of a wheelchair and not their legs. That's a little bit more cut and dry in many ways, and I think something that society, again, has got a good grip on. in my opinion, and we're getting better. Not to say we always do well with that, or that everybody gets the access they should, but at least we've got good ideas. That's a little bit different when the idea of your disability or your impairment isn't immediately apparent. And that's what we're talking about today, the impactfulness. So the notion that if somebody needs to come into a situation with a wheelchair, I can make those accommodations. The idea that if somebody that's an autistic individual comes into a room with certain stereotypy, for example, comes into a room where somebody's speaking publicly, and they come into that room to join, but their stereotypy is vocal in nature and is now competing in volume with the speaker in that room. From a social perspective now, that impairment, if you will, um and how it translates into a disability in that particular circumstance that's a little harder for us to contend with what would we do about that without excluding somebody or discriminating against somebody whether it's the speaker in that situation or the person who's you know caught up in a certain level of arousal and doing vocal stems for example

SPEAKER_01: 16:47

so how do you think on on your uh your analogy there how does it play into effect if So you're talking about being observable versus not observable, somebody in a wheelchair versus somebody with autism. If it's observable but not a direct representation of the quote-unquote disability. So an example I might use, so like a wheelchair is a direct observation of the individual's disability or say a prosthetic leg that you could observe, right? Or somebody with an eye patch, right? take somebody with Down syndrome. That is typically observable, but what's observable isn't necessarily a direct relation or manifestation of their disability. Do you think that would be different?

SPEAKER_02: 17:36

Yeah, I mean, in some ways, yes, especially because you might have a physical manifestation of certain traits with Down syndrome. However, until... you see some sort of outward behavior, how those translate into, yeah, now a person's ability to engage with their environment, for example, that remains to be seen. So that's an interesting example you give because there can be a very easily identifiable physical manifestation of certain traits that insinuate, infer... Present the possibility, again, looking at Down syndrome of disability.

SPEAKER_01: 18:19

Also a genetic trait you can test for so that it's concrete and observable.

SPEAKER_02: 18:23

Right, and these are things that I can now observe with my two eyes, right? That I can look at somebody and go, oh, there might be a chromosomal issue at hand there based on somebody's physical manifestation. I'm going to draw some inferences here, and based on what I know... It could be that this person is challenged this way or that way. Now, the notion that just because they present physically in a certain manner, that I am not going to exclude them from certain things, that's an important premise that we're getting past. If we're talking about autism, those physical manifestations probably, or more often than not, they're not going to present themselves. We're going to have to wait for some sort of socially... significant expression of behavior to then go, oh, that individual might be autistic. And that might be different for you and I. We deal with this every day than it would be for anybody just off the streets. I don't know if I got to the heart of your question there, but... You did. Yeah, I think you're speaking to the varying degrees of our responses here.

SPEAKER_01: 19:30

So what do you think is the significance about being able to observe... Whether you're talking about medical model, social model, whatever, being able to observe the individual and having a distinct physical trait, say the wheelchair, versus the autism piece of not being able to physically observe that. What is the significance of that?

SPEAKER_02: 19:50

Basically just a preemptive effort. The idea that the physical manifestation in its observability could allow you to anticipate, accommodate, facilitate, ahead of time could also make you discriminate ahead of time in many ways if you're not careful. And then with the ones that aren't so readily observable and are more translated into or admitted behaviorally, I think that creates more of on-the-spot accommodation or facilitation, maybe runs the risk of being a little bit more bombastic or cumbersome to people that weren't expecting it. I imagine that probably creates... I would imagine that creates less of a receptive environment in some cases because people are taken aback or surprised by it. And then even people that want to do well by the situation may not, again, in their surprise, may not be fully surprised. Prepare to facilitate or accommodate or assist or collaborate, maybe is the better word I'm looking for there.

SPEAKER_01: 20:53

So you said expect. So it's that piece that I always talk about. It's not what happens, but it's somebody's violation of an expectation, which can be surprising. So if I'm like, hey, Johnny's going to come over and Johnny might make a lot of noise and jump up and down and flap his hands. And you're ready for it. That might be different than if you're watching a movie and all of a sudden Johnny out of nowhere jumps up in front of the movie and starts flapping his hands and making a lot of noise. Right. Right. Yeah. So there's two kind of directions that I'm thinking we can talk about is we can talk about the medical side or the social side. Obviously, we'll talk about both. Which one do you want to talk about first?

SPEAKER_02: 21:31

Let's go medical, right? Because the idea here that we're going to fix something or make something go away or reduce the symptomological expression of something toward the comfort of the individual and then, in this case, toward the impact on the rest of the environment.

SPEAKER_01: 21:46

So the medical model, and again, we're trying to be very cognizant of our language here. It is the medical model, and sometimes the medical model does appear to be harsh in their labeling of things. So we're going to try to be very aware as we do this and make sure that two things aren't brought together to seem something that they're not. The medical model is based on this idea of a symptom or a disability, right? That's what the medical model is based on. Doctors come in when you have symptoms or symptoms that you're trying to get rid of or disability. Is that a fair preface? I think that's fair,

SPEAKER_02: 22:20

and it's a deviation from a norm, so to speak. I think that's an important phrase to put in there.

SPEAKER_01: 22:26

So, actually, let me add a third part that we can talk about just now. Follow this in the back of your head because this is behavioral pediatrics, that traditionally doctors come in when there's a symptom or disability or something like that. However, currently and moving more forward, doctors are trying to get more on the preventative side of things. So that's behavioral pediatrics, right? Let's file that in the back of our heads because we'll maybe get back to that. Rarely do people, you probably don't call your doctor, although you might go for the annual physical, so maybe you do. Trying to get better at that. Rarely do people call their doctors and just be like, hey, everything's good, anything I should be doing right now. For the most part, they only get involved when there's an issue to get involved with. So from the medical model, which is currently how ABA treatment is administered because it's funded by medical insurance, right? It's the behavioral health treatment funded by medical insurance. So something that we have a lot of experience and we'll talk about in future episodes recently dealing with the medical insurance. But by virtue of how, I don't want to say pigeonholed because that has a negative connotation, how ABA is kind of settled, maybe for lack of a better term, into the service delivery has been funded by medical insurance. which means it's the medical model. Initially, it was almost more of the educational model. ABA was more so done in schools and things like that, but then with the California insurance mandate, things of that nature, ABA's done more through the medical model. So from that medical model of disability, there's a symptom or a disability. So let's talk about that from an autism perspective, because that's who are predominantly serving In this example, and this is how this parent came about because she really was not fond of the medical model of disability. Autism is a disability that presents symptoms that maybe need to be reduced or cured or fixed. Now again, I really want to emphasize, in our field, we never look at the metric of success being cured. So I'm not saying that people with autism need to be cured or that's even a goal of ABA. But traditionally in the medical model, that's typically a goal, right? Is there are symptoms that are presented and those need to be remediated, cured, whatever a doctor might want to say. Is that a fair assessment?

SPEAKER_02: 24:51

Yeah, no, that's good. I mean, and we would expect the medical model to do that. But in this particular example, it gets a little bit... What can I say? A little bit confusing, I guess. A little bit unclear because if... We only apply toward cure, fix. There's some things that can be missed is what we're saying here.

SPEAKER_01: 25:11

Correct. So the disability, and again, we're walking through this as we talk, so careful to not fall into any traps here. We're both being very trepidatious about this. So the disability, which is interesting with ASD, isn't necessarily from the individual experiencing it. It's from the individuals around them. So it's not, you know, with the medical model, your wife probably doesn't go to your doctor and say, hey, you know what? Mike's having this symptom. I would like you to do whatever with Mike. You have to go there, right? So it's interesting from the medical model. It's people from the outside chiming in and saying that we want to work on We want to help this alternate person with their symptoms. I think maybe that's where some of the discrepancy comes about. And then further,

SPEAKER_02: 26:05

it's we want to help with symptoms. We want to normalize those symptoms. And I'm speaking statistically there as well as socially. And I think that's where things get a little bit hairy, to say the least, because the idea that I'm going to give you treatment to make your... congestion go away such that you don't have that impairment in your voice you know that's one thing and i'm not saying um hey you know that impairment in your voice that gruff voice is really bothering me it's really impacting a little bit i want it to go away dan but in that case it's cut and dry the doctor's like hey you had some virus that virus uh led to your body having an immune response, which was collecting mucus. And now I can give you this treatment to make that mucus go away. Real nice cut and dry example of the medical model. Let's bring something in like autism back to your point that that's just not so easy to delineate anymore. The idea that, excuse me, your hand flapping incessantly as a way to modulate your arousal okay hypothetically speaking versus your hand flapping and it seems to attract a lot of attention in the classroom and now that's bothersome and that's where things can get really dangerous to say the least all right

SPEAKER_01: 27:33

yeah i think even are there's probably times where you've been you've had a cold or something like that and your your wife has wanted you to go to the doctor and you're probably like i'm fine

SPEAKER_02: 27:44

yeah

SPEAKER_01: 27:44

right that's the you're your symptomology isn't interfering enough with your day-to-day routine that you feel like you need an external remedy for that.

SPEAKER_02: 27:57

Well, and my wife's intent to say, I want you to feel better versus, wow, you coughed all night and I couldn't sleep either. So now your impairment, if you will, has an impact on your environment and somebody's speaking to that. And again, my wife might be saying, I really want you to feel better. And then part of her might also be saying, you're going into those coughing fits and it's been two weeks and it's really bothering me. And again, I keep harping back to that point because I think that's where this situation can get very challenging for women. the greater society.

SPEAKER_01: 28:37

But at the end of the day, it's still your choice whether you go to the doctor or not, right? Whether

SPEAKER_02: 28:43

I even want to get rid of the cough for that

SPEAKER_01: 28:45

matter. That's the point, right? You alleviate those symptoms or not, and we'll just call them symptoms, not good or bad, the coughing or things like that. And a lot of that's going to come down to a level of theory of mind, right? Of saying, I realize my coughing is potentially imposing on somebody else. So as a result of that, I... want to make their experience different. So I'm going to... My experience is different as well because I don't like the uncomfortability of coughing. And I also don't like what it's doing to those around me. So there's also a theory of mind level with that as well, right? No, there

SPEAKER_02: 29:22

is. There is. And it's funny you mentioned that. I don't know. Hopefully, I can explain this well. But there is nothing like... It's happened to you a couple times here today. It's happening to me. But nothing like having that theory of mind with this particular example of a cough and being in a situation where you realize your cough is impactful and you're trying to hold it back and you're sitting there and you're struggling. And that's kind of what we're talking about here in terms of how far an individual demonstrating a certain symptom is singled out. Correct. In terms of Hey, can we help you with that? Because you seem uncomfortable with your cough versus, hey, we're in the middle of a keynote speech. Can we help you with your cough? Because certainly we want you to feel better. But at the same time, if you feel better, then the rest of the situation also improves. That's the social significance part. You're not coughing in a vacuum. You're coughing in a public place. And that's where I think this gets really difficult for everybody, especially for us as clinicians, in terms of how we approach our goals or what behaviors we're replacing, what behaviors we're reducing and or increasing, knowing that, at least for you and me, we really were partial to increasing and acquiring new behaviors to replace ones that are troublesome. Correct. But that's that's, you know, that's again, that's a tall order. That's where we get stuck here is while your cough bothers me, I need you to stop it versus while your cough indicates something that's going on with you. How do I remove myself from your cough if it's bothering me? How do I help you control your cough sometimes? And again, we're talking about symptoms here in general. But that's important when you think about behavior and how it impacts your environment and vice versa

SPEAKER_01: 31:17

for sure and i think one of the big things with a cough since we've been talking about that is the the contagiousness about it right so that's that's one of the issues of that's one of the impetuses of go to the doctor is or people don't want to be around you when you're coughing is because it's typically a symptom that might be be contagious right so if we were to take out the the contagion from coughing Just an auditory. An auditory stimulus that might be inconvenient or somebody with Tourette's maybe saying a word. That's not contagious, right? Or somebody that has a tick. Those things aren't contagious. They might just be perceived by somebody else as uncomfortable or annoying, for lack of a better term. So that's from the medical model. That's also an interesting piece because Basically, we're saying that somebody needs treatment for something that may or may not, they may or may not feel like they need treatment for, they may or may not feel like they need to change, they may or may not even feel like it's a disability. And that, I think, is one of the issues as you get into masking and things of that nature. If your cough wasn't contagious and maybe you're like, yeah, you know what? Maybe it bothers me a little bit, but I don't want to deal with it. It's not worth it. Or maybe for whatever reason, you enjoy your cough. Again, taking the contagion out of it. Then it's kind of interesting for me to say, no, you can't cough anymore. Because, you know, with COVID, we had to wear masks because you directly affected me. But outside of that, it no longer necessarily... It affects me from an auditory perspective, but not anything more than that. I'm going to

SPEAKER_02: 32:58

make... I hope I can do this successfully. So it's almost like if we're looking at stereotypy, the idea that I'm hand-flapping, and that helps me regulate. That's akin to somebody clearing their throat to feel better to speak. But... somebody could, on the other hand, say, hey, stop doing that. That bothers me. Hey, that's really bothersome. It's getting into my peripheral vision when you're flapping your hands. It's like, well, but this helps me regulate. Would you keep me from sneezing because it's too loud for you? So again, we're trying to really, again, we're being very careful, and we're narrowing this down to both sides of it. The idea that, yes, any individual's behavior is going to have an impact on their environment, and then how the environment affects Yeah. And

SPEAKER_01: 33:46

what's interesting from the behavioral or the mental health side of things is, are you allowed to have bipolar? Yeah, sure. Or schizophrenia or be depressed? And you don't need to seek treatment for any of that stuff. Nobody can necessarily make you seek treatment on that unless you are bipolar. I can't impose a treatment on you because you are acting in a way that I don't want you to act. That might be a better example than the cough. The autism piece is interesting because one could argue from the medical model that a treatment is being imposed on individuals that haven't sought it out themselves. I got a call, I don't know, maybe three years ago from a 40-some-year-old woman with autism who, I don't know how she found her ABA company, but she was interested in ABA therapy. I think that is very different than somebody getting ABA therapy against their will per se. Not that we shouldn't do that because people aren't able to sign contracts before 18 and free will is interesting below 18 because it all goes through a guardian. But I think that's an interesting piece that maybe people on the spectrum would argue is that, yeah, my... my disability isn't a disability because it wasn't hurting anybody. I didn't necessarily have, I wasn't missing out on an ability that allowed me to function in the world. That's an interesting side on the, on the medical side of things.

SPEAKER_02: 35:32

Well, and you talk about age of consent. Um, we talked to a lot of parents, um, actually the parent that, uh, kind of brought this, uh, current issue to us or this current topic to us. Um, That's difficult. She is somebody who very much would champion the social model. And then at the same time as a parent, she's had to take on the medical model in order to be able to access any semblance of a social model, and then she gets clinicians...

SPEAKER_01: 36:06

And fight why it's medically necessary.

SPEAKER_02: 36:08

Right, exactly. So this really interesting quandary we have where we have something that needs to be medically defined, but socially addressed.

SPEAKER_01: 36:17

That's a great point. Something that needs to be medically defined, but socially addressed to be able to get funding outside of private pay.

SPEAKER_02: 36:24

And it's not that we didn't know that. We throw the phrase social significance around all the time, right? But but I've never really thought of it until now this way. We need to define it from a deficiency standpoint. That's what qualifies somebody in our current political forum. That's what qualifies somebody to say, hey, you have, number one, you might, given your deviation from the norms, we might give you a label of a developmental disability. but more importantly is going to manifest in certain impairments particular to you and then that's where your resources come in to see who's going to help you do what to address those impairments such that they don't achieve a level of inability or disability but allow you to access whatever you want to access barring people then try to discriminate against you.

SPEAKER_01: 37:30

That's interesting, almost circular reasoning. I never thought about that. Again, not until now. I'm uncomfortable with the medical diagnosis and the medical modality, but I need to prove that it is a disability so I can get funding through my insurance.

SPEAKER_02: 37:45

Well, then to get a little more specific, the idea that to use communication or talking as an example again is The idea that a parent who's following more of a social model because that seems to not just present better but have better outcomes in terms of treatment, the medical model would say, so that child is deficient in their vocabulary. Developmentally speaking, they're not saying enough words to be at a good developmental trajectory. So the medical model would say that deficiency needs to be addressed. The social model says, well, it needs to be addressed not from a word perspective, but from a communication perspective. So now it doesn't matter whether this child is using signs, gestures, pushing a button, exchanging laminated cards, as long as they have some access to expressing themselves somehow, knowing that some of those expressions might actually be behaviors that are then too challenging for any given environment to tolerate, to sustain. Yeah. Yikes,

SPEAKER_01: 38:53

man. That's interesting because ABA is no more effective for individuals on the spectrum than neurotypical individuals. It's as effective for everyone. But for whatever reason, the funding is only set up for individuals with the medical diagnosis.

SPEAKER_02: 39:10

So really quickly here, just based on time, what you're saying is ABA doesn't have a particular magic toward autism or autistic individuals. The ABA magic is general to any organism or to humankind.

SPEAKER_01: 39:25

Yes. If you're concerned with the medical model, it's only because that's what has been deemed the funder of the source. Not the treatment, but the

SPEAKER_02: 39:36

funder. Let me take this time here to speak a little bit more about some different magic, and we'll come right back. 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 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. 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 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: 41:01

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_02: 41:18

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: 41:30

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

SPEAKER_02: 41:39

Wow. So really lowering my stress such 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: 41:57

Well, it's going to do what the others have done. Talked about. And what have the others been? Reduce stress. Reducing stress and anxiety. Which

SPEAKER_02: 42:05

then helps me have a better mental state, a better flow altogether. 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. We'll be right back. All right, and we're back. Thank you for that time there. So getting back to this, we use the medical model to define, to get access to certain resources, and what you and I are saying is you use the information from the medical model to look at what deficiencies... might be manifesting themselves as impairments toward that definition of disability or that idea of disability. And then behaviorally speaking, from a social significance perspective, if we're up to date and doing the best we can, we're coming in to look at, as we should, how to modify the environment toward new behavior and learning. We're not modifying the individual

SPEAKER_01: 44:03

ever. Correct. So use the word deficiencies, and I'll transition over to the social model now. The medical model looks at these as deficiencies. The social model looks at them as differences. So I think that's the big key. The social model says that the world is set up for certain people, and that's how societies typically work, is they work kind of with that bell curve, right? We've got, what, 350 million people in the USA or whatever it is, somewhere like that. We can't accommodate for... every single person in the society. There's just too many outliers. So what society typically does is they take the, you know, 80% and look at the 10% on each side and they focus on how to accommodate the best for those 80% of individuals. And then those 10% outliers on each side either need additional accommodations or they need to kind of figure out their own accommodations because society just can't, you know, within reason fund that. So the societal model of disability would say that autism isn't a deficiency. It's a difference. And the way that society is set up is not to accommodate for those differences because it falls outside of those bell curves. That's literally what the definition kind of of autism is, right? It's a spectrum, and we're all on a spectrum of some sort. And I remember talking about with my mentor at the other company about, like, when does... quirky becomes stimming or when does it become autism? Like it's kind of when it hits that arbitrary line at the bell curve, right? Like we all have our quirks and he would define it, he defined it as whenever it becomes, affects that individual's ability to interact with their environment, then it becomes a disorder. So the social model would say that we're gonna address society, and help them become more aware of the differences, but also accommodate for the differences. I'll give one example, and then let me pass it to you, Mike. The company I work with is Proact, and we do a lot of trainings for all sorts of individuals. One of the trainers last week did a training for deaf individuals, a de-escalation training for, it was a company that works out of Massachusetts that works with individuals that are deaf. Most of the staff is deaf. So that is a difference, right? Being able to talk and hear versus being able to not talk and hear. Presumably, at some point in time, before sign language was around, those individuals were not necessarily, society wasn't really set up for those individuals. Or even still, I don't really understand sign language, so even still society isn't necessarily fully set up for individuals that are deaf. However, society has accommodated. We've come up with sign language. And now we were able to deliver a training through an interpreter that without having that interpreter and that ability to have somebody understand both sign language and vocal language, they wouldn't have been able to get access to. So what happened, society accommodated. And now these individuals don't necessarily, I mean, it's still probably considered a disability, but it It doesn't need to be a focus of any treatment. There's no treatment for it.

SPEAKER_02: 47:22

So this, again, and I like the semantics here because I think they help us understand the possible solutions as well as the problems, and you just spoke to it. So somebody has a disability. They're hearing disabled. For example... So the fact that they can't hear is their disability. They are not able to hear literally. Now, what impairments that disability brings about is what we're talking about. So the impairment is if you're presenting something to me, if it's verbal in nature and auditory in nature, then I am disabled in that situation. If... you present me with sign language or written language, now that's an impairment that I'm facing that I am able to work with and integrate myself into. So now there's social significance to that. I am no longer unable to understand based on my disability. That's just now an impairment that can be remedied by sign language or text.

SPEAKER_01: 48:29

So from that, now, if I go into a group of all deaf people, Yes. Yes. The death piece, the disability, and not the not being able to sign piece. But if you flipped it, and 80% of the world signed, and I talked with words, now I have the disability, right?

SPEAKER_02: 48:59

I have a sign language disability, yes. I am not able to use sign language. And that's a really good point. That's a great way to flip that whole situation on its head, because that's what we're talking about here when we say things like normal and abnormal. When you talk about normalcy... All that really means is a distribution statistically across a population. Good point. And a lot of us fall under the dome and then there's tails on either side, the outliers. We tend to look at the right side in terms of intelligence quotients, for example, is very favorable. And we tend to look at the left side as the notion of disability in many ways, right? Intellectual disability. But that's not to say that there aren't impairments that that are present across that entire distribution, whether you're under the dome or not. Everybody has some level of impairment relative to your circumstance based on your ability.

SPEAKER_01: 49:59

Yep. Yeah, no, that's a really interesting point that I didn't even think of before we come there, right? Normal has a a connotation of better, but normal just means under that bell curve. And you think of the

SPEAKER_02: 50:12

range, the variability under that bell curve, under the dome, there's nothing easily reconciled about that. It's huge. The differences from one side of that dome to the other, left to right, they're probably... larger and more expansive than any of the differences within the tales.

SPEAKER_01: 50:33

Yeah.

SPEAKER_02: 50:34

But somehow you're right. We run the risk of seeing something as better, and that's where this idea or the idea that the medical model can tend to be an ableist model. Is that something you want to speak to really quickly? That's tough for me because the semantics, again, I don't disagree with what people are saying with those words. This is where I feel like I fall a little short. Like I'm not exactly sure... how to navigate the whole terrain.

SPEAKER_01: 51:00

It can be challenging because we all think that people with wheelchairs should have the same access to any residence, any business, whatever. Now, if you're the business owner and you don't really have too many clients that have wheelchairs, but you have to now spend a lot of money to accommodate that place, now that... That can create a little bit of an issue, right? Is that kind of what you're talking about with the ableist piece? Yeah, yeah. No, again, and that's

SPEAKER_02: 51:31

because ableism is not something that's looked upon favorably with good reason. And then to your example there, that business owner could be unfairly labeled as ableist, and they're just saying, hey, man, I... You know, this is my ice cream shop and I'll bring the ice cream to you. I just don't have the resources to help you get to my counter.

SPEAKER_01: 51:58

Yep.

SPEAKER_02: 51:58

You know, that's tough. That's not an easy situation.

SPEAKER_01: 52:02

That's tough, but... On the flip side, the person with the wheelchair would potentially say, well, I shouldn't have be treated any differently, right? And that's where the Americans with Disabilities Act or a lot of the non-discrimination pieces have come in that you can't discriminate with somebody based on their sex, religion, sexual orientation, also all these different disabilities as well. Because you do risk becoming an ableist because it's that normal, that difference is uncomfortable, right? We've talked about the difference between disability and differences. And the difference does kind of become uncomfortable. And it's something that society has... Really with social media and things like that, how there are like silos and things like that. I'll take an example of maybe like furries, right? The people who like to dress up and act like animals, whether it's dogs, cats, foxes, whatever. There's communities of that, right? And that seems abnormal probably to the people that are not in that. But if you were to go in one of those communities, it's abnormal to not do that. So that's that social... The world is not necessarily set up for that, so it seems abnormal. But you go in those communities, and number one, obviously they're not hurting anybody, so the question is, okay, it is not normal in... That doesn't fit under the bell curve, right? That would be the tails of the bell curve. Now, when you're in those areas, we're the tails of the bell curve. The question is now... How much as a society do we need to accommodate for any individual? Should we allow that individual to express themselves however they want to express themselves? Should I make the change? Should I teach them how to change? Or should I force them to change? Would be kind of the three options.

SPEAKER_02: 53:59

Well, that's where the collaborative part comes in. I think that's a very nice word. It gets overused. It's one of those trendy words that I hope doesn't... become overly diluted. But that seems to be the only answer for me, right? So the idea that I'm trying to think of, you know, a really good, well, the idea that from an ableist perspective, a child isn't speaking. If I go in as a clinician and just focus on the spoken word, now I'm adhering to the medical model and I run the risk of being ableist. If I go in thinking that I'm going to just help their communication. Now I might be adapting a social model which might be more effective. From that parent's perspective for this child, the idea that they want the social model based on the treatment outcomes and the humanity that is going to be expressed in that social model, that's good. At the same time, I wonder as a parent how many of those parents in that situation wouldn't accept the medical model upon their child actually learning to use words as opposed to any other alternative model of communication. So it's not so cut and dry, right? Correct. I'm not trying to be unfair or disparaging by any means because I do hear a lot of parents say, for example, I would never want to change my child. I hear you. That's a really beautiful sentiment from a social model of disability. At the same time, we talk to those parents and say, well... What if your child spontaneously started using words today? Would you reject that notion? Of course they wouldn't. So it really falls upon us as clinicians to understand the difference between those two. Yes. And it's not that we ever abandoned the medical model. It just can't be what we lead with.

SPEAKER_01: 55:54

So you mentioned bringing up words. Let's say you as a parent, let's just say hypothetically, your three-year-old daughter became deaf all of a sudden. Do you think as a parent you would learn sign language? Yes, absolutely. I think that's what the parents of individuals with autism are saying is that their kids communicate differently. And if it was different, if it was being deaf, they would learn, the parent would learn how to communicate first so they could teach the child how to communicate. They would change their behavior instead of forcing a different way of communicating on their kid because it's more comfortable for the parent.

SPEAKER_02: 56:35

And that's the important point, I think, for me in all of this is that that essence of collaboration. It's one thing to speak about a parent, and then it's one thing to speak about a greater society, to speak to the differences in these models that is going to require a medical definition of, this is your disability, this is your illness, your disorder, your diagnosis. It's going to bring about these impairments. These impairments could... be overcome they might also be highlights of what you're unable to do and then what can your environment do to consider the situation and give you so the idea that you know you're in a wheelchair um and and uh that you're going to play a sport that requires running okay well That's where the disability is going to be very clear. But the idea that you're in a wheelchair and now you can participate in basketball, no less, given certain accommodations and changes in your environment is a very simplistic example I'm giving here, but I think it's an effective one. That's what we're talking about. And again, we can come up with a million examples because I think this is an active process for us as clinicians to be thinking about this because we're always at risk of trying to simply correct the situation toward the greater good. And I use that phrase very specifically because the greater good can also be the basis for discrimination of a single person. Oh man, this is so complex.

SPEAKER_01: 58:08

Yeah, I think that the disability piece refers to either the inability or the greater energy to do something. I think that we want to set up the world as much as possible to allow us the easiest amount of energy to get a certain result. So I would imagine that, and I could be wrong, please, if somebody feels differently, that a lot of individuals maybe that are in a wheelchair, it might take greater energy for them to traverse a distance or drive or something like that. So assuming that that's the case, that Most people would probably rather be able to do less energy, i.e. use their legs or use a word as opposed to sign if that takes less energy. So that's another thing to think about with the disability piece. It could either mean the inability or it takes greater energy to accomplish the same result.

SPEAKER_02: 58:59

Right, right. There's a lot to cut through here, man. This is interesting. So we're at that time here. Let's try to reel this in really quickly and get some wrap-up points that are maybe more particular to ASD. We've given a couple of examples of behaviors. You got something?

SPEAKER_01: 59:17

I do have one more point that I think is very relevant to the ASD piece, and I think it's one of the most specific things to ASD versus any of the other diagnosis, and I think it comes down to theory of mind because I think that's something that individuals with ASD tend to struggle with. And that theory of mind allows you to take the perspective of someone else. So it allows you to look around and realize, oh, everybody else is looking at me kind of funny because I'm hand flapping or something like that. Let me adjust my behavior based on how the people around me are doing. Yeah. A lot of individuals with ASD struggle with that theory of mind. So they don't have the ability to necessarily look around and say, okay, people are looking at me a certain way or I'm getting a certain reaction. So I want to change my behavior to get a different reaction. The question now becomes, do they want to change? If they knew the reaction, would they want to change their behavior? That's what can kind of be imposed on individuals, and that can be the masking piece, right? And that's the challenging, kind of unique to ASD. It's where, you know, as a child or as a parent, you might be like, you know what, Johnny, let's sit down. I'm doing this so you don't stand out. Well, does Johnny care if he stands out? And we don't know, right? We can't necessarily answer that question. And I think that's the big impetus with the ASD

SPEAKER_02: 1:00:43

piece is that theory of mind. I hope I can explain this effectively and this might be a good way to conclude. But interesting how that theory of mind is one directional, right? For all of us. So in your example, the idea that nobody in that room who otherwise we would think has... would likely have theory of mind, would look at somebody who's self-regulating by hand-flapping and go, oh, that person just needs to hand-flap to self-regulate. We're cool. No, it becomes this really clear notion of a difference, of a distinct difference that suddenly, maybe from a tribalist perspective, well, nobody else is flapping their hands. They need to stop flapping their hands. I want to invite everybody, I meant to mention this earlier, but I think a really, really basic example of this could be fun for any listeners out there to revisit. I don't know if you're familiar, Dan, but Dr. Seuss has a story about the Sneetches.

SPEAKER_01: 1:01:39

I am not too familiar, but I know you've talked about it

SPEAKER_02: 1:01:43

a lot. Yeah, yeah. Again, this might be a nice, simple example for any of us to revisit as we consider these constructs and look at differences amongst the population and how we regard those differences, how we accommodate, how we facilitate, how we would want others to do that for us or for one of our family members. It's a really interesting human dynamic from the medical perspective that we wanna help somebody by making a symptom go away. I don't think that there's malevolence in that, But if we're not careful, it can turn into that. It's

SPEAKER_01: 1:02:23

a weird theory of mind exercise, huh? It's a very weird theory

SPEAKER_02: 1:02:26

of mind, because all you want to do is help, and the idea that my intent is to help, and now you're telling me that I'm being an ableist, and how dare you? That can be very frustrating. But yeah, it's a very careful tightrope, I would say.

SPEAKER_01: 1:02:40

Yeah, I think in conclusion, I've come to the conclusion that that social model is an interesting theory of mind exercise. We're trying to help, but... Maybe we're not taking into consideration their perspective. So

SPEAKER_02: 1:02:50

we're saying consider the medical model based on the tools we have to work with and how we define the notion of a disability or how we might identify somebody medically as perhaps qualifying, being eligible for certain services. And then once those services, once we come in to deliver those services, that interesting exercise in theory of mind from a social model perspective is what we're saying. And that's not an easy dance. I get the feeling, Mr. Dan, we're going to be revisiting this topic at least one more time. I don't know if we'll do a two-part series because I don't know that we set ourselves up for that on this one, but there is so much more to explore here.

SPEAKER_01: 1:03:29

Wow, that was a good road, but I think we got to a good conclusion there.

SPEAKER_02: 1:03:33

So be mindful of the medical model. Make sure that you're looking at collaboration from a more social model perspective. And always

SPEAKER_01: 1:03:42

analyze responsibly. Cheers, brother. Cheers, Mike.

SPEAKER_02: 1:03:45

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.