ABA on Tap -- Why 40 Hours? (Inaugural Episode Revisited)

Bringing back greatest hits as we wrap on 2025! Our inaugural episode - what got everything started! Originally published 2/15/2020 please enjoy our discussion on the 40-hour ABA model and if it's still medically necessary 40 years after Lovaas published his article stating that it was.

Behavior Analysts Mike Rubio and Dan Lowery kick off their podcast adventure by pouring a user-friendly, unfiltered, smooth and easy to consume discussion on Applied Behavior Analysis (ABA). In this inaugural episode, Mike and Dan sort through the idea of 40-hours a week of in-home ABA treatment--a common pairing on the ABA treatment list for individuals (usually younger children) diagnosed with ASD (Autism Spectrum Disorder). Pedagogy, professionalism and parenting alike are invited to toast and learn with Mike and Dan. Cheers! And remember, always analyze responsibly. 

Transcript

SPEAKER_01: 0:00

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

SPEAKER_00: 0:55

And welcome once again to ABA on Tap, this being our inaugural episode, the first time we get to reach out to you and let you know what we're thinking about. I am Mike Rubio, here with my co-host.

SPEAKER_01: 1:06

And I'm Dan Lowry. So let's go ahead and skip a little bit of the history. Let's fast forward about 50 years from about 1970 to today. How did we end up with 40 hours?

SPEAKER_00: 1:18

40 hours. So what Dan's referring to is the question that... most parents approaches with, or the concern that most parents approaches with when considering ABA services for their child, the idea of how much, how much is good, how much is gonna make the difference. And Dan alludes, Briefly to 1971 start by Dr. Ivor Lovaas over at UCLA, our guru, somebody that we're very appreciative of in our field, having his nominal work in ABA and pretty much the creation of discrete trial training. One of the sets of procedures that we have in ABA that has a great deal of empirical validation has been proven very effective in teaching individuals with autism spectrum disorder. From that nominal start in 71 came a publication in 1987 that gives us as a field of behavior analysts, this number, 40 hours a week, I guess being what the study over 16 years determined was the right dosage of ABA to make a socially significant difference in kiddos receiving treatment. Now, let's just kind of think about the practicality of this, Dan. Why do you ask the question? Why would 40 hours be a concern? Do you think, I'm a dad, you haven't quite hit that level yet But you've been working with kids for a long time. You understand family dynamics. As somebody who doesn't have their own kids, why would 40 hours be exciting to you? Why would 40 hours be concerning to you?

SPEAKER_01: 2:58

Yeah, good question, man. Well, I don't have kids, but I do work a job that's about a 40-hour work week. So with 168 hours in a week, that's about a fourth of that work week or about a fourth of that week that I'm spending at work. So that's another fourth of that week I'd be spending in therapy with my child. So... That's half of my week that would be spent between my work and therapy, which seems a little bit excessive. Think about the kids that we work with. They're spending about the same amount of time in school, so they're spending about half of their life between school and therapy. You add another about quarter of that sleeping, that leaves not a lot of time to do anything else. I guess my first question is, so we came up with 40 hours, and Lovaas did show with 40 hours with parent training. I think that's another key that kind of gets left out is, oh, yeah, 40 hours, but there was also a big parent training component, but that just kind of gets left out, and we just come in and just do 40 hours of direct services, right, because that allows us to pay for our therapist to be in there. Why not 38 hours? Why not 43 hours? Why not 39 hours. Why 40 hours? Why do you think that 40-hour number, it's a nice round number, divisible by 4, 2, 10. Why

SPEAKER_00: 4:13

that one? The answer is I don't know. I think that part of the podcast here is intended to explore these topics for ourselves, for our own professional development, and hopefully for others who will be listening. Obviously, We're both, for lack of better phrasing, big fans of Ivor Lovaas. This is not in any way an attempt to disparage the research that came out from the UCLA Young Autism Project. It's our bread and butter. It's our mainstay. But I think one of the things that we need to consider in that 40-hour accounting is the fact that there was no other remedy available for autism before Lovaas brought that out. So when you start... And this

SPEAKER_01: 4:57

was the first remedy, too. This was the first try.

SPEAKER_00: 5:00

Yeah, we're talking... There was

SPEAKER_01: 5:01

no refinement because there was nothing prior.

SPEAKER_00: 5:03

Exactly, exactly. And you make a point that we'll explore in much greater depth later, but yes, it was the first, and we haven't moved very far away from that direct transfer of technology. Again, Lovaas studied from 71 to 87, published or did his research, published that first nominal... article in 87 to tell us about that 40-hour dosage. And I think that rightfully so, people took it and they ran with it. And nobody dared to ask the question, well, what about 39? What about 41? Now, why 40? I think you, again, without offering any disparagement to Lovaas and the amazing work that he did and his crew and some of the individuals that were his graduate students that we still continue to follow, people like Ron Leaf, for I think that that 40 hours suspiciously sounds a lot like a work week. Like you might have a laboratory and say, hey, we need to study these kids. And you're a graduate student. We probably need to pay you some sort of full-time hour or full-time wage while you're here to make ends meet and to make sure you're getting your due. And yeah, you're gonna spend time with these kids that politically and socially we've, up to this point in 1971, we've by and large institutionalized and considered not being able to be educated. And at this time, historically too, our schools are enacting parameters of the Individuals with Disabilities Education Act and the first versions of that. So everything's moving toward remedy at that point in time. We do find a remedy with one huge nominal piece of research, and I don't think anybody has really taken the time to question it since then. So, you know, very long answer, Dan, that I gave you there, but I think that suspiciously I would say that 40 hours falls right in line with a 40-hour work week, and it really means that these parents were being told you have to spend every waking minute possible, providing this therapy to your child to make a difference. And you make a good point. 40 hours pales in comparison to 168 hours a week. And maybe we take eight hours, maybe we take 56 hours away from that just to allow for some sleeping, which is very, very human of us. But that's really hearkening back to the other point, which is-

SPEAKER_01: 7:26

You mean they don't need

SPEAKER_00: 7:27

ABA while they're sleeping? I've seen some people recommend it. Okay. But that's my point is we've kind of come in with a really set of powerful tools to provide help. But maybe we've overextended ourselves. And in talking about 40 hours, we've put... the notion out there that if you're not giving your child that much, or if we're not providing that much, there isn't going to be a difference made. I don't think that's true, and I also don't think it's fair that parents feel this undue pressure to have two full-time jobs if they think that they can make a difference for their child's behavior and their child's learning, who may be experiencing some impactful traits of ASD. Any parent's going to do anything for their child. I think it's a little unfair, and I don't think it's what Lovaas intended by putting putting out that recommendation, I think it's a direct transfer of technology that, as practitioners, we've taken. Finances come into play. It becomes also very convenient to be able to schedule a registered behavior technician, for example, 40 hours a week, and the logistics pan out. But yeah, like you ask in our intro, how much is enough? How much is too much? Can there be too much? And I think the answer to that is yes.

SPEAKER_01: 8:42

Sure. I think clearly you had a point of diminishing returns, and that's something that we found. And I'll circle back to that in just one second. I want to kind of harken back to original Lovaas and, you know, compare it to maybe the development of the airplane or the Wright Brothers. back in the early days. And that came out, and the airplane had two wings. It was a bi-wing. And it worked. But if you think about quickly after that, they said, OK, cool. We now have this whole new technology of flying. Let's not just keep doing the same thing. Let's figure out how to improve on it, right? Okay, let's take away a wing. Let's add a jet engine. Let's add different things, right? All of a sudden, now we're really efficient. We're not flying 50 feet. We're flying 50,000 miles.

SPEAKER_00: 9:27

Across the ocean. We're fighting wars with fighter jets suddenly, not even 40 years after the original Wright Brothers flight.

SPEAKER_01: 9:37

Exactly. So was the Wright Brothers plane awesome for today's standards? No, but for the day that it came out, it was awesome. So that's That's kind of what Lovaas was. It showed that we could fly, essentially. It showed that we could get up in the air. But I think what's concerning is we're still looking back on that 1970s technology and referencing those studies and things like that. And we're not looking at the jet engines and things like that. And how can we accompany these 40 hours now? A lot of people in the ABA now have digital data. Those things didn't exist in the 70s. There's all sorts of new technologies. Going to school. So... In the 70s, schools didn't really know how to deal with individuals on the spectrum. They weren't getting much ABA behavioral therapy or even education for the most part in schools for individuals on the spectrum. Now with IDEA and all sorts of special ed, they're getting lots of therapy. No, not necessarily ABA therapy, although a lot of schools now have some sort of ABA specialist or behavioral specialist on staff. They're getting a lot of individualized attention and education. So how much of that comes out of the 40 hours that Lovaas was referencing? There's a lot of other variables that I think we need to consider. Before we just blindly quote Lovaas and say, oh, 40 hours because, hey, we got this new staff that wants 40 hours. It fits nicely. And looking at the ulterior motives, if nothing else, start to beg some questions. I do want to circle back, though, to that initial point of the diminishing returns and how we might, I joked about doing ABA while somebody's sleeping, but I've done three hours with a three-year-old doing DTT and pretty much by hour and a half in, the kid's pretty much sleeping.

SPEAKER_00: 11:17

Or they're trying to pretend to fall asleep to escape the situation. I love that. I love when you've got a three-year-old trying to just show you that they can't take anymore. And that hasn't happened to me any time recently, and neither has it happened to you. I know that. But, yeah, that's a really good point.

SPEAKER_01: 11:33

Because we have a warehouse with all the tables and chairs that we don't use anymore, that we had to use all throughout the 90s and 2000s, right?

SPEAKER_00: 11:41

If you don't have an IKEA table and a cube chair, you're not doing discrete trial training, so you're certainly not doing ABA. I'm glad to see that at least we've moved far away from that, and I think most outfits are beginning to move far away from that original Wright Brothers DTT technology.

SPEAKER_01: 11:59

Which leads me to think maybe we should sell some IKEA stock short if a large part of their business model, the IKEA table and chair and ABA therapy is no longer necessary. They might have some business struggles on the horizon. My point, though, about diminishing returns is, so you look at two different demographics of individuals. You've got the highly impacted individuals that traditionally companies have looked at this and tried to put, you know, one plus one equals two and say, well, they're highly impacted. Ours help individuals on the spectrum. So these highly impacted, they need the most hours. But if you think about it, these individuals are lacking a lot of the prerequisite skills like joint attention, attending, things like that. So if they can't attend for more than two minutes, what's three hours of ABA, eight hours of ABA going to do when all they can do is attend for two minutes? So begs the question on these really highly impacted kids, how much actual work are we getting done in these long sessions? Can we condense it, be it 90% is effective and 20% is much time and give these kids the opportunity to just be a kid because I think that's what's lost. So that deals with the highly impacted demographics. So then you might say, okay, well then the less impacted demographic would need it. But if they're pretty neurotypical and just working on social skills and things like that, granted they can attend more, they have more joint attention, so sure, they can utilize those hours, but now we're taking their ability to be typical and that's the whole point of of ABA is to help these kids achieve most typical results in the least restrictive environment. And as a parent in my ABA group yesterday said, ABA can be pretty darn restrictive sometimes. So I think we're hitting kind of a wall on both ends, the more restrictive or the more impacted and less impacted ends when we're offering or recommending that 40 hours. Not to mention the parental end of how are they going to afford this because that's going to affect the work schedule, babysitting schedule, family routine schedule, etc.,

SPEAKER_00: 14:00

Yeah, just having had the benefit of being with you at that group you alluded to, I think the parents said invasive. I have never, and again, not to offer correction as much as I think that it highlights your point. Restrictive is certainly one word that we need to look at. And then invasive is the other part. And again, I'm going to point back to that direct transfer of technology. And you can't blame us as practitioners. And I say us inclusively. I wasn't born until 1974, so I couldn't be included from the very beginning. Neither could you. But I say us in terms of our ongoing practice. What else could we have done with the Lova study other than bring it out into the masses and replicate it? Now, what's wrong with that?

SPEAKER_01: 14:46

Otherwise, we don't get on tap.

SPEAKER_00: 14:48

Exactly. We've got to start serving it up somehow. And again, politically, socially, this population, kids with autism, I hope I don't botch this, but I believe before 1970, the stat is that something like 90% of individuals... with what at that time was being called, not autism spectrum disorder, I forget what the exact term was, the DSM has changed so many times, but like 90% of individuals with those traits were being sent away from their families and institutionalized by the age of 13. So the idea that we come in with this alternative and now you get to do this therapy with somebody and it's 40 hours a week and some of it looks a little bit like that, Animal behavior model, behaviorism, yikes. Nobody wants to talk about that term because that clearly doesn't apply to my kid. That's a human. We would say that's a human animal. It still works. Again, there's a lot of political pieces there. So you can't blame us for taking that 40-hour number and saying, hey, this is what works. Because it did work. And that's what he proved. So I think that it goes back to that direct transfer of technology and us not realizing that that was just the first version. That was the first brew, the first variety.

SPEAKER_01: 16:05

And you said he proved that. And I do just want to clarify that he proved that 40 hours a week of direct therapy plus intensive parent training is more effective than 10 hours a week of direct therapy with no parent training. So I do just want to clarify that for any of the listeners who aren't familiar with the study.

SPEAKER_00: 16:21

Thank you for making those numbers straight. We want to make sure that we're precise about this and not letting out conjecture. And we'll make sure that for you out there listening that we're clear about that. I think that Dan and I are very committed to precision. So again, you can't blame us for that direct transfer of technology. It worked socially, politically. Nothing else had worked to that time. So You know, that 40-hour number, while we know now, might not be required, might have some other logistical difficulties that it presents for parents. You bring up, you mentioned earlier, some other very important things, Dan. If we take that number for what it's worth, having started in research in 1971, at that time, we were just getting into special education services in this country. Clearly, educators, teachers are much more well-versed now, not just in pedagogy and educational research, but now in ABA as well. I think that a lot of these things were kind of operating separately because of the animal behavior models that came before ABA was so applicable to humans. So, yeah, there's so many changes that have transpired. I think it's almost a disservice to us professionally and ethically in a sense that we don't recognize the value, that we over-recognize the value of discrete trial as being that first Wright Brothers plane, but we haven't yet really seen the technological progress, to say that specifically, over these past now almost 50 years that I think technologies like the airplane experienced or benefited from. So we can talk all day about being technological, and we are, I feel like there's a lot of advancement that can be afforded in our technology, and not to be disparaging. We obviously do great work, but I like your comparison. We haven't advanced the technology. We're certainly very technological, but in many ways, if you think about a little table and chair and discrete trial training and all the trial types and just the notion that, say, for example, in picking up verbal behavior, the notion that we're going to take... a set of targets like colors and go through all the trial types in discrete trial and learn, you know, what be it, eight different colors. You know, when's the last time any of us mastered out eight different targets? Across

SPEAKER_01: 18:56

eight different months in DTT.

SPEAKER_00: 18:58

So a two-year-old is picking up those words two a day. Two new words a day. So our technology just to date, again, very powerful. There's no disparagement to be had there. But there's certainly an urgency to advance it, certainly an urgency for us to realize that what Lovaas, even in 1987, left us, with all due respect, that he'd be turning in his grave if he saw people, I think, still doing discrete trial the way they demonstrated in 1971. Clearly developmental research, human lifespan research, brain imaging research, all those things have taught us so much more. It behooves us as a field to integrate all that other empirically valid science and just become, as we have over the past several years, past decade or so, with insurance mandates or whatnot, finding ourselves as newbies to medical tables or to other venues. We've certainly been pressured or inspired, motivated to become friendlier or more user-friendly, but I think we still have a ways to go.

SPEAKER_01: 20:03

So I do want to also highlight that there have been some technological advancements in the field of ABA. So we're talking about two different things. And the company that I currently work at We don't really do much DTT. We do more along the lines of NET or PRT, more naturalistic-based training. So the technological advancements have been made in some regards, but it seems like the FAA is still recommending the same amount of pilot training and things like that, the same things. Well, presumably in naturalistic training, for layman's terms, lack of better terms, play-based therapy, A kid's going to be a little bit more motivated. A kid's going to want to learn their colors a little bit better, right? So instead of a kid staring out the window until they can identify green 10 times, maybe the kid's going to learn green as we play with a green toy or Blue Thomas the Train or things like that. And they're not going to need the repetition because the reason they needed all 10 trials in DTT is because they really didn't give a crap and they weren't paying attention. Now there's some context cues. Now they care because now when they want the blue toy, they can ask for the blue toy. Context. Maybe they don't need those 40 hours anymore because the technology actually has improved so I do want to highlight that difference where the technology has improved in a little bit or in some ways I'd like to think a lot of ways which makes the recommendation of these 40 hours kind of incongruent with how technology has improved I do also want to talk about this hour or this notion of 168 hours in a week ABA is happening all of the time So ABA, when we're not there, it's not like ABA just stops and waits until the therapist comes back. No, that kid's still learning different things. Oh, if I cry, if I call mom this name, or if I run into the room, will I get attention? What if I hit my head, will I get attention? What if I throw the broccoli, rip my homework? ABA's happening all the time. Kids aren't necessarily always following directions, but they're always listening, they're always learning. So If we take that 168 hours that ABA is always happening, minus maybe the 52 that a kid's sleeping, even if we do 40 hours, that's still only 25% of that individual's week. That's still 75%. The ABA is still happening. Again, I want to stress, the ABA doesn't stop happening when the therapist leaves. ABA is still happening. So it's so important that we train the parents. 25% of those hours. So if that's the case, if we're going to say that an individual needs more ABA is better, why not 150 hours a week? What do you think? Why not? If more is better, why stop at 40? Why not 100? Why not 150? That's

SPEAKER_00: 22:44

a really good question that, again, it's not a shortcoming of the research thus far, but that's not the question that was asked. And that's what makes me suspect that they started from a logistical baseline and said, hey, 40 hours a week, 8 hours a day, you know, you get this... treatment through our graduate students, or whatever the people that were doing it, Lovaas' graduate students. So yeah, we never really asked that question, and again, just did a real direct transfer of technology. When you say ABA is always happening, I think that's a very powerful statement. Let me

SPEAKER_01: 23:18

interrupt you real quick, just to finish up that point. I think that the The reason that we wouldn't suggest that is because we'd look at that and say, that's ridiculous to put somebody in that many

SPEAKER_00: 23:28

hours. Yeah, no, of course. Sorry, I didn't mean to gloss over that. I know,

SPEAKER_01: 23:33

right? It's ridiculous to have that many hours of somebody in your home. And the point we're making is, well, maybe it's ridiculous to have somebody in your home in 2020 or about to be 2021. for 40 hours a week. Maybe that's almost as ridiculous as 100 or 150 hours a week. Maybe we should look at that with the same level of what the heck are you talking about? Is that really what's necessary now?

SPEAKER_00: 23:57

I think it really highlights what you're talking about, that ABA is happening all the time. And what we mean by that is that contingencies are surrounding us all the time in a multi-planar fashion. I say that because DTT or some of our procedural technologies or procedural packages have kind of made it a very linear premise you know you got one antecedent one behavior that you have one reinforcing consequence hopefully to be delivered and we simply know that's not true ABC right that's it right but we know that there can be many different A's for one B for one C there can be many different A's for many different B's that can lead to many different C's all differentially reinforcing and strengthening different sequences or behavioral tendencies habits if you will and that now becomes a much more multivariate non-linear, multi-planar way to look at things. And I think that you make a really strong point. Lovaas, in a way, was saying 40 hours represents to America, even at that time, your productive or industrious waking hours dosage, right? This is when you're going to be at work. This is when kids are going to be at school. So in a sense... Yes, I think that Lovaas was saying you have to be doing this with your kids who have autism all the time. Maybe not when you're sleeping because everybody should be resting, but when you're putting them to sleep, when you're waking them up, these are all routines that have now been filtered through these contingencies so that we understand how to help parents better achieve desired socially significant behavior from their kids and to have that reciprocity. So I think Lovaas was very much alluding to that and saying 40 hours. And there's been a little bit of confusion in terms of the fiscal benefits, for example. Logistically speaking, it's really nice to say, yeah, this kid's going to get 40 hours. That represents a certain amount of money. I don't think that always represents the best interest of the child. Again, without being disparaging, I think that a lot of our colleagues in the field run the risk of being bedazzled by the fiscal prowess that's available through ABA and that's been made available through insurance mandates, and that makes this 40-hour recommendation all that much more confusing, unfortunately.

SPEAKER_01: 26:35

Yeah, I think as you were talking, just to harken back to the airplane analogy, and then I'll leave that one alone, is that LOVAS was a new teaching modality at this point. This was the first ABA with individuals with autism. Nobody else knew how to do it at this time, so there was no... teaching parents or other people how to do it. This was the first time, so you needed these people who had these new strategies to come in and implement this modality. Just like the Wright brothers, nobody else was building effective planes at this time, so they needed to be there to monitor and make sure that things were done at their spec. Now that LOVAS was able to show what worked and what didn't work, now it's incumbent on us to train the parents how to do these things. Now that it's been shown what we can do Let's spend these hours training the parents because even if we're there 40 hours a week, that's still less than 25% of their week. So let's go ahead and train the parents. Now, as you said, from a fiscal model, that might not be the most awesome fiscally, right? Because now we can't have one of our staff members who we're getting a good margin on be in that home and reaping the benefits of that.

SPEAKER_00: 27:48

That's a really good... I think that that's where we have to think about some of the unfairness that we might inadvertently perpetuate with this 40-hour recommendation. Now with insurance mandates, people having different copay rates, their insurance structures being different, their work schedules being different, just plain accessibility being different. Let's take a geographic location. We're here in San Diego. How often would we realistically be able and reasonably be able to serve somebody out in Far East County who, you know, the logistic doesn't fit for? How realistic would it be that we could provide them 40 hours a week? We even have trouble finding vendors that might provide that. So now suddenly the research is telling that parent that because of where they live, they're not going to give their child a fighting chance at school. At managing this idea of autism spectrum disorder that simply can't be true that that just that can't be true. And again, it's where Yes, we've got this great technology. We've got this airplane it can take different configurations It can it can fly different distances. It can carry different amounts of passengers Exactly so we need to differentiate the delivery how our ABA looks, how it's served up, the different recipes. I think that we've been very linear to date because we had such a strong recipe to start with. Lovaas gave us the world in that package called discrete trial training. But we need to recognize that there's pieces of that that can be reconstructed, newly fangled, put together in different configurations, and we know that We know that ABA is working for individuals with autism. We know that there's no way any of us are maintaining 100% of the experimental control and fidelity that Lova said, because we're not in a lab. So that proves to us that variations of ABA also work. It should very easily be able to make us adaptable and give people more options than this is 40 hour a week, or I guess now the board to some extent modify that 25 to 40 hours a week. It'd be interesting to look more into the research behind that to see. where the board had to even look at this number and obviously become a little bit alarmed by it and say, wait, we gotta give a range. 40 by itself, that would not be ethical for us to say. Again, probably a lot of the things we're talking about that came into that decision because it presents a lot of unfairness if you can't provide your child with that, either financially, geographically. We can't always schedule people. At our place of work, we tend not to get anywhere close to that number level of recommended hours because we don't deem it necessary given that our kids are going to school and doing other therapies. And being kids. Being kids. You know, going to baseball practice, going to soccer practice, doing things after school where we might be helpful in those settings, we might also be restrictive. It's odd to be an eight-year-old and have a 20-something adult helicoptering over you All the time. It's bad enough in society. We give so much trouble to the notion of helicoptering parents or helicopter moms, and now we've got helicoptering RBTs on top of that with a kid who already may be emitting a certain level of idiosyncrasy socially, so getting that response back from people, and now you've got an entourage. How many times do I make sure I put my notes away during a community outing for a session and that I'm standing back from the crowd? I feel like you have a seven-year-old who has an entourage of people. Why? through the grocery store just to make sure that a behavior doesn't happen. That's just not natural. It's not natural for the family, not natural for the kid, and certainly recommending that 40 hours of that has to happen to make a difference, I really don't think that that's what is at the heart of that research or really at the heart of our recommendations when we're thinking about that.

SPEAKER_01: 31:57

So you talk about natural, and I want to segue, continuing on the same train of thought here with parent involvement and natural behavior, How are we going to naturally get parents involved? I think historically, parent training has been very much your kid is not engaging in the desired behavior, your kid's screaming and yelling, you need to ignore your kid. Your maternal or paternal instinct might say your kid's in distress. And now you're in distress because your kid's in distress and your kid might have some communicative delays. So let's teach them some communicative strategies. But until they communicate appropriately, until they use their words, until they stop crying for a period that you deem appropriate, you need to ignore your kid, which is probably going to go against any natural parental instinct that you have. Is there not any gray area in there? Is it black and white? Your kid's doing the appropriate thing, they can get attention. Your kid's doing the inappropriate thing, no attention.

SPEAKER_00: 32:51

That's an excellent question you're asking, Dan. I think there's a lot of exploration to be had there. And that's probably the best example I have of this direct transfer of technology without any progression, any innovation. So I think what you're alluding to is this idea of extinction. which again has a great deal of power and comes with empirical validation. It is what it is. It works how it works. But somehow in ABA we translate it into this blanket ignoring. The extinction means you turn your back on your crying kid and you don't give them any attention at all whatsoever because if you do, you run the risk of reinforcing the crying behavior. Okay, that's very logical. It's not untrue at all. But when you've got a largely non-vocal kid who's three years old whose language development is just burgeoning anyway, or should be.

SPEAKER_01: 33:50

What about his self-soothing strategies?

SPEAKER_00: 33:53

Exactly. That's absolutely right, Dan. When you have a three-year-old who's non-vocal, how else would you expect them to express their distress? And now you're asking a parent who's already concerned about the diagnostic pieces and all the paperwork they've been filling out. And what you tell them to build a relationship with them and their child is, oh, they're crying, they're having a tantrum? Blanketly ignore them.

SPEAKER_01: 34:19

So that's different than what they would typically do. Yikes. with a neurotypical kid, right? That it's going against the maternal and paternal instincts. And the whole point of ABA is to say it's not an autism-specific therapy, right? It's across the board. But now what we're doing is we're saying because your child has autism, you have to respond differently because they have autism. Johnny, the neurotypical brother, when he cries, you can go soothe him or whatever, but the one with autism, you have to blanket ignore.

SPEAKER_00: 34:52

Where's the inclusion in that?

SPEAKER_01: 34:54

I don't know, and I think it comes down to the communication. What autism is displaying is a lack of communication, and if an individual can't communicate, then you have to look at it maybe on a different trajectory and look at it like, well, if this individual can't communicate, I gotta help this individual soothe so that I can teach them how to communicate.

SPEAKER_00: 35:15

And I think that where we come in very logically, but likely erroneously, is in this idea that, well, by doing that, you're reinforcing the very undesired behavior we're trying to change. When we're talking about a young kid specifically, again, I don't wanna take our example and blanket it either. When we're talking about a young kid who isn't speaking yet, well, what is it you're ignoring? Is there only means of communicating? So yes, soothing for a young child. And nothing taught me that more than as a young professional supervising a session. And I had taught a parent about extinction and done such a good job that during the session, the child was coming over to say hi to the parent. during a break, and she tripped, and she hit her lip on the table, on the kitchen table, and what do you think the parent did?

SPEAKER_01: 36:07

Ignored.

SPEAKER_00: 36:08

Ignored the child based on my recommendations because the child was crying. You know, I sat there in shock, and, you know, fortunately, this was several years back, and I said, this is a great time to sue your child. She just hurt herself. No, but she's crying, Mike. Exactly. So confusing, right? And this is, again, a great non-vocal child. A equals B. Barely had any words. You and me right now, even not having an audience, enough nervousness will make our body react and make us stammer a little bit or lose our words. So largely non-vocal child who is crying because they just got hurt, how do we expect that they're going to use any level of vocal communication other than to scream and cry? So it's been a very erroneous approach, a very unnatural approach. I like the way you put it, Dan. We claim to knock down barriers to access, yet a lot of our practice says, oh, you have autism? You get treated this way. And other kids get treated differently. That's the definition of exclusion. I don't think that, again, in our hearts, as better professionals, putting our best foot forward, that's not what we intend to do, but by and large, I think it's what ends up happening. You always make the example of... how families model treatment toward the client or to the affected kid, and the idea of seeing siblings, you know, therapize their younger kids, or the younger brother or sister who's been identified on the spectrum. Use

SPEAKER_01: 37:42

your words, Johnny, say

SPEAKER_00: 37:43

Paul, Johnny. Use your words, Johnny, first this, first that, and all of a sudden it's like, wow, what are we, are we working with a human animal here, or does this look a little bit... Like a test subject. Exactly, exactly, and again... We have a lot to do with that. It was a direct transfer of technology. We work hard every day to try and advance that. But it can become confusing because that direct transfer works. It's still effective. The question we're saying is, can we humanize it more? Sure.

SPEAKER_01: 38:10

And you talk about inclusion. And I think anyone would be hard-pressed to argue that the current level of inclusion isn't much, much more exponentially more inclusive than institutionalization. Absolutely. That has to be said. Thank you. I think what you run into is you have this level of support provided and this individual has this level of support for a few years and maybe they're ready to have some more inclusion, but now there's this staff member that the entity, the business has that this staff member now needs hours. So how are we gonna run an effective business with this reducing the hours for the client while retaining this staff member. So there's certainly, one could argue, there is a fiscal, the ability to run a successful business that then, I'm not gonna say compromises the integrity of the fade-out services, but at least begs to question if it's going to incent the company who says that their service is designed obsolescence to actually become obsolete, because then your source of income is now gone.

SPEAKER_00: 39:19

That's a very dangerous notion, right? Obsolescence from a business perspective? You're gonna go out of business. You don't wanna consider that. Yeah, that's a really difficult question that we're having to contend with. Let me add another level of complexity to that. We're often asking young psych professionals who, by and large, don't have kids, who are still learning how to get along with their parents, who have just come in and learned a whole new slew of procedures and really specific information that expands on whatever textbook exposure they may have had in their undergrad career. And I

SPEAKER_01: 40:04

like how you said expands because there's still very few ABA undergraduate programs. So very few people are coming in to their first ABA job with much understanding of exactly what ABA is.

SPEAKER_00: 40:15

And the ones that are coming in with a very strong knowledge of the non-human animal models, that's very valuable because that knowledge, technologically speaking, is the best you can have. But again, it begs the question now, you have somebody who socially, experientially, and academically is not prepared to, or isn't a parent, or necessarily prepared to be a parent, and we're expecting them to, by and large, train the parents through those 25 to 40 hours a week, knowing that as supervisors and case managers, we can only be there a small percentage. It ends up being, what, 10% of the time per board guidelines. So, I mean, the discrepancy's there. We're asking non-parents, new professionals, who are just honing their skills, to now train adults who are older, more experienced than they are, especially at the task at hand, and then retrain them sometimes with completely unnatural procedures or behaviors that would baffle most parents. Ignore your kid while they're crying. So there's a lot of exploration, a lot of refinement I know that we've undertaken that the field still needs to see with even the idea of discrete trial, the idea of extinction.

SPEAKER_01: 41:32

You mentioned ignoring the parent as they're crying. Yes, and you mentioned that coming from a lab background. The ABA originally coming from the Skinner Labs and things like that, which they did prove if you don't reinforce a rat with a pellet from pressing the lever, the rat will eventually stop pressing the lever. Or the pigeon will eventually stop pecking at the food source. That was the ignoring part. Extinction will work. That's not the... we're not concerned about the humanity of the pigeon or the rat or any, we're just concerned with if we do an antecedent and a consequence, what will the behavior be? And like you said, the direct transfer of that technology sometimes seems pretty inhumane when we're talking about having to worry about individuals who might escalate for sustained periods of time, up to and even leading to some brain trauma from sustained long periods of escalation through blanket ignoring. So yes, blanket ignoring will work. It will get the behavior to stop. But with all the ethics and everything else that we have to consider, we're talking again about human animals and the difference between the EAB, experimental analysis of behavior in the lab, to the ABA, putting that to socially significant behaviors. But now we're into that BSD, the behavior service delivery model with ethics. So I think I just wanted to reiterate that you brought up such a good point talking about how these individuals might have experience in the lab and really that's where ABA came from in just showing that certain consequences will result in certain reductions of behavior, but we really have to consider the ethics of that.

SPEAKER_00: 43:09

There are so many examples that the ethics and then just the nature of human development. and then everything else that we like to talk about but that's very hard to integrate. Cultural differences, family preferences, you know, so many different things that if we don't consider, we end up maybe implementing a less than humanistic applied behavior analysis. And that's... But at least we do it for 40 hours. Well, and again, and it works. And it works, and without it, you know, we had these kids being institutionalized by age 13, so... We need to honor those advancements, but like you keep saying and we keep alluding to, the innovation in terms of the humanity of the procedures and how they get presented, by and large, I think most practitioners are coming up to speed. I don't hear too many horror stories anymore. I did recently hear one. I heard an escaping station one. I knew you were going to bring that up. Without getting into too many details here, I did hear... Recently I have a story from an old colleague, somebody that we used to work with who moved from locations and began working with other ABA professionals. So she approaches me and says, I have a question for you about ethics. And I'm like, okay, go ahead. She goes, my new job, we're using escape extinction for kiddos around age three who have eating trouble. And I'm like, are you saying eating trouble or feeding trouble? Because that's That's an important difference. If a kid needs help gaining weight or there's a medical reason to be concerned about what they're not ingesting, what they're not eating, yeah, okay, escape extinction sounds reasonable. Before you get intubated, either in your nose or in your gut, yeah, let's use something that's a little bit more demanding in terms of a procedure to make sure that this individual is okay. So yeah, these kids are really sick, right? Well, no, these are just three-year-olds who are picky eaters. Okay, tell me more. Well, they're using manual restraint. What? I mean, a three-year-old who's a picky eater. Name a three-year-old who isn't a picky eater.

SPEAKER_01: 45:26

But extinction, right, if they're doing the undesired behavior, we're not going to let them get away with

SPEAKER_00: 45:30

it, right? I guess having somebody shove a stalk of broccoli in your mouth and not take it out until a certain amount of time will get some broccoli down your throat. But is it the most humane way of doing this? And again, was it even necessary to manually restrain these kids who weren't having feeding problems? They were having eating concerns, right? I like chicken nuggets five nights of the week. That requires manual restraint in somebody doing escape extinction. So again, escape extinction works for somebody who's about currently working with some individuals facing this concern. Before you have a G-tube or a tube in your nose to get nutrition into you, there's got to be other ways before escape extinction and something very restrictive, manual restraint, There's got to be an advancement of the technology, innovation, so that it is made much more humane and we can still preserve the effectiveness, the validity, the reliability. But clearly there's a way to do this differently and to realize when our procedures are being implemented at the wrong time. If you're going to get that restrictive and start using escape extinction during... eating, there better be a really good medical reason that will lead to more invasive procedures before you use something that restrictive. So yeah, we really need to, as a field, understand that just because it works doesn't mean it's applicable. I

SPEAKER_01: 46:56

absolutely agree. And I think as we become more and more of the medical model and revisiting that 40-hour suggestion, that we have to look at ourselves more and more... Especially in California, as we're typically funded by medical insurance, it's more and more synonymous with medical recommendations. And I had a blood clot, so I had to go on blood thinners. And if they say take five milligrams, if I take 30 milligrams, it's not going to make it any better. It's not always more is better. It's dangerous. It's dangerous, right? But there's new technology, right? There's new, instead of having to do blood thinners that you have to go get tested and they play with it, it's like you can take one pill a day or one pill twice a day and then you're good, right? There's technology resulted in the reduction of the amount of blood thinners that I needed. Constantly looking at that. I think that's something that we have to lose the notion that if ABA is good, more ABA is better. I will absolutely agree ABA is good. I've been in the field for over 12 years now. And this podcast does run the risk of somebody listening to it and saying, well, man, they were bashing ABA and saying, well, I don't need ABA. And quite the contrary. What I'm doing is, what I'm trying to communicate is that I think ABA is so good that what we could do in 1970 and 40 Hours I think with new technologies that we can do those same things in 10, 12 hours, depending on the kid. I think we can be so effective that we don't need this 40 hours. The only reason that people are touting this 40 hours anymore is because of the fiscal benefits that it brings in a company. So I still abide by ABA. I still think the world of it, and I think that As we continue to improve, we can continue to help make these kids' lives more normal, which is really our goal, and give them more accessibility to the outside world, typical individual experiences, not this entourage that you were talking about earlier where everyone's over their back 24 hours a day or 40 hours a week.

SPEAKER_00: 48:58

Yeah, and I think it gets to the, I guess we'll call it the 108 hours of ABA, subtracting the sleeping time, and I think that you nail it. You don't need... What we do currently is we come in and we provide this concentrated dosage. I like to talk about the fact that as a parent, I spend a majority of my week giving my undivided attention two hours at a time to kids that aren't my own. I don't even get that luxury as a parent. Now what that really tells us is that, as you were saying earlier, ABA or these behavioral contingencies, this way of interacting with your child with a disability whose behavior you're trying to modify, whose learning you're trying to advance or enhance, it's really a full-time venture. You have to do it all the time. So those 40 hours now means that maybe us as professionals, case managers, RBT's, we're doing 10 to 12 hours of that a week. And then the school. is gonna be taking care of another section of that. And the parents are gonna make up the difference to the 108 hours, which brings us to parent training and how important that really is as part of your behavioral treatment. I mean, it's priceless, it's invaluable. We try to find so many more ways to deliver it, knowing that we're always facing some logistical issue about whether or not you can bill time concurrently or people defining it differently, supervisions a courtesy of the service parent training is separate. There's always some caveat, again, fiscally driven usually, that provides, that almost gives us some limit on the parent training. I'm almost of the opinion these days that we could have 25 to 40 hours of parent training.

SPEAKER_01: 50:44

Give a man a fish versus

SPEAKER_00: 50:45

teach a man a

SPEAKER_01: 50:46

fish,

SPEAKER_00: 50:46

right? And then maybe sit with the kid once or twice a week to demonstrate and make those things happen so that the parents see that they're possible. I wouldn't be opposed to such a shift. It would mean a change in logistics. Wait,

SPEAKER_01: 50:59

you said... Let the parents do the parenting, not have people who don't have kids do the parenting? Right. Let

SPEAKER_00: 51:08

the parents do the parenting. And let them do the parenting in a way that is a little bit closer to their instinct, a little bit closer to parental instinct in general. Taking the lab to the living room. Taking the lab to the living room. Going back really quickly to the example of extinction. Extinction just means that the rat pressed the lever and they didn't get the pellet. It didn't mean that the lights got turned off in the operant chamber, that they took the lever out of the chamber, that they took the pellets out of sight. No. They held the rat down. It just meant that the same behavior that had been previously rewarded did not encounter the exact same consequence. Yet, we've taken that technology and by and large talked about ignoring. Well, there's at least three levels to ignoring your child. You could stop talking to them, verbally ignore them. You could... turn away from them, visually ignore them. You could physically ignore them by completely removing yourself. And I'm sure if we sit here for the next 10 minutes, we could figure out 50 other ways to comprise what ignoring might mean or how you might, better yet, I almost want to get rid of the word ignoring with relation to extinction. Better yet, how are you going to make sure that the consequence they're seeking isn't being achieved? It doesn't mean that you have to ignore your kid. It does mean that if it's an attention function, you may want to limit the way you provide that attention, differentially giving more attention for anything closer to the desired behavior and minimizing it for the undesired behavior. It's like the old recommendation that we're going to go to a high school in a special ed classroom and tell a teacher who has a student who's saying F you continuously to just ignore that kid. That's just simply not going to work. The other kids are going to start saying, hey, teach FU. So I think that that's one example where we took a direct transfer of technology, even erroneously interpreted that technology, and we've kind of blanketly been implementing it for years now.

SPEAKER_01: 53:12

Sure. And you talked about the attention function. I won't get too much into it now, but people talk about the attention function and the sensory function. And I really feel like those are highly overused. They'll say like, oh, this behavior is sensory. Any behavior has some sensory function. You're experiencing the world. Your physiology is changing during a behavior. If you have the iPad, maybe you feel physically more calm. So that's sensory,

SPEAKER_00: 53:37

right? My favorite is sensory play. I challenge anybody. Tell me any type of play that doesn't involve your senses. What is sensory play? Anyway.

SPEAKER_01: 53:47

Well, maybe we try to do play in a dark room, in a vacuum. They call those

SPEAKER_00: 53:52

sensory deprivation chambers.

SPEAKER_01: 53:55

So there is no senses there. Anyway. And then we've got the attention. So we'd love to throw that one out. This behavior is done for attention. That behavior is done for attention. I feel like attention is more of like a secondary function. Anytime a kid is crying or yelling or screaming or cussing, clearly there's an attention function. Otherwise, they would just leave the room. But they're trying to communicate that there's something, there's a distress, right? But most of the time with an attention function, it's either going to be a tangible or an escape, even at a young kid. Yes, they want mom's attention, but they want mom's attention to let them know that they want to be put to sleep. or fed, or as older kids, they want to get parents' attention because they don't want to do homework, or they want the iPad, or things like that. So this blanket ignoring, the attention isn't the primary function of the behavior. The primary function is the access to the iPad, or the escape of the homework, or that I want to go back to grandparents' house, or I want that chocolate, or I want to be put to sleep, or I want to be left alone. The attention is almost always a secondary function, hence why ignoring isn't the best strategy for that. By ignoring, you're not addressing that primary or secondary function.

SPEAKER_00: 55:04

I think that a very familiar term, differential reinforcement, becomes more important. So it's not that you're removing your attention from your child with extinction. It's that you're removing the type of attention or response that would reinforce that behavior you're trying to change. And again, maybe we should go on a campaign or on a crusade here. Extinction does not mean ignoring. Rubio 2020? Rubio 2020, extinction does not mean ignoring. Extinction does not mean ignoring. And in that learning that there's a whole slew of differential reinforcement opportunities that a parent can learn about in soothing the child, the child is not quiet, now there's a chance to discuss the behavior or other alternatives to the behavior. Think about how much instructional time has been lost Because we sit in a two-hour session and sit with the parents ignoring the kid for 45 minutes. I

SPEAKER_01: 56:01

remember in my previous company when I was pretty new in the field, ignoring a kid for almost an hour and a half. Session was an hour and a half. Almost an hour and a half for them to lick a strawberry. Because that's what I had to do. I set the contingency. Eat the strawberry. Kid starts crying. Well, I can't remove the strawberry now because if I remove the strawberry, they're going to associate crying for getting the removal of the strawberry. So when we're talking about needing 40 hours, well, I guess if I'm taking an hour and a half for a kid to eat a strawberry, then I probably do need 40 hours. But I'll pass it back to you. But I remember that clearly.

SPEAKER_00: 56:36

No, no. That's a great example. And everything you said in there was exactly right. I made a demand. I can't remove it, especially not in response to crying. So it begs the question, and I know we've both learned this since then, you've got to be careful what demand you set from the get-go. And I think that that's, again, another innovation, really huge innovation for ABA is, yeah, we're not always going to be able to dictate demand. the targets or the response with RSD, there's going to be errors made. The learner is a learner. They don't always know what we're presenting them. And we're working the antecedent base a little bit more, right? By and large, up until now, we've relied on the consequence base, right? The idea that even if the learner isn't aware of what they're being put through, they will learn so we can prompt them through it. That is not incorrect. That is absolutely correct. But it's not the only side of the contingency. So... So in considering that antecedent base, more than just the consequence, I think it brings us to a lot of other ideas about how to build rapport. The idea that trial-based learning may not start right away. In fact, there's a lot of engagement to be had, a lot of rapport to be built before you can expect that a kiddo's simply, that you're gonna have that level of instructional control. How much time in the past have I seen, or have I invested in physically prompting a child to sit down at the table and chair? That was a complete waste of time, and a level of physical contact that was completely unnecessary. I look back to those days, thankfully many, many years back, I cringe a little bit. Yikes. I can't believe that's what we were doing. And unfortunately, I think that a lot of practitioners are still kind of using that Wright Brothers technology in many ways.

SPEAKER_01: 58:39

Yeah, you brought up the attention function, and it harkens back. I remember in my previous job, this was probably about eight years ago, I was on break and I was at a McDonald's, and I was sitting kind of... catty corner to a play place and I was eating my food and I remember a parent taking a kid out of the play place on their shoulders as the kid was screaming and the parent was then explaining, the parent was talking to the kid. I don't remember specifically what they were saying, but they were saying like, you know, you'll be okay, it'll be fine and things like that. And initially my ABA brain went off and I was like, what the heck is this parent doing? They shouldn't be talking to their kid. Their kid's screaming. That's completely incorrect. So, but what do you think the main function of that kid's crying behavior was?

SPEAKER_00: 59:26

It was just, they didn't want to leave. Yeah, escape, right? They didn't want to leave the... So

SPEAKER_01: 59:30

if you give your kid attention, it's not violating the behavioral principle of escape.

SPEAKER_00: 59:34

As long as you're still leaving the play place. As

SPEAKER_01: 59:35

long as you're still leaving the play place. So this blanket ignoring, my initial ABA jumping in and saying, oh, kid's crying, you have to escape, was not necessarily accurate. And when I was able to sit down and think about it, it gave me some new insight on how we can deal with these behaviors and avoid this blanket extinction or ignoring. We can do extinction for certain behaviors while maybe soothing the kid so that the quicker we can get in that example, that kid calmed down, the quicker we can then teach the appropriate way for them to ask for more time or something like that, rather than letting them cry themselves to sleep and then having lost the motivating operation completely.

SPEAKER_00: 1:00:12

And that's a really good point. It's counterintuitive. In fact, if you ignore and you don't leave that play place as that parent, you're completely contradicting yourself. I said we have to leave. Now you're crying. So now we're not leaving. You're actually teaching the very message you're trying to go against in that sense. So I think that, yeah, we've got to wise up. We've got to wise up and realize that when we're saying ignoring, we're saying don't let the child get through with their course of behavior, but make sure that your course comes through no matter what their response is. Within reason, of course. And I think that that's where, yeah, it makes sense. You're going to ignore the crying at the play place and leave anyway. And A lot of the recommendations fall short and just the ignoring is the blaring more prominent recommendation. So you've got parents turning their backs on their kids or not talking to them, not providing any soothing when maybe developmentally that would be of greater value. You alluded a little bit earlier to the notion of agitation and some brain research that we've become privy to in our partnership with San Diego State and the Center for Autism and the idea that spending extended periods of time in an agitated state, developmentally speaking, can create kindling or, I guess, for lack of better phrasing, memories to make tantrum behavior more likely. In other words, you're wiring your brain during those extended periods of so-called extinction where the kid's crying and getting no feedback. You're wiring your brain to be more prone, have a higher propensity to that tantrum behavior. So think about it. What is behavior a product of? Your environment. And if you're spending 45 minutes in your environment expressing a certain behavior... It's being strengthened somehow. Again, so much instructional time is lost during those waves of extinction that we've practiced in the past. It's probably one of the better examples that we've discussed as to how innovation is very much needed in our field, and I think that people are doing it, but it'd be nice to gain a faster pace.

SPEAKER_01: 1:02:21

Yeah, I think in conclusion, we've covered a lot of ground today from the extinction to differential reinforcement to hours, parent training, all sorts of things. Recircling back to just the initial question, the initial premise, is 40 hours necessary? I think I'll speak for you, Mike. Please interrupt me if not. I think our answer is maybe. Don't know. We don't know. But we're hard-pressed to say that it's absolutely necessary. Same thing with 25 hours. We're hard-pressed to say that it's absolutely necessary. And from the medical model, it seems most ethical to start with the lowest dosage that might be effective and then move up from there. I think we've talked about kind of being stuck in these scientific ways. And I think people tend to look at ABA as the science of behavior. But ABA isn't actually the science of behavior. And I know you like... to what is ABA, Mike?

SPEAKER_00: 1:03:15

Well, I won't get too far into this, but it's actually the philosophy of the science of behavior. And we say that without getting too technical, primarily because human behavior, by and large, won't be predicted in that sense.

SPEAKER_01: 1:03:29

Exactly.

SPEAKER_00: 1:03:29

So

SPEAKER_01: 1:03:30

it can be replicated to the extent... of scientific inanimate objects. Every time I do a procedure, while there will be a level of consistency, it won't be quite the level of consistency of gravity falling at the same speed every time. Humans are a little bit more, while they are predictable, they're more dynamic and variable. So I think what that brings us to in conclusion of this 40-hour discussion is that being the ABA is not the science of behavior. It does not need to be replicated exactly the same way in every different environment. It's the philosophy meaning that we can constantly look at different ways to debate about things and modify and philosophize about how we're gonna do different procedures and how we can make procedures better. And while something may not have worked or might be working differently in the lab than it is in the living room. So constantly looking at that and questioning and being philosophical about how we're delivering our services and the recommended hours And all of those things I think will lead to a more humane and better treatment.

SPEAKER_00: 1:04:37

Yeah, I think that's very well stated. I think that as professionals we need to realize that autism isn't going anywhere. In fact, the incidence rate, the prevalence only keeps increasing. Maybe we'll discuss that. We'll talk about that later. Yeah, we'll discuss that controversy at some point. But I think it's important for families to realize that treatment has to feel comfortable. Treatment has to feel accessible and viable. And like something you can actually engage in. And yeah, so to answer that question again, is 40 hours necessary? Only when it's necessary. Is it the only recommendation that's going to make a difference in any given individual with autism? No, absolutely not. Absolutely not. Less than 40 hours, more than 40 hours.

SPEAKER_01: 1:05:23

I would put our less than 40 hour, our 12 hours a week to our... six to 15 hour typical amount of hours a week against any other companies, 40 hours a week and put progress to progress.

SPEAKER_00: 1:05:35

I would back that up too in the sense that when we see, professionally speaking, see recommendations for out of group providers or those things, we tend to notice a very different rate of fading services. I think if you start high, you stay high. It's been our experiences that if we start Within reason, if we look at a five-day work week within a seven-day week, and we realize that kids really only have four hours maybe max after school, that at most, if you choose to take up the entire four hours of free time during a Monday through Friday, that's at most 20 hours a week. How would you even implement anything other than that without impinging into a family's now weekend time, which is supposed to be rest and recreation and time to integrate some of those lessons and enjoy time together? So, yeah, I think that it's time to really recognize the 40 hours a week for what it's worth, recognize that there is 39 other recommendations other than those 40 hours that can be made, and really looking at the client and looking at their availability, not as a way to fill all those hours with an RBT, but as a way to reasonably look at where they may need more help, how to prioritize, knowing that you're not going to cover all the ground all at once, that we're not going to delineate all the targets they need to learn right away, that it's going to be a work in progress. So you learn to prioritize, you take the most impactful behaviors and learning needs, you work with those first. You know, we won't get into this right now, but the idea that we're going to run 30 goals in a two-hour session. That's something that's still very prevalent because as behavior analysts we've come across this idea that we can delineate all the targets a kid's going to need to learn. That's just simply not true. So again, I'm obviously an aficionado of ABA, tried and true. You know, I bleed ABA, but I think that it's certainly time for us to start innovating and start humanizing our approaches much more than we have to date.

SPEAKER_01: 1:07:44

Thanks for joining us this week. We'll look forward to anyone who has a different opinion. Coming on the podcast, we'll be having various guests, various different discussions and debates. So anyone who has a differing opinion and is convinced that 40 hours is the way to go, we encourage you to get in touch with us and we're happy to have you on and debate so that maybe we can be educated and deliver ABA in a way that is more effective.

SPEAKER_00: 1:08:10

It's an open forum. We serve ABA to anybody who dares come here. Cheers. Thanks a lot. Cheers.