Joint Attention Part I

Better late than never,  Mike and Dan kick off the 3rd season of ABA on Tap. Thank you all out there for your continued support and listenership.

In an effort to advance the 'lab to living room' approach, Mike and Dan give a historical account of their current practices in early intervention. Given that these particular programs take a 'preventative' edge in their purpose and objective, the idea of blending ABA technologies and methodologies with best practices in Early Childhood Education takes the forefront. Young children in these early intervention programs, at least in this case, are not diagnosed with any condition, just identified as 'at-risk'. Without careful and considerate pause from professionals, these children might receive traditional, standard ABA treatment otherwise cultivated and specified for children on the spectrum. This situation is examined closely as the impetus to innovate and progress the idea of ABA and what it looks like in planning, practice and further data collection. Part I will provide a more personal and historical account of the references, experiences and concepts that led to joint attention as an important correlate to imitation, but lacking focused examination or useful implementation as an important aspect of programming thus far.

Sit back, relax and always analyze responsibly.

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Transcript

SPEAKER_00: 0:00

Hey Mike, how do you feel about today? Feeling pretty good about it?

SPEAKER_02: 0:04

I think today's a great day, Dan.

SPEAKER_00: 0:06

I couldn't agree more. Like you say, any day that you wake up and your name's not in the obituary, you're off to a good start. Speaking of which, today's also a great day to start your own podcast. Whether you're looking for a new marketing channel, you have a message you want to share with the world, or just think it'd be fun to have your own talk show, like we did. Podcasting is an easy, inexpensive, and fun way to expand your reach online. Maybe learn something. Now, Buzzsprout is hands down the easiest and best way to launch, promote, and track your podcast. It's what we use. Your show can be online and listed at all of the major places podcasts can be found, like Apple Podcasts, Spotify, Google Podcasts, et cetera, within minutes of you finishing your recording. You know, podcasting isn't hard when you have the right partners. And the team at Buzzsprout is passionate with helping you succeed. Join over 100,000 people just like us sharing their message, already using Buzzsprout as the conduit to get their message across the world.

SPEAKER_02: 1:08

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SPEAKER_00: 1:46

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

SPEAKER_02: 2:42

All right, all right, all right. Welcome to the next installment of ABA on Tap. I am your co-host, Mike Rubio, along with... Dan Lowry. Dan, how you doing?

SPEAKER_00: 2:56

I'm doing better. Doing better. I can use both of my arms. So back in effect, I'm excited. We've got so many things that we've... been formulating over the last couple months, so I'm excited to get on the tap and get to brewing and get this stuff out there.

SPEAKER_02: 3:13

And briefly, we apologize for our delay in starting Season 3. As Dan just alluded, he had a slight motorcycle accident. Maybe not so slight. I'm really glad that he's back and he's okay. So thank you for your patience, but just like he also said, we've got a lot of good stuff coming for you and planned for this season, and we'll try to make up for lost time. So, that said, we'll jump right right in. Dan, if you want to give a little bit of an introduction to our topic today, knowing that it might be a two, three-part series, and then I can jump in at the appropriate time, I'd appreciate it, sir.

SPEAKER_00: 3:45

Absolutely. So I'll say from my perspective that you have revolutionized the way that we procure ABA to the clients that we work with. And we've gotten extensively enthusiastic feedback from our clients. in the way that we do ABA. And a lot of this is based around the concept of drawing attention. So what I actually want to do is pass it to you. You shared a little bit of a story in our new hire training when you were explaining why we do what we do and how we do what we do. Kind of how we got to this point because I think it's really, really important. And I hope all of you will listen to this story as we talk about typifying this treatment. Thanks, sir. Thanks for

SPEAKER_02: 4:40

the kind words. I have to give credit, first of all, this joint attention stuff is not new. I think where I've seen a lot of success given the strong team that we work with is in implementing it in a way that hopefully makes a more considered effort at bringing together early childhood best practices and ABA early childhood intervention. So I think there's a lot of ground to cover there, and I will back up a little bit. I have sort of an interesting career path, and it wasn't planned at all. It was all by happenstance, but somehow it's worked out relatively well for me. And that's to say that I'm a developmental psychologist by training, or that's been my academic course of study primarily through both my undergraduate and graduate work has been developmental, human development with a focus on early childhood development with my experiential practice. I've also done a lot of brain and behavior work. And all this stuff kind of comes together in my career. And it's very exciting because I've been able to use all of it for ABA. But most poignantly and most recently has been this venture of what we call early start intervention here in California. which allows us to work with children under the age of three who are at risk developmentally. So I'm going to rewind a little bit. Many, many, many years now. In fact, 25 years now, which is kind of scary to say.

SPEAKER_00: 6:12

That'll always be 1975. 1975 will always be 25 years

SPEAKER_02: 6:16

ago. Is that right? Yes. So back in 1996, I had the right, close to 1975, only a few months later, I had the privilege of getting a job on staff at the psych department at Stanford University, where I was also an undergraduate. And it's this lovely, lovely developmental lab school called Bing School. And I had a chance to work as a teacher by and large there, along with taking care of some other duties as I developed my experience as a young professional. And to say the least, because I could probably do a whole episode on Bing School, it is an amazing, I haven't been there in a while, but it's an amazing setting that is truly dedicated to best practices and research in best practices in child development. I'm probably missing some pieces there, but if you walk into this place, there's four separate classrooms and three of them at least have these open half acre play yards with large redwood trees and everything is built just for nursery school-age children, from the size of the benches to how the mirrors are placed around the classroom to the shelving to everything's about kids. During this time, about five years earlier, there'd been this really interesting article in Time magazine about the best educational model in the world. And it didn't specify an age group, but one of those educational models was Reggio Emilia, which is something that derives from that region in Italy. And they have a very open-ended, child-directed, play-based approach to nursery school education, if they even call it that. I think that's more of an Americanized phrasing there. But you can learn so much from just following the lead of the child and giving them access to things as reasonable, as safe, exposing them to anything. So you see these cool things like very small kids working with small glass beads on our projects, things that here in the States we would see as a child safety concern, right? But they do it in a very careful way. At Bing School, I got to do a lot of woodworking with kids under the age of five when they'd put their goggles on. We'd have real hammers and real drills. And again, you set it up. You become so good at conceptualizing the best way to set it up for these children from their height to their ability that you can do almost anything within reason in terms of exposure. This is actually where I end up encountering my first child with autism. I won't explain too much about that, but in short, I was sold. I needed to know why and how and what to do. How does one... assist in a situation to help a child settle into a play-based setting, knowing that this particular child was not having any success. And there's a lot of parent distress around that.

SPEAKER_00: 9:30

And you said this individual was just kind of flapping their hands, kind of doing their own little thing, not really integrating with the other kids on the playground or what have you. So that's how... I guess you got your first experience on the, I don't know whether this individual is actually diagnosed or not, but into what you would later understand would become autism.

SPEAKER_02: 9:52

Yes, and there was a diagnosis at that time, and I don't think it was a very... common. I think that the incidence rate at that point was still like 1 in 10,000 live births. Imagine that, right? That really dates me. Wow. I'm old.

SPEAKER_00: 10:08

I think it's down to 1 in the 40s now.

SPEAKER_02: 10:12

And I'm not sure if that compares live births to the way they measure it now, but whatever. It was still not as commonplace. And yeah, there was a big difference. And again, there was a lot of dynamics in and around this diagnostic that really sold me. So I said, I have to learn more about this. And I went and started working at a non-public school in hopes that I would get more exposure to individuals on the spectrum and learn more about how I might fit into a role to assist, to advocate, whatever the case may be. Well, I quickly learned, quickly learned, and not that I was working with preschool age children or nursery school age children now at this non-public school. I was working with older elementary school age students. But I quickly learned or discerned a difference. Idyllic, open play yards, really child-directed, student-directed approaches shifted immediately into much more authoritarian, adult-directed, Very constricted situations. Now, when you've got kids who are expressing aggressive behavior, for example, okay, I'm not criticizing this shift or this difference as much as saying it was a stark contrast. Yes, some of these students presented behaviors that required much more authoritarian approaches, but by and large, it seemed like it wasn't all the time, yet that was sort of the mode of instruction. Kind of fast forwarding, doing a little 80s style montage. If anybody wants to play some music through this, I do that for a little while. I come back to graduate school. I decide to do developmental work still, but decided to do my thesis involving MRI research and brain scans into behavior and specifically looking at the development of certain aspects of language and the differences between controls and individuals with ASD. So I'm continuing to learn more about brain and behavior, whatnot, and right out of graduate school I get offered a job for an ABA company doing educational consultation. And I learned about this thing called early start, where you do early intervention before the age of three. And, you know, it's supposed to be preventative in that sense. It's educational service.

SPEAKER_00: 12:47

And at the time, that was the predominant funder of, because this is way before, you know, the 2013 insurance mandate. So was ABA authorized? almost exclusively relegated to Early Start at that point?

SPEAKER_02: 13:00

No. There was still a regional center, California regional center services over the age of three. That's right.

SPEAKER_00: 13:06

That's right. They'd get their four contracts, three, three, six, four, four, six. And then by five, the school would take over.

SPEAKER_02: 13:12

That kind of thing. That kind of thing. And sometimes even later, right? So I remember ABA consultation, maybe even going to kids that were 10, 11, 12. So regional center, amazing service. idea, amazing agency here in California that I think isn't replicated in any other state in terms of its early intervention especially, which is a whole podcast in and of itself in terms of diagnostics and age of diagnosis and whatnot.

SPEAKER_00: 13:42

Hopefully after our podcast continues to gain traction, that will change.

SPEAKER_02: 13:48

So I learned about Early Start and I get excited because now it's early intervention and this is actually, you know, I can do this. I've worked with kids and I know the best methods and I understand the best early childhood practices and unfortunately I face that shift yet again where I get introduced to discrete trial training I'm not being critical of discrete trial training however I will be very candidly and openly constructively critical about the way in which it was being implemented now we're talking at this point you know 18 years ago. So yes, I think the field's come a long way and it's awesome. And this is what we're talking about today are some of those very important cross-disciplinary integrations. In this case, developmental psychology, early childhood best practices, and ABA. So I started working in the field. Again, I see that there's a stark contrast between what you know, the exposure that we would offer in best practices, and now this really restricted environment, very sterile, very laboratory-like, and I start learning more about what discrete trial training is, and okay, this makes sense. I see why we're doing this.

SPEAKER_00: 15:02

And I want to again just highlight the story and your unique perspective, because I think most people in this field just come from the ABA methodology, so it's all we know, and I think this preface is extremely important that you understand both the neurotypical kind of development psychology trajectory and what that looks like. And you have a lot of experience with being in the preschool rooms and things like that, as well as at the time and still currently in some regards, what developmental trajectory and procedures look like for individuals on the spectrum. So just wanted to highlight that as you continue to share your story, because I think that gives a very unique perspective and is very valuable to this discussion.

SPEAKER_02: 15:42

Well, I couldn't have asked for a better segue, my partner here. Thank you, sir. So I think You're absolutely right. One of the really important pieces here in seeing that stark contrast is the whole notion of early start. So fast-forwarding to modern day, a little over three years ago, getting to my current position or my current place of employment and having the privilege of being asked to find another viable funding source with which to provide services and... first thing in my mind was Early Start. And what it did for our staff is allow us to contemplate a super important premise. And I'm actually going to use some slides of a presentation that I've created just to help guide us through some of the logics. I think it's important to be very clean and systematic about the way I presented this. By and large, we've got this exclusivity between ASD and ABA in terms of intervention. It's not to say that ABA is limited to ASD treatment, but if you think about the greater portion of our existence, that is what we are relegated to. Now, that says that, of course, as professionals, as content expertise, as board-certified behavior analysts, we're going to develop procedures that are specific to the population that we work with and their needs. Of course. Absolutely. Nothing wrong with that. Okay, so now let's shift gears. This is Early Start. What diagnosis do children in Early Start have?

SPEAKER_00: 17:22

None. They're too young.

SPEAKER_02: 17:24

There is no diagnostic. In fact, this is an early intervention, a preventative effort. So... What does that mean about the procedures that we're going to use in our ABA treatment? Are they going to look the same, or should they look a bit different? Should we be adjusting them?

SPEAKER_00: 17:42

Well, that's a good question, and that's kind of what led us down this path.

SPEAKER_02: 17:45

So we hypothetically answered they

SPEAKER_00: 17:49

should look different. Look different, right, because they don't have the diagnosis, right? Right. A lot of his research was on individuals that had the diagnosis. That's what the insurance mandate funded was, evidence-based treatment for individuals on the autism spectrum. So a lot of these treatments, while not necessarily specific to autism, had been designed around individuals for autism.

SPEAKER_02: 18:13

And that's true. Sorry for the pause there. I was doing some technical stuff for us. So that's absolutely the perfect point there, Dan, is that's what we're getting at. So we hypothetically answered our question and said, yes, our treatments should look different. So now we were left with a big open space of, OK. So how? So what do we do? And then what about this discrete trial thing? And we're going to be called heretics, and we're going to be laughed out of the service model.

SPEAKER_00: 18:39

And this is where, again, going back to full circle, maybe takes you back to Bing school a little bit. And how do you recreate some semblance of that?

SPEAKER_02: 18:46

Absolutely. To give a quick example that doesn't necessarily go to the treatment, one of the things that I learned at Bing School that I was very closely involved with as a young professional was the idea of gradual separation. That is that every child, or not every child, most children, some children, a noticeable, observable percentage of kids are going to do something like cry during their first day of school or their first week of school. or their first month of school it's not uncommon to see this but it can be very distressing to the family now when you add a set of diagnostic traits on top of this prolonged crying you get what the better lot of us like to call tantrum behavior, which I would say I would contend, again, you know, to our discredit, I don't know that anybody has a really good operational definition, but we like to use it.

SPEAKER_00: 19:44

And it fits really nicely in the behaviors for decrease section of our progress reports. Oh,

SPEAKER_02: 19:48

beautifully. Traditionally, that's exactly what you need. You need one for tantrum. You need some protest, right?

SPEAKER_00: 19:54

Yep. Aggression. Yeah.

SPEAKER_02: 19:55

So all these things that... I'm going a little bit off course here, but on my gradual separation, make sure you loop me back in. But you make a good point here that I have to go on a tangent on. In redefining these behaviors, developmentally, tantrum just means prolonged crying. And it's not... uncommon or unforeseen for a three-year-old to throw a tantrum. But if you now throw that tantrum under the ASD moniker, yeah, now we've got a problem. Now we've got a reason for diagnosis. Now we've got a reason for treatment and a whole program and a whole set of graphs for reduction and a whole behavior plan. A lot of focus on a behavior that might be attention-based. Hmm. Interesting. But yet not out of the realm of typical child behavior. behavior, crying a lot. Oh, but these kids sometimes have a language delay too. So now you're crying on top of that. And then maybe we come in with our better ABA practices and we withhold items that they want because that's our motivating operation to promote repetitive behavior that's desired. So maybe we're part of that tantrum too sometimes, but we're measuring it all the same. I've never seen a graph that says tantrum because staff was held incorrectly or unnecessarily or tantrum because the kid has ASD. We don't have that information.

SPEAKER_00: 21:19

Just like you've probably never seen a personal information graph that said amount of times that the individual responded incorrectly to their name when they're paying attention versus when they're not paying attention.

SPEAKER_02: 21:30

So you're killing me because you're bringing up a million things that I want to talk about and I want to make sure I don't forget.

SPEAKER_00: 21:36

We just know they don't know their name,

SPEAKER_02: 21:38

right? Let's call it ten times in a row ad nauseum. We're being facetious now. We've got to be careful. The point is that we realized there was a lot of abnormal modes of behavior that we were representing under the guise of very well-intended treatment. And yes, I emphasize well-intended treatment. I'm not criticizing anybody. We're all learning here, and that's why it's so exciting to share this, because I feel like we've really, you know, we've happened upon something very important. Back to gradual separation, this idea that kids are going to have prolonged crying, which I like to label now in my reports now, as opposed to tantrum, prolonged crying,

SPEAKER_00: 22:18

right? Communication via yelling and tears might even be a better one.

SPEAKER_02: 22:22

And for periods of time longer than you as a parent can tolerate. Again, not blaming the parents, but that's what we're talking about is their distress is going to make us feel distressed and then we might do things in a more authoritarian or less authoritative manner depending on the circumstance and that's going to guide behavior in and of itself. I love that we're getting into all this. So gradual separation. We're getting into all these topics. Here I am showing our staff videos on Reggio Emilia and molecular gastronomy just to get the idea of innovation flowing. And you guys are probably sitting there. Everybody was very kind, but I'm sure a lot of us were sitting there going, what's Mike talking about? Why is he showing us this stuff? And it wasn't until we got to the joint attention piece that it all started making sense, I think. But one of the collateral effects here was having the privilege of having on-site groups We're able to identify clients that behaviorally might fit in well to an on-site or away-from-home setting where we might be able to socialize in a way that isn't possible just within home services. So a lot of these kids... will come, and of course they have to separate from their parents, and then we might have to contend with the communication through water flowing out of your eyes, down your face, and the screaming, right? Getting really operational here. And trying to move away from this idea of tantrum. If we have a child who has ASD, and they're noticing and lamenting their parents' departure, That is awesome. Absolutely. That means that that aloofness that might also be part of a diagnostic like this is not there. They're noticing that the parent is leaving. So, again, looking at all these premises now and looking at it more from a. developmental psychopathology perspective, a true spectrum perspective, meaning we all have certain traits. And depending on their frequency and intensity and duration, then they become more and more clinically significant based on the response of our environment, for example. So here I have a kiddo who needs to come to group. He's very young. I think he would benefit from group. And I find out, because he's very young and he's just starting his IEP process, not early start young, but past that age, young three-year-old, I am recommending that he come to a building he's never been to and separate with his mom and spend two hours, maybe even three hours at that time, it was summertime, with a bunch of adults he'd never spent more than two hours with, and me being the only adult that he had spent two hours with during my initial assessment. So... It dawned on me, this is not good. I'm not prepared for this traditionally and logistically, because ideally they drop them at the door. We do a quick... goodbye and we're done.

SPEAKER_00: 25:16

And then he gets upset. We would call it tantrum, whatever, when the parent leaves. We have to ignore and redirect because we don't want to ever inadvertently reinforce that with attention. He cries for however long. We mark it as a tantrum and now we tell the parent, oh, your child tantrums. Now that continues that psychopathology from the parent's perspective. Now the parent thinks their child has more of a problem when it's actually a neurotypical trait. But because of that autism or at-risk diagnosis, now it becomes more of a thing. Almost a self-fulfilling prophecy.

SPEAKER_02: 25:48

So to your point, that child is going, I want my mommy. I want my mommy. That's one interpretation versus just now uncontrollable crying without us knowing. any other words that we can understand, but taking crying as a negative, as an undesired behavior, as opposed to understanding it as a completely reasonable and natural behavior for a three-year-old to be admitting whose mother just left when he's in a novel setting. I mean, it's completely typical.

SPEAKER_00: 26:20

Especially one that has limited vocal communication.

SPEAKER_02: 26:23

Right. In words, right? Because he's vocalizing beautifully as he cries. So he comes over. And I realize, okay, we're going to have to do this differently, and that's where it clicks again. Bing school. What would we have done at Bing school? Well, we would have done gradual separation. So that means I'm going to ask this parent to get here early so that we can be in the treatment setting alone with the child before other children come, get them acclimated, and then when the other children come, we'll try to separate at the door and see what happens. Okay? That's as far as I prepared. Well, Child didn't separate at the door. They weren't ready, and now we've got sort of our ethical dilemma knowing that we're trying to maintain a certain level of confidentiality in the treatment setting, and we're not allowing parents, by and large, to be in there, right? So I've got to make a decision, right? Well, the child's not ready to separate. We're going to have to go do something else, but I've got to keep him somewhere close to the setting. Let's go walk around the building. Let's use the elevators. Let's go downstairs to our other office and see if we can play. Whatever it is, you're getting more comfortable with me and with this entire setting. We did this over a span of three to four weeks. And by the fourth week, with increasing times where the... The parent finally was able to leave and then come back in a half hour based on our phone call, meaning that as we saw the child starting to become a bit agitated and look around and get a little bit weepy, we assumed that they were probably looking for their mom. So we had mom come right back and pick them up before any distress started. So we were paying very close attention, right? Which isn't always possible. This was a nice little experiment for us.

SPEAKER_00: 28:04

And that paying very close attention, keep that in mind. That's going to come back up later in future episodes when we talk about contingent and reciprocal imitation. Paying close attention.

SPEAKER_02: 28:13

Yes, sir. That's perfect. So after four visits doing that, we were able to have the child stay the entire time and separate without tears. And then subsequently, later that summer, at the end of the summer, they started school. And that little experience from our groups had a collateral effect on his separation at school. And then they didn't have to go through that because he'd already gone through an experience where he didn't have to tantrum, meaning that there was no fight or flight response that was triggered because there wasn't a need to. There's no need to make a child feel that response, I would say, in a school setting. without some sort of reason. Maybe logistically, yes, sometimes they just gotta grab the kid and make him deal. But the other point that you made earlier is that based on prior practice, like blanket extinction, then we might have had this three-year-old just sitting there crying and not paying attention. This is an attention-seeking behavior, but a three-year-old doesn't necessarily have the self-regulation, autistic or not, to be able to soothe themselves in that circumstance. So something else that we learned there, too, was Know your function. Because for a young child, you might be well-suited to soothe, bring them back down to baseline, and restart your instruction, knowing that as long as you're not allowing access to the tangible or escape based on that soothing, then it's okay. And even if it's attention-based... All you have to do is wait until they calm down before you continue providing any more attention beyond the soothing. So again, a lot of crossovers that we learn from and just examining that one situation.

SPEAKER_00: 29:55

And that also goes back to, as we talked about with Chloe Everett and masking and the whole masking thing and kind of the anti-ABA piece that if that child doesn't have a vocal communication and I'm using that interchangeably with words and they're crying and their mom's leaving and they're trying to let everyone else know that they want their mom and And nobody's willing to listen. Nobody's even acknowledging because it's not done in the way that we want it to be done. That in some ways is masking. We're no longer allowing them to communicate in any way unless it's the exact way that we want. And we're no longer allowing them any way for us to help them meet their needs unless it's done in the exact way that we want it to be done. Kind of in the example you gave, going back to a few podcasts ago when Chloe Everett was talking about that, this may be where some of the validity of what she was saying of that masking premise comes into play.

SPEAKER_02: 30:48

Yeah, I think there's a lot to unpack there. With regard to how we usually... We can typically access or utilize a lot of extrinsic reinforcement in that effort to calm, and that's tricky right there in the sense that... especially for a young child now, we're really not reaching to that, intrinsic peace to calm, to soothe, knowing that somebody's there to take care of you, right? So again, now that with the blanket extinction and knowing that I'm going to ignore you, I'm going to offer extrinsic motivation for you to quiet down when really what we might really be needing here for a three-year-old, for example, is a little soothing, a little calming, a little modeling of that self-regulation as the parent learns to breathe and stay calm with the child. Another child resolves the tantrum or prolonged crying, and now we're back to business.

UNKNOWN: 31:37

Yeah.

SPEAKER_00: 31:37

Absolutely. I love that example. And that highlights kind of the story, right, as we're about to move here into joint attention. I just want to put a little bit of a recap onto that and kind of how we got here because that was a super rich story from the Bing school to the gradual separation of the Bing school and those experiences giving you kind of the understanding of the neurotypical environment and then your work experience with the ASD environment and then now having this early start modality where we're an ASD provider. with a client without an ASD diagnosis. So how we would do different modalities. And I'll speak from a little bit more of a management perspective, but I could also see the parents, because they talk about their level of satisfaction with services. Parents, and also I can speak specifically to RBTs, were really satisfied with the services that they were getting with this early start. It just felt better to the parents. The RBTs felt better with it. Everybody felt better with the services that we were giving for the small subset of population that we had. We were still doing our more traditional ABA services for the over three with those that were diagnosed. But this under three, everybody was just feeling really, really good about it. So over time... We started to implement some of those methodologies into the older demographic that we worked with because if we're doing different services for those individuals that are not diagnosed because they're not diagnosed, but yet we're trying to typify the treatments for those that are diagnosed, maybe we should utilize some of those treatments that are done with those that aren't diagnosed for those that are diagnosed because they'll be a little bit more... you know, typified treatments and more evidence-based, more along the lines of the least restrictive, I guess, would be the best way to word that procedure, as we're always trying to achieve. So I think that's kind of how we got to where we are today, and then I'll pass it back to you. But how most of these early start modalities and procedures have integrated into our Older, the treatments that we do for individuals that are over three, but not only over three, diagnosed with ASD, and we're now able to do treatments that look very similar to that Bing school that you talked about and very similar to treatments you would find not in ASD treatment, you know, in a Lovaas lab, but in a fun preschool. And sure as heck, it's been really effective for the individuals that are also over the age of three with ASD diagnosis. So it's a little bit of a recap to kind of how we got here. I'll pass it back to you, Mike, to continue. But I think that's kind of the moral of this story of what we're trying to get across here.

SPEAKER_02: 34:20

Thank you for that recap. I think that's super important. So I'll spend a little time. I had no idea. I remember early on being very explicit with our staff and saying, now, this is just for early start, right? We can probably, ad nauseum, I would say that. And then suddenly I realized that the only reason I was saying that was my own fear of failure. presenting something so... So I had this great excuse in changing the methodologies, right? Hey, these kids don't have autism, right? So we've got to change it. That's our hypothesis. So that was a great motivating operation for us. But there was a lot of fear, to be honest with you, because we have a great team. Change is hard. Change is difficult for anybody. And so there was enough skepticism to make me discouraged because I was already kind of fearful and not... It's interesting to look back on it now because it was not necessary. It was a matter of the learning curve and knowing that I had spent some time getting comfortable with these topics and now I'm presenting them in this heretical excitement and I'm gesticulating and showing you guys all these strange videos. And so, of course, it couldn't have been more well-received by the team, but I had a lot of fear in being very honest and saying, yeah, this is what... else we can do. So there's a couple of things I'll say, and then we should jump right into joint attention because this is quickly turning into a multi-part series. And I think that's okay. Maybe we'll go over the whole developmental treatment model at once or something.

SPEAKER_00: 35:58

So yes, I absolutely can understand and respect the way that you went about it because I feel like ABA kind of had this wheel, but it was a square wheel for a long time. And you can move a square wheel. It works in terms of trying to typify arrangements and help kids in integrate into less restrictive environments, and you would just slowly try to chip away at the wheel. And people kind of liked their square wheel, and it worked. And it's uncomfortable sometimes as you're chipping away because now that material's gone, so what if the new wheel you're making doesn't work? But I think we found that this methodology makes much more of a round wheel, and as we all know, that turns much better and more efficiently.

SPEAKER_02: 36:39

So... Quickly, I can see that we could probably spend the next 30 minutes just talking about this integration and this early start motivation or piece, and then get into joint attention. Again, maybe we'll see what happens, because you keep making some really important points. The first one that I would speak to this thing called joint attention that we don't seem to talk a lot about. Well, we like to talk about it, but we don't really... I'd never seen a joint attention program, so to speak, or anybody really focus... Although they'd focused on certain aspects of it, they'd never really brought it all together.

SPEAKER_00: 37:16

It was one slide in the previous company that I worked for that we had, like, a two-week training. There was one slide on joint attention.

SPEAKER_02: 37:23

Yeah, so I came across this thing called joint attention, and the more I read into this research, the more... I also saw the idea of language development and the development of play skills. So we've got imitation, joint attention, language, and play. Those are all the ingredients we need. That's it. That's all the stuff, right? So I started thinking, OK, how do you put this together? Well, if we're starting with imitation, but joint attention's a deficit, how do you imitate if you're not attending? Well, you prompt through it, right? You do, you do. Oh, okay. Well, that's one way, but maybe there's an antecedent-based effort that's more continual that we can do to not have to prompt. And with this idea of maybe us being a little bit encroaching or a little bit too quick to physically prompt in some cases, now we might allow for the child to demonstrate some sort of consent before we prompt because we've done everything on the front end. Wow, this is coming together, right? Yeah,

SPEAKER_00: 38:28

so it all came down to joint attention, and those two words have revolutionized the ABA that we've done the last three years since you ventured on this program. I think we should put a pause in it, start next week on exactly how we implement it and what this means.

SPEAKER_02: 38:47

People got to come back. They've waited. So we're not going to jump into the exact joint attention piece until next episode. But let's riff a little bit longer, if you will, on some of the other pieces that we've learned, right? So we talked a little bit about gradual separation and the idea that tantrum behavior, maybe we were a part of it in terms of maybe using some prompting or blocking procedures. Maybe we were withholding at times that wasn't necessary.

SPEAKER_00: 39:17

Sure. They were probably engaging in joint attention, actually, when their mom was leaving. Say, we're looking and pointing at mom, like, I want mom. But we weren't acknowledging it because we didn't know about joint attention.

SPEAKER_02: 39:27

Right. And the other piece being that I'll mention really quickly, and we can discuss that a little bit, and then, yes, let's end for today knowing that we were supposed to talk about joint attention, and all we've done is introduce the reasoning or our motivating operation for happening upon joint attention. I like what it's done, really. For example, with how we approach visuals in our early start practice. Visuals, just like sensory, are two terms that we talked about in our Strange Technologies podcast. Words, phrases that have become very common in our tradecraft that are hard to define and actually, when it comes down to it, maybe don't mean a whole lot. But We were able to expand on those pieces, knowing that visuals are anything that a sighted person can see, and realizing that from an early childhood perspective, books. Books are a very common stimulus that every developmental assessment asks about in terms of turning pages, being able to do some joint attention behaviors on each page. it really has changed the way we conceptualize it, knowing that, well, wait, we're using very specific technologies, visuals, these one-by-one, two-by-two laminated cards, not knocking those. There's a reason for those, and we can elaborate that on another episode. But the idea that now we could use more commonplace, visually-based stimuli like books or manipulatives, right? So the idea that it doesn't have to be a square card. It can be something that's cut out in the shape of the actual object.

SPEAKER_00: 41:03

No, it has to be a square card first. ASD has to be a square card. It has to be about six inches by three inches laminated. And

SPEAKER_02: 41:11

then top to bottom, left

SPEAKER_00: 41:13

to right. And then if there's any Velcro, hard has to be on the card.

UNKNOWN: 41:17

Oh, shoot.

SPEAKER_02: 41:18

Whoa, you're going way back there. Hard on the card because of sensory issues, right? Correct. Anyway, so a lot of those hard and fast cards, rules of thumb that, you know, we're kind of poking fun at them, but they allow us to be systematic in our practice from a job perspective. But so much of that then has sort of spilled over into some sort of therapeutic attribution. So like you're saying, I mean, we're kind of joking about it, but unfortunately, no. You know, a lot of these things like, yeah, let's use visuals. They need sensory play, which I've said here before. Name me a type of play that isn't sensory based. You know, please. Any of you listening out there, if you want to message us, call us, hit us up on Facebook. Name a type of play, unless you're in a sensory deprivation tank, that isn't going to be sensory-based. But there are these phrases that we've used that I think this new view that we're taking in terms of a developmental psychopathology approach, in terms of combining early childhood best practices with this idea of early start ABA. How is it going to be ABA-based and have that repetitive practice and use those motivating operations based on now more intrinsic motivators how are we going to keep all that but make it look like the best preschool program or the best I hate to put it this way but it's like the most fun nanny or babysitter situation you could have but it's therapeutically and intervention rich right so it's allowed us to redefine a lot of these for lack of better phrasing strange technologies that we've gotten very accustomed to which has allowed us to look at our clients in a whole different perspective knowing that You know, we're not dealing with diagnosed children here. We're dealing with more of a preventative effort, which is super exciting.

SPEAKER_00: 43:06

Yeah, yeah. And if we have our way, we talked about how we got here with the Early Start program. If we have our way, ABA will be looking different in the next 5, 10, 15 years. And the main catalyst for that are these two words, joint attention. Everything that we're talking about is going to be based on that concept. And we'll continue to talk more about that in this joint attention series. But keep those terms in mind because that's going to be essentially the catalyst of how ABA can look different, be more humane, and maybe we can decrease some of those anti-ABA Facebook groups as well just through these concepts of joint attention.

SPEAKER_02: 43:46

Well, that said, this is probably a good place to stop for today. Thank you for listening to the background. I know that... I got to talk a lot about myself, which is exciting, and I'll leave it at that. Maybe rather egotistical, but thank you nonetheless for listening. I do think that it was an important historical background to give, so thank you, Dan, for allowing for that and actually prompting it. Because as we get into discussing joint attention, we're going to do this dance back and forth between ABA, and best practices in early childhood education and what this hybrid that we're working on looks

SPEAKER_00: 44:20

like. It's important for people to know why, just like with our company. People want to know why. People want to go and just kind of do the same thing yesterday or today that they did yesterday. And it's uncomfortable for like tomorrow. I want you to throw out those things you've done the last six years and do something different. That's really uncomfortable. So I think it's important for everyone to know why, kind of where this came from, so that when we talk about what it is and then also how effective it is, people have the full picture. picture and it maybe can be a little bit more uncomfortable or a little bit more comfortable.

SPEAKER_02: 44:48

All right. Well, thank you for your attention. Please, please do reach out to us with any questions, concerns, comments, ideas, and always, always, always

SPEAKER_00: 44:59

analyze responsibly. Cheers, brother. Glad to be back.

SPEAKER_01: 45:04

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.