Tap Into A Reinforcing Conversation with Nicole Stewart and Christina Torres

*FOR PART I of this interview, please go to the Reinforcing Conversations Podcast

Grab a cold one and pull up a chair! In this episode of ABA on Tap, hosts Mike Rubio and Dan Lowery are joined by a powerhouse duo shaking up the behavior analysis space: Nicole Stewart and Christina Torres, creators of the Reinforcing Conversations podcast. This is a pod-swap, so part I of this convo starts on the Reinforcing Conversations platform. Please do check it out.

Nicole and Christina are known for their honest, unfiltered dialogue and deep reflection on the ethics of real-world practice. In this "pour," the crew moves past the rigid, compliance-based textbook jargon to focus on what it truly means to center humanity while still honoring the science. They dive into the realities of modern clinical practice, the nuances of trauma-assumed care, and how to build an authentic professional brand without losing your mind.

In this pour, we are serving up:

• Textbook vs. Reality: Why standard "one-size-fits-all" behavior protocols fail in the field, and how to individualize affirming care.
• Trauma-Assumed Practices: Shifting the focus from strict behavioral compliance to fostering true safety, assent, and belonging.
• Building an Authentic Brand: Christina shares her journey as a self-made entrepreneur and how she uses social media to make ABA accessible.
• Navigating Field Burnout: Honest talk on setting boundaries, advocating for yourself, and upholding ethical supervision standards.

Whether you are a seasoned BCBA, an RBT in the trenches, or a business owner trying to steer the future of therapy, this episode delivers the straight talk you need—minus the boring jargon.

Tune in, drink up, and always analyze responsibly!

Connect with the Guests:

• Listen to their podcast: Reinforcing Conversations on Spotify
• Follow on Instagram: @reinforcing.conversations

Transcript

SPEAKER_01 0:01

Welcome to ABA on tap. I'm Mike Ribio with Dan Lowry. So without further ado, sit back, relax, and always analyze responsibly. All right, all right. Welcome back to yet another installment of ABA on tap. I am your ever grateful co-host, Mike Rubio, along with Mr. Dan Lowry. Mr. Dan, how are you doing?

SPEAKER_05 0:41

Good. An installment already in progress.

SPEAKER_01 0:43

Installment already in progress. You're gonna have to go somewhere else to get the first part of this. So without further ado, our special guests today are Nicole Stewart and Christina Torres from the Reinforcing Conversations Podcast. Alright. So you could you could hear that maybe? Are you dancing?

SPEAKER_03 1:07

A little bit. We got a little. We all love jazz music.

SPEAKER_01 1:10

Okay.

SPEAKER_03 1:11

The house band. Can you where did you? I wanted to know. This is like the first question I had for you guys.

SPEAKER_01 1:18

Oh snap.

SPEAKER_03 1:19

Where did you get your intro music? Did you do it yourself?

SPEAKER_01 1:22

You mean for the whole episode? Like the very beginning? So we I don't know how long you've been listening, but it recently changed. Okay. This season we have a new intro. Before that, yeah, I put it together on Garage Band. I just pieced it together. But I'm very proud to share. I'm so glad you asked this question. The intro music now is me and my son.

unknown 1:45

Awww.

SPEAKER_01 1:46

Yeah. Yeah, I play drums. I've been playing for a long time. And we for as long as my kids have been alive, I've always had some sort of back line in my living room, meaning drum set and amps and basses and guitars, and it's in my living room now. So when he was about seven, he finally took to it. And uh he's a really accomplished guitarist, but can play just about anything with strings or that makes a sound. He just picks it up and does it. And yeah, and I was after him for a long time because it was like, dude, please help me redo this intro music. And he was busy and he's got his band, and you know, but uh we finally got it done, and I'm super stoked about it. It was actually a minute long. And people were like, That's too long for an intro, you're gonna have to chop it. So it was it was yeah, it was much more self-indulgent. Yeah, maybe I'll share that with you. Yeah, I did.

SPEAKER_03 2:40

Yeah, yeah, I would love to hear it. How old is your son now?

SPEAKER_01 2:43

He's 20. He's 20. Yeah. And I can talk about him all day. I he as a parent, like I just went through the first experience of having a child move away, which has been interesting. And he's doing great. But uh yeah, you know, it it's been great to see him grow, to see him just develop as a musician. And there's I think if he wants to pursue this, he can. I mean, it's always a long shot, no matter how good you are. Right. But he's certainly garnering all the right attention and and all the right people are are talking to them, him and his bandmates. So they just they just opened up for Yachty. It uh so they just played their biggest gig, which was at the UCSB, University of California, Santa Barbara, like indoor arena, which is like six thousand seats. And they opened up for Yachty, which was a much bigger rapper artist that I didn't know until he introduced me to him. But yeah, so that's that's where he's at.

SPEAKER_03 3:35

Amazing! That's so cool. Living his dream.

SPEAKER_01 3:38

Living my dream, his dream. Yeah, my older brother's dream, yeah. Yeah. Yeah. I like his dream. I used to play, I was used to be a little more active here in the early 2000s in San Diego. So he kind of he was raised on on music and rock and roll, so he took to it. And uh, I thought my my other child, my my 16-year-old, my daughter, they when they were in elementary school, they had a little kids' band. They were called uh the accidental green bean. And they used to play these gigs. I thought for sure they were gonna be a little duo, but uh she dropped she dropped off from that. We'll see. We'll we'll get her back in at some point. Yeah, she does show choir, so we're she's still singing. We'll we'll get her back in the middle.

SPEAKER_03 4:19

She do some backup vocal harmonies, things like that. I don't know. I'm just saying words.

SPEAKER_01 4:23

It's so interesting. Like she she's I don't know if she lacks confidence or she gets a little bashful, but all her brother and I want when we jam is for her to come grab the microphone. We're always like, just come sing, like come sing with us, and she won't do it.

SPEAKER_05 4:38

So his daughter just got her license like last week. Oh my god. And I remember when his ex-wife was pregnant because he used to work with his ex-wife who I worked with at that company, and I remember when she was pregnant with his daughter. So I can still only see her as like this little baby who used to walk around the office, who apparently now is old enough to have her license.

SPEAKER_03 4:57

I know it's crazy, isn't it? Just how quickly this life goes, like when people say the what is it, the days are long, but the years are short.

SPEAKER_01 5:07

Oh man, it's crazy.

SPEAKER_03 5:08

Never a truer sentence, apparently.

SPEAKER_01 5:11

She just took the car out for the first time, or at least our car out for the first time last night. So I mean she says she's newly licensed, like last week or something. So yeah. She was like, Can I go to a sleepover? Yeah, can I take the car? It's like you're gonna take the car all night. Okay.

SPEAKER_04 5:28

Okay, I guess that's okay. Sure.

SPEAKER_01 5:30

I think it made it back safely. She might be roaming around out there. I think. Yeah, I think that's it was hammering next door. Legit. She knows we're podcasting. Why is she hammering? I don't know. Teenagers, right?

SPEAKER_05 5:42

Did do you ladies wanna maybe introduce yourselves to our audience? We had a great, great conversation back on the reinforcing conversations podcast, right? Did I say that right? Yes, yeah, reinforcing conversations podcast. We'll link you in our description as well. Hopefully, you all can hear that. Nicole and Christina, would you ladies mind telling us our audience a little bit about yourselves?

SPEAKER_03 6:04

Yeah, Christina, you want to go first? Sure.

SPEAKER_02 6:06

I'm so excited to be here to share communities.

SPEAKER_01 6:10

Thank you.

SPEAKER_02 6:11

Community girl. So I'm Christina. I have my own platform as well. It's called ABA Made Easy Online. I do a lot of dissemination, mentorship. I do a lot of live shows on Instagram and on TikTok. And I'm really passionate to empower BCBAs to go independent and help support the future leaders of our field.

SPEAKER_05 6:32

Excellent. Right off.

SPEAKER_03 6:33

And I I'm Nicole and I do some things on social media, but nothing like Christina. But I do a lot of dissemination on ADHD and how we use ABA for ADHD and then workshops, trainings, lots of different things for organizations, really bringing awareness. Even if you work in the medical model and think that you mostly see children with autism, the comorbidity between ADHD and autism is like 50 to 75%. So you probably have a lot of kids with ADHD. And when you don't realize, you don't realize when you don't know what you don't know, you don't realize that you could be actually harming these kids. And so I feel very strongly about people better understanding ADHD in our space, whether you work in autism or whether you're looking to expand into a different diagnosis and a different way of delivering ABA. And then I also do some training things and I teach at Hunter and I connected with Christina a few years ago because she was looking for someone to pick to pick their brain about being independent. And then I saw her explode on social media and I was like, man, look at this girl go. Like I meet with a lot of different people who are like, maybe I'll go independent, maybe I won't. And Christina was like, like a rocket. And I was so inspired by her journey that we started collaborating on dissemination of ADHD. And then we just really enjoyed talking to each other. And we thought maybe other people will like listening to us talk to each other. So we started our own podcast.

SPEAKER_05 8:03

Nice. And you ladies are two seasons in 21, 22 episodes. Is that correct?

SPEAKER_03 8:07

Yep. Yeah. So we're in recording our third season now. I think you guys, this is our fifth, will be like our fifth or sixth episode of our third season by the time this these are released. Which actually we'll have to coordinate. I didn't think about that.

SPEAKER_05 8:20

Uh yes.

SPEAKER_01 8:20

So talk to us about the learning efficiency here. Like, what's if you think back to episode one and the mic setup, I mean, what have you guys learned? I mean, because I I understand our own progression, it's you know, if I hear back to like season one, we just re-released at the end of last season. We needed to cover some some ground. So we re-released our first episode. And I just happened to go back and listen to it. I'm like, oh my God, I sound terrible. Like, and that I'm not saying that I listen now. I'm like, oh, I sound great, but you know, we you develop a flow and the the ums, for example, the ums. Maybe I've gotten a little better at the umms. But yeah, I mean, tell us about your progression here. What do you guys think?

SPEAKER_05 8:54

Maybe I've gotten better at the ums.

SPEAKER_01 8:56

Right. Exactly. Well, exactly. Plan intended. I'm very I mean what I say, Dan. Go ahead.

SPEAKER_02 9:04

It's definitely evolved. I still get stuck on the intro. I'm always like, Welcome in, guys. Like I go live all the time. I'm like, what's up, guys? And it's like, okay, girl, you gotta get it together. What am I saying for this intro? How am I welcoming us? Am I saying Nicole's name too? And I'm saying just my name. So we're still kind of shaping that up.

SPEAKER_03 9:21

Yeah, I think it's the deliberate parts that trip us up when like we you know reference our sponsor or we're saying goodbye, like the outro trips me up too. So yeah.

SPEAKER_01 9:30

So have you, I mean, do you do you ever script anything? Like so you are feeling confident about that. So we we had a sponsor with Magic Mind for a little while. And it was it was a little, it was it was a bit of a pressure situation, right? Because you we'd have to generate, I'd have to generate our own ads. And yeah, if I tried to like riff it, we would riff, and then I would try to riff into the ad, and it was like, no way, man, I'd have to write it down because otherwise I felt like an idiot. It was like bumbling and stumbling over my words and repeating my words and just not saying anything meaningful, but yeah, and the ball does a really great job creating these amazing guides for us.

SPEAKER_02 10:05

Like, so it does have the intro prompt, and then we usually have like questions to help us navigate the conversations, but we just kind of like yap and it just flows naturally.

SPEAKER_05 10:14

A teacher creating good visuals, that sounds legit.

SPEAKER_03 10:19

Yeah, I have to have a lesson plan.

SPEAKER_01 10:20

Oh, I was gonna say I made it all marked with time signatures, and at this point in time, Christina's gonna say this.

SPEAKER_03 10:26

And then we don't, as I feel like is is true in like the natural environment, we follow absolutely none of the lesson plan, but at least we have it, and I think that helps if we get stuck somewhere, or you know, kind of neat. But I think that that's evolved too, because I think the lesson plan, like at some point we were really like I was trying to be really statistic heavy and really cerebral, and I found it very I'd be like, but I didn't get to talk about all my statistics.

SPEAKER_01 10:51

Well, it's tricky too. Like we just did that episode with on the white paper, and uh it we ran into the same thing. We actually ended up recording that one twice because we did it once, and Dan had delved into all the statistics and stuff, and the during the first run when he was trying to organize that, I think you just felt like it was a little scattered, and then luckily we were able to do it again, and and he felt better about it. But yeah, it's almost like if it's too scripted, uh, and we've had this discussion because from the video to like how much more production work do we do. Whenever we've scripted too much of it, it's it's like you're going back to your notes, and all of a sudden you lose the spontaneity, and then there's the other end of it, which is you're too spontaneous, and then it feels really loose. But I think we've we've I feel pretty good about our flow so far. I'm sure you guys are are feeling a lot better than that first episode.

SPEAKER_03 11:35

Oh yeah, yeah, oh yeah, yeah, definitely. I feel like there was a point where we started working with guests. I don't know if you felt this way, where I got comfortable with Chris Christina and then we've added a guest, and I was like, what do I like? Are we interviewing them? I feel like that took a while to kind of shape up and like what is the purpose of the guest? Why are we what are we doing with are we just chit chatting with them? And so I think we've gotten a lot better at that too. And that for me, that was a growing pain. I think Christina is much more natural at just like talking about anything. I felt like I was like, when do I talk? When does she talk? I don't know what to do. Yeah.

SPEAKER_05 12:11

Yep. So speaking of yes, sorry, my bad.

SPEAKER_02 12:15

No, just pausing, right? It's like, okay, what do I say next? Especially when someone shares so much information. Because you know, when people are talking, it's like, oh my god, you have an idea to insert a question, but then like four other topics come, and it's like, oh my gosh, I forgot what I was gonna say.

SPEAKER_05 12:28

Yep, that's why I write stuff on my phone. It's sometimes it looks like I'm texting, but they're questions because I ask a million questions.

SPEAKER_03 12:34

I have a notebook.

SPEAKER_05 12:36

There you go. So I do have some questions on the podcast on their end. We just spoke with Christina about bringing ABA out of the medical model, which was awesome. Please listen to it on their podcast. She had some great, great anecdotal situations, including some big wins and victories in her home state of Connecticut. So, shout out to you again, Christina, for that. I have some questions for you, Nicole. On you talked about the low-dose model and the ADHD. But before we get there, I want to ask both of you ladies, maybe just a little bit of your origin story. So, how did you, Christina? How did you get to being the BCBA and like where you are now? And then Nicole, kind of the same thing because I'm sure none of you, when you were in like elementary school, were like, I want to be a BCBA. So, how'd you get there?

SPEAKER_02 13:20

Yeah, I feel like this is a story similar to so many, right? It was it was all by accident. Like my undergrad is actually in criminal justice, and then I actually moved on to from Connecticut. So once I graduated my undergrad, I moved on to Florida for a year and had so much fun. And then I'm like, okay, girl, you're getting old. I was like 24 or 25 at that time. I'm like, right? You feel old at 25.

SPEAKER_04 13:44

Your prime is gone at 25.

SPEAKER_02 13:46

Right. So I went back home and I'm like, I was struggling trying to find a job in my space. And then I ended up finding a position as a life skills coach and a community mentor for adolescents and adults with autism. And I really loved it. And it was it was pretty cool, but it was just a per diem. And then I was like, okay, I found a full-time position as an ABA therapist in a school district that was nearby. And I'm like, okay, let me try working with kids, you know? And then once like that first week of working with our friends, I was just like, wow, what is this? And then I'm like, how do I make more money? Because this is exactly what fit my personality. And then as soon as I found out I had to go back to get my master's to become a BCBA, that's when I kind of dove really deep into this ABA space, making sure to get exposure in the homes and the clinics and the communities with adults, and then trickle down to early intervention, and then obviously becoming a BCBA and kind of shaping myself from there.

SPEAKER_05 14:42

So life coach, then working with people with autism, then you're like, okay, now I want to get my BCBA, and then so you got your B C B A, and then you worked kind of in the I'm gonna call it the common field for a little bit until you had your daughter. Is that daughter or son? I'm sorry. Daughter, right?

SPEAKER_02 14:58

Yeah, my daughter.

SPEAKER_05 14:59

Daughter, until you had your daughter.

SPEAKER_02 15:01

Yes. So I was in the field for about like eight, eight years when I became a mom, and I shared on our on our um episode earlier that I had my daughter at 25 weeks. So we spent this is her diaper actually.

SPEAKER_01 15:16

Oh wow. That's incredible.

SPEAKER_02 15:19

So after having my daughter and being in the hospital for four months, I got home and I'm just like, you know what? I can't go back to the typical medical model. I need to start my own practice, I need to be able to have flexibility because I knew we were gonna be in and out of the hospital for a while. So that's when I decided to start my own consulting practice and started disseminating online and sharing my story and kind of pioneering my own space in our field.

SPEAKER_05 15:41

How long ago was that? Did you have your daughter? How old is she now? Four. Four.

SPEAKER_02 15:45

She's gonna be four next month. We're trying to figure out what to do for her birthday party. But yeah, she'll be four next month.

SPEAKER_05 15:52

So you've been doing your own as you can. Four years. Yeah.

SPEAKER_02 15:55

Yeah, it's gonna be four. Maybe made easy is gonna be four in October.

SPEAKER_05 15:58

That's amazing.

SPEAKER_02 15:58

How exciting.

SPEAKER_05 15:59

Right on. Nicole, how'd you uh how'd you get to where you were? I'll get started. Yeah.

SPEAKER_03 16:04

Well, as a child, I wanted to be a behavior. No, I'm kidding.

SPEAKER_01 16:07

Oh wow, that would have been a first for sure. I thought you wanted to be a good one. When my parents gave me my first skinner box for Christmas, right?

SPEAKER_03 16:13

Is that my mother actually toilet trained me using MM, so that was my first experience with ABA, and I just knew from then on.

SPEAKER_01 16:21

Tell us a story about how you like raised uh pigeons, like carrier pigeons or something, right on your rooftop in New York City or something. Come on.

SPEAKER_05 16:28

When my mom sat me down at the IKEA table in chair and handed me my DCT cards to learn my first token economy, my first star chart.

SPEAKER_01 16:35

Amazing. We gotta let you go. That could happen in the near future. Yeah.

SPEAKER_03 16:44

Um so that was not my story. I did always know I wanted to work with children. Like, even as a child, people would say that I was always good with children, which is like kind of maybe a weird thing to say about a child, because I was a child. But I was like, I wanted to be a pediatrician or a teacher or an actress or Katie Couric. Those were my options.

SPEAKER_04 17:06

Okay.

SPEAKER_03 17:07

Yes, I'm not Katie Couric, so here we are. But I guess that lends itself into like that. I like training and podcasting and dissemination because I do like public speaking, which I think is that piece. So I decided, you know, I was pre-med in college, did the whole like organic chemistry. I even took it over the summer to get myself accelerated.

SPEAKER_05 17:28

That's everyone's favorite class, Ochem. Ochem one and two, by the way.

SPEAKER_03 17:32

Did you take it also?

SPEAKER_05 17:33

I sure didn't. I did.

SPEAKER_03 17:36

You took it?

SPEAKER_01 17:36

Yeah. Yep.

SPEAKER_03 17:37

Yeah, we have a lot in common.

SPEAKER_01 17:39

I I I tried chemical engineering for a little while. We won't get into that.

SPEAKER_03 17:43

Okay. Yeah. You know, I like really love science. I really like, I love how it makes sense. I've always been a science person. My parents, like, my brother's a lawyer and he was the history person, and I'm uh I'm I've always been into science to the point where my parents did a really good job where I didn't realize how rare it was for women to be and girls to be interested in science because they did such a good job encouraging it and normalizing it. Oh wow and just being like, Yeah, cool. You want to go to like a math tournament? Great. You want to like do science camp? Like I did a camp at some point that was like building your own electrical things out of you know, circuit, like building your own circuits at some point. My mom was like, Great, whatever. It's nearby, great.

SPEAKER_04 18:22

Nice.

SPEAKER_03 18:23

And so I was pre-med and then I signed up for the MCATS, and I'm a very bad test taker. I took the SATs like seven times. I took the ACTs. I was like, we're gonna do everything. MCATS. And I think the MCATS freaked me out. And the whole idea of like it's gonna take me another 10 years to get there, and I don't even really know where I'm getting to, and I don't know if I want to do this, kind of like you know, existential crisis at 20 or 21. And so then, as part of my public health major, I had to do an internship. So I went to a career fair and the New England Center for Children was there. And I was like, oh, cool, school for kids. That's cool. I'll work at the New England Center, I'll do an internship there. That sounds great. And my first day, I was like, this is it, this is what I'm gonna do. This makes sense to me. I it's like I can still, I still know the like exact moment that I saw one of the kids that I worked with, and I like was like, Can I work with that kid? I want to work with him. And he was like one of the more challenging kids to work with because he had a lot of what we called back then non-compliance, but now what I would call is like withdrawing assent. He would just lay on the floor and refuse to work. And that's really hard for a new person and really not reinforcing when you haven't been in the field for very long. But I was like, I want to figure this kid out. I want to understand, I want to get him to like me, and I want to get him to want to do work and like I want to work with this kid and figure this out.

SPEAKER_05 19:48

It's almost like a math problem.

SPEAKER_03 19:50

Yeah.

SPEAKER_05 19:51

I feel now I feel you.

SPEAKER_03 19:53

And and so I interned there and then I worked there after graduation, and they offer master's programs. So now it's completely subsidized where they pay the entire cost if you work there. When I went there, you had to pay $200 a course. So my master's was $2,000. It's like 10 courses.

SPEAKER_05 20:10

Nice.

SPEAKER_03 20:11

And I got a master's in teaching, and then I worked in some public schools in Massachusetts, and then I moved to New York, worked in a private school that was very similar to the public schools I worked in in Massachusetts, and then kind of moved up and they started a center, and I became the clinical director there. And then I got really burnt out for reasons you know, we've already discussed about COVID and divorce and what life changes. And I started my private practice and really dove into the ADHD space, and I'm really enjoying that space.

SPEAKER_05 20:40

That's so much similar to your story about like working in because you worked at the school at Stanford and found the kid. It's a real similar story. So that that resonates a lot, I think, with us, you know, working, not even knowing what you're getting into and being like, oh, this might be it. Yeah, yeah, for sure. So you said I talked about, oh, I'm sorry. No, go ahead, go ahead. ADHD. That seems to be a big, kind of a big passion of yours. I I could ask some specific questions, but let me just open up the door. What you want to talk about with ADHD, Nicole? I'm sure you got a lot. I don't want to limit well ADHD.

SPEAKER_03 21:14

We can go in any direction.

SPEAKER_05 21:15

ADHD. What what do you like? If you already give a presentation, or what what is it most interesting? What do you find most fascinating? What do you think the listeners would would like to know most about ADHD?

SPEAKER_00 21:24

Yeah.

SPEAKER_01 21:25

What what's the particularities with that comorbidity, for example? Since we have a we probably have a you know good audience in terms of understanding ASD. Talk about the comorbidity features, for example. That might be something that that all of us can use a little uh enlightening on.

SPEAKER_03 21:41

Yeah. So I think you know, ADHD uh is often referred to as an executive functioning deficit. And so I think you see when somebody has autism and ADHD, you see this executive functioning, which is like all of these skills. It's the executive functioning is like the CEO. Of your brain to get you to execute tasks and to organize them, to remember things, to be able to execute something on demand, to be able to recall something on demand, all these different skills that you're using. And then when you have somebody who has autism who's maybe rigid, those two parts of their brain can often clash. And so you really have to be conscious of like I'm putting in a routine for somebody knowing you have ADHD to make things easier for your because that can really like routines are really helpful for ADHD, right? Because you you automate it. And so instead of having to recall this information, it's like a task analysis where you're like, okay, I put on my shoes. Now I always put on my jacket. And then I always know I grab my keys after I do that so that I don't forget anything when I'm leaving the house. But somebody with autism, now you have rigidities. And if that routine needs to deviate, you might have behavioral issues or sensitive, like sensory issues that come in. And so like that can be really hard to understand when you're working with someone of like how do I deliberately program these TAs to be generalizable and meaningful for this executive dysfunction, but also keep in mind that they need to be able to do this in across many different contexts because they still also have autism. And I think like that's a way I really see it show up.

SPEAKER_04 23:18

That's cool.

SPEAKER_03 23:19

And a lot of like the task analyses and routines. And then I think also sometimes when the ADHD is really an issue, you see that impede on their ability to learn those tasks because it's just so, it's so like, especially in attentive ADHD. I think I'm noticing a trend. I don't have any scientific data for this, but a trend where people with inattentive ADHD tend to have poorer executive functioning, whereas people who are more hyperactive, I see as adults tend to have stronger executive functioning skills because I feel like it's almost like that energy, that hyperactivity energy goes into these coping skills of making lists and keeping myself organized and creating my routines and compensating. Whereas like inattentive, it's like, oops, oh, I was supposed to get on the train.

SPEAKER_05 24:08

Like so, what's the difference between inattentive ADHD and ADD?

SPEAKER_03 24:14

So AD ADD isn't really used anymore. Like the DSM 5 got rid of ADD. So I guess that's the the difference is that you know they like to change the names.

SPEAKER_01 24:24

So it's just the inattentive or hyperactive.

SPEAKER_03 24:26

Hyperactive, and then there's combined. Okay. And so like my both of my kids have ADHD, although my younger son's not yet diagnosed. I likely have ADHD. Sure. Christina.

SPEAKER_05 24:37

I feel like I probably can lose.

SPEAKER_03 24:39

Yeah. I feel like I yeah.

SPEAKER_01 24:43

Well, see, there she that's the inattention that got her.

SPEAKER_03 24:47

I would say Christina's more hyperactive if I had to guess, right? If I if I had to make a diagnosis. Not that I'm qualified, as I always say to my clients, I'm not qualified to diagnose, but so what would you say, Nicole?

SPEAKER_05 24:59

Because I get this a lot from parents, you know, same thing with autism diagnosis, right? Where people are saying, oh, like it's overdiagnosed, it's not really a thing. But more so actually with ADHD, people saying, oh, like they just need to learn to behave or it's not a thing. It in my day, like people just didn't get the diagnosis, they just learned to behave. What are your what are your thoughts on that?

SPEAKER_03 25:19

Well, I think, yes, and kids learn to behave, but at what cost to their, I think, to their self-esteem. And there's a high rate of sexual abuse, alcohol abuse, drug abuse, unemployment, domestic violence, all of those things within the ADHD population. And I think that's so maybe they're not like they were diagnosed later or they didn't receive proper treatment, but like those are all reasons I think to get diagnosed because even something I've done a lot of research on medication. We've my son is on medication, he's very open about it. ADHD medication, people people are very hesitant to put their kids on medication because they're afraid they're gonna be on it forever. But the right medication can actually lower your and also like I was also scared of this. That if he's on Ritalin and he realizes he loves Ritalin, is he gonna abuse Ritalin? Is he now gonna like be like, oh, I need the Ritalin, I have to have it? And they actually find that people who take stimulants as as they need it and appropriately, it lowers their risk of drug and alcohol abuse in the future because they're using it as they need it and appropriately, as opposed to like a reacting to a bad situation.

SPEAKER_01 26:37

That that's that's really interesting. The the medication part, so you had to buy into it, so to speak. You were hesitant at first?

SPEAKER_03 26:46

Yeah, I had a whole existential crisis.

SPEAKER_01 26:49

Well, talk I mean talk about that a little bit because I think that you're right. I think er most parents are gonna be, and then you're talking about stimulant medication, which is a concern. You're talking about the idea of addiction, and I like the point you made. The idea is that you're taking it systematically as opposed to as a means of escaping or coping, which is probably a huge probably constitutes a huge difference in terms of the detriments or potential detriments later. So what was the what what shed the light on you where you went, oh, let's try this thing out? Or maybe you had to try it first. What was your experience?

SPEAKER_03 27:21

Well, it's kind of like the same. Well, so he was not diagnosed with AHD at first. So he was diagnosed, classified as gifted and anxious. And then the anxiety started really impeding on his sleep. And our pediatrician was like, it's the anxiety, like I could put him on a sleeping medicine, but like the anxiety is the core problem. So let's put him on an anxiety medicine. And the anxiety was what kept the ADHD in check, which I think is true for a lot of girls with ADHD as well. Is that like the masking, the anxiety like prompts you to mask and keep and internalize it. So you'll even see like girls who might be hyperactive, their brains are lit up inside and they're sitting there. I mean, like, I feel like I'm a good example. I shift occasionally. My kids would have moved across this entire room. Like they cannot sit still. I also can't sit still, but I do it in a much, a much less noticeable way. And so the anxiety, like, without having anxiety, his ADHD was like, whoop. And Christina, did we know each other by this point when Jack was going through all this? You don't think so? It was fourth grade. So 2020. Yeah, yeah. And he's talked about it. He's very open about it. And so we went on. I knew immediately. I was like, this anxiety medicine is not working for you. Like within a week, I was like, this is not working. And I kept like, no, no, you gotta trust your gut, you gotta go, like, you know, you gotta just wait. It's not, it's not even to a therapeutic level, you gotta keep going. And I was like, this is not gonna work. And then we took him off of it, and the doctor was like, All right, maybe we should look at ADHD meds. And I was like, I don't know. Like, I don't know. I just I felt that if meds helped him, what is my whole job? If I'm doing behavioral therapy and teaching kids coping skills and emotional regulation, but he needed meds to do that for him, what am I doing personally and professionally? Like, and so it like put me in a weird headspace where I was like, but I shouldn't not put you on meds because you maybe you need them, but like, is this now gonna like upend me?

SPEAKER_05 29:32

Interesting. Some cognitive dissonance coming in there for sure.

SPEAKER_03 29:36

Yeah, I know. And I was like, I don't know what to do with this. And then I was also just very nervous to put him on another medication after like the Zoloft was such a disaster. And so I made a data sheet and I took data on him every day for two months. And then I had AI graph all my data and like give me, you know, and like I just kept it because I was like, I want to make sure this is working and it feels good and that this is the right thing for him. And you know what? It helps, it reduces his cognitive load during the day so that he is less reactive and more able to access the tools that we have worked on for years.

SPEAKER_04 30:13

Perfect.

SPEAKER_03 30:14

And that's what medication does. But without medication and mommy's emotional boot camp for years, he wouldn't be the same. And I feel like it allows him, it allows him to develop his self-esteem and it like takes the edge off for him so that he's not it's not like, oh, by eight 8 45 in the morning, he's now been reprimanded by me and his teacher, and a friend has told him to be quiet. And this person, like, he's not getting as many corrections, he's not working really hard to hold himself together. It's just it's less friction in his life. And I don't know, like, yeah, go ahead.

SPEAKER_01 30:49

No, no. I mean, it gave you more to reinforce, I guess. It made things more accessible for him, but for you too, as a parent, to be able to go, yep, let me reinforce that behavior and that behavior and that behavior, where maybe you weren't he wasn't admitting those necessarily. I have a I work with a client and for some reason the parent, I think we've had good discussion on medication. And one of the things that I like to talk to people about is side effects like therapeutic effects of medication are things that we can reinforce and or discourage. And a lot of times I think almost like you started discussing it, we think about it in isolation where they're gonna take the medication and that's gonna fix everything, and then what did I do behaviorally? And it's like, well, you know, I just had recently had this discussion where a kid had changed medication, and mom's like, Yeah, that's going great. Isn't he so agitated? But he's asking a whole bunch of questions. And I'm like, and that's annoying to you? And she's like, It is, and I'm like, but he wasn't asking them before, he's seeking information. She's like, Yeah, oh, and I'm like, so just answer as many of them as you can, and then at some point teach him that mommy needs to take a break from the questions, and then you know, have him write them down or whatever it is. But I I like the way you describe that because I think we do tend to think about it as separate, and we forget that there's that medication is gonna lead to some sort of behavioral outcome that we can reinforce, and then it kind of works together. So yeah. Neat stuff, man. Yeah, what a what a good progression for for you and your son, and now he's killing it on the baseball field. He said two doubles today, is that right?

SPEAKER_03 32:18

Yeah, two doubles today. I know, I'm so proud of him. And you know, he's just that's killer man. And like, I don't know how many parents listen to your podcast, but four parents who listen to the to that. My number one recommendation is find the things that your kid loves because, especially if they have ADHD or autism or any, you know, need, because he is much more willing to, and I see this with my clients too when I give this advice, they're much more willing to overcome these hard cards that they've been dealt when it's in the name of something that they love. And so I see like his empathy build, his self-control build, his, you know, because it's like pairing, right? Like you're pairing these hard skills with this environment that you absolutely want to be in and show up in. And so, you know, like how he works for his teammates and his commitment to his team, all that stuff. It just, those are lifelong skills that he's going to have and that he's learning in that, in at as being part of a baseball team.

SPEAKER_01 33:16

That's the whole strength-based strength-based approach. That's what you're saying.

SPEAKER_05 33:20

Currency, right? You gotta find your currency, something that because of so many things he's probably feels like he has to work so much harder than his peers at something that he's effective with, like his currency, that's that's awesome.

SPEAKER_01 33:31

I have a question for Christina here, and hopefully it doesn't get too personal. But your experience in the NICU, that's fascinating, behaviorally speaking, and so many other levels. But I guess what it makes me think about is often, you know, one of the the obstacles that we face when we're providing treatment is we're very much expecting in vivo contingencies to occur as we plan them, meaning I present something and then there's your response, and then I can consequate that response and so on and so forth. For you as a parent in the NICU, you had to do a whole bunch of things without necessarily getting any feedback in return. Is that fair to say? I don't know if you care to share about that experience a little bit. I mean, there's so many things that in terms of handling, touching, managing, just things that weren't necessarily leading to any an immediate response, but you had to trust the process.

SPEAKER_02 34:22

Yes, absolutely. So one of the which is a little crazy, a little backstory. My I had a friend that actually had twins maybe like three years prior. So I was already exposed to the lifestyle of the NICU of understanding like this is just temporary, right? So when it happened to me, I understood, like, okay, we don't know when she's coming home. I understand the process. She was so fragile. I actually had to wait like two weeks to actually hold her for the first time because she had to be in the incubator and then like schedules of reinforcement, right? So every four hours is when they do the care times where you put your lifter up like this, and then they wear, and then you could do change her to little diaper. So I knew like, okay, every four hours was an opportunity to really feel like a mom because really you have to just kind of like it's like set it and forget it. They gotta grow, right? There's really not much you can do. So for and also too, like, you know, in that type of setting, it's almost like you know, like we were at Yale, so there was over a hundred nurses. So, you know, and this is just routine for them coming in doing the checkup. So to for the nurses, she's just like another client, right? But to me, it's like, oh my gosh, I wanted to make sure I had the primary nurses. We had two nurses that I knew that I trusted because they would always share and like discuss things, but then you know, with the nurses' schedule, they work 12-hour shifts, so they're working for three days and then you're gone for five. And it's like, oh my God, you know. But I did a lot of, you know, I had a calendar that would help me go through and I could measure how many milliliters and how many ounces was she weighing every day. Talk about data tracking. Yes, to kind of reach these little NICU milestones to really help me go like get through it and just to be strong for her. And then, like when she would hit little milestones, they create a little, like, you know, really cute art project, like, oh, hit 1000 kilograms or first diaper or first outfit or first bath, you know. So it's really cool, kind of cool to kind of see the progress, but also too, you know, it was great that I was kind of keeping record in data because I would be able to kind of share my concerns. Like, I remember one time she gained a whole entire pound in a week, and that was not normal, you know. It's like, and she would actually behave different. I'm like, why like you know, we're it was just unheard of. Like, how is she growing so fast in such a short time when we've been here for like three months and she's kind of gaining at a couple ounces a day? So it was really important to kind of take data and analyze and ask questions because it's so fast-paced in the hospital. You you really gotta advocate, even though if you don't know, it's like, you know, like, hey, can you let me know what's going on? Or, you know, like I remember one time her lungs collapsed and no one told me. And it's like, well, why can't like why is she acting like, oh, well, her lungs collapsed, so we have to put her under size so that she goes like, Well, who was gonna tell me? You know?

SPEAKER_01 37:05

It's so customary to them in the NICU, right? Oh, yeah, this happened. It happens all the time. That's what we do here.

SPEAKER_02 37:12

A lot of delayed reinforcement for sure.

SPEAKER_01 37:14

But oh wow, what a what an amazing journey. There was something that Nicole said that I want to branch off of. Did you have anything pressing you wanted to jump in on? I have one for Nicole and Christina, but if you have one, so you said you you kind of juxtaposed the idea of non-compliance versus withdrawing assent. I think that's a really important thing to talk about in this day and age in our field. We certainly have to shoulder some pretty strong criticism sometimes. I can't say that that all of it is undeserved. I think sometimes I hear people talk, you know, or lend harsh criticism of ABA treatment, and I kind of have to go, yeah, yeah, okay, I remember that. Both of you kind of talk to us about that. What does that mean? Where do you think we are as a field? It's it's nice, it's easy to change your vocabulary, but then your practice stays the same. You know, that that's a hard task that we're trying to do in terms of evolving. We talked a little bit on your platform about you know, sort of the history. We mentioned regional centers. You think back to like you know, this all really came about like 1964, Civil Rights Act, right? And then we had the Education Acts. And clearly there's an inherent progress that that we've incited because it's we're sort of forced to look at certain demographics or certain populations of people differently now, meaning we can't continue treating them the same. We have to evolve our perspectives and our views, and a lot of that is, I think, again, you know, maybe attributed to some of our success, and then actually going through the evolution is really hard. So, what does that mean to you guys? You know, the diff what is non-compliance, you know, versus withdrawing assent and and how do we actually make sure that we're making the right changes as a field?

SPEAKER_03 39:02

So it's interesting because like with the kid that I described, the what the first one I worked with, I feel like back then at New England Center for Children, like I did basically what I would do now. And I feel like there was some kind of loss somewhere in the middle where if he was laying on the floor, I wasn't forcing him to get up off the floor. I wasn't forcing him to do, I wasn't sitting on the floor being like, touch red, touch yellow, touch this, touch that. Like I wasn't like forcing engagement. It was like, oh, you're unmotivated. There's nothing here that motivates you. And until you have motivation to sit with me at this desk, whether because you like me and you're well paired with me, or the reinforcer at the end, or the activity we get to do next, or whatever is motivating enough, you're not gonna get off the floor. And so I feel like I learned from that experience that it was about making, it was almost like competing contingencies. And so it was about making myself or the activity that we're gonna do, or the activity in progress more motivated or the activity, the next activity more motivating, so that you would want to join me. And I didn't have the language to say withdraw ascent. I feel like I called it non-compliance because that's what you would called it, yeah. But I didn't necessarily approach it from like an extinction-based place of like, oh, you're avoiding work. I'm gonna force you to do work until I don't have to force you anymore. And I think that then there were spaces where I did do that, and you have it works, but I also think like at what cost? Like to the, and I think like I'm a very like, let's preserve a self-esteem and rapport at this point. So that's my my practice has almost come full circle back to where I was originally of like, okay, you don't want to work with me. Like, I gotta, I'm here anyway. So like I'm gonna sit here and read the, you know, smartphones. Like, I was like, I'm gonna sit here and read my magazine, I'm gonna make myself a snack. And sometimes that would work too. Like, we would kind of like bait the environment where like I'd go make myself a snack and then come back, and I'd be sitting there eating cookies, and he'd be like, cookie, cookie. And I'd be like, Oh, come on, come join me for cookies, come sit at the table.

SPEAKER_05 41:08

You're gonna change your behavior before you expect him to change his.

SPEAKER_03 41:12

Yeah. And like, I but I wasn't like desperate, you know, and I see that a lot in techs nowadays, where they're like desperate to get the kid to come back to the table. Um, and I feel like that is like a different you're teaching the kid that all the good stuff, you're gonna like you're gonna break out all of the good stuff until I come like whenever I lay on the floor.

SPEAKER_05 41:34

Sure. I think that comes from one of two places, the desperation. One is the parents there, and then if you don't respond, then you feel like the the parent doesn't really know what's going on a lot of times. So they're like, well, the parents gonna think I don't know what I'm doing if I don't do something. And also the more historical approach of ABAs, we gotta do 10 trials and we gotta do 50 programs, so we gotta do 500 trials at in this day, so we gotta keep it moving. I gotta get these trials. It doesn't matter if he's staring at his fingers, like I gotta still ask him, like you said, what color yellow is. Yeah, which is still, I'm sure, still done a lot even currently, which is mind-blowing. But I think maybe that's where it comes from, the one of those two.

SPEAKER_03 42:11

Yeah.

SPEAKER_01 42:12

Well, there I think there's what Christine. No, go ahead. I said I think there was a big impetus too. I think something that we've stopped saying or people have moved away from is this idea that we're fixing something. And I think that gave a whole lot of impetus to like, well, it's gotta happen now, and it's gotta happen at a certain pace, and it's gotta look a certain way. And then, Nicole, you said something interesting in terms of considering the learner's like self-esteem, you know, and and and those things. And maybe we've gotten better at considering that from unique populations. Maybe, maybe we've been, you know, oh hey, there's a self-esteem there. It may not be communicated the way we may envision it, but yeah, you know, we it's not just about forcing somebody to do something, although maybe it started that way. But yeah, it's been a cool evolution. Yeah, Christina, what are your thoughts on that?

SPEAKER_02 43:00

Yeah, I always love to share with my my students and the techs and even families and people that ask questions all the time, like when it comes to behavior, right? It's like you got to ask yourself these two questions. Is it a skill deficit or is it a will deficit? Is it do they have the prerequisites to accomplish and you got that's a prerequisite? Is it willing? Are they willing to? Is the motivation there? Is it more motivating to escape? You're gonna give them a math problem with 20 questions. What if you just say, hey Johnny, I just want you to do these three or fold the paper in half so it's not so overwhelming to look at, right? And then people kind of like like, oh, dang, that's a good question, right? And then another component I love to share with them too is that you know, you always gotta meet the learner where they're at. And it's like also consider processing times. So sometimes your learner might take 30 seconds. I I always share this story when I was working with the adults. One of my learners, I would go to his apartment, he had his a checklist, and I would, you know, check off did he wash his dishes, did he do his bed, did he, you know, all this and all that. And I remember I sat down and I was like, let's say saying this Meg, like, oh hey, Mike, how was your day today? And I'm a I'm a person that counts. I count the steps and I go up the stairs. And so I just started counting and I got to 30 seconds. And he acknowledged me and he's like, oh, it was good. And you know what he told me? He said, Thank you so much for being patient and waiting for me to respond because it just takes me a bit to process. And I share that story every single time to my therapist because it's like, now think about it. If I ask them, oh, how was your day? Hello, hello. 30 seconds, 30 seconds. It's a hundred and a minute and a half. And then it's like, just wait. ABA is considered intensive because we have a longer duration. So what is the rush? What is the rush? Right. So that's kind of like what I share. And people really have those light bulb moments, like, dang, let me just wait. And I tell them, just wait 10 seconds. Count 10 seconds, like one Mississippi, two Mississippi. Time is a contract, right? It just goes by so quickly. But what if we just sit and wait? And like you'll notice a difference.

SPEAKER_01 44:57

I mean, that debunks the whole myth there that somebody can't, right? You waited just long enough to go, oh, wait, you can do this, and it takes you this long. And so now I know how long I have to wait, and then maybe we work on reducing that, you know, or whatever the case may be, or maybe we work on other people understanding, hey, give this dude some time. He's gonna answer you, just give it time. That that's a great example. I really appreciate that story.

SPEAKER_05 45:20

One question for each of you ladies. So something that we talked about earlier that you said you had some thoughts on. I want to come back to that. Nicole, you talked about the less hours is more. I want to talk about this. You got some thoughts on it. So what are your thoughts on it?

SPEAKER_03 45:33

So most of what I do is low dosage. So low dosage, that's the word you use.

SPEAKER_05 45:38

I'm sorry.

SPEAKER_03 45:39

Yeah, Christina actually coined it. So we're gonna send the royalties to her every time we use it. Okay.

SPEAKER_05 45:44

All right.

SPEAKER_03 45:46

But I most of what I do is low dosage. So working with kids one or two hours a week or working with their families, doing parent coaching where the parents are then managing, you know, whatever we talk about to implement. And they're not doing like discrete trials with their kids, but you know, behavior management or antecedent interventions, things like that. But I really felt open to it, not from my ADHD kids, but from I worked with a kid virtually during COVID who was maybe four or five, nonverbal, like mostly, you know, non, I guess non-vocal, and actually didn't have another way to communicate. So I guess non-verbal. And we worked virtual for 30 minutes a week because that's all his parents could afford. And we did this for a year. And by the end of the year, he and then he had to transition to school. So it like it didn't fit in his schedule anymore. And by the end of the year, we could have a whole session and he would say, He'd be like, Hi, Cole, and we talk. We like literally, and he'd say, like, where I don't know if you guys have heard my cat meowing outside the door.

SPEAKER_05 46:51

I have not.

SPEAKER_03 46:52

But he would say, Where cat, and he'd say, Where Hamilton? Like he would actually make we had this whole routine script where he would say these one to two word phrases, and then I'd be like, I, you know, I'd turn my computer in different directions, and I'd be like, Is Hamilton here? And he'd be like, No, try again. And like we created this whole script, and then he was using this. Then the nanny would sit in on our virtual sessions, and so then she would carry over these things and do hide and games at their house and then expand the language. That 30 minutes was life-changing for them. He was communicating, he was able to communicate, but I got him to focus on very specific communication targets in this 30 minutes. It was a very predictable session. Every single time we did it, we did the same exact thing with the cats, and it worked. And it like, I just it he was he was you know not non-verbal by the end, and he was able to vocalize a lot more. And I just started with just like modeling, and because he was interested in the cats for some reason, it worked really well, and it was 30 minutes a week, and that was it.

SPEAKER_05 48:00

And I feel like that's on Zoom with a non-vocal individual. That's amazing.

SPEAKER_03 48:05

Yes, yes, like for you, man. And I was like, again, you know, one of those existential crises where you're like, why do we even do everything we do if that was so effective?

SPEAKER_05 48:17

Yeah. Well, it was 30 minutes a week of your services, but if the parents are trained, then they're able to do I don't know 23 and a half hours a day if they want.

SPEAKER_03 48:25

True. And so the nanny would carry it all over, and then they would see it succeeding with the nanny, and then they would see, then they would do it. I would meet with the mom once a month, and then she would be like, What can I do? And so it's not perfect, but I'm giving her targeted strategies of like model this language. We're working on these where questions. Like, here's the language she's able to do. You do it. And so sorry, go ahead. Yeah. No, go ahead, I have no idea. Go ahead.

SPEAKER_05 48:54

Christina, where did you uh where'd you come up with that term? Did you want to do you have any input on that? Low dosage? Is that the thing?

SPEAKER_02 48:59

Low dosage?

SPEAKER_05 49:00

Yeah, did you have any any additional input on that you wanted to add?

SPEAKER_02 49:04

Well, when I came up with the term, honestly, I forgot. I forget a lot.

SPEAKER_01 49:14

You can't let me ever pinpoint when it happens. Come on.

SPEAKER_03 49:18

Yeah, yeah. No, you were helping me brand myself, and you were like, Well, you do low dose dosage ABA. And I was like, huh, no one has ever phrased it that way.

SPEAKER_02 49:25

It's so individualized by whoever I'm talking to. So it's like, okay, tell me and I can come up with something. I love I like being slick. Yeah.

SPEAKER_05 49:33

We love that though, Nicole. That's how we do it. I don't think any of our clients get more than four hours a week. I mean, that's that's even pretty rare. So we hear, you know, sometimes we'll get patients call us and they'll be like, well, this clinic said I have to do 25 hours a week, or I can't go to their clinic. Are you gonna make me do 25 hours a week? It's like, how do they know that your child needs 25 hours a week before they even meet your child? Like, what is that? Well, they do. Yes, exactly. It's is that for your child's benefit, or is that the same thing?

SPEAKER_01 50:01

Because the research says, Dan. The research says which is the optimizer, right? Which is back to the white paper, right?

SPEAKER_05 50:08

Yeah, in 85, maybe that was that was the point.

SPEAKER_01 50:11

Let me ask this where does where does the shift go into high dosage? Is that based on hours? Is that based on each individual learner? I don't know the answer to that. Yeah, what do you think?

SPEAKER_03 50:23

Yeah, it's a good question. I mean, Christina, I feel like you could talk about this because you work a lot in EI, and I think EI is a space, which actually we often tend to give low dose, like EI, state funded EI services tend to be like two hours a week or maybe two hours a day. But I actually think you feel very passionately, Christina, about how more more hours for littler kids.

SPEAKER_05 50:43

EI being early intervention, I think.

SPEAKER_03 50:45

Yes, yep, yes, yeah, yeah.

SPEAKER_02 50:47

Yeah, yes, um yeah. So I I started with adults and triggered down to early intervention, and especially like as soon as they age out of the perf to three, like I was mentioning before, right? From perf once you get a diagnosis at three, you go to the school district, and then you're in school, right? Monday through Friday from 8:30, six hours a day. And a lot of our learners, especially at that age, you know, they're all struggling with attending, sharing, emotional regulation, FCT, right? Being flexible, transitions is another huge one. So I think it's it's it's one of the things that I'm really passionate about is early uh intervention and knowing, like, like I mentioned before, like it is considered intensive because we have longer duration, right? So like we do have 25 minutes to help a learner regulate their emotions because the tower fell during blocks. We can practice sharing, especially with being able to help them kind of build that stamina to attend for 10 minutes of circle time or attend to an activity and engage in arts and crafts so we're not feeling rushed, especially having like that one-to-one support. So I'm definitely a fan, especially around that age of you know, if they were going to be in a school setting or at daycare for 40 hours a week, kind of being able to kind of customize a plan that supports them to give them those prerequisite skills to practice all those essential skills that they're going to be needing once they are streamlined in a classroom. It's definitely meeting it where they're at, but I'm definitely a fan of more intensive therapy or early on.

SPEAKER_01 52:14

And I like I like your sort of rebranding of the word intensive there. I think people automatically think a high amount of hours, and you're saying we might have that, but more than anything, we can take the time to sit back and focus on very specific. I really like that. That's really cool. That's a better way to look at it. Yeah.

SPEAKER_02 52:33

Because think about it too, especially in the school, they have service providers that got a speech on Tuesdays for 30 minutes. Well, guess what? It took 15 minutes to transition to your classroom, and now they're having a tantrum, and now guess what? Their time is over and they're they're out of that their time and they're on to the class, right? So it's like, who's gonna generalize those skills for a learner?

SPEAKER_03 52:51

I will naturalistically throughout their environment, the third the 25 hours, 30 hours that we have them, right? We're gonna practice 10 transitions and get you really good at this. So you time, schedule, schedule, yeah.

SPEAKER_01 53:03

I like that. Yeah, what do you do? I make sure the child can transition from this place to this place. And then when they get there, but that's the exactly what we do, right? We take those unorthodox situations, like, oh, so they're making it this far out of the classroom and then they stop there. That's where we pick up, and then yep, once they deliver they get delivered to the speech therapist, then our job is done and they've, you know, we're we're good. But that's I like that that story there in terms of how it conceptualizes what you know some of the tasks we take care of. It's literally just trying to get Johnny from the classroom to his speech therapist quickly so that he can get the full, you know, 28 minutes of this other necessary intervention. That's nice.

SPEAKER_05 53:40

So it's not necessarily low dosage, it's like low direct dosage because they're still getting it, they're just getting it from their parents. And if we can train the parents to do it, then then it's even better, right? It just means we don't have to have to accommodate our schedule, they can do it within the context of their schedule. Is that is that a fair, a fair statement?

SPEAKER_03 54:00

Yeah, I mean, I don't think parents implement ABA with a high fidelity, usually. Usually.

SPEAKER_01 54:05

That's interesting.

SPEAKER_03 54:06

Uh, but I think that they take behaviorally based strategies. And I think like I always say to my parents, I'm like, you know, like kids don't come with guides, and then you have a kid who has a uniquely wired brain that like really doesn't come with a guide. And so I help get to know your kid, and then I give you, you know, I say, like, okay, your kid is really triggered by this. Like, I had a kid who struggled to sit still at the dinner table, and so they got a I had them get a motivator and use a motivator, and he sits at the dinner table now. Like super simple intervention, doesn't need a ton of ABA for it. They just needed mom, just needed a motivator and then like directions on how to how to use it and like maybe modeled once. So I guess like in that case, yeah, mom is implementing it. But that's true.

SPEAKER_05 54:50

I also think it's like although parents are always manipulating consequences and antecedents, whether they know it or not, right?

SPEAKER_03 54:56

Yeah, right, exactly. Like parents are doing things any are reinforcing or punishing behaviors anyway. And so their previous intervention was they yell at him to come back to the table. There you go. So I gave them a new intervention.

SPEAKER_05 55:10

And the kids are always better than the parents at ABA. Kids are masters at figuring out how to manipulate all of us. I do have one question that I do think is really important. I do want to ask you, Christina, but before we do that, just the intervention. You talked about early intervention. So that's always been Mike's kind of cup of tea as well. Uh he's worked with regional centers, which you do what's here is 805 early start intervention. And it's actually really changed the way that we do our services, which kind of vibes, I think, with what you're saying. I don't know, Mike, if you just want to briefly tell them kind of what how you got to where where you are with how we do our services, because it is pretty a SEM-based based on his whole experience with the early intervention.

SPEAKER_01 55:51

I'll I'll try to be brief because I do get excited about these things. But so I'm a I'm actually a developmental psychologist by training first. Oh. And I had early experiences professionally where I got to work in these idyllic laboratory schools where I mean everything is built in and around two to five-year-olds. And there's a lot of child-directed approaches. So, long story a little shorter, I I became very interested in where that I guess professionally I worked in that setting. I got very good at corralling the three, four, and five-year-old boys that work in packs, and you know, they run in wolf packs and they they're kind of destructive and they bother other people, and they just kind of like working in groups, and for some reason they would gravitate to me and I could make them sit at snacks. So all my colleagues would be like, oh, you know, you might be good at working with kids with behavioral issues. Okay, let me go try that. And I remember going from this idyllic laboratory school to now this non-public setting that was, you know, all treatment-based, and just the stark contrast in the enrichment of the environment. And I knew why one environment was very barren, it's because kids were knocking things off and throwing them. So let's put these things away, and then now you've got this super sterile environment that isn't very enriched. And okay, so this is a stark contrast between the way we treat these kids and the way we educate these kids. So I've always, from the very start of my career, become very interested in trying to, I guess, close that gap, right? And early childhood is a really good place to do that for many reasons I won't get into, but I guess what we started exploring was the overlap between ABA early intervention and best practices in early childhood education. And what that led to was a lot of child-directed or client-directed approaches where we were waiting for those things to happen, and then all of a sudden, we could delve into something they were interested in and build that rapport, and then before you knew it, you're introducing new things and you're doing the more adult-directed piece. So I guess we when we were doing that with our you know, our staff was a little skeptical at first, and then they really enjoyed it because it was almost harder for them to be spontaneous and impromptu, as opposed to these elaborate plans that we can have in ABA where you're you've got your visual schedule and you've planned out this activity and you've already picked this stimulus for that activity. So there's very little wiggle room and it's very structured, which sounds very strong, until that plan fails, right? So this other you know, shifting gears was like, Yeah, well, you can actually just within a reason follow the child, and then once they're interested in something, you delve into there and you you build from there. So that led our staff to start asking questions like can we do this with older clients, with adults? And so that you know, opened up that conversation. Well, yeah, very much the same. It's not us coming in with such an authoritarian stance to say, you're gonna do what I say when I tell you, but it's coming in and saying, Hey, let me connect with you, and then before you know it, we've got some level of collaboration where you are able to do these things that I've taught you that you weren't doing before, that now maybe make you more accessible to your environment because you're reinforcing to your environment as much as completing these tasks is now reinforcing to you. So it's been a cool progression. It is it is something I get very passionate about, and I know why we have specialized treatment, and no way am I being critical of that, but I'm always curious about not having it be so distinct for two different populations, and I think early childhood really lends to that because you know it's a three or four-year-old, you can kind of make things converge a little bit better as opposed to having highly specialized early intervention. It could be a little bit more like pre a good preschool program, and you're playing. It could be play-based and child directed, and then you can get a lot of that the more structured learning task done as well because now you've paired, now you've got rapport, you're reinforcing to the child, they know you'll give them access, all those things that we try to establish as part of our instructional control.

SPEAKER_02 59:43

No, I love that. I think another another thing, too, that's a big part, is that you know, you need to be intentional with the time and being mindful of manipulating the environment in a way that's gonna promote learning and promote opportunities for our friends to be exposed to these, you know, contingencies that's gonna promote more learning and more curiosity and like never stop building rapport with our friends. Like I have a learner, you know, you know, he's got a lot, like, you know, oh, he's escaping demands. It's like, no, his body is telling me he needs to move. This is a for 12 seconds, right? And I tell you, yeah, and it's like, listen, I don't want you to see it that he's escaping. Like, no, his body is telling me that, oh, I gotta move, I gotta move. So allow him to escape him out on and say, Oh, I need a break, right? And give him a couple seconds, and then we'll try to bring him back for this, right? And then I was also telling him, you know, we have a couple new staff, and you know, one of our friends is a little bit more demanding and like you gotta be on your feet and stuff. So I was just saying, like, you know, I'm gonna place, you know, his program right here, and I'm gonna start with his highly favored. He's hyperlexic, he loves reading. So watch me put the we use up the first work app, so it's a digital DTT. And so he's you know, engaged with his toy, and I was like, now I'm just gonna place it here. And it's like if he looks over, he's gonna be able to actually transition to work without having me to prime him or anything. And they were like, Oh my god, this is somebody that was working with a friend that can't sit longer than 12 minutes, and we just sat for 10 minutes without any hard demands, and he's motivated, he's engaged, he's complying, right? But it was all about helping her see things from his lens and a behavioral perspective to help her feel more confident supporting him, you know.

SPEAKER_05 1:01:18

Yeah, that intentionality is so important. That's something that we talked about our previous company with the admin time. RBTs were actually able to plan for their sessions before they went out so they could be intentional. Even at our current company, we allow some so they're still able to plan for it. I mean, that's not the norm in the field. Usually they have to, you know, they only get paid for the hours they're directly with the clients. So there's no real planning, it's just go and do whatever you know you can try to do in that session with no real intentionality because you might still be getting over the client you had 20 minutes ago that you drove to the next client. Yeah, yeah.

SPEAKER_02 1:01:51

And you know what also thing that I love to do too is like in the programs, I love to give multiple exemplars of what I know would count as a plus or a minus in their environment. So it's like, oh man, if you pull your hand, if he points to the door, if he does this, I'm giving you all the ideas so that you don't have to think. It's like I'm giving you five things and then generalize those other five things. So if you see this, plus this, plus discounts, this counts, like helping them generalize outside of just one modality.

SPEAKER_05 1:02:17

That's like my they don't just have to man for SDs you've presented either. They can just man without any SD presented by the RBT. Imagine that.

SPEAKER_03 1:02:25

Yeah, that's always I find so hard where I'll be like, like people, I feel like a lot of people take away those opportunities because they just do things for our clients. And I'm like, wait till he like if you give him a bag, don't then open the bag. See if he opens it himself or hands it back to you, or like just do something. Like, we don't, I feel like there's like a lot of learned helplessness and like almost like pity for our clients where people are like, I'm just gonna, I'm gonna tie their shoes for them. No, wait till he asks to tie his shoe, or like indicates, even just holds up his foot, like some kind of indication or communication, or maybe he'll try and maybe he'll do it. Who knows? Like, I've had kids where I'm like, Oh, look at you, you figured out how to do that.

SPEAKER_05 1:03:05

Imagine that. Yep.

SPEAKER_01 1:03:07

It's such an interesting dance back and forth between that. I mean, you want to be intentional, you want to be structured, you want to plan, and then what we're talking about here is a good part of that time that plan's gonna fail. If it's anything we know about our learners, they're built to sabotage your better plan. And then you better have something. You better have something ready to then steer back towards your plan or go, oh, wait, we can spend some time on that because that happens to be part of another program. And I think that's that's a real challenge, I think, in in the field for any young professional in the field to learn how to pivot and shift that way, learn how to do the shuffle and the dance, knowing that we can spend so much time developing these beautiful linear programs. And if it's one thing we know is it's probably not gonna look the way we envisioned it. It's gonna there's gonna be some circuitous roundabout way that we're gonna get to that desired response.

SPEAKER_03 1:03:57

Well, I think that they a lot of RBTs will plan, like, I'm gonna run this, I'm gonna come in, and we're gonna do a snack, and he's gonna make a snack, and he's gonna do this, and then we're gonna clean it up, and da-da-da. And then like you come in and the kids already had a snack, and they're like, I don't know what to do for these 20 minutes. And so, like, you just see, I feel like these green RBTs, you just see like the plan actually needs to be here's what I'm gonna do, but like let me think through some other scenarios of like, well, what if it's raining, or what if this happens, or what if that happened? Like, your plan also needs to include some of those what ifs or things like that. You know, that it like the I feel like a good plan isn't just here are my 10 programs. A good plan is actually like, here are my 10 programs, what am I gonna do if he has a behavior? And what am I gonna do if he asks to do something else?

SPEAKER_01 1:04:43

Like, and I may not get to all 10. And I may not get through all 10, and and that maybe is okay, but I can't just get through one or two every time. I need to build up toward those 10 based on the plan. And yeah, it's it's it is, it's such an interesting shuffle, I think, especially for those younger pros. And a lot of it can be self-imposed, a lot of it we might inadvertently impose on them. A lot of it's just kind of performance anxiety. I want to do well. If it's 10 programs, I gotta do these 10 programs, and I like the way you're pitching it, which is no, come in, you have a plan, and then it's probably not gonna look that way, and that's okay. You're gonna recreate that plan, you're gonna build, you know, you're you've got all the ingredients for a cake, and you might have to leave a couple out, which means that your cake's a little flat, but it's still cake. It's okay. You know, you you you got it done, and then you try again the next time.

SPEAKER_05 1:05:30

I have one question I gotta ask you, Christina. So you've talked about like being big on social media and branding and things like that. Honestly, the reason that we started our own podcast is because of the brand of ABA. And I feel like that's taken a lot of reputational hits.

SPEAKER_04 1:05:46

Yeah.

SPEAKER_05 1:05:46

Like what one of the first not one of the first clients, but one of the clients Mike had right before COVID came to us and was like, if the people in my Facebook forum knew my son was getting ABA, I would get like disowned because you know it's like traumatizing and We would post some of our initial podcasts on Facebook and just the comments would be like ABA is trauma. And I would try to go back and forth. And they're like, I'm not going to talk to you, BCBAs, or you know, abusive and et cetera. So we created the podcast to say, okay, what's true, what's not true, because we don't want to be dismissive of these people experience. We want to educate people. Long long story short, I feel like ABA as a brand maybe leaves a little bit to be desired in terms of how people are feeling about it right now. So coming from someone that's so in tune with branding, what are your thoughts on ABA as a brand and any suggestions kind of for the field as a whole on how we can maybe look to improve that?

SPEAKER_03 1:06:43

That's a big question.

SPEAKER_01 1:06:44

That's a good, that's a damn good question. I love it.

SPEAKER_03 1:06:46

I cannot wait to hear Christina's answer.

SPEAKER_01 1:06:48

Christina, go for it. Take us away.

SPEAKER_02 1:06:50

So you know, one of the things that stops a lot of BCBAs, especially like starting their own brand, is because they're afraid of people that are anti-ABA. Right. And honestly, I think I probably can count on my hand how many people have been like so anti-ABA. Actually, when I started TikTok, there's there's a lot of hate. So I actually used to duet other providers that used to like bash our field and then actually duet and share, like, oh, this is an ABA strategy. This is like explain what ABA was going on in those videos to help generalize that, hey, you know, ABA looks like this too. And you're actually doing ABA. So that's why I'm so passionate about dissemination. And I actually use videos of me and using ABA with my daughter and helping people see that ABA is a science of human behavior. And there's so much that goes to it besides, you know, like the history that we're coming from, right? And I think it's also so important to always acknowledge, like, yeah, people have been harmed. And you know, ABA is a science and it's all about how you're using this science. So, you know, as the ABA brands, I think it's definitely getting better, but you know, we all had to have started somewhere, especially like the ethics board. Like the field is like what, 40, 50 years old? It's not that old. And like if you actually look like the because we did a whole CEU, me and Brenda on neurodiversity affirming practices, and I did a whole timeline of the history, and you can actually see, like, even like you know, if you were gay, that wasn't a DSM 5 as a disease. And it's like 30 years later was you know removed. And then also neurodiversity affirming practices. This has been coined in 1990. It's 30 years old, but it kind of just started to kind of pop off recently, like two years ago. And I think it's very important for people to realize that change takes time, and we are literally in the middle of change. So knowing the information that we have right now is going to dictate and shape how the field is gonna move forward in the future. So I think it's important to be aware of where the field has come, but also where the field has yet to go. So I'm a really big fan of ABA. I'm a little ABA cheerleader, and it's like, please share your experience. I love to share my uh behavioral approach to things and under help you see things from a different lens. Um, especially, you know, like for people that only think like they don't they don't even know, like making a sandwich is a behavior. Like that is absolutely a behavior. You know what I mean? Like behavior is literally all around us, and it's another big thing is like the environment piece. I feel like people forget it's the environment that shapes how we behave and respond and react.

SPEAKER_05 1:09:17

Yep. So, how can we improve our brand? Then is it by looking at people like you said and and showing them how what they're doing is actually ABA or any other suggestions? Because brand doesn't even like when you said that initially, I mentioned doesn't it's not something that ever enters my conscience because I'm so old, but it's so relevant. And ABA as a brand, I think it's not social media, not good. And then yeah, with social media, right? I'm sure half the people that said ABA is traumatizing or ABA is abuse, they wouldn't go back and forth with me. They they just said it and left. So a lot of people just want to say something and then leave. But yeah, I'm I'm I'm really interested in how we can improve our brand as a whole.

SPEAKER_02 1:09:55

Well, I well, that's another thing too, is like we cannot be the brand of ABA. You are your brand yourself, right? Because there's a lot of providers that have their own take, like their own niche, right? Some are anti-ABA and some are pro-ABA and some are this and some are that. I love to represent and disseminate in the areas that I feel confident in. And like at the end of the day, I'm in charge of what I'm gonna reinforce, acknowledge, accept, allow, or things that I'm gonna put on punishment, right? So when it comes to like seeing the science as a whole, I'm not representing the science as a whole, I'm representing me, myself, and my space in ABA. So I think if you are coming on and you want to kind of brand yourself, be authentic, stay true to your values, and you know, you will form your own community. And listen, you're not supposed to be a part of everyone's not gonna like you. You're not everyone's cup of tea. And I share that all the time. Some people like me, some people think I'm annoying. That's fine. But I know I want to add value to my community. And if you are joining my live, if you are purchasing my resources, if you are sharing the impact that my page has had for you and your life, that means the most to me. So I really I kind of like I I I literally mind my business. I just show up to my community and my business and then I go live and then I unplug myself.

SPEAKER_01 1:11:07

Interesting. Okay. Nicole, you want to add to that? Yeah. The the ABA brand.

SPEAKER_03 1:11:13

You know, it's interesting because like I think that it's not a it's a good, it's not a bad practice, but there are bad practitioners and that causes harm. Like I said, like I feel like when you don't understand, which is part of our ethics code, like if you don't understand that a child has a dual diagnosis of ADHD and autism, or I work with a lot of kids also with rare, I kind of work at like the ends of the needs of like kids who have ADHD and may appear typically developing, and then kids with rare genetic disorders who like may use walkers or you know, like may not be fully ambulatory or may have a genesis of their corpus callosum. So their brain, they actually have like brain malformations. And so I feel like it's it's even as simple as that is like if you don't and Pratt, if you don't take all that into account, which I think ABA does not teach us, like ABA programs often do not teach us to take those things into account, then you can cause harm. So if I'm trying to teach a child how to, like I had a kid with two genetic disorders, not one, two. And he, when we would teach him signs, he had to use signs that referenced a part something else. He couldn't just like, you know, like all done or something like that. He could do like finished because he needed something to ground his movements. If I'm trying to teach him to say all done and he's not making progress, he's gonna get frustrated and that's going to be a bad situation. And that's going to feel traumatic for him over time if I keep trying to teach him these signs that he's physically not able to do because of his proprio-receptive awareness. And so I feel very strongly like we, I guess I my like what I'm hearing myself say is that it's a training problem and that I struggle with the fact that the B, and this is maybe this is my hot take, that the BACB keeps restricting like CEUs and things to behavior analytic content to a point where that could do more and more harm. And I think like a lot of my, I've always worked in multidisciplinary settings. A lot of there's no other, not I think there's like four of us providing ADHD training in ABA. So where do you think I learned about ADHD? Not in ABA. I had to go to psych programs, I had to go to social worker CEUs that I'm not getting credits for. And you know, you have like, but that's how I had to learn about the neurobiology of ADHD because you have to learn it. I have in order to practice with it, I have to learn it. And so I think it's a training problem that we have. And we need to be teaching practitioners to really understand their scope of competence and the risk of harm.

SPEAKER_05 1:14:03

Very much appreciate that. Before I ask him anything to plug, anything you had to do.

SPEAKER_01 1:14:07

No, I think we're good. Can you guys believe this hour has already passed by? We're an hour and 15 minutes. We could talk forever. That's dangerous. So we'll have to do this again.

SPEAKER_05 1:14:17

Yeah, but ladies, both of you, what would you like to plug to our audience again? We'll put everything in the description, but uh let me open it up to both of you on how people can find you. Anything you would like to plug, any of your works?

unknown 1:14:29

Yeah.

SPEAKER_02 1:14:31

Well, piggybacking off of Nicole with the training, her and I collaborated with the ADHD Exchange, which is a 10-part series for BCBAs and everyone in the space to get CEUs on understanding ABH, ADHD a lot clearer. So you guys could definitely check that out. I'm on social media at aba.madeeasy with the E and a Z. You can we go live on TikTok on Tuesdays, Tuesday mornings, like around 10 o'clock in the morning for behind the scenes of our recordings on our podcast. So you guys could join us there and just follow our social media's at reinforcing.conversations. Cool.

SPEAKER_03 1:15:05

Yep. Yeah, I think that's most of them. I have my own website, Nicole StewartBCBA.com. So businesses want trainings or more education on ADHD or workshops or to find our CEUs easily, all of that's accessible on my website.

SPEAKER_02 1:15:20

Yes, and one more thing. We will hold business mentorships, and my second business mentorship, I host it once a quarter. So the second cohort this year is coming up. So if you guys want to start learning how to go independent and start your own practice, whether it's a medical model or consulting or other avenues, please reach out.

SPEAKER_01 1:15:37

Cool, cool, cool. Well, I always have to end with a toast since we're ABA on tap. So here we go. Give people plenty of time to respond, consider low dosage, champion the ABA brand, and always analyze responsibly.

SPEAKER_05 1:15:55

Thank you so much, so much, like cheers.

SPEAKER_04 1:15:58

Cheers. Always analyze responsibly.

SPEAKER_00 1:16:03

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.