Escalation Cycle Part I

In this episode, Dan and Mike tackle a very important and dense topic--the idea of a cycle of escalation as it pertains to behavior management. Starting from the perspective of crisis management, specifically considering a familiar and widely-recognized system like 'Pro-Act,' the premise is to consider not just the outward behavior itself, but perhaps more importantly, the internal antecedents and correlates from a brain and behavior perspective. In this first portion of a multi-part series on escalation, your hosts walk through important factors in autonomic arousal, as well as the work of the sympathetic and parasympathetic nervous system in so-called 'assaultive' behavior. More importantly, the notion of what this can teach us with regard to all behavior management approaches is explored. That is to say, any deviation from baseline can be considered an escalation, such that there is much to learn about with regard to managing and preempting challenging behavior from contemplating crisis. Dan and Mike begin to explore the empathetic aspects of understanding the experience of an individual emitting challenging or even assaultive behavior toward safely and effectively responding, not reacting. All of this in an effort to work back down to baseline, and allow learning to continue more freely, adaptively and collaboratively.

Sit back, pour yourself a tall beverage and enjoy this very complex episode. And more than ever, 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_01: 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, etc., 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_01: 1:08

We use Buzzsprout and we love it. Buzzsprout will give you a great looking podcast website, audio players that you can drop into other websites, detailed analytics to see how people are listening, tools to promote your episodes and much, much more. So here's what you'll do if you want to start your podcast today. Follow the link in the show notes. This lets Buzzsprout know we sent you. It gets you a$20 Amazon gift card if you sign up for a paid plan, and it helps support our show. So make it a great day today. Get on to Buzzsprout and start your podcast. Inform the world. And of course, always analyze responsibly.

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_01: 2:42

All right, all right. Welcome back to ABA on Tap. As always here, your co-host, Mike Rubio, along with my gracious partner, Daniel Lowry. Dan, how you doing? So

SPEAKER_00: 2:54

good to be back and in between fighting off of this continuous 2020 bugs that have been coming in and out, but so good to be back. We're going to finish this year strong and have a really good momentum into next year, which I'm super, super excited about.

SPEAKER_01: 3:06

Dan, somewhat alluding to my experience with toddlerhood and currently with my daughter and She's building up her immune system, having attended daycare here for a few months now. And man, I tell you that the clear snot and that cough, it's just been persistent since like, I don't know, end of July, early August. Can't get away from it. We're away from it for about three days. But I guess that's how kids build immunity, huh?

SPEAKER_00: 3:32

And that's also how we got into today's topic of escalation. Is that right? Yes, I'm sure you've experienced plenty

SPEAKER_01: 3:39

of it. Oh, there's been a lot of fussiness for sure. Of course, I'm referring to my daughter when I say that. But no, that's a good way to segue into this quickly, even though we've got to take a step back and do some shout-outs. Yes, yes. We've had some really, really good response on Facebook from some listeners out there, so we want to shout you out, starting with Jennifer Main. Jennifer Main from Florida, I believe. Shout-out to you. Thank you so much for listening, tuning in, and giving us your feedback. And then certainly Jennifer Stevens out in Kentucky and the Stevens Behavior Consulting Group, who also seem to tune in and send us some feedback. We really appreciate your listenership. We're always open for you to reach out, give us a call, email us, give us ideas for topics to talk about. If you want to come on our show. Reach out. Let us know what you want to talk about. And we're more than happy to entertain that, especially toward next season, where I think we're going to ramp up the guests here on ABA on Tap and get ourselves some new gear and some new ideas flowing through here. Well, with that in mind, Dan, you've already hinted what the topic for today is. Today we want to talk about, I guess, escalation cycles. Sometimes we term that as crisis management. Particularly, we want to talk about the idea of the most severe behaviors, say, assaultive behaviors that we can face, not because we want to entertain the idea of always encountering these assaultive behaviors, but more specifically, what can we learn from crisis management toward day-to-day behavior management, especially with regard to how we react and respond to those behaviors.

SPEAKER_00: 5:22

Yes. So as always, we're going to give some applicable strategies, which I can do being a certified product trainer, which is a crisis management intervention, and also give a little bit more of the abstract kind of holistic look at things. Kind of where this came about in terms of the autism realm, again, as I mentioned, I am a certified product trainer, so that's used in our area for a lot of school cases and things like that where clients may become assaultive. Again, this goes goes beyond just autism, and this is for individuals in group homes, schools. institutions, police officers, but also maybe about six years ago when we started to partner with the San Diego Center for Autism, San Diego State Center for Autism, they did a symposium and they asked parents the number one thing that they were interested in receiving some training on, and that was crisis management. So Mike and I have done numerous presentations with Vincent, who's no longer there, at the San San Diego State Center for Autism, with many parents throughout our community, providers, et cetera, on some strategies for crisis management. So this is going to be a discussion of that, which may go through multiple episodes. So I guess the first thing, let's talk just a little bit, setting the tone here, is it's interesting that parents number one request was crisis management. Now the question is how often are these parents in crisis? How often does the behavior present a crisis versus how often does it maybe feel like a crisis either because of the perception of what might happen or the quantity over the magnitude or quality? Let me ask you that and then I'll kind of go on my spiel.

SPEAKER_01: 7:14

That's a really interesting question. Again going back to that initial meeting at the Center for Autism at San Diego State and us listening to those parents And they specifically wanted to be trained in PROACT. I think they were using that phrase specifically. And that was, in fact, the question that we came upon in saying, well, wait a minute, why would a parent need that? How often would a parent need that? Knowing that you couldn't certify them in the crisis management system, per se, it was our venture to then apply everything that applied or to try to capture everything that applied into a presentation toward more behavior management. So to answer your question we didn't think like or we didn't perceive that these parents were facing that much crisis, but they were perceiving a lot of difficult behaviors as crisis, and maybe even thinking about the idea of having to physically restrain toward resolving those behaviors, which I think is quite a misapplication, if I'm not mistaken. Now, I spent very, very early on, eons ago, early on in my career, I do remember the first time I worked at a non-public school, and there was a different crisis management system that was used there. And the facility was equipped with quiet rooms and places where a lot of these procedures could be implemented. And I remember thinking to myself as a young professional, wow, there's a lot of restraint happening around here. And how much of this is really necessary or how much of this has spilled over into more of an authoritarian mindset with regard to behavior management? You know, things like a child maybe turning their desk over, not really trying to hit anybody else or not hurting anybody else But at that point in time, again, kind of eons ago without dating myself, the idea, well, that the child was going to hurt the environment. So that was okay now to apply physical restraint because of that. Clearly, I think that the field, our mindset as people in general, even through law enforcement incidents, hopefully we've evolved and come a long way away from that. But again, back to your original question, I think that's what I felt like these parents were alluding to. Sure. physical force. to stop certain behaviors. And I think today we're going to spend some time really clarifying what behaviors might require physical restraint versus, again, what can we learn from crisis management toward general behavior management that hasn't yet hit an assaultive level, per

SPEAKER_00: 9:45

se. Sure. Yeah, I think like you're saying, perception is reality, right? So if there's somebody with a hand grenade in front of me or something like that, that's going to be a crisis pretty much wherever we're at. That's pretty universally going to be crisis. But some of the things, like look at COVID, for example. COVID symptoms two years ago may have been a crisis, and now we have a better understanding of protocols and things like that and call-out methods and things like that. And while it's not desired, we have strategies and ways of going about it and dealing about it. So while undesired because of that, because of our strategies, may not hit the level of a crisis. And I do think language is very, very powerful. And when we label things as crisis, when we label things as something terrible or something out of control, even somebody's manipulative, I think it kind of, again, language is very powerful. So we respond as we label things. So Because of that, I did want to talk just briefly about the difference between stress and distress, which is something you've harped on a lot. And I was not made aware of until you did a nice presentation with our team, again, maybe five years ago. Because I think that difference between stress and distress is very, very relevant to what we're going to be talking about. And stress, I'll preface it and pass it to you, Mike, being... just the general elevation of our physiology or respondents and response to various things in the environment versus distress being when that kind of topples over. We may go into fight or flight mode, which we'll talk about a little bit later, but then that becomes the point of where we're no longer rationally thinking about how to problem solve. We're kind of just so focused on the fact that we're stressed. We're kind of in a circle here because we can't really deal with it. We don't have a strategy. So if I could pass it to you to maybe talk a little bit about that difference between stress and distress, because I think that sets a really good tone for what we'll talk about.

SPEAKER_01: 11:37

So I think that you've hit the basic principles there already in just alluding to fight or flight mode or the idea of autonomic arousal, more importantly, the sympathetic nervous system, then maybe at some point requiring our parasympathetic nervous system to kick in and bring us back down to baseline. And again, you spoke about sort of perception and its relationship to reality for every individual. And I think that's where today we're going to try to dissect a lot of those differences between stress and distress for example so stress as much as we kick it around as a general term you know we're stressed and people deal with stress actually stress is what you go to the gym for sure and after a good amount of time on that treadmill and you hit that runner's high for example now you're in eustress right this is something about an arousal of your central nervous system one of the variables here that now is working toward making you feel good. But we've used this word stress with a negative connotation, almost like negative reinforcement. Immediately people think negative, negative. Well, stress has a negative connotation.

SPEAKER_00: 12:43

Or manipulation has a negative connotation. Consequence has a negative connotation.

SPEAKER_01: 12:47

Exactly. Everything sort of, we've been looking at it from a negative filter, right? So you're absolutely right. Stress is something we want to bring on. Stress is helpful in solving problems. But now the distinction that you'll help make today is the tip over into distress where now you are in fight-or-flight mode, all the physiological effects that are happening when you do kick into fight-or-flight mode, and more importantly, the amount of time that it truly takes an individual to go through that cycle, kick in their parasympathetic nervous system to then bring down respiration, bring down heart rate, all those things that allow them to dip back down below baseline, back into baseline, and now we can start working. So when we talk about a kid having a tantrum, we may or may not necessarily be talking about a fight or flight response. There are parameters of time, parameters of physiological markers, again, respiration, heart rate being two very basic ones. that we would have to measure to make a distinction. Now, we can't look at somebody's brain, but we also know that there's a big difference in what's happening in somebody's brain between something stressful and distressful. So stress is something that your immune system goes through when it first gets exposed to a cold virus, right? It is. It goes into some sort of stress and it starts developing certain antibodies and responding and you get a runny nose and to try and stuff up your nose and keep the virus from going further into your body. These are These are stressful things that are necessary to resolve problems. But now when that viral load takes over you, now you're at a point of distress, immunologically speaking. So now you might be getting a fever. You might be doing other things, physiologically speaking, to try and fight that off. Now facing some sort of behavioral stimulus, some sort of undesired response from your environment. takes a very similar course. In fact, if we look at escalation cycles and things like action potentials in neurons, they follow the exact same curve of activation, which is really fascinating. Maybe we'll spend some more time talking about that later. But you're really hitting home with this. What is that difference between stress and distress from that physiological aspect, what's happening in the brain? And we're not brain experts. We've got a little bit of background here. But it is important to understand these things so that we speak that technology, and then we can speak to it behaviorally with regard to how we might respond. So whenever somebody says taking deep breaths is a self-regulation strategy, This actually ties right back into what we're talking about today, although all that background knowledge may not be something that is immediately trained to us or lent to us when we're saying, hey, blow out the candles, which is even something more important we will talk about because how we breathe in order to help de-escalate is something very important that maybe the field needs to look into a little further. So you're going to help us delineate today that difference, stress and distress. Stress being something desirable, even though the connotation generally doesn't state that And distress being what we want to try to avoid, what we want to try to help de-escalate within reason as soon as possible, because I don't believe there's any learning or much learning happening in a distressful situation.

SPEAKER_00: 16:02

Yes, yes, that was a lot to unpack there. I guess, yes, stress being desirable, maybe it's more neutral, but it can be channeled in desirable fashions, whereas distress... maybe not so much right stress is what gets you to worry about getting a good grade on a test so you're studied because you're stressed about the test so you're studying about it where distress is i i don't know any of the information i i don't know and you just spend all the time just worried about what to study or that you don't know the information so you're not able to channel channel it productively to study

SPEAKER_01: 16:34

so stress is a motivating operation yep and distress maybe as a motivating operation but only if you can hold it or contain it within a certain level and bring yourself back down.

SPEAKER_00: 16:46

Yep. And then, again, differentiating, getting slightly technical here, from a behavioral perspective, stress would be the behavior. There would be an environmental antecedent, and then your reaction to stress would be the behavior, where more maybe traditional psychology or mentalism would look at stress as the antecedent. So I think that's... That's good, as you talked about too, Mike, kind of looking at it as that motivating operation, right? But you also mentioned fight or flight, which is kind of the direction I guess we'll go, because that's what a lot of... This crisis management is going to be based on, and that's what sends us potentially from stress to distress is that fight or flight response. So basically what that is neurologically is starting from that amygdala. That's like your, I like to think about it as like the submarine alarm on the submarine that there's like a, there's a, there's a problem. It's like the fire alarm. That's your amygdala triggering. Like there is a problem. And again, all of this is an evolutionary pathway. So it's not really learned or unlearned. Basically, You learn or unlearn what can trigger it, but once it's triggered, it goes down the evolutionary pathway through your brain, eventually into your kidneys, which produces stress hormones, cortisol, stuff like that. Yeah, so that's the kind of fight or flight pathway. You know, a lot of you have heard of moms picking up SUVs because they're in fight or flight mode, or we would call it they have had adrenaline kick in, literally picking up SUVs to pick up their kids under it. Normally wouldn't have nearly enough strength to do that, but... Because you have increased blood flow to your extremities and things like that. You have increased strength, reactive abilities. You're faster. I can speak to that after my motorcycle accident. Right afterwards, I felt nothing. Again, those are stress hormones. Those are fight or flight. And adrenaline kicking in. And then 15 minutes later, I felt the most excruciating pain in my life. Again, that's not a cognizant or cognitive thing. That's just a reaction that our body comes into when we experience fight or flight responses. So I want to relate that back to the brain. Before I do that, though, Mike, anything you wanted to chime in there?

SPEAKER_01: 19:07

No, no, keep going. I think you're on a good roll here, and then we'll dissect. I know there's a lot to unpack here, and again, we're trying to make a lot of comparisons between regular, unnerving, undesired behavior, and this idea of now fight or flight, right? Thinking that maybe tantrums might be similar to fight or flight. More importantly, what can we learn about the way we manage those things? Sure.

SPEAKER_00: 19:30

So I guess the question then becomes, if this is a natural pathway from our amygdala through various portions of our brain, literally into our kidneys, do we stop that by making the amygdala not trigger for certain stimuli? Or once it triggers, are we able to slow it down and kind of recap it? And I think potentially both of those are an option. Like, I hate heights, right? So through desensitization, theoretically, right now, heights trigger my amygdala. They trigger my fire alarm in my brain. But over enough desensitization, I could make it so my amygdala no longer triggers when I'm presented with heights. Or probably more commonly, what we would do in ABA is some of these things might still trigger your amygdala, but can we interrupt it before it really starts to produce a lot of stress hormones and before so much blood leaves the brain that we're no longer able to kind of recoup ourselves? So where that comes from is, and going back to the example of the woman picking up the SUV with her child under it, is all of this extra blood flow comes from somewhere. It's not like your body just magically starts producing extra blood. You only have a finite amount of blood, and it has to come from somewhere. And where it comes from is the brain, specifically a couple of places being the prefrontal cortex. So a lot of you are probably pretty familiar with what that is, but that's part of our brain, the big front of our brain that separates us from a lot of other animals. and allows us to basically think about thinking or the executive function or cognitive functioning part of our brain. So I see something happen in front of me, and I don't just react to it like my dog might just bark. I'm able to think about it. And if I do option A, this is what happens. Or if I do option B, this is what happens. I see somebody drop a$20 bill. Should I let them know, or should I pick it up myself, right? I'm rationalizing a situation. Somebody wrongs me. Do I hit them? Do I yell at them? Do I ignore it? Do I ask them what's wrong? I'm trying to rationalize the situation, before I react to that. And that's kind of your prefrontal cortex, being able to, first of all, stop and rationalize the situation, and then also rationalize the situation and think through it. Skinner would call that prevocal speech, but basically how do we go through this in our head and come up with a game plan that's gonna be best suited. A lot of people might refer to that also as impulse control. How do I not take the one cookie now for two cookies later. That's the prefrontal cortex. And that's an area that doesn't finish developing until late teenage years in females and I think early 20s in males. Really interesting research on that. I won't talk too much about that. But this is something, too, that I think sometimes we get frustrated about that Maybe our kids don't understand. They start to develop theory of mind and then they start lying all the time. Well, that's kind of a new skill that they have. Learning with the prefrontal cortex or, you know, murder. Murder, we would say, or you use aggression, right? A lot of us look at aggression as a negative behavior. But what if you're about to get beat up or your daughter's about to get beat up? Well... aggression might be a positive behavior. Same thing even with, like I said, murder. If you're an army, maybe it's a different thing. So there's a lot of nuance in the world that we learn through experience, both contingency-shaped and rule-governed, that eventually shape our prefrontal cortex and give us the ability to rationalize these situations. So that's the first place that Blood kind of goes away from when we get into fight or flight mode. So we lose the ability to rationalize. So I want to highlight this. I'll talk about this a lot more after I pass it to Mike. But I want people to think about this almost empathetically or almost compassionately, that when an individual is escalated very highly and they don't have blood in their prefrontal cortex, it might not be that that individual is saying, you know, F you or whatever. Trying to attack you, I think a lot of times we put our own feelings into a situation and say, oh, they're trying to hit me. They're really trying to hurt me. They want to hurt me. It might not be like that. They might literally not have enough blood in their prefrontal cortex to rationalize what's going on in that situation. So rather than them saying, I'm going to hit Mike because I don't like Mike and I want to hurt Mike, it might just be a reactive thing. And I think that's an important... thing with the prefrontal cortex that until we get blood back in that prefrontal cortex, they're not going to be able to rationalize it. So we can try to use whatever behavioral stuff. They're not going to be able to process it and rationalize it until we get blood back in that prefrontal cortex. Let me pass it over to you, Mike. I know I've talked a lot, and then I'll go more into the brain stuff, but I know that's a lot to digest.

SPEAKER_01: 24:38

Certainly a lot to unpack. Excuse me. A huge, huge topic we're dealing with today. And again, it's going to be a challenge for us to dissect as well as draw relationships between these concepts. And I say that because I'm about to jump into that pool right now. So what we're saying is from a prefrontal cortex or frontal cortex perspective, a brain development perspective, we're looking at a part of our brain that is going to develop gradually over two decades for any of us. And I mentioned some of the physiological markers earlier that might hallmark, say, a fight or flight response, respiration, heart rate, things like that. Well, those are two things that maybe we could consciously try to control as we just heard a gunshot outside We're able to take in the situation, knowing that I'm sort of referring to the moral reflex, right, the idea of falling backwards or loud sounds, something that we never really get rid of from a fight-or-flight perspective because it alerts us. So you hear a gunshot outside. Everybody usually kind of ducks down all of a sudden. You look around. You take in. You realize that... There's no danger. You don't hear another gunshot. You're able to now rationalize. You start talking to people. What was that? Do you know what that was? Where did that come from? So you've got all this language and all this perceptive ability to start to bring that response or that reaction. Let me use that very poignantly. To start to bring that reaction down before it tips over into fight or flight. You want to

SPEAKER_00: 26:04

jump in? Yeah, I was just recently in Vegas maybe like two months ago and there was what somebody thought to be a gunshot which actually wasn't a gunshot but literally eight hotel worth of people down the strip just literally started running all throughout that, kind of from that distress point of an immediate stimulus, not even being able to rationalize what's going on in the situation. Literally everybody started running. It just made me think about it when you talked about the gunshot example. I was living proof of that as I hid in a hotel room for 20 minutes until I realized it was somebody who threw a rock at a glass like eight hotels down the strip. So

SPEAKER_01: 26:40

the moral reflex, very, very important thing that you can look up here. Because again, developmentally, we're born without the ability to soothe ourselves. So we're talking about hitting a point of distress or even a high level stress. It means that we develop skills over time, whether it's realizing about our physiological markers, trying to slow our respiration down towards slowing our heart rate down, which can help curb that fight or flight response or keep it from I guess hitting that threshold where now you have to let it run its course. So we're not born with that ability, right? That's why the rocking and the swaddling and the shooing and all those things that parents do that I've been doing actively for 20 months now is very important. The idea that you can do certain things to soothe yourself. Other people can do certain things to soothe you such that you're able to manage stress without hitting a point of distress, right? So we're talking about central nervous system. We're talking about self-awareness. We're talking about a part of your brain that needs to develop gradually for you to be able to understand your escalation in terms of your heart rate. And I just heard that gun sound. And then now I'm thinking about it. I'm listening. I'm interpreting. I'm watching what other people are doing. If they're running, well, they must see something that I don't. I better run with them. All these stimuli that are now being processed through your frontal lobe, depending Now, let's think about a lot of the clients we work with day to day. How many of these skills are online even, say, at age seven, eight, or nine? Not a whole lot. Sometimes, a lot of the times, the reason that they're receiving services from us is going to have to do with some aspects of their ability to perceive stimuli from all around their environment. The idea to communicate that fear, which helps a ton in that situation, not knowing who you were in Vegas with, but, hey, did you hear that? What's going on? Even those simple questions and getting that feedback that information is going to help you regulate that distress response a lot of the kiddos we work with are challenged are facing struggles with a lot of these skills a lot of this level of understanding so now you add that to their level of brain development to the natural moral reflex to the idea that often in order to create motivating operations traditionally we've withheld certain desired things and now we've got a beautiful recipe for escalation certainly challenging behavior from day to day, certainly depending on how rigid our own techniques and procedures can be, how restrictive they can be, now a real threat. Hey, that's my toy. You're in my house. Why did you take it away from me? You're withholding it from me. My mom's not helping. I keep telling you no. You keep insisting. Yeah, maybe now I am in a fight mode. And now I'm assaulting you. And herein lies then our better understanding of, well, number one just because we know these techniques does that mean that we want to get to use those techniques or in fact what we're saying dan is the reason we learn all this stuff is to never have to use these things if we can avoid it

SPEAKER_00: 29:54

absolutely the the proactive side of side of things so we've got that prefrontal cortex which you talked about and then the hippocampus is another another big big one and a lot of that's dealing with the uh you know short-term memory centers of your brain and um how do how do i draw where do i draw from um to alleviate a situation. And a lot of times, well, when anyone gets upset or escalated or stressed, the blood also leaves that part of the brain as well and goes into the extremities. So I think that's really important because when A lot of our kids, first of all, struggle with communication. So language might be very difficult for them. Whereas, you know, if I see a box, I know it's a box and I can quickly get that word out. For some of the kids we work with, it might be difficult to think about, okay, see this four-sided cardboard thing. What word is that? Okay, that's box. How do I say that? How do I get that out? That's a process. And that can be when there's less blood in the hippocampus, that memory center is not working as well. So it's going to be very difficult for them to come up with things. So when parents are like, Use your words. How are you feeling? What zone are you in? Things like that as individuals start to escalate that might not be very effective as the blood's leaving the hippocampus and they literally can't remember it. So the more people get frustrated with them not remembering it, it's not necessarily that they're saying, screw you, I don't want to tell you. They might literally not be able to remember it. So as we talk about this again, going back to the compassionate care, how can we be more compassionate of this individual? and help them out. Going back to what you said too, Mike, I think it's important too, you were kind of alluding to the way that we did things historically and the blanket extinction or removing all attention from these situations put people in increased fight or flight responses because you were talking about self-soothing, right? If we're never able to, in order for our behavior to increase, we have to reinforce it. If we're never able to get this individual to successfully deescalate, Because we're not allowing them to deescalate, or we're not showing them how to do it, because if they're not doing exactly what we want them to do, we're completely disengaged, then they're spending, number one, longer times in fight or flight mode, which is clinically shown to have negative effects on development, but also they're not learning those self-regulation skills, which you talked about, or how to self-soothe. So we might have these seven or eight-year-olds that have self-soothing skills, like two or three-year-olds, because we've never demonstrated, and maybe as a We've taken some accountability there because we've disengaged ourselves so much from allowing an individual to self-soothe. Go

SPEAKER_01: 32:35

ahead. So I'll pause you there just for a second. Let's see if I can articulate this because I think that we face a real general quandary that maybe you and I can speak to right now. And I think, I don't know that I've ever heard anybody describe this, so let's see if I can do a good job. But we're sort of caught in this dilemma, right? especially if we're talking about a lot of the clients, the age that I work with. When you don't yet know how to self-soothe, and now maybe you're facing a developmental delay, which means there's other aspects of that that have kept you from learning that skill a little bit. And we're going to talk, you allude to a very traditional approach of sort of blanket ignoring, being equated to extinction, which now we know much better. We know a lot better, and we've been talking about it for a while. But this idea that this is going to be tough. So one of the reasons we perhaps one of the reasons that we talked about blanket ignoring as extinction was in order to ensure that we weren't responding in any way to reinforce the undesired behavior. Of course, yep. Yet what you just talked about, which makes a lot of sense, is developmentally speaking especially, we might have clients at the age or at an ability level where they're not yet able to soothe themselves. Yep. Which means that we're going to have to help soothe in order to get back down to baseline to some sort of learning baseline, right? But therein lies the risk of us inadvertently reinforcing an undesired behavior by paying attention to it. So let's talk about that a little bit, because I think you and I, our team has... dealt with this for a few years now. I think we've got some really good responses or ideas with regard to this, but maybe that's where we got into trouble, right? And it makes a lot of sense. Sure. Hey, this kid is vying for attention inappropriately, and now they're escalated because we didn't give in to that first bid for attention, so now I'm going to sue them and give them that attention and run the risk of reinforcing that undesired behavior? Yeah. Well, OK, that's a good question. But if I don't do that, then there's a good chance that I'm going to run 45 minutes to an hour of this behavior. And now that entire learning opportunity is lost. We can never recover that time. Give me your thoughts on that.

SPEAKER_00: 34:55

Yeah, yeah. So I think there's two things. One, my kind of funnel of when I advise parents on how to deal with any situation that comes up is the first question is, is it a can-do or a won't-do? So if the child has no other way of soothing themselves, then it's a can-do. It's not a won't-do. And I think historically... We treated it often as a won't do. And if it's a can do, we have to teach. If it's a won't do, we have to motivate. So if they don't have a better way to self-soothe, then we need to get some better way to self-soothe in their arsenal and teach them. And then the other thing that makes me think about is with our ethical code, there's kind of three... Three ethical codes that guide our practice. What is the right thing to do? What is worth doing? And what does it mean to be a good practitioner? I think it's that second one that I want to focus on. What is worth doing in that situation? So there's always a risk versus reward, right? With anything. Is it worth getting shoulder surgery or is physical therapy going to figure it out? Is it worth me putting this behavior on extinction to deal with holes in my wall in my house and stuff like that? I think as we become more seasoned, we're looking back on what you're saying and saying, is it worth us risking having a child be in fight or flight mode for extended periods of time to make sure that we don't inadvertently reinforce this one behavior, or is that not worth it? So on the short term, I think we were maybe thinking short term. So we were on the short term, like, yes, we don't want to... I don't want to have to answer to somebody why I reinforce this inappropriate behavior. But I think long term, that might actually have more aversive effects of an individual being in fight or flight. Well, even like in the longer short term. The individual being escalated for long periods of time, so they've lost all their motivating operations. So how are we going to get them engaged and teach them the desired behavior? And the longer long term of individuals being in the fight or flight response, the distress response, for longer periods of time where there's actually brain development issues that come about this. There's been research that shows that individuals that spend time in prolonged fight or flight have different brain development than individuals that don't. And I hate to say that maybe we've been a culprit of that. I would like to think we're not, but that might be Rose Sunglasses thinking that by some of the advice that we had given historically about don't give in to this behavior. And well, parent, you've got to ignore it until it stops, have put kids in fight or flight responses for an hour that may have been counterproductive, even though by ignoring the parent may not have given them what they wanted in that initial time.

SPEAKER_01: 37:56

Yeah. Yeah. The short term, I think, that phrase really resonates with me. And again, because we weren't incorrect in saying, well, if we respond a certain way, we run the risk of inadvertently reinforcing that crying behavior, for example. Or if a child speaks to me in an undesired tone, a seemingly quote-unquote harsh tone, and I respond to them and give in, well, then I'm reinforcing that harsh tone. And we've come up with ways to distinguish that and saying, well, if you're frustrated because, or if you're working yourself up because you're having to do something that's challenging to you, like communicate, and then on top of that, you're having to face homework. And to use this example loosely, suddenly you're telling your parent, okay, I'll do my homework. And they're like, oh, thank you for saying that, but now say it appropriately and I'll get off your back. So the idea that you're already agitated and somebody continues to move the goalpost and then you hit a point of escalation and suddenly As the adults, we're blaming the learner for that escalation and enacting some level of crisis management or further applying extinction or whatever it is. I think that's a really good premise you bring up because I do think that, unfortunately, historically, we have been guilty of that in many ways. And that's why I think this conversation is so important in understanding, number one, what is crisis? Number two, what is the difference between crisis management and managing undesired behavior? And number three, the idea of undesired behavior and its perspective. Undesired to whom and functional to who else, right? So if you're frustrated and you're like, ah, Mike. damn, this, that, or the other. And I'm like, oh, Dan, it's okay. Calm down. At some point, you're going to be like, man, man, you're not validating me. Sure. What's going on? I'm frustrated. I can be frustrated.

SPEAKER_00: 39:46

Especially if you lack theory of mind.

SPEAKER_01: 39:48

Or you're having trouble communicating already, or maybe your receptive ability is a little bit low. You're going to easily be able to interpret some of that as a threat, as a full block to your well-being, right? So it is a very interesting premise we're dealing with here. in trying to bring these ideas together. What is crisis? What is behavior management? How does the tantrum relate to these things? And yeah, where are we responsible or where are we the best actors in that dance between placing demands, and then understanding how to help that learner achieve those demands in a way that is stressful enough, but also soothing at the same time, so that we're maintaining this sort of perfect learning zone, if you will, knowing that once we tip over into crisis, then the brain's no longer learning a whole lot other than how to put itself into crisis. And then maybe in that moment, learning, okay, People act at certain different speeds. If I'm hitting them, they tend to respond a lot faster. If I break something, they tend to move much more quickly in comparison to now me showing that escalation with my voice or that frustration and now getting redirected and told, oh, no, that's inappropriate. So even that. particular decision and how we respond to those behaviors, desired, undesired, or otherwise, I mean, there is some level of learning there, but learning in the wrong direction when it becomes things that are aggressive or assaultive or destructive. But unfortunately, historically especially, even outside of that blanket ignoring for extinction, we still have to and tend to respond much more quickly to some of those undesired behaviors. So there's a lot to unpack here again. We keep getting ourselves into these large bundles of information, but I'll pass it back to you, see if you can help me unpack some of those pieces.

SPEAKER_00: 41:47

Sure. Well, the first thing while you were chatting, I googled the definition of crisis because I thought that would be useful. So crisis is a time of intense difficulty, trouble So as we go through this podcast and future podcasts where we talk about it, I think it's important that we delineate exactly what crisis is because, again, a lot of that is subjective. And you talk about learning. I think it's probably important that we define that or contextualize that as well, because we think of learning as, you know, school or something like that. But in ABA, learning is probably just reinforced experiences, right? And the more experience, think about the kids that we work with, they spent a lot of experience engaging in these maladaptive behaviors. So by virtue of us maybe not reinforcing that behavior, they sure still spent a lot of experience doing that maladaptive behavior. So there was a lot more chance for us to inadvertently reinforce the one that we don't want to have occur because that was the majority of what they were doing because we weren't really setting up environments to get what we do want to have happen. Um, so that's another thing I think as we talk about learning moving forward is, you know, just looking at it as reinforced experiences, um, And even if it's not reinforced experiences, just experiences that individuals engage throughout their life. And I think our individuals on the spectrum throughout time and even in the early ABA days spent a lot of time in these distressed physiological states. Moving on to the last thing I want to talk about, I want to kind of provide an analogy as we move on. into some of the behavioral strategies, which might actually be part two of this podcast, because we've talked a lot about the neurology and physiology. So I want to provide the analogy of, think about this fight or flight response, almost kind of like a dam. And there's a certain amount of water that flows through the dam, just like there's a certain amount of blood that flows from your brain to your extremities. And that's a controlled amount. And that's kind of what we would call homeostasis. There's a usual amount of blood, you can think about it like water going from the lake through the river. And at some point, something triggers and it starts to increase that amount of water that is now flowing through the dam. And it's going to increase and increase and increase. Now, at some point, There's going to be too much water where you can drop that damn door and that damn door is not going to be strong enough. And that's kind of that crisis that we talk about. There is going to be a point where you shut the door and it's just not strong enough and that water is going to flow. But the question is, once we see the water starting to increase, how do we as observers or we as operators of that dam, how do we acknowledge it? and try to get that door shut or get it back to optimum levels before it gets to the water then starts to take over. And that's the analogy that I want to provide because we can continue to do that. We can stop. So once that amygdala is triggered, okay, the water is starting to increase. It's getting more and more and more, but we can still do some things to get the water to slow down to where we can get back to kind of a homeostatic point. We don't have to Let it get to the point where it's now becoming its own sort of monster. So when we think about that, think about the blood leaving the brain and the amygdala is triggered. OK, blood starting to leave the brain and go to the extremities. But we'll talk a little bit today and definitely a lot in the next podcast about what can we do to start to reverse that cycle so we can get it under control again. And I do want to highlight it. I think the neurology, that's why I like to talk about this before we talk about the behaviors, because we're good with the behaviors. That's what we are as behaviorists. But it all, like you said, comes back to the neurology. And you could, like you mentioned too, the actual firing of the neurons and the refractory period and what that looks like. The behavior is a product of the neurology. So if an individual is fully escalated, I really, really want to stress this, they might not literally be able to control themselves. They don't have enough blood in their prefrontal cortex and their hippocampus to control themselves. So some of the things that we're asking them to do and some of the things that we're attributing that they're doing, are not intent, there's no intent behind it. They're literally not able to control themselves. So if we want to teach them the desired behaviors, we need to first get blood back into the hippocampus and the prefrontal cortex before we start doing that. Historically in ABA, I think we tried to do them at the same time, and that was not effective. We need to first get an individual de-escalated, get blood back into their brain so that they're receptive Number one, they're able to, and number two, they're receptive, and number three, that they will remember what we're trying to teach. Let me

SPEAKER_01: 46:39

pass that over to you. The irony in the statement you're making there is very interesting because oftentimes we were trying to be the most efficient in responding to the behavior. That's a good word, yeah, the most efficient. Which means, oh, if I let them get to this, if I let them escape, if I let them leave the table, now getting them back to the table is going to take forever. Well, we're comparing that. to the amount of time it would take to go through a full escalation cycle. Right, and I wish we had visuals up here. I know we always talked about taking our podcast onto the video platform. YouTube 2023. Right, that's the campaign. And that would be very helpful here because we've done this, and again, not that those PROACT graphs are to scale, so to speak, but we've done that from a conceptual framework in saying if we're able to stop the crisis here, looking along that x-axis, look at the general time savings, right? So in a sense, when we talk about this, And I'm going to try to stick to the neurology so we talk more about behavior in part two of this. The idea is we're having blood flow now leave the better part of our prefrontal cortex to other parts of the body in response to this. Yep. And we have to take the time. in order to soothe or respond in a way that allows for that blood flow to be restored back to the better part of the brain, or the greater part of the brain is a better phrase, such that the learner has the capacity to act with their own volition and emit behavior that we're able to reinforce from a more desirable realm and avoid not just the undesired behavior but the entire time of escalation, which then gets lost in the shuffle.

SPEAKER_00: 48:28

Yeah, so I think just an analogy to piggyback on what you're saying, it's kind of like somebody's behind you with a gun and now you're running for your life and somebody's running next to you like, what's your address? What's seven times seven? What's the periodic table for gold? You're probably not processing those things right now. You have to get to a better physiological cognitive state before you're ready to process those kind of things.

SPEAKER_01: 48:54

I have to laugh because Because, I mean, I can say this comfortably now because it's been years, but the way you were describing that actually reminded me of a lot of therapy sessions, intervention sessions that I've been a part of. Or what zone are you in as you're about to get shot? How does your engine run right now? I'm scared! Oh, man. So that's really interesting. A better tone, please. Oftentimes, that's exactly what we've done. Historically speaking, and olden times, the way you described that was, I mean, it was almost true to form in terms of, you know, even asking them, even asking a learner who has difficulty with vocalizing and saying, look, I'm withholding, yes, my better intent was to create a motivating operation in order to run this next trial, but here I modeled something, I took a toy away from you, now you're upset about that, and in order for you to get it back, even though you're now escalating, and blood's moving away from your frontal cortex and therefore likely your inferior frontal gyrus, which is your language center. So in this moment, I'm going to ask you to do something that developmentally has proven challenging, now physiologically is proving more challenging, but that's the only way you're going to get access to this reinforcement that I'm now withholding from you. is pretty nuts. I'm really glad that we've embarked on the conversations we have here over the past several years now, and that we're able to present it on this forum. And again, I don't think that anybody had malintent, but if you start dissecting it from that, clearly we were missing a lot of variables there, right? I mean, we're asking a learner to do probably what's, oftentimes, the most challenging thing for them to do, which is come up with a new word, say it, and do so in the worst time possible, physiologically speaking.

SPEAKER_00: 50:46

Yep. So, again, what this looks like physiologically, and then part two, we'll talk about how to get there behaviorally, is we need to get that dam stopped and water... back where it needs to be. We need to get blood flow back into the brain. So how do we go about doing that? Again, we'll talk next time about some of the behavioral strategies. And I hope we're not coming across of, oh, your kid's tantruming because they want the iPad. Just give them the iPad. And every time they tantrum, that's not at all what I'm saying. I'm saying there's nuance. And we need to think instead of that child needs to do what I want to do before I interact with them. We need to think, how do I get blood flow back in their brain so they can process what I'm trying to get them to do so they can go into the memory center of their brain and figure out how they're supposed to do it so that they can get access of reinforcement? And additionally. how is my behavior affecting that situation? How is the blood flow in my brain? How is my prefrontal cortex? Because a lot of times you look at the ABCs from the kid's perspective, but I really encourage parents to look at it from their perspective. And ABA behavior is a product of the environment. Who's the environment? The parents. So, you know, it's kind of like in your situation, Mike, maybe, you know, when your kid's sick, I know you shared the example um about your your kid uh crying longer when she was uh sleeping as a result of being away from the home but also being sick and thinking about how your prefrontal cortex and blood is leaving your brain the longer and longer she cries and eventually your ability to rationalize that situation is going to become much less thoughtful much less proactive and much more reactive um and that's going to affect her behavior so we really need to look at how our behavior affects that that's situation and what we can do in that situation to help that other individual. And that's only going to happen if we're staying calm ourselves. And that's a lot.

SPEAKER_01: 52:46

That's a very, very tall order, right? And I can say that. And I'm going to use the word you've been using, the idea of compassion. The idea of empathy, I think, is where this is important. Now, we've done our best to unpack a lot of brain information today. And I think what you're talking about right now does boil back down to this idea of compassion, empathy, and helping us stay calm. You alluded to a recent experience with my daughter as a toddler being sick, in and out. Recently, back in May of 2022, she was actually hospitalized. And she was very, very fussy. But knowing that she was going through what she was going through, being in the setting that we were in with hospitals and doctors and my wife and I not being home ourselves, was a real big eye-opener for me, a big reminder, I should say, that As much as her constant fuss and crying and complaining, I am hardwired to respond to it. And sometimes that gets my better patience. It tips over into frustration myself. That hospital setting, seeing what she was going through with needles and this and that, being poked and prodded, nobody sleeping, it would have been very easy for me to tip over into that frustrated response myself. But my better compassion and empathy allowed me to stay calm, which probably worked wonders towards soothing my daughter. She's in distress. I'm in distress. Now maybe my wife's in distress. So there's a lot to be said for this really tall order, this nearly impossible task seemingly at times, to be alert enough to respond to your child's stressful or distressful cry, but remain, for lack of a better phrasing, calm. Now what happens to us automatically as parents, as people, is our frustration makes us speak in what we would interpret as a firm tone. Sure. And when that firm tone works to stop our child's undesired behavior, we're negatively reinforced by the emission of our firm tone because that crying goes away. And in there lies this better disciplinary traditional approach of raise your voice, yell at your child, when in fact what you're saying is, physiologically speaking, that's likely going to lead to more escalation.

SPEAKER_00: 55:04

Yep, that's why I talk about that a lot with parents, about raising their voice. And I tell them it's a lose-lose. And they look at me like, wait, what? I yell at my kid and then they listen. And it's like, well, one of two things is going to happen when you yell at your kid. Either they're not going to listen and you just raised your voice for no reason and you just caused yourself to get escalated for no reinforcement. Or they listen, which might seem like a victory, but that just means that they didn't listen when you were calm. So all that's going to teach them is next time the kid's going to ignore you until you start raising your voice and then they'll start to listen. And now you have to yell all the time. But yeah, I think that physiological physiology piece in that compassionate care is important because in ABA, we do look at behaviors. And I think maybe that's got us maybe we've been labeled partially at our own accord and partially inaccurately from from outside sources. as solely focusing on that. And at the end of the day, there is a human being emitting those behaviors. And the more that we can maybe look at them compassionately and look at, hey, it's not just a behavior in a vacuum, it's an individual emitting behaviors. And I'm sure your daughter's not... checking, going through her behavioral repertoire and saying, maybe I could ask dad this. Maybe I could smile. Maybe I could give him a hug. Maybe I could cry. Maybe I could throw something. She's not like, hey, let me figure out which one of these I want to do. She's upset, and she's reacting in that situation. So understanding that, I think, again, I want to reiterate that. This will probably be the last time I do it, this training, that your daughter's not basically saying, I want to do the most upsetting thing to you because I want to upset you the most. That would mean that there's a lot of blood in the prefrontal cortex. There's not blood in the prefrontal cortex. That's just a reactive behavior that an individual is doing. She's not choosing... she's not cognitively choosing to do that behavior. She's reacting in a behavior. So almost environmentally choosing to do that behavior. And that environment comes back to us and we can hope to be compassionate, help these individuals deescalate and show them a better response. Again, we'll talk a lot next time about what we can do behaviorally to do that. But I think that compassionate care is something that we can continue to improve on. You know, the refrigerator mom piece 20 years ago. But, you know, maybe we were responsible for that with our blanketing So how do we bring kind of the compassionate care back in with the ABA strategy so it can be the best of both worlds, not that world or this world?

SPEAKER_01: 57:39

Yeah, so we're nearing the end of our time for this episode. I think that, again, we took on a noble challenge to discuss brain physiology, autonomic arousal, fight-or-flight response, and in relationship to challenging behaviors, knowing that not every tantrum is a fight-or-flight response. Thank you. If we escalate ourselves and prolong the time in which our child is in that escalated behavior, you're saying that behaviorally speaking from a brain perspective, we're actually allowing the brain to strengthen that response. Yep. So

SPEAKER_00: 58:34

that pathway is going to be much stronger at the expense of other pathways. Right. That we would call more adaptive. So the more frequently

SPEAKER_01: 58:40

we do that, the more time we spend in that response. Right. the stronger it's going to be. Imagine that. We knew that from the beginning yet. We didn't think about that from a blanket ignoring extension perspective long ago. I

SPEAKER_00: 58:54

do just want to say, because I just used the term adaptive, so we would say that pathway is becoming stronger at the expense of more adaptive pathways, but that's actually not true. That is the most adaptive pathway because that's the time the individual is spending the most time in.

SPEAKER_01: 59:08

Right, which means that just by default, things might be resolving in their environment while they're in that behavioral state, which now leads to some level of interpretation that when I do this, these other consequences happen. Okay, so if we wanted to do a couple wrap-up points here today, we're talking about fight-or-flight response or escalation, knowing that our bodies only have so much blood in them, Yep. Yep. environmental stimuli in a way that allows us to manage them or help our children manage them or our clients manage them without necessarily tipping over into a distressful or autonomic response. And if we do tip over into that response, then back to your dam analogy, either working slowly to get that water back or sometimes having to let that water flow through until it recedes down to baseline levels and starting over, knowing that that's going to have to be an option sometimes. Yep.

SPEAKER_00: 1:00:23

It's kind of like the computer, right? If you cut off the electricity to the connection to the processor or the RAM, you can bang on that computer. You can yell at it as much as you want. It's not going to process things. And that's the same thing with the brain, right? If we're cutting off the electricity, we got to do whatever we can if we want that computer to run to get electricity back to that processor, back to that RAM so that that computer can function. And that's what we're talking about there.

SPEAKER_01: 1:00:49

All right. Let's cut here for today because we're going to come right back. and talk more about the behavioral side of this, knowing that we tried to unpack the brain part. So I hope this was helpful to everybody. Again, talking about crisis management, but more from a behavior management perspective. What can we learn about brain and crisis and fight or flight when we're dealing with those behaviors that we might perceive as crisis? Yeah, and we'll stop here for now. Always.

SPEAKER_00: 1:01:14

Analyze

SPEAKER_01: 1:01:14

responsibly. Cheers. 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.