Visual Structure and Support

From vertically-oriented wall schedules to PECS to token and choice boards--ABA practitioners love their so-called 'visuals'. In this brewing session, Mike and Dan dissect the idea of these strange technologies to understand what is meant by 'visual,' especially if all parties involved are 'sighted' individuals. Taking the ideas of joint attention and naturalistic strategies, Dan and Mike are able to boil it down to the difference between what can be easily accessed visually in the environment, versus more artificially driven, icon-based, laminated squares.

So, grab your favorite libation, turn off the laminator (as its jammed and you're out of laminating sheets anyway), and take a look all around, as you enjoy this illuminating pour of ABA on Tap. And of course, always analyze responsibly.

AND--if you are ready to enjoy the benefits of Magic Mind and boost your brain performance, please use the following link and use the discount code ABAONTAP to receive 20% off your purchase:
https://www.magicmind.co/ABAONTAP

Transcript

SPEAKER_00: 0:00

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

SPEAKER_01: 0:53

All right, all right. Welcome back for another installment of ABA on Tap. It's good to see you, Mr. Dan. It's good to be back, Mike. It's been a while. Taking care of some life matters and whatnot.

SPEAKER_00: 1:06

When it's, you know, it's always another health issue on the horizon, but hopefully we've gone through most of them, and now we're back to the recording consistency that we had in the beginning of the year.

SPEAKER_01: 1:14

Well, we started this whole thing during COVID pretty much, so the health issues are par for the course. I think we're going to have to keep that as a theme. I failed to introduce myself As everybody out there hopefully knows at this point, I am your gracious co-host, Mike Rubio, again, along with Mr. Dan Lowry.

SPEAKER_00: 1:31

Cheers.

SPEAKER_01: 1:31

We've been on a little bit of a break, but we're back. And we're back with an exciting topic.

SPEAKER_02: 1:37

Yes.

SPEAKER_01: 1:37

I'm going to rewind here, look at a little historical perspective. I think it was season two, episode five.

SPEAKER_02: 1:46

Okay.

SPEAKER_01: 1:46

Where we talked about strange technologies. Yep. And we're going to elaborate on one of those technologies. quote-unquote strange technologies. I don't want to get on my soapbox too much today. Before we started recording, we were talking about this. We're offering criticism. We'd like to do it constructively. What we're saying is, as we do these things that have become almost staples in autism treatment, one of the questions we're asking is, is how do we progress past these things? Are these things just mainstays? What does the learning theory tell us, right? And I think it's an important question because so many of these things are just plugged in right away. You get a new client, you're working with somebody new, and I've worked with some providers that even sort of pre-make these kits, right? So you've got your choice board, and everything's pre-made, and let's make visuals. And what we're talking about today is visual supports, visual structures. in autism, which is not... devoid otherwise in the world. I mean, technology has brought a ton of visuals into our lives, things that are now more symbolically representative of communication. And at the end of the day, words are visuals, right? So if you're a literate individual, then even words by themselves can then serve as a visual, which reduces the intrusiveness of the prompt from a verbal prompt to now a visual prompt, which is a good thing. I'm already packing up a lot here for you to jump in on, sir. So I know that I've been critical in the past of visual supports, not because they don't work, but because I do think that it's kind of a first go-to for us. Almost intimates that there's something specific about autism and these two-by-two laminated visual cards, which is what these visuals sort of boil down to be. And what's interesting is that that's across the board. Yeah. you know, so on and so forth. So I'm going to hand it over to you there. I know I sort of scattered a bunch of different musings about the visual supports in autism. Why don't you give us your introduction on this topic today?

SPEAKER_00: 4:12

Sure. And I know you said that we've kind of gone to the same types of visuals. So I think, you know, Boardmaker would be very happy that they either have or continue to make a lot of money because we only have our one type of visuals that we use with the kids with autism because those are the ones you have to use, right?

SPEAKER_01: 4:29

Are those... So... Boardmaker. Cornered that market well. Certainly cornered that market. I'm not going to look it up now. Do they still exist? Does that software still exist? I'm sure it does.

SPEAKER_00: 4:40

Yeah, I imagine it's more easily accessible now.

SPEAKER_01: 4:43

So historically, things that were staples in ABA treatment, and we're sort of trying to debunk that, you don't need the IKEA table and chair. You don't need it. It's a good thing to have, but you don't need it.

SPEAKER_00: 4:55

But what if Boardmaker and IKEA merged?

SPEAKER_01: 4:58

And they made laminators

SPEAKER_00: 5:00

together? Yes.

SPEAKER_01: 5:03

We might have to beat them to that idea. That's a lot of money. So we're being, obviously, facetious here. But yeah, board maker symbols, obviously, much like PEX Phase 1, you're Pairing the exchange of a certain symbol with it resulting now in a certain action. And one of the things that I'll jump right into, and I know will be a theme for me, and I'd love to get your take on it. One of the concerns I have is that maybe, especially for younger professionals in the field, we're not always clear as to what the behavioral magic is. Is it that you're pairing this symbol with a certain consequence? A lot of us... maybe think that there's something inherent to those symbols that speaks to autism.

SPEAKER_00: 5:48

That's a good point.

SPEAKER_01: 5:49

And that's one of the things that certainly does rub me the wrong way because I'm like, wait, this kid, I talk a lot about joint attention. this child isn't even jointly attending to what you're demonstrating. How do we think that this symbol is going to have any meaning to them at the start?

SPEAKER_00: 6:06

Well, it's kind of like what you said with schedules. Schedules are pointless until they become a routine, until there's a consequence attached to it.

SPEAKER_01: 6:12

Yeah, yeah, no, there you go. And again, so not being overly critical, but knowing that, okay, so once you've built the joint attention, and then now to the credit of the visuals, and I think I know I've alluded to this before here on the tap, those little squares make it very easy for you to put it right square in somebody's line of sight. I used a pun there, right? Squarely in there, which now limits their gaze shift. So there's a... inherent problem there. Now, again, very useful tools really want to break down as to how they're being used, why they're so ubiquitous, because you can go to almost any ABA outfit in the United States or any website, and you're going to see these board maker symbols. We've all arrived at the same dimensions. We all freak out in our offices when the laminator breaks down. Nobody wants to use the page protectors. They don't work as well. See, and we can laugh at this, and I'm have to consider because inevitably we train our younger professionals and these are the things they're seeing. And we do run that risk of somehow saying, hey, autism, there's an auditory processing piece to it, which means the visuals work better, which automatically means that boardmaker figured out how to tap into the autistic brain and say, look at these weird symbols. They make sense to you. And what we're saying is, well, no, these symbols probably make more sense after they're paired with a certain consequence over time.

SPEAKER_00: 7:33

As does everything, right? Everything's a neutral stimulus until it is paired with something and a consequence. I just want to kind of elaborate on something that you said earlier. So we're not coming down or poo-pooing visuals at all. In fact, I think, what is it, like 70% of the human brain is devoted to visual processing, something like that?

SPEAKER_01: 7:52

I don't know that stat, but I would go with that.

SPEAKER_00: 7:54

I think it's part of a video that I show in my new hire training. So don't quote me on that number, but it's a large percentage. And I think we're not saying visuals are bad. In fact, the visuals that we used have been good. That being stated... The world is so visual. When we say, let's use visuals, people think of a board maker icon. Why don't they think of a bedroom? Why don't they think of a tree outside? Why don't they think of a trampoline? Everything is, you know, there's probably literally a million visual stimuli in this reptile office, reptile recording studio right now that I could think of. I could think of this empty Magic Mind container that I'm sure you'll be promoting a little bit later. Shout out to Magic Mind. But all of these are visuals. So how come if I was to tell anybody in ABA, what do you think of when you think of visuals? They're all going to think of the same thing. So that's, I think, kind of where you're coming from. I just want to highlight that because I don't want, in fact, I train visuals in my new hire trainings. And I stand by, I think we all use visuals all the time. I use visual speed limit signs to tell me how fast to go, road signs to tell me where to go to get here, open and close signs. We use visuals all the time. You know what button the L is on your keyboard because there's a visual L that shows you that that's the L button. We use visuals all the time. So we're not saying not to use visuals. I think what we're trying to say is kind of this standardation of practice, like you mentioned of, okay, I've got a three-year-old client. So with my three-year-old client, I'm going to have the choice board and the travel schedule and the first end strip and this and that. And it's going to always look the same. Did we think about number one? Is that the best visual holistically for the client? Is that the best procedural way to go about it? And then number two, if we've decided that those visuals are the best, are those visuals specifically best for that client specifically? But instead, a lot of it's just so standardized. We're like, okay, well, I want you to make the iPad visual and the macaroni and cheese visual and the M&M visual and the chicken nugget visual and the Candyland visual. And they always look the same for every single client. But what we're trying to say is let's stop and think about number one, is that the way we want to go? And number two, is that how We want to go about it.

SPEAKER_01: 10:05

And there's a particular premise. So this is not a bad thing, but we're giving the client immediate credit that they can do a non-identical stimulus match, right? That they can look at an actual object, look at its representation symbolically or from a photograph now in a 2D representation. Sure. And that they're able to match those two things up immediately and even though they may not be performing identical match tasks for us at that point. So again, I agree with you. The visuals are very important. They're everywhere. They're in schools, whether you're in a special ed setting or not. Visual representation for sighted people. The idea of visualizing inside your head is a very important premise for everybody. So you're absolutely right. We're not against that. But just some of these questions that I think are important to ask as visuals and visual support become standardized in autism treatment to ensure that we're conceptualizing in a fair way and we're not overgeneralizing their use or their effectiveness, right?

SPEAKER_00: 11:10

And I think we run into a little bit of both stimulus and response generalization. And this specific example would be stimulus generalization coming from maybe someone like Temple Grandin, who has that book, Thinking in Pictures, who talks about the way her mind works is when she sees a church or a school or something. She hears the word church, for example. She thinks of one particular church versus thinking, okay, I've seen a church with a steeple. I've seen a church without a steeple. I've seen one that looks like a house. I've seen one that looks like All sorts of crazy different things that could be considered a church. She thinks of one. And I think, again, it's that chicken or the egg thing, right? Do some of these individuals struggle from stimulus generalization because maybe the way their brain works or because it's a symptomatic trait of ASD? Or do we only present them with one visual for every stimulus and then wonder why they don't generalize it? Because they only have their one 2D visual, right? I can't show them different visuals. So that could also be an issue that we run into, that we inherently reduce their field or their representation of what a church could look like because we only show them the one 2D representation of the church over and over and over again.

SPEAKER_01: 12:19

So it would, in a sense, be a disenrichment of the exemplars. Exactly. And it's not to say that– and I love, obviously– I've historically been a fan of Temple Grandin and the insight that she brings to us in sort of identifying or navigating her visual world. I remember hearing her tell a story about how she uses visual representation for humor. So people will write jokes into her speeches, and they're not funny to her, but she waits to see all the people, I think she described it like, open their mouth and tilt their head back, And then she does the same thing in imitation. And now from a social perspective, she's right. in there, right? So she didn't need a card that said laugh, although I guess in all fairness, we've got cue cards for the audience and sitcoms, and again, these are all visual representations, right? We did have a laugh track early on, remember? It was just a lot of work. I'm not sure that everybody thought the same jokes that I thought were funny were funny. Anyway, we did have a laugh track from our virtual studio audience, but you get my point. When she says thinking in pictures, we all think in pictures, but the important part is for her she has one exemplar and then you're right with our tendency to it's not like you've got a pex book and it's got you know five different representations of an item it usually has one yep so Otherwise, that's going to be a really big textbook. And they already get pretty big. And even if you're talking about an AAC device and some of the software involved, you have to navigate through those pages and through those directories, right? So it does get more and more, for lack of a better phrasing, cluttered. It gets to be a lot. So we appreciate the use of these technologies and the enhancement that it provides. And then to your question, the same question I'm asking, is this the best way? Is this the only way? Can we get into different different levels of impaction, depending on the individual. If everybody's hoping that maybe there's a more universal sense of or mode of communication that can be achieved, even in terms of gestures between attention or any sort of vocalization, well, if you're using the visual, you're now not directing that child's face or gaze to your mouth, which is also a visual as it opens up and down and your teeth show and your tongue moves around and you blow air out of there and you make these things call words, which are now auditory. There is a visual aspect to those.

SPEAKER_02: 14:50

Absolutely.

SPEAKER_01: 14:50

And if we're using those cards, guess what we're usually not doing? Promoting the orientation of the gaze shift to the face. So some people will speak in words. Some people won't. I understand that. By no means are we saying everybody's got to do it this way. But again, I think you ask a very important question. Are we, in fact, creating a detriment with our enhancement?

SPEAKER_00: 15:12

Yeah, it's interesting. You bring up communication in the Temple Grandin example, I think is very interesting because that's one of the maybe new developments in autism or different ways of looking at individuals with autism or autistic individuals, that autism is not necessarily a developmental delay. It's just a different way of processing and communicating with the world. So it seems like Temple Grandin in that example may not have understood what kind of the joke would have communicated to other people or maybe not even what laughing And that context meant, but she was able to see it repeated over a certain amount of times that she was able to then attribute that to something and now communicate with other people through that laughter. Now that has meaning to her, right? Because communication is just kind of the interchange of ideas, thoughts, whatever, between two individuals. And certainly individuals that don't speak have thoughts and ideas, et cetera. And the way that they might try to communicate them to us, us being individuals that don't have autism, might be a way that we don't understand, i.e. the Temple Grandin saying the joke example. So there is that kind of dichotomy in communication and a way of looking at that. That being stated, I think you bring up a really interesting point about visuals either promoting... Auditory processing or kind of transgressing and getting rid of the auditory piece. So it makes sense that we would say, okay, these individuals that have auditory processing disorders that may or may not honestly have auditory processing disorders. It

SPEAKER_01: 16:43

is a high percentage of individuals with autism or autistic individuals that would be considered to have an auditory processing challenge, just to be fair.

SPEAKER_00: 16:51

Absolutely. So if we want to teach these individuals in a way that they may understand better with visuals, That's great. But the point is, now if we only do that, is that auditory processing going to regress even farther? Because, you know, it's nature and nurture, 100%. If we're not providing environmental stimuli... then they're not going to get that nourished environment in the auditory process, so that part of the brain might get pruned off. Or just behaviorally, they're going to focus more on the visuals because that's what their world is, and the auditory piece might even get weakened. So I think it's awesome kind of what you're saying, that if we're using the visuals, let's linguistically map with that. Let's work on joint attention. Because so often, I think of a client you used to have that came in the group room and just was not environmentally aware at all, wouldn't look around. None of those things. And if we're just constantly putting these visuals right in front of this kid's head and the kid just emits a behavior and then we give them what the visual was or we say good job or whatever, hopefully we don't say good job. That's a different episode. Then this child's never learning to seek out the environment, to look around, to find the visuals that are already in the environment, the millions of visuals. Because remember, we don't provide the only visuals. Regardless of if we provide them or not, there's still millions of other visuals to orient around, to look at people, to look at their reaction and now have a meaning and a feeling behind that interaction rather than just presenting a visual and then going through the task with no personal interaction or as you would probably better call it joint attention.

SPEAKER_01: 18:22

And I think that's a key piece here and again I know there's a lot of information out there in terms of like what was traditionally called eye contact and how uncomfortable that can be but I like that you bring up the joint attention because and the language or the linguistic part meaning that even with Vocalization right now, I often have to work with staff and say, hey, when they vocalize something, it may not be that you hand over what they're vocalizing, because vocalizing while they point to that object, while they look at your face, is actually maybe the optimal way behavior that we're looking for, right? Sure, sure. But I think you're asking the question, whether you knew it or not, how do we know unless we try? And

SPEAKER_00: 19:32

I want to just reiterate something you said earlier. There's a difference between linguistically mapping when the child's eyesight and eye gaze is directed at the visual versus us linguistically mapping when the child's eyesight or gaze is directed at us. That's a big difference.

SPEAKER_01: 19:46

And that's really interesting with regard to, and maybe we'll talk about this in a future episode, this idea of eye contact versus gaze shift, knowing that from a direct eye contact perspective, we do know that not all individuals take in stimuli most saliently right in front of them right many of us are going to use our peripheral vision and there's some reason or some research out there that says that many individuals on the autism spectrum actually end up taking things in more saliently off to the side that actually direct eye contact with stimulus especially faces can be very uncomfortable and again I don't know the research well on that but I do know that that's a very common premise and that's something that I took into consideration when shifting from eye contact to the idea of gaze shift, right? The notion, the premise that if you are looking at something which now you can identify by reaching at or pointing to it and then you do this three-point gaze shift where you're reaching for that object, you point to it, you hear me say the word of that object, which then hopefully captures your attention, makes you shift, gaze shift over to my face, which now allows me to say that word again, which in and of itself, as we just discussed, is a visual representation of that word. And then the child can look back at that object that they're otherwise directing their gaze to as led by their point or their reach, having just looked at my face. So think of all the visual aspects of that, even though we would break it down and call it auditory in nature because it's a word, Think of all the visual pieces that are actually part of

SPEAKER_00: 21:18

that structure. Or like I'm sitting here looking at a Rice Krispie treat box. That is a visual, right? So if we're saying let's provide the kids with visuals, we could provide all of the toys. Those are visuals. It doesn't have to be 2D or photo or board maker or clip bar, whatever, icons of the things. It can be the actual objects or items as well.

SPEAKER_01: 21:39

So... You just made me think of something which might be a good parameter here, and I'm hoping we arrive at more of these. When you're going to use visuals based on what you just said, you've got things that are accessible that you can demonstrate readily in your environment, and then you have those things that maybe aren't. Yes. And maybe that's a really good way to conceptualize which two by two laminated cards you're going to create and whether you're going to use board maker or an actual photo. So there's a consideration that I've never vocalized there that I've never put into words, but that might be a good idea because then otherwise what you're doing is you're allowing the environment to be enriched and then you're actually then calling upon things that aren't available visually and readily. to make that consequence happen which makes him you know maybe makes it more salient so this idea that you've got something visible and out of reach and the child is using a picture to ask for that versus looking at it and pointing at it that might be interesting because now you're saying wait i know you visualize something in here you can think about something whether or not you're looking at it and i'm trusting that ability in you to be able to now take this card Give it to me and ask for something that isn't readily available. So that really changes a lot of the premises we use. Again, I'm not saying go out there and do this tomorrow, but... Certainly something that I would feel comfortable in considering as I look at future casework and how to integrate visual support or structure.

SPEAKER_00: 23:06

Yeah, that's phase two of PECS, working on the traveling piece. There you go. Being able to ask for something that's not readily in your environment. You do bring up an interesting point that why would we necessarily need a child to give us a picture of a Rice Krispie tree box if they're staring at the Rice Krispie Tree box as well, unless we're trying to train them to move it out of their line. But again, a lot of these things, as you would say, maybe get bastardized. And now we're just doing these things just because we did it when something was out of the room. Now we're doing it with something in the room, not thinking about, hey, it no longer maybe makes sense in this context. We just did it because we did it. And I always hate the term, well, why are you doing it? Because that's how we've always done it. That's not... That's not going to work as we look to progress the field. We should always be kind of questioning why are we doing it and is there a better way?

SPEAKER_01: 23:55

Yeah. No, and I think you bring up an excellent point there in saying that that is part of the trouble here is that we create these standards that maybe– are good standards but don't apply in every single situation or aren't being applied in a way that is systematic or expresses some sort of solid methodology. So that's a really good point. Thank you for bringing up PECS. I know you like to joke in the past that I hate PECS. I do not hate PECS. I do not hate visual supports. But I've always asked the same question with PECS. It was like this first go-to, right? And I understand why now. Because it created, it's almost like this for more. It creates a quick mode of reinforcement. The parent can look at it and go, oh, my child is doing something, and they're doing something that's functional and effective, and something that I can now reinforce, and that makes me very excited, and then we have to deal with the risk of not advancing or varying that excitement into different visuals, different signs, the idea that we might actually reinforce vocalizations just because there are sounds that are being made, which is kind of what contingent imitation and linguistic mapping do in honoring those sounds whether or not they are sensical in their initial forms, right?

SPEAKER_00: 25:13

Yeah, I think a lot of the visual piece probably, too, came from the TEACH methodology, you know, with Schleichler in North Carolina. And there's a lot of validity in what they did. And shout out to what they did, these individuals that now we know were diagnosed with autism. It obviously wasn't prevalent then, the diagnosis. They were not integrating into schools and being successful. And one of the big pieces was the predictability and the understandability of where to go and what was expected in certain areas. It's kind of like having a classroom in an empty Costco. You're like, where do I go? And why can't I run over there? I don't know where I'm supposed to go. So visuals at times do a really good job of providing that predictability. You sit here on this mat, and this is your mat, and this is where you're supposed to sit. And the things on the board, this is going to be your schedule. So you're not going to be doing homework all day. We've got homework, and then we've got recess, and then we've got art. So it adds that predictability and understandability, which is very important. Everybody wants to have an understanding of what they're going to do for the day. So I do think a lot of the teach kind of brought about the visuals. And again, shout out to them for it. I think ABA is a much better practice for it. Now it's just how do we continue to expand it? I'll think of maybe like a wall schedule. Wall schedules are great. There are times that there are other visuals that we could use instead of a wall schedule. What if all of the kids are going into a different room? Maybe that could be a visual to say, well, maybe I should be going into that room. You know, I was in Vegas when there was a fake shooter that they thought was a shooter and there were just hordes of people running. And we didn't, you know, we didn't. It wasn't on our schedule. I wasn't planning for it for the day, but I saw people running, so we started running, right? Picking up on those cues and those nuances. And if we're only saying, well, for everything you do, you go to the schedule and then you go to the room, then that's also going to be limiting in a sense as well. And I think that's kind of the overall point that we're saying is that the visuals... themselves are limiting because we're not progressing, and if we're only using visuals, that can be limiting as well.

SPEAKER_01: 27:20

I've got a couple stories from my historical practice here. I've been doing this for a long time. One demonstrates a challenge to the fixed use of visuals, and then one demonstrates a real advantage that I've witnessed. In the first premise, I worked with a client when they were maybe about eight years old and then, having been doing this for a long time here in San Diego, when he was about 16, the family circled back. Having been trained in a very traditional ABA practice that included some teach elements, we had a visual schedule for this kiddo that outlined his day, his old schedule, when he showered, when he ate, really beautiful pictures, worked really, really well. Fast forward eight years after I did that, and he's had these huge tantrums. Meltdown's gotten physically aggressive. I go back in. I start working with the family. I talk to, at this point, the adolescent. No, not a boy anymore. And kind of get a feel for it, start building my rapport again. And I start investigating, and I say, wait, so tell me about the incident that happened. And we went to the beach, and he came back, and he was really, really sandy. And we were trying to get him in the shower, and he just would not go in the shower. And we were trying to explain it to him, and he was pointing at his schedule. And I said, whoa, whoa, wait a minute. What time did you get back from the beach? And they were like, oh, it was about 4 o'clock. And I'm like, yeah, look at the orientation. Look at the order of his schedule. That wasn't what was next on the schedule. We were violating a premise that we had been very successful in teaching in a very fixed manner. Now, I'm not going to blame the visuals solely for that. It was really the way they were utilized. But just to sort of make a point of that. Now, another child that I've worked with, same thing, vertical schedule, wall schedule. When we were still using them in our practice, we've largely faded from those at this point. And I think we found that that it's OK to do that. But one way in which this was useful for this child, and this could have been unique to this child, is, and I forget exactly how I realized or how I came upon the idea that instead of looking at the symbols, the child was looking at the words that were depicted underneath the symbols. So then simply noticed that and had an idea to remove the pictures and just put the words on the schedule you know, long story a little shorter, realized the kid was hyperlexic, really good at reading. And now we could actually shift from a picture schedule to just words, which would be much more commonplace and mainstay, right? Sure. So again, both examples just kind of demonstrating where maybe it was a user error. But again, the real risk in this is that they're such a mainstay. Visual support is almost like a given. As soon as you start a case, in many places, we have to have the schedule. We have to have the token board. And of course, that has to be on a laminated board with a certain type of star. We're going to talk about all these technologies in a second. But again, I think some of this is user error in almost conceptualizing that this visual support is specific to autism. And I'm not saying that that's untrue, but more specifically, looking at every individual, knowing that we all benefit from visual supports, we would all benefit from using vocal behavior, we would all benefit from a whole slew of abilities and skills, and really, really want to encourage everybody in thinking about it that way to move away from concentrating so much on these visual supports and structures. Sure. Important, but not the only thing that's at our disposal.

SPEAKER_00: 31:12

No, not at all. I think visuals are great because they are typically and almost universally considered the least intrusive prompt, and we always are trying to use the least intrusive prompt. But we use it because we're trying to facilitate independence. And any prompt we're using, even if it's a visual prompt, means that that individual is not independent. So if we're talking about like the visual schedule on the wall, we want to eventually, we don't want that child to be 18 years old, 20 years old, 30 years old, still going to the wall to pick up the art icon and going to art. What we want to do is almost top down instead of bottom up is deconstruct why we know where to go and how to be there, and always try to get one step closer, right? Like, for example, today, to come to record this podcast, I didn't need to check my visual schedule. What did I do? Well, there are a few steps that got me here, and I think the first one, let me take a quick step back, kind of comes down to countdowns and timers. I'll tell parents to use countdowns and timers. They'll use them, and I tell them to use them more, and they'll use them, and they'll start to have some success. But I rarely use a timer in my life, and I ask parents all the time, What do we use? Because we don't really use timers. I'll say, do you use timers? And they're like, well, with my kids I do, but with myself I don't. Why don't we really use timers, Mike?

SPEAKER_01: 32:31

Well, you don't necessarily need to in most life applications to measure your time that precisely.

SPEAKER_00: 32:37

And then how do we measure our time?

SPEAKER_01: 32:40

I mean, just the basic sense of the passage of time, of actions, of things that are completed or things that still need to be completed. And clocks. The daylight. Yep, the clocks. What time is it? But the idea that we go around limiting or constraining our time to a certain time frame to complete something, that's not... I mean, again, I see your point. Not a bad way to teach kids or to be consistent, but certainly not something that's commonplace or universal in its application.

SPEAKER_00: 33:09

Yeah, and my point is that we use clocks so often, but so often parents don't fade from timers to clocks because timers are working, right? Like you say, practice doesn't make perfect. Practice makes habit. And if something's working, if the parent can set the five-minute timer and the timer goes off and the– child transitions, the parent's happy. But the thing is, the parent's always going to have to be there to set that timer and make that timer somewhere that the child can either auditorily or visually see. For example, today, coming to the podcast studio, I didn't set a timer. I just referenced a clock. And I didn't have somebody there The clock was actually the SD. And like you said, it was kind of an inherent

UNKNOWN: 0:00

.

SPEAKER_00: 33:50

So the clock was the SD, not somebody saying it's time to transition. But so often we get stuck in these routines of somebody saying, timer went off, you hear the timer, check the schedule, then that person goes and checks the schedule and then rotates. Without that person being there to check the schedule, how are we fading for that person, for the individual that we're working with, to independently know they're trying to check the schedule and independently know where to go? We should be fading that icon to maybe the word or the idea of where the art room is because you've been there a bunch of times, so you've paired the picture with the location, and you've paired the word with the location, right? That's transitivity, A equals B equals C, so A equals C. So pairing all three of those things, so if I say it's time to do art, that child should know where art is without having to check the schedule. If I show a picture, the child should know where to go. And then once we can help this individual understand time, they can then start to navigate their environment. But so often, we stop at the point that it works for us, Because we're more concerned oftentimes with efficiency and getting it done quickly. Having everybody, if we're doing it in a social group, everybody comply or cooperate. If we're doing it individually, people to comply and cooperate fast so we can get through all our programs. That we don't mind being the SD and we don't mind using things that works, not consciously thinking how do we independently fade to the next step.

SPEAKER_01: 35:20

I like the inherent point you're making, which is, I think as part of the erroneous application of some of these things, visuals, we'll consider a timer a visual.

SPEAKER_00: 35:29

And a clock is a visual. In that sense, right? Nobody thinks

SPEAKER_01: 35:31

of that. But again, we almost consider these as though they're going to have this quick, magical value in changing the behavior. Oh, you're using a timer, so that means when the timer goes off... I'm the child. I'm naturally going to change and go over here. The idea that, no, I'm still going to protest because I don't want to leave this activity. So what does the timer really do in that purpose there in that sense? Is it saying, hey, I'm wanting you to do something for me right now, and right now would be a good time. Oh, you're saying you're not ready? Okay, let's give it a few more minutes. And then the timer isn't for you to now change your behavior. It's for me... to come back and ask you if you're ready to fall into time and place with the rest of the environment. And again, we can probably think of a million examples and the effectiveness, the value of timers. I think that one of the pitfalls that we run into, just like with visuals or first then or token boards, we almost... We run the risk of believing that those technologies inherently have some sort of power over the client's behavior. And the way you're describing it here is it's got to be paired. It's got to be learned. It's got to take time. All the timer really does is give us a cue now, a visual cue, an auditory cue if it's an alarm, to say, okay... Billy's supposed to go to the reading table now, and Billy's not at the reading table. So what are we going to do next? Because if we don't stick to this consistent time frame, then Billy will never know what other auditory or visual stimuli are in the environment that you may be cluing into that tells you to tell him to please go to the reading table. You see what I'm saying? Of course. Again, I almost feel like we... Like we think it cuts through all that teaching and somehow the timer has this inherent magic or the visuals now, oh, the child with autism understands now because I've got this weird board maker icon. And we know that's not the case, right? So that's one of the things I think we're doing well in dispelling here because I do think that as a younger professional, even... professionals in the field for a while we implement these things ad nauseum and we don't necessarily see whether they're working or not or the diversification in their implementation

SPEAKER_00: 37:49

yeah yeah it's nothing you have to consequent the visuals right without a consequence after it um it's it's going to be meaningless right and the visual itself like there's no inherent thing that helps an individual understand a timer different than the position of the sun if you Consecuate the position of the son for a child over enough repetitions, they'll understand that. So like you were talking about earlier. That's a

SPEAKER_01: 38:11

visual cue to the son.

SPEAKER_00: 38:13

Yeah, absolutely. That is a visual cue. And choice boards too. Again, talking about, I can think back to my older ABA days when we would be having an enriched play thing and a kid would want to play with something and I'd have to stop to redirect them to the choice board. to ask for the thing that they're already asking for that's now kind of detracting from the whole experience, right? No, go ahead. But that being stated, you were talking about cues, and I should probably give you a quick cue that we have a sponsor that we have. Yes, you were talking about

SPEAKER_01: 38:48

time and time of day, and I'm going to tell you a little bit, or tell everybody a little bit about my morning routine today, which has potentiated my active conversation and illuminated my mind. Really? We're going to chat a little bit more about human behavior and daily efforts to get the day started very well, to boost performance, to energize, to stay alert. As you know, historically, coffee has been a staple as a source of caffeination, a little pick-me-up to start the day and to keep it all going later in the day. A little story time here. Legend tells us that a goat herder discovered the coffee plant when his goats ate the red berries of the tree. After that, the goats were found to have increased energy. The goat herder ate the fruit and noticed his own energy increased as well. From that time, I don't know when that time was exactly, coffee began to replace the common breakfast drink beverages of the time, which were... beer, and wine. Those who drank coffee instead of alcohol began the day alert and energized, and not surprisingly, the quality of their work was greatly improved, maybe because they weren't drunk. Now, in the year 2023... This year, right now, we've learned much more about boosting human performance, both physical and mental, particularly with what we put in our body. It's been a long time, Mr. Dan, since I've started the day with a beer. I promise you. Really? Maybe college. And I reserve wine for pairing with good cuisine at lunch or dinner. I still like coffee, but there is something better to start my day. You've already alluded to it. It's called Magic Mind. Beautiful green little shot. Keep them in my refrigerator. Why is it better, you ask? I can explain. It's about natural, healthful ingredients and no crash or nausea as often found with coffee alone. We're talking about adaptogens. These are herbs, roots, and other plant substances like mushrooms that help our bodies manage stress and restore balance after a stressful situation. In this case, we're also talking about a root called ashwagandha, just one of the natural ingredients that makes this elixir so magical for your mind. Nootropics. These are non-prescription substances that can enhance brain performance or focus. L-theanine is a naturally occurring non-protein amino acid that promotes relaxation by reducing stress and anxiety levels. It can boost your energy during the workday while also promoting calm and improving sleep quality by promoting a more relaxed state later in the day. What this means in Magic Mind is another simply natural ingredient, matcha, just tea and basic goodness. We're also talking about vitamin D3. Everybody learned a little bit more about that during COVID. What does it do? It strengthens your bones. It strengthens your immune system. It can improve your brain function. It boosts your mood. It helps lower blood pressure. It fights inflammation. It can strengthen your oral health, support a healthy nervous system. It can improve your cognitive function, and in doing so, serve as a preventative measure for dementia. And then finally, a little sweetness to wrap it all up, agave. Where some energy drinks on the market include up to nine cubes of sugar in each serving, Magic Mind uses three-fourths of one cube of sugar per shot. And this is not refined sugar, but derived from agave. This means delightful sweetness with less than 10% of the sugar found in most energy drinks. So, if you want to boost your brain performance, your memory, your mental acuity, your alertness, try Magic Mind today. In fact, look at the episode description to find a link with a discount toward your prospective purchase. I hope you try Magic Mind and enjoy the benefits that I've discovered.

SPEAKER_00: 42:20

So I wanted to take a brief little detour because I think something that really highlighted this visual is we have a client that recently lost his ability, hopefully temporarily, to access visuals. This individual has actually gone, at least temporarily, blind to a certain extent. And it's very interesting when that happens that a lot of times, it almost seems like some people throw their hands up and they're like, well... If you have a child with autism, they need visuals. Wait, they can't see anymore. How can we teach this individual? Because they don't have visuals. I thought you did a really great job of kind of breaking down and inadvertently highlighting that maybe sometimes our excessive use of artificial visuals, and maybe that's what we should say. We should say artificial versus natural visuals.

SPEAKER_01: 43:07

I like that distinction. It's really good.

SPEAKER_00: 43:08

Artificial visuals. Maybe... make an area a little less dynamic because we're not talking about the other senses and ways that we process the environment. So I don't know if you maybe want to just talk a little bit about that, but I know your suggestions have really brought some more vibrancy, I guess for lack of a better term, into this individual's environment and the parent couldn't be happier.

SPEAKER_01: 43:31

I appreciate that, man. I don't get to work directly with, or I guess I get to interact to some extent on the parent education part. And just while we're on the topic, a dynamic, dynamic parent, very, very active individual in their child's treatment and life and very, very tragic turn that they find themselves in the current circumstance. Again, I agree with you. Hopefully this This is just temporary, and there's reason to believe that'll be the case. One of the things that was interesting, and then please let me know if there's anything else you wanted me to touch on, but I think one of the things that we've alluded to today that becomes very poignant in this particular example is the idea that from a visual perspective, We talked about Temple Grandin, the idea that you can see something and then you can envision something in your mind, right? And if you have a person that was sighted to begin with and that can also see, express vocal behavior or talk to you, then we get to tap into some of these things. That's not the case for all of our clients, unfortunately. And I liked what you said earlier. We could safely assume that there's internal thoughts and internal visions, and there's clearly internal drives that we can't see until they take place. So the idea that in this particular case, this child has compromised vision at the moment, And that we might take their visual memory to be able to provide them enough sight as enhanced by the rest of their senses. Exactly. And I think that's super important. So we talk a lot about multi-sensory approaches. And then at the end of the day... it usually becomes some sort of tactile, some sort of interoceptive breathing, all toward the idea of calming down because this kid's way too active for us and they're emoting behavior that we think should be good. Well, in this case, we're talking about stimulation through the other senses, right?

SPEAKER_00: 45:37

Which is another, actually, you just made me think about it, which is another interesting thing, how we compartmentalize things in ABA, like you've talked about, and decontextualize things in ABA.

SPEAKER_01: 45:47

It's our task analysis habits, man.

SPEAKER_00: 45:49

You said multisensory, right? But if we're doing sensory, what does that mean? That's tactile, right? Almost exclusively. We don't do sensory with visuals, unless it's like bright strobe lights or something like that, or we don't do sensory with words. Right. But those are all sensory. Right. Yeah. So I think that's kind of what we're highlighting here, that a lot of this stuff is decontextualized. Visuals are very important. Artificial visuals can be very, very useful. But when decontextualized and used in isolation, now that the individual's environment becomes that much less stimulating, just like saying that we're going to do sensory time. Well, why couldn't. There'd be sensory time. Was this individual not taking in visual and auditory stimuli before? Maybe tactile time. So I think that's kind of- Tactile time. I like that. Tactile time, right? It didn't

SPEAKER_01: 46:36

sound as cool.

SPEAKER_00: 46:37

It's like tummy time.

SPEAKER_01: 46:37

Man, you took me on a ride there. It has to be our task, analytical minds that make us break things down or isolate them, which I think is a good skill. And then at times like this, I couldn't agree more. Yeah, sensory play is probably one of my favorite... least favorite phrases in ABA because it's like, okay, can you show me a form of play that isn't sensory? Or if you're playing with an iPad, you don't use any senses, right? At all? No, you're completely locked in. Somebody did, to their credit, and I wish I could remember who it was right now to give them full credit, but somebody made a nice distinction for me recently in which it said, well, wait, but some play is more sensory-based than other play. I'm like, oh, okay. I don't think that's what we mean, but good point. I think that people are looking to calm kids, and it's always a dark room, some sort of light, things that we would think of as soothing. as opposed to kind of considering what the child's behavior is. And even some of that would then now take visual representation, right? The idea that I'm showing you this picture, that me doing the action isn't enough for you to understand what I might be doing for you. So yeah, we run a risk with our task analysis. We run a risk with over-implementation of certain tools. And in this case, the visual supports run that risk.

SPEAKER_00: 47:57

I think, again, the artificial visual supports.

SPEAKER_01: 47:59

Thank you. Artificial. And when we say that, we're talking about those squares Everything that's square and laminated with strange icons.

SPEAKER_00: 48:08

Exactly. And going back to the whole everything has to have a consequence in order to learn, as we talk about in ABA, the more contiguity there is, the quicker the consequences right after the behavior, the quicker that individual will understand the consequence of that behavior. So I'm like looking at your mixing board right now, and if you twist these dials to the right, things get louder, right? Yeah. Right. We don't need a like a one to five visual for a kid to do that. They will quickly figure out. I guarantee it. If you hand them a microphone, they'll start making noise and turning it and they'll figure out exactly what that does using the natural visual that's already there. Right. Or a lot of times, you know, and I'm not saying the one to five visual isn't useful. Of course, it can be very useful, especially if you're running a group or an outing and you want to say use your number one voice, use your number two voice. But there's a whole lot of technology that we're not necessarily using because we are stuck I have a sound meter, like a decibel meter on my phone that I love using with kids because they can see it go up as soon as they talk, right? Rather than me saying, nope, that's your number two voice. They can get the immediate consequence objective and see that as they talk louder and softer, the decibel meter goes up. Another visual. So these are all, again, things that we can be using. In addition, not instead of, but in addition to the visuals that have shown success, as we continue to develop and make ABA not only more humane, but more up-to-date and technologically advanced service.

SPEAKER_01: 49:31

I love the example of the decibel meter you just lent, and I'm going to try to break this down, hopefully effectively, because I think this is another... part of the problem that we run into. A lot of people might take your decibel meter example and boil it down to the fact that if it hits red and I redirect you to lower your voice, that's not your inside voice or whatever we're gonna label it, that that decibel meter is going to in fact be the SD at the start. That decibel meter is going to take a long time to be the effective SD to have somebody lower their voice. In fact, you're probably going to have to sit there and play with that kid and make that thing go red a lot so that you can understand how something's too loud and, oh, that was too loud for your mom, or wait a minute, that's actually too loud for me, or whatever the case may be that now has something kind of non-visual related to it or a consequence that's not related to it. And again, I wanted to exemplify that because I do think that's the problem we face. Yeah, I agree. Before that visual by itself. And then we want that visual to actually transfer over to an auditory stimulus that goes, oh, wait a minute. Whether I see that red light or not, I'm being too loud. I need to... reduce my voice volume because now I'm seeing other cues from the environment, visual or not, where people are going shh or somebody's covering their ears or somebody's withdrawing or whatever it is. I'm really glad you brought that up because what a great tool that decibel meter is. If we don't break it down like this, we might misconstrue that that's got the power, that the inside voice is the ultimate premise to make a kid quiet down.

SPEAKER_00: 51:34

But the immediacy of the consequence of watching the meter go up or down based Amazing. Amazing. I hope people aren't really using them, but I know we probably still do. And board makers probably free... It's like Microsoft 2003, probably. Stuff when... Now these things, you can go online and find them anywhere. This was when clip art was just coming out. So the technological dark ages, right? But there's so many other things we can do. It's kind of like a speed limit sign that's consecrated by a police officer, which may or may not be there. One of... 100,000 times the police officer is there to actually give you a ticket for driving over that 55 mile an hour sign versus having one of those dynamic speed limit signs that shows you the speed that you're going in real time. You get that immediate consequence to look at it. Now, in terms of the societal consequence of getting a ticket or something, that's not necessarily there, but it shows you the experience. It shows you exactly how fast you're going. So you can see that this speed, this feeling that I get of traveling at this speed, consequences So we're giving that experience. And I think the more that we can have visuals represent experiences for these individuals, the much better it'll be rather than these kind of artificial visuals that are all consecrated by us trying to devolve the experience to them.

UNKNOWN: 53:24

Okay.

SPEAKER_01: 53:24

Oh, man, we've covered a lot of ground. We're near the end here. We could probably talk for another hour on this. We won't today, but maybe we'll come back and circle back to this with some journal articles or some other research. I think we sort of talked off the cuff from our experience today, and we did a good job. I really, really, really enjoy the delineation you made in defining... Artificial visuals or visual structure, which are all those icons and things that we create, the 2D things we create that we laminate, as opposed to just anything else in the environment that could be visually based if you're a sighted person. I think that's a really good distinction because by no means... So I can recant and go back to the beginning of this and say, it is the artificial visuals almost exclusively that cause concern for me. Sure. And it's not... by and large because of what they are, but more of how they tend to be used.

SPEAKER_00: 54:24

I think maybe if I want to articulate that even differently, the blind use of artificial visuals exclusively, like there's times for them, and if somebody can justify, hey, this is why I'm using it, you probably have no problem with

SPEAKER_01: 54:37

it. So a first-then board. Do I have a problem with a first-then contingency? No, I actually prefer when then in some situations, as I've explained before. Maybe we'll spend some time on that. The idea that you need a laminated visual representation of that, to your point, then becomes the more important question. Have I started building rapport with this child and this family? What does the visual do? Does it also prompt the parent to use the conditional statement? It sure does. So it's got a real value there. even beyond just what it might represent to the child that we're calling autistic, right? Sure. So I think that's a really important premise to consider, and I really love the distinction you've made. So the blind use of artificial visual supports that could otherwise be replaced by just the natural environment or things that are readily available that the child will pay attention to in the natural environment. Now, to that, I'm kind of trying to provide a summary here. We do see the value of visuals in terms of being very portable and very salient, something you can put right in somebody's face. So that's a positive. And then the downside of that is that we're not promoting gay shift necessarily in those moments if... we're not careful about it. So sort of a double-edged sword for the traditional, right. Instead of what people use for pecs, right, or the same things that we're seeing on the AAC devices now in those dynamic screens, which are, you know, now analogs of those or digital versions of those squares, not

SPEAKER_00: 56:11

laminated. Yeah, Ken, the kid just pressed the button for milk and not orient to anyone, and then somebody just appears in their environment with milk. So they've done it. There's zero attention there. Versus

SPEAKER_01: 56:19

does the child carry the device over to the parent, tap the parent, and then point milk. Big difference. That's a huge difference. You're right. And I think that's what we're talking

SPEAKER_00: 56:28

about. And then orient to the parent, like, why aren't you getting my milk?

SPEAKER_01: 56:30

Yep, exactly. And that's exactly what we're talking about is... As we're using all these technologies, how are they being integrated in a way that provides the most access, that communicates optimally? So I think that's a really important thing because maybe at the start here I sounded like a visuals hater. That is not the case. The artificial visuals and the blind use, I really love the way you put that specifically, the blind implementation of those artificial visual supports, that is a concern and something that we need to continue progressing in, continue evolving because they are very useful and maybe a little bit too ubiquitous at times. All right. Any other closing thoughts here, Mr. Dan? One quick thing here. I know we're nearing the end. One thing I did want to mention in using visual supports like books for early intervention, something that's come up for me recently is this idea of visual boards and for say circle time songs and then a distinction that i've presented to the staff that is we're sort of in the process of examining what's the difference between visuals and manipulatives the artificial visuals tend to be a square the manipulatives now can take the shape of the actual object they represent and they're not necessarily meant for exchange and communication but not for symbolic play as you're doing. So again, that's a nuance. But if I'm not careful about the way we're implementing our early intervention, These visual boards and this idea that you take the speckled frog off of there and you put it on there, and again, very

SPEAKER_00: 58:09

useful. Put them on the log, Mikey. Put them on the log. But

SPEAKER_01: 58:11

what isn't it cool when it's not a square and it's actually a shape of a frog that's a little bit bigger that the child can manipulate and actually make hop around? Yeah, I would say there's a little more value to that. Now, is that what you have to do? No, you might be starting with the basic pieces. You might be modeling a lot at the beginning and pairing the activity with an enjoyable experience. Sure. So these things, these artificial pieces, by and large, don't have inherent power. we still have to go through the behavioral steps to teach them.

SPEAKER_00: 58:41

Yeah, I think for the speckled frog thing, like, yeah, it'd probably make a lot more sense to have plastic frogs and, like, a log. So that's for

SPEAKER_01: 58:48

3D objects or manipulative.

SPEAKER_00: 58:50

The 2D does allow for portability. That's probably the only

SPEAKER_01: 58:53

advantage. And for affordability, for example. Sure.

SPEAKER_00: 58:56

But I guess, yeah, and wrapping up, Mike, I'll just ask you, do you think in the future, in the near future, in the next couple weeks, you'll be using visuals with your clients?

SPEAKER_01: 59:06

I'll do.

SPEAKER_00: 59:06

Do you think you'll be using artificial visuals with your clients? class?

SPEAKER_01: 59:08

Yes, very likely. We're

SPEAKER_00: 59:10

still going to use all of them. We're not saying there's anything wrong with them. Just maybe think about why you're using them and how you're using them and is there a better way?

SPEAKER_01: 59:19

I love that. That's a great way to close. Think about why. Think about how. Think about how else you might toward actually maybe fading these things in some future. Focus on fading. Focus on fading. That sounds like the title of our next episode. Until then, always... Analyze responsibly. Cheers, brother.

UNKNOWN: 59:39

Cheers.

SPEAKER_01: 59:41

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.