Shared Joy Before Data: A Discussion with Dr. Megan DeLeon Miller, Part I

ABA on Tap is proud to present Dr. Megan DeLeon Miller (Part 1 of 2):

Join us for an insightful conversation with renowned behavior analyst, author, and speaker Dr. Megan DeLeon Miller. As the founder of the international Do Better Collective, Megan is a leading voice in advancing humane, person-centered, and neurodiversity-affirming practices within Applied Behavior Analysis (ABA). In this episode, we dive into:

• The crucial role of building genuine trust and rapport with clients.
• Strategies for approaching challenging behaviors while maintaining dignity and respect for the individual.
• Translating complex behavioral science into practical, compassionate, and individualized interventions.
• The "Do Better Movement" and the importance of lifelong learning and self-reflection in the field.

Dr. DeLeon (Miller) offers valuable insights for behavior analysts, parents, and service providers looking to bridge the gap between research and practice, and deliver truly impactful, human-centered care.

Transcript

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Cold Open & Show Setup

SPEAKER_05 0:11

Welcome to ABA OnTAC, where our goal is to find the best recipe to do the smoothest, coldest, and best tasting ABA or out. I'm Dan Lower with Microdeal, 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 food, how much to consume to achieve the optimum bust 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_04 0:51

All right,

Hosts Return And Tease Guest

SPEAKER_04 0:52

all right. Welcome back to yet another installment of ABA on tap. As always, I am your ever grateful co-host, Mike Rubio, along with Mr. Daniel Lowry, Mr. Dan, cloudy day today. But a very bright outlook for this episode for sure.

SPEAKER_05 1:10

Yes, yes. This is a long time in the waiting. This was scheduled for a while ago, but uh due to some circumstances it got postponed, but we are super excited for for this episode.

SPEAKER_04 1:20

So I I've got it I've got to tease you a little bit, as I like to do here at the beginning. We've been working together for a long time. In fact, we've been working together almost 20 years with a few breaks here and there. And a little over ten years ago, we had a a little reunion, started our reunion tour, which has lasted about ten years around. And you've been very active in that time in parent education. And you've got this, you've amassed this amazing repertoire, this amazing library of materials. And one of those materials is a very important article.

SPEAKER_05 1:54

Seven steps to improve instructional control.

SPEAKER_04 1:57

And about a year ago, we had this uh we had the distinct pleasure of moderating a conference. And during that process, we made the connection that one of the great professionals we were having the privilege of meeting on the that weekend was in fact one of the co-authors of this. Yeah. It's exciting. It's exciting to be able to make those connections. We've had an exciting season where we've met a lot of people that whose work we admire, and and that's where we're at

Introducing Dr. Megan Dillion Miller

SPEAKER_04 2:21

today. So without further ado, ABA on tap is proud to present Dr. Megan Dalion Miller.

SPEAKER_00 2:30

Hi guys.

SPEAKER_04 2:36

Thank you. Thank you so much. Perfect, perfect. Again, we can't thank you enough for giving us part of your Sunday afternoon. Luckily it is cloudy, as I said, here in uh in San Diego where we're at, so we're not missing out on too much, but we are super excited to be speaking with you today. Again, thank you for your time.

SPEAKER_05 2:54

So there were two people so I I've mentioned this in previous podcasts. When Mike and I moderated this podcast of the podcast, the conference, we were kind of at a crossroads at our uh at our career, and I think we were kind of maybe downtrodden on the field of ABA a little bit, looking at kind of what our options were, what the field had become, and we weren't very sure what the podcast or the podcast the conference was going to be like. Jennifer, you know, really prepared us for might be might be interesting, a lot of contention and things like that, and the conference was far from that. But I think Mike and I were so pleasantly surprised and both very re-invigorated with the field after the podcast, or after the conference, excuse me, because it kind of took us out of the you know daily, day-to-day billable life, and I'm sure we'll get there. But there were two people, at least for myself and I think for Mike as well, that really, really stuck out to us. One was Maggie, yeah, Harabuddha, who's been on the the podcast, and she was amazing getting the insight from an autistic BCBA. And the other was you. So we've done a lot since then, and we can talk about it, but with our introduction, thank you for all that you've done and probably unknowingly really inspiring us in the field to go out and do some things that we've done since then. So thank you and welcome to the podcast. Yeah, thank you.

SPEAKER_00 4:12

You are you're so welcome, and I appreciate the time to words. And I'm like I said, happy to be here. I enjoyed when you all were moderating the different panels at the conference as well. It was really nice. And I know you all put a ton of work into that because I think you were on like every single one panel every time there was one happening.

SPEAKER_04 4:31

So yeah, no, it was exciting. I said we we we were uh we were honored to be able to do so, be able to uh actually meet you know folks like yourself. Let's start with the origin story.

Origin Story And Early Career

SPEAKER_04 4:40

That's the way we do it here on ABA on tap. Everybody has had similar experiences, and then all of us are doing something a little bit different, which is exciting uh toward the innovation and progression of the field. But tell us, you know, what got you started up until the current moment, what keeps you driven. Uh yeah, tell us all about it.

SPEAKER_00 4:58

Well, I know you said we have a certain amount of time, so I'll try to keep that part short. We could probably spend the whole thing.

SPEAKER_04 5:04

Take all the time you need, please. Don't you worry, we got you. Take all the time you need.

SPEAKER_00 5:10

A lot of my like from the time I started in the field, and even I still feel like now, if a lot of things are more what I say would be happenstance or butterfly effects. Like, it's not there's not necessarily I make intentional moves, like I have my values and I make decisions based off of those, but where my path goes, it's not like I'm like, oh, this year, this is what I'm doing. It's just stuff happens. So when I was in all the way back in high school, I read a book randomly for my one of you know, language arts class. We had to pick a nonfiction book to read and a fiction book to read, but they had to be on the same topic. And I just I liked the whatever we had different categories to choose from, and there was one on autism. I didn't obviously really know what autism was in high school, but I was like, this sounds interesting, and it might not have I think it might have been broader, it might have been mental health in general. So I picked that, but the person in the book happened to have an autism diagnosis, and I was just fascinated by you know the what the story was that happened in there and and the way she navigated things and whatnot. So then when I was in undergrad, we had to do an internship and or like a practicum for our senior year, and there were only two places to choose from. There was an autism clinic and a mental health institute, and the autism clinic was closer to my house. So that's what I chose. It just feels like everything is kind of like that.

SPEAKER_05 6:39

Serendipity, I think is what they call that, right? Yeah. Were you a psych major in your undergrad or what were you? I was. Okay.

SPEAKER_00 6:45

Yep. I was a psych major and a really small school. It's funny though, because I was at a really small private school called John Carroll up in Ohio, and we didn't have a lot of the cool classes that you know bigger universities would have. However, there was a learning and behavior class, and like everyone always talked about this one professor and her rats, but they always made fun of it. So like I never even tried to take any of the classes because especially the one semester that I could take it, the person teaching it wasn't her, and everyone said he was really mean. And I was like, Well, I don't I want to take something else then. So I had the opportunity, even at my small school, to take classes and I didn't. So then when I I did that internship and I worked with the Cleveland Clinic as a like in-home like contractor, and basically showed up to a child's house, and the consultant came and she handed me a binder and she was like, Here you go, see you later. And that was that.

SPEAKER_04 7:42

That had to be a three nothing, had to be a three-inch binder, too, I imagine.

SPEAKER_00 7:45

Oh, yeah, it was real thick and had all his programs and had to be, but there was no like, you know, nothing. I mean, I had what I knew, like I had observed, you know, at the clinic, but that was it.

SPEAKER_04 7:57

No, nothing when people say, you know, the amount of training people need, and I'm like, well, I just taught myself that I think a lot of us have a similar story, and the three-inch binder is inevitably and maybe unfortunately a part of that and the IKEA table and chairs.

SPEAKER_05 8:13

That's all you needed.

SPEAKER_04 8:14

And it had to be IKEA. Dad loves that, but maybe some pecs. Oh, at that at our beginning, yes, maybe some pecs. Certainly, something laminated had to be there. Otherwise, you weren't doing it right. Anyway, continue. Right.

SPEAKER_00 8:26

Yeah. So I just I did that for a little bit. I thought I was going to go to grad school for my PhD, and nobody at the small school I went to had prepared me that how competitive clinical psych PhD programs were. Yeah. So I was like a failure for the first time in my life. I applied to really big schools like Duke, Ohio State, that took five students out of a thousand. Like no one had ever said, you know, I figured I had straight A's, like good scores on my GRE. I felt like I it was fine. And then afterwards found out that like it was basically impossible. So I took a year off. And during that year, I moved on to Columbus and just worked in home with families. And I had a really unique situation where at that time there wasn't the BCDA that had just started, right? This was like early 2000s. So no one in Ohio was certified. It was consultants who mostly were trained by people that I worked with low boss, but there were other people starting to kind of branch out and see what other things might be, other like strategies and techniques and styles might be out there. So I had I think three or four different consultants, and each one did things slightly differently. So I never had that like rigid, you have to do it this way. This is how we do things.

SPEAKER_04 9:41

That's kind of awesome, maybe to your benefits.

SPEAKER_00 9:45

Right. I got to see from the beginning that it's flexible.

SPEAKER_04 9:48

That's awesome.

SPEAKER_00 9:48

So that was nice. Same similar similar situation though, where like with each family, we were meeting with a consultant, you know, once a month, but it really felt like we were all just figuring stuff out on our own and trying to do the best we could for each kid. So I learned a lot because I had to, you know, if I wanted to do the best to support the children. And then I also, like one of the teams I was on, the two people that were also working were friends of the mom and had really unique backgrounds. So one was an art therapist and one was a play therapist. And they just brought in, again, really creative, unique ideas, and the consultant was really open to just doing whatever everyone was suggesting and just aligning it with the science. So again, I got to have that modeled for me and see very early on how well that works. And like when people were trying to be rigid, I saw that wasn't working. And then I saw when we were flexible and really working with what would work best

From Clinics To Grad School Mentors

SPEAKER_00 10:45

while doing things in a scientific way and taking data. So that that worked for me. And I just fell in love. I went to Florida State for my master's, it was the only school I applied to. I had taken, again, happenstance. I when I didn't make it into the clinical PhD program, I was like, I want to live on the Gulf of Mexico. So I went online and I found all the universities I could on the Gulf of Mexico, and Florida State just happened to be one of those. And when I found out you could go to school for behavior analysis, they had their application window was still open, but Ohio State's wasn't. So I just applied to Florida State, moved down to Panama City, got to go to school. Like we showed up, and Dr. Bailey, you know, everyone was like, oh my gosh, it's Dr. Bailey. And I was like, who's Dr. Bailey? Like, I don't know who this is. And I always love to tell people my very first ABA class I had to take at Ohio State because I needed it in order to go to Florida State. Like I didn't have any college coursework and behavior analysis, and they had a few prerequisites. So I took ABA for teachers with Dr. Cooper. Oh that was my first class. Oh wow. So again, had no clue who he was.

SPEAKER_06 11:55

With the Cooper. Yeah.

SPEAKER_00 11:59

And he was so cute at the end of every class. He would bow and say, Thank you for learning. And we would bow and say thank you for teaching us. And he was just like the sweetest, best professor ever.

SPEAKER_04 12:09

What a cool that that's what a cool little story you just shared there. Man, that's awesome. How great. I mean, to so you know, you mentioned people being trained by Lovas. You're, you know, you're saying Bailey and Cooper from a very strict ABA perspective. That that what a cool contrast, right? Because so many of us are are now this our experience is based in some sort of autism treatment. So you've got a a much more peer experience in saying, hey, Cooper and Bailey, those are my guys. Yeah. That's awesome. That's awesome.

SPEAKER_00 12:37

And when I was at Florida State, I was frequently reminded that I was in a behavior analysis program, not an autism program. And I I would tell my like one professor, Dr. Murphy, I'd say, but Dr. Murphy, autism brought me here. Like I wouldn't be here learning about the science and wanting to know what was going on if it wasn't for autism. So you gotta let me have my autism thing too.

SPEAKER_04 12:58

Well, we'll get into this too. I mean, that's that's sort of a modern quandary, right? What else is our utility currently to a lot of people? It seems to be the only thing we do. So, but we'll we'll get onto that. We'll we'll let you continue.

SPEAKER_00 13:08

Yeah. Well, I mean, that's pretty much it. Like I went to Florida State. I realized as I learned more about the science and grad school, especially, that I was kind of a natural behavior analyst. I was a lifeguard and swim coach and swim teacher for a while before like when I was in undergrad and even high school. And I was using shaping with my little ones, like that were scared of the water, and I just didn't know what that was called or anything like that. And I was in gymnastics growing up, and I recognized a lot of the things my coaches did in gymnastics. It was similar, unfortunately, very punishment focused. But I mean, there was some reinforcement involved as well. And then I took a few years off. I went to, I worked at Florida State as a clinical director, moved up to Virginia, started an ABA company called Navigation Behavioral Consulting. As I was doing that, I decided I wanted to go back to school to get my PhD. And I went back up to Ohio, did my PhD at Ohio State. My advisor, I had an advisor at Ohio State. Her name's Dr. Malone, and she works more with significant disabilities. A lot of folks in more of like just ABA don't really know her work as well. But if people in disability, like disability studies and focus more on intensive, like more severe disabilities know her work because she she was working with like gaze shifting and looking at, you know, children with really significant, like motor disabilities that couldn't in like physically could not do anything besides use their eyes to communicate. So that was her research. It was really fascinating. But I also she was very flexible and I wanted to do my dissertation on precision teaching and motor movement fluency. So Dr. Rick Kubina, he was at Penn State, but had graduated from Ohio State. So he served as my co-advisor. So that was really nice too. I was able to have like two incredible people giving me feedback on my dissertation. Then I graduated, moved back to Florida, and I still have my company, but I was like, I'm gonna be bored being in Panama City if I don't have like a physical job here. Like I don't want to just be doing stuff like running a business online. So I didn't want to take on clients in Panama City because there's already really good services there, and I just didn't want to really be doing that. So there was a group that's funded through the Department of Education here called the FSU Card. It's not card like Doreen Brampanisha's card, like here in the state of Florida, it stands for something similar but different, and it's funded by the Department of Education. So I applied to work with them and another really happenstance, unique experience. They so they they wanted me, but they were also doing research. And one of the researchers, her name is Dr. Amy Weatherby, and she is phenomenal, like huge autism expert. But from social communication, she's a speech language, her doctorate's in speech language and communication disorders. So I got to join this multidisciplinary team. And I had been at that point, I had been at BCBA for eight years. I had already been traveling and working internationally, thought I knew a lot. Holy cow, did I know nothing? Like I was blown away by the amount that I did not know. So it was really, really cool experience to get to work with her and her team and learn so much that really drives a lot of what I do now and a lot of the training and coaching that I provide. Again, just happened to, you know, I wasn't intentional about it. I was just like, oh, here's this opportunity. So yeah. And then I moved to St. Pete and started doing Do Better in 2018. So that's my very long origin story.

Multidisciplinary Training At FSU CARD

SPEAKER_04 16:45

That's amazing. That's amazing. You you might have noticed that Dan usually gives his little caveat that he's looking down at his phone because he's taking notes. He's actually checking his Facebook. He's a little bit addicted. No, what I'm saying though is he's got copious notes from that great story. So we are prepared to discuss. If you don't mind, I'm gonna jump right in. Of course. You just said something that really resonated with me in sort of the progression of your learning and saying, wow, I had done all these things and I thought I knew it all, and then you hit this experience that taught you a whole bunch of new things. Talk about that a little bit more. What were those new things? Maybe pick a few that you know you picked up during that time that are integral to your practice right now, and they're probably a little bit different from what other people are doing. So that really resonated with me when you mentioned that. I'm like, oh, I need to know more about that. What is that stuff? Because that's that's the good stuff. That's probably what sets you apart in your practice and the things that people can really learn from, take away from.

SPEAKER_00 17:39

Of course. Before I do that, I'm just gonna mention two things in case you all want to come back to it. I completely skipped over the work with Robert Shram and how that started. And then we skipped over the international work, like how much how that started. So a lot often people want to know like how that started too. So we can come back, obviously. Dan's saving the two big things in the origin story that I skipped over.

SPEAKER_04 18:02

Dan's already saving that for the third hour of the installment. Don't you worry. We got all right.

SPEAKER_00 18:08

No, so the yeah, the research, what what we were doing is early screening for autism diagnosis.

ADOS Insights And Shared Enjoyment

SPEAKER_00 18:14

And so I was working with families where they would come in for an evaluation, and I had to be trained on the ADOS at the research level, which is like very intensive training. Some people will go to like a little workshop and learn how to do it as to to just do it and then assist psychologists and diagnosing. But this, the research level is a much higher level of fidelity because you have to be able to score it in such a way that you would have IOA and all of that kind of stuff. So when I the ADOS part was part of the most eye-opening because there's it's very well written. The way you code for the different sections of the ADOS, the operational definitions are pretty detailed. But the things that they were defining, like shared enjoyment and reciprocity and all these social communication things, I was like, I don't know what any of this is. Like, what are we talking about here? I've never been taught to look at any of this. You know, like we sit down with our kids and try to get them to man and tact and things like that. And there's not much of a focus on relationships or that shared experience. So through doing the ADOS, I was able to see how integral that piece is in what we do, but also like how much I didn't know about even what how to measure it or what it should, you know, what it looks like or anything like that. And the shared enjoyment, especially, was one that was really hard for me because I'd be doing an activity with the child and they'd be laughing and having so much fun. So I'd score shared enjoyment as you know, the highest score you can get. And then I'd go to the person that was coding it with me so I could pass my, you know, little tests. And she's like, no, that was not good. But I'm like, wait, what? They they were laughing, they were enjoying it. And then they would point out to me, they were enjoying the activity, they weren't enjoying you, right? Like they weren't hating me either, but they weren't like they sharing that experience with me. So that's become a really big focus for me when I even within like a few seconds of watching a parent or a therapist interact with a child, I'm like, there is no shared enjoyment here. And that's one of the biggest pieces for when we look at autism specifically, best outcomes is the shared enjoyment. And like no behavior analysts are trained to measure it, trained to promote it. And we were trained to pair, but it's not the same thing. It's this more like authentic, genuine experience where the child genuinely wants to be interacting with you and it's not transactional. Like a lot of us set up, you know, pairing and stuff, like, oh, well, I'm gonna dangle this thing and like try to get you to hang out with me because I'm fun. But we're doing it so we can check off boxes and get through data collection. And we're not doing it to genuinely and authentically understand the child and connect with them. So I was able to really see like how important all that was. I'll pause there and I'll tell you one other thing. I don't know if you all have comments on that part first.

SPEAKER_06 21:05

Uh he does. You know, I have a lot of questions. We just hold off on my question, the fourth.

SPEAKER_04 21:11

I know you just uh um everything you just said just resonates with me, uh, with us, with our new vision, especially with the idea of early childhood uh intervention, which is sort of my bag. And I think that's where you know my differences come in in terms of training. I was trained in developmental psychology first and foremost, and when I got introduced to ABA, it just seemed so unidirectional, meaning I was doing for the child, and then to your point, there was nothing that I was supposed to wait to come back other than this already predetermined correct answer that I would reinforce. And it just seemed so surgical, it seemed like something was missing. And I understood why. But just everything you talked about there in terms of we use the word rapport very often. And I don't know that we actually established that a lot of times with what you're talking about in terms of shared enjoyment. So I don't know if you could expand on that a little bit more or more examples of what that's supposed to look like. What does that mean? I talk a lot about joint attention, which I think is is relevant to the idea of shared enjoyment. We're paying attention to the same thing, we're looking back at each other, and now maybe we're grinning and showing our teeth and making these sounds as we tilt our head back, and then we're doing it again, which means we're laughing together, and then maybe in our very esoteric operationalized definition of shared enjoyment, as behavior analysts, we can check that box. I'm being a little facetious there, but tell us a little bit more about what that's supposed to look like. Or what are the measurable parts and again, I'm gonna ABA it a little bit and and we don't need to sterilize it, but what are the measurable parts that people could learn from? Because I think you're you're hitting something very important, especially for younger professionals who maybe get a little more training than you and I did and don't just get plunged into it or you know, thrown into it. But there's still a lot to be learned from this idea of I'm providing reinforcement versus what is the reinforcement provided by the idea that you and I are laughing at the same thing. I mean, there's just so many immeasurables there. Talk to us about that.

SPEAKER_00 23:12

Yeah. Yeah. And that that's what makes it tricky. And I think that's part of why behavior analysts historically haven't done as much with it. Yeah. Like even with joint attention, I went to a conference one time and the presenter was very excited to present their research on joint attention, and they were from a very well-known, reputable research place that like produces a ton of research. And they showed the video of what they did, and it's a a person sitting next to a child. Like they're first of all, they're sitting next to each other, which in general, if you're trying to promote social engagement and like have that, you're gonna be sitting like across from each other, like you know, not next to each other. But anyway, so the therapist is sitting next to the child, and the therapist is like prompting, like gesturing to the toy, gesturing to themselves, and then handing the kid an MM. And that's how they were they thought they were training joint attention because they were looking at it topographically, right? Like, okay, three point. Okay, they looked at the thing, they looked at me, they looked back at the thing. We've got joint attention. It's like, no, no, no, no, no, no. It's not what it looks like. This is not based on form, you know. It's and I think that's what makes it so tricky because it's like a feeling it's like we're connected right now. I can feel that you want to be here with me. And it's like, how do you operationally define that? It's obviously a lot trickier, and then it's trickier

Measuring Connection Versus Pairing

SPEAKER_00 24:32

to train people on that too, which is part of why when I was doing the ADOS, it was hard to get people to match on their codes with shared enjoyment because the experience I'm having is gonna be different than the person observing my experience, right? So it is a very, it's a lot trickier to measure, but it's so worth it. So we look at things like you were talking about, you know, the laughing, are they smiling, are they reaching, approaching or moving away? It's a lot of that kind of stuff. But there's still this qualitative piece to it where the person and the child in that engagement that they're having, it's like what we hear about with pairing, oh, this is this experience is better with me than without me. Right. So like if if I could sit here and judge, like is if I walked away right now, would the child have as much fun or not? And it's like if I could walk away and they would enjoy themselves just as much, then we're not having shared enjoyment. But if I'm, you know, here and they're enjoying the activity, but I'm like whatever we're doing together and the that social experience that we're having is making it that much more enjoyable, then we have shared enjoyment. So it's hard, it's like a tricky thing to again train people or really measure fully. But there's again in the ADOS, they have the codes for it. When I observe people, I have some data sheets I've made that look at active engagement and looking at how the adult is promoting it, but also how the child is responding and seeing, you know, a lot of it's about being responsive and training people on how to be responsive and observing of whatever the child is doing. Obviously, Hanley talked about happy, relaxed, and engaged is a big piece as well. But there's still this piece when I hear people talk about using PFA SBT and like trying to get that happy, relaxed and engaged with their clients. They're not talking about that shared experience though. They're they're just like checking the box if the child is happy, relaxed, and engaged, but it doesn't have to be with someone. And I'm not saying it always has to be with someone, but in the research that we're seeing, the more we can create those experiences and really bring more value to this shared interaction at a young age, the more likely we are to see better outcomes because that's what sets the stage for communicative intent, for communication to be functional and meaningful and have that motivation to want to interact with people, whether it's just to get their needs met, like or whatever. I mean, the reason why the communication happens can, you know, is going to vary drastically. Every single one of our clients, some are more extroverted than introverted, and that's fine, but to at least set that foundation of hey, when you need something, when you want attention or whatever, this is where we get that. The shared enjoyment and the various social communication skills are what get us there. And again, a lot of people aren't focusing on that. So I've I've been working on, we didn't talk about this at the beginning, but I've been working on pulling together all of the research on that's coming out on these different topics within the autism research, and then creating a new assessment and programming curriculum. And a lot of it focuses on the connected relationships piece because that's something I've been working on since like 2012. And I've pulled in work I've done with clients, but also the research and the training I had at Florida State, and to kind of make a more step-by-step way of how do we build a connected relationship? How do we measure the get baseline on it and see if we even need to be working on it? How do we train people to build a connected relationship? Like what are the scores that we would, you know, show, okay, yes, a connected relationship is here, and then we can move on because a lot of people jump into just trying to teach language right away, but you're not going to get very far if you haven't built that connected relationship first.

SPEAKER_04 28:25

Wow. So man, so so much to talk about here. I want to I want to let you loose, but one thing I want to say, and and uh certainly Dr. Megan comment on this if it resonates. But enjoyment's almost a misnomer here, and I'm not saying that it doesn't apply. We use it as a way to uh immediately connote and measure this idea of the the child's happy while they're interacting. But you're you could be talking about shared focus and problem solving. You could be talking about anything like that. It doesn't have to be that the child's laughing, just that you're jointly attending and together in a way that's clearly and observably unified. That's that's really interesting. I think that that we could talk so much more about that and train our younger professionals so much more on that because it's so easy to think that you just draw the straight line between you know, I present the stimulus, you behave, I reinforce, and that's it. It's this very linear, you know, one unidirectional interaction. And what you're describing is a much deeper, much more involved choreography of coming in with drawing, and the child comes in

Social Communication Predicts Language

SPEAKER_04 29:25

because they want to be with you, so they come towards you and then you re-engage. I mean, it's a dance. And we we that that three-part contingency at its best just draws this straight line through it and it misses a lot. And it's not to say it's not important, but you're talking about something much richer, much more involved.

SPEAKER_00 29:41

Yeah. And there has to be this more like nuanced, again, looking closely, observing and responding based on what you're seeing from the child. It's not just this like black and white, you know, set of instructions that you're following, but you're you're coming in and going out based on what the child is. Doing and where their focus is, and being attuned to so many different things and making decisions based off of a calculation that you're doing again, not just following like the black and white steps that exist there. What is funny to me though is when any of us think about what how we learn best, it's when we're in environments where people are engaging and we're sharing an experience with them, you know? Like when we go in and the people like are off putting right away, we're like, oh, and we probably just get out our phones and start scrolling TikTok or something. Like we're not paying any attention. But that like goes into, I didn't learn about this necessarily at Florida State, but that would tie into like a different topic of perceived safety, too, like how safe we're feeling both emotionally and physically within an environment sets the stage for effective teaching as well.

SPEAKER_04 30:53

Wow. I mean, you know, again, so much, so much to explore there. And there's a nuance. Those things aren't necessarily measurable, but they're certainly very tangible, and and you can recreate them. But yeah, Dan, I'll let you loose.

SPEAKER_05 31:04

Yeah. So you said um you you used a phrase that I wanted you to elaborate on a little bit. You said set the stage for communication when you were talking about that reciprocity. And I'm just reflecting back on you know my history of training, and a lot of it was more older school, I put in quotes, ABA, and it was more, you know, coming from the idea of individuals with autism traditionally don't tact that often, and we teach through manding. So I remember some of the research was we teach through manding because that's how communication is learned. And then that oftentimes became very transactional of like, I'm gonna teach you to say I want ball because that's what you can communicate for when you want the ball. But one thing that we've been really looking at is like Mike talked about, enhancing the joint attention piece to where maybe you might not speak or verbally communicate as quickly, but when you do, the language becomes much more diversified, and we do see the tacting, which again, and I don't know if the research proved this initially or not. I just know that that's what the training slides that were presented to me showed, that it was so much more manding heavy versus tact heavy. So, do you have any thoughts on that? On if it is a common trait of individuals with ASD to be skewed so high on mans versus tax, or if it's actually more of a product of the way that we taught it and so transactionally versus you know reciprocity and joint attention based.

SPEAKER_00 32:24

Yeah. So that's like a whole an hour on five hours. Okay. Um with the time difference, it's only two.

SPEAKER_05 32:34

I like that. All right.

SPEAKER_00 32:36

For this topic, it's like so much bigger to me. And it's the short answer is yes, I think it's about how we're teaching, but that's partially because people think that mandning is what comes first and it's not. When you look at the research on language development, the social communication skills are what matter the most. And there's a study by Dr. Morgan where no, wait, not Dr. Morgan. She did a really cool study. Yes, it is hers. Okay, Dr. Morgan did a study where they were looking at an intervention. It's called ESI, it's part of the research that was being done at Florida State and early social interaction, and they're training parents how to engage their children. And they, at the beginning of the study, they looked at a few different baseline measures, and they did one measure was a social communication measure, another measure was a language development measure, and then they did a couple of others. They provided the intervention, and then they did the post measures. What they found was in terms of the final language development that the children had, the thing that best predicted how much language development we would see was not their baseline scores of language development. So you would think like, oh, the kids coming in with higher language development scores, would end with higher language development scores. No, it was social communication. So social communication better predicts language development outcomes than language development itself.

SPEAKER_06 34:01

Really?

SPEAKER_00 34:02

That's how important social communication is. So when we have so much of us focusing so heavily on we need to teach them demand, we need to teach them attacks, and we're doing all this language focus without first measuring social communication and building up those skills. If you think about your clients, where sometimes you're like, man, these clients kind of came in. I thought they would make the same amount of progress, but one really progressed and one's still kind of in the same spot. If you looked back, the difference was probably that one had social communication skills and one didn't really have those yet. So the more that we can get everyone understanding, hey, this is the critical thing that we need to be really measuring and taking into account whether we're working with two-year-olds or 20-year-olds. Like it doesn't matter if that social communication part isn't established, anything we're trying to do that involves language is not going to go as well. And I saw that really frequently when I was doing assessments because we'd have kids come in who were talking, had tons of words, but they were had zero social communication. Interesting. And then we'd have kids come in that had no words, but their social communication was amazing. You know, so there's like this huge difference that happens. One other piece to that though is the criticism, I guess I have in general of

Honoring Interests And Authentic Play

SPEAKER_00 35:20

research that's happening, even from my favorite researchers, which is the failure to also connect with the unique interests of the children that we're working with. So when we say social communication needs to be focused on and social communication isn't there, the ADOS and other things that are measuring social communication are doing it based off of what a like typical child might be interested in. So when we would do our different assessment items, we're like playing with a doll or playing with a car, doing certain things that like a two-year-old generally would be interested in. And the kids are like, no, no response whatsoever. But I watch them and they're, you know, lining up something or stimming on something. And if I were to join them in that and connect with what they're interested in, we'd see all sorts of social communication. So there's that's the other piece of it, is it's not just about understanding we need to be measuring and programming for it, but we need to be doing it in the way that's functional and meaningful. Why do young children engage in social communication? Because their parent is imitating the what they're doing, because their parent is connecting with them. If we are constantly trying to redirect them to like, this is what uh you know you should be doing or whatever, and we're not honoring and affirming how they're showing up and just connecting with that, then we're not going to see those skills. And like the research on social communication right now is pretty much all based on, well, we tried these things that like a two-year-old would normally like, and they didn't respond to that. And it's like, well, what it would, what do you think would happen if you just tried if you backed it up a bit and thought about, okay, well, why does the two-year-old like those things? Or like, why does that experience happen for the two-year-old and you emulate that instead? Oh, it's happening because people are imitating them. It's happening because people are laughing with them. People aren't constantly following them around, trying to get them to do the opposite of what they're naturally drawn to. So two big things have to happen. We have to understand social communication, but we also have to connect with the actual human in front of us and not try to like fit them into a box.

SPEAKER_05 37:28

That makes a lot of sense. I do have more questions, but I know Mike is uh you are talking Mike's language. I'm gonna go ahead and pass him down.

SPEAKER_04 37:35

How you've moved my nonverbal imitation program into my communication section in this three-inch binder, Dr. Megan, that's very confusing. What are you doing here? Come on now, that makes no sense. I let me obviously being overly facetious there, I went on a little uh what should we call it, uh a revival a few years back in terms of rapport building and this idea of linguistic mapping and contingent imitation. Literally, you're commentating on what's happening in the environment, what they're doing, what you're doing, and within a reason, you're imitating what the child does, you know. And I had a lot of RBTs kick back, well, this is an ABA, what are we doing this for? And I said, for one simple reason, so you can pay attention to what the child is doing. Because otherwise, we're gonna come in with all these predetermined programs that may or may not work, and you're gonna run these contingencies in a linear fashion, and you're not gonna pay attention to what they're uh engaging with. But if I make you imitate them and commentate on what they're doing, what they're doing, what's happening in the environment, then you're forced to pay attention to the child for a little while. And then you might build rapport and figure out. And I have this theory too, if you do that enough, which also makes you kind of be in their space and and then maybe they move away, so you move away and you come back. Eventually what ends up happening is you show up and the child gets right next to you. And now because they're accustomed to that, that's what you've built over time. So now, you know, I'm skipping over some stuff, but it's a perfect time. That's what we sort of refer to as instructional control, or at least the

Targets Shift: From Child To Environment

SPEAKER_04 39:05

opportunity to have it because you've got somebody's sustained and interested engagement. You've you've done for me, you've shown me things now. When you show up, I want to be in your space. And then now from a more adult directed perspective, you have a chance to demonstrate those learning pieces or those targets. The other thing I was thinking about, this is I'll get to a question. What do your targets then look like, right? So let's go back to that three-inch binder. If we're talking communication, you're gonna have a colors program, a shapes program, all these things that make sense from an educational linguistic perspective, but you're talking about something that's way different from that in terms of targets. So what do those targets now look like in what you're talking about?

SPEAKER_00 39:48

So yeah, that it depends on the child and like where they are. So I have this thing called phases of service delivery that I've developed based on my clinical experiences and all the unique opportunities I've had. And I what I do is I go through the phases. So the first one's connected relationships, the second one's emotional regulation, the third one is the big four preventative skills from the article by Allah Rosales in 2018. And then we finally start to move in, it's depending on their age, executive functioning. And then the last is if necessary, a functional assessment. So if they're in like that connected relationships phase, the targets are more looking at if I'm essentially following the child around and joining them, how are they responding to that? And like, are they allowing me in their space? Are like how many gay shifts are we getting? Looking at that shared enjoyment and reciprocity and just that kind of like, are we having these back and forth interactions happening? For imitation, I use reciprocal imitation training, which puts imitation in that communication box. The research shows imitation is an early form of communication. So it's it has certain phases that it goes through. And the first one is you're just imitating the child and they continue to imitate, like, or they continue to do the action. Some children, if you imitate them, they're like, What? And they move on. They're like, I don't mind if you're around me. So that means you have to do more to build up and like earn that you know, respect and interaction with one another. But the phases from reciprocal imitation training are really nicely laid out. There, it's one of the only models that has group like randomized control design to study its effectiveness, which is funny because like do this imitation training has none of that, but everybody does it.

SPEAKER_05 41:33

But how are they gonna do it if you don't tell them to do it, Megan?

SPEAKER_04 41:38

And you better not label the you better not label the action. That's too enriched. You have to say you have to say this, right? In order to make sure it's non-verbal. Oh my, I love I could talk all day about that stuff. Um man, I had a question and I forgot it. Shoot. Oh, we took this question. We did were you referencing, was that the Shridman? What what joint attention uh or reciprocal imitation training?

SPEAKER_00 42:00

Reciprocal imitation training is uh Shridman did a really good article.

SPEAKER_04 42:04

I think with Wayland. Yeah.

SPEAKER_00 42:07

Yeah. There's been a few different folks who are publishing the research, but I think Shridman's like the main was like the initial There was an early one.

SPEAKER_04 42:15

Maybe she did it with like Weyland or or Ingersoll or somebody like that.

SPEAKER_00 42:19

Yeah, the the three of them have done publications and like together and separately. And then there's been, I think Landa might be ones who there's different people who have replicated and extended and all of that.

SPEAKER_04 42:30

The uh the reason I it it it resonates with me is that that Tribeman paradigm or that protocol is one that I've adapted to in my training for younger pros and saying, look, this is the research-based one. I'm not expecting you to use it as a recipe. So I don't want you to be a baker with this. I want you to be a cook. These are the ingredients. This is the stuff you do to saute and to chop and to mix, and at the end you're gonna get you know something good. And and it it's a lot about you know presenting the the SD, if you will, and then maybe there's a no response. And then you're gonna try again. And so it's it's a lot, again, a lot more of a choreography than this straight line, I show you, you do it, I give you an MM back to your other example. And I still don't know why MMs are so related to every behavior. We we tend to think they're related to everything else in the MM minis. Oh, the MM minis were essential because then you when the state street is fast. Anyway, we like to be a little facetious about some of the silly things we've done earlier in our career. And not to say they were, I mean, they they were just a little misguided, right? We didn't know any better, and and that's why we want to talk. We learn better, do better. We'll get to that in a second.

SPEAKER_00 43:36

Just real quick for the target, sorry. Oh, yeah. So my ultimate dream, at least in the autumn space, is that we eventually can hit a shift in the field where the focus is less on targeting the child and collecting data on like them. And it's more based on teaching the staff or the parents or the teachers how to create an enriched environment. And we're setting up opportunities based on what we know from the research to promote these skills and to like make it more likely and more probable that those skills would functionally occur. And then we take data, we still would take data on whether or not they did, but it's more we're we're putting more of the onus and the responsibility on the adults to be able to understand, you know, what to do instead of trying to measure every little aspect of the child. Because again, we don't it's based on my clinical experience, but I think the research is getting us there too. The difference between different outcomes is not typically how many boxes we can fill in on the VB map or the ables or peak. It's how well the environment is feeling safe and supporting this unique person and like being able to navigate everything that's happening around them.

SPEAKER_05 44:52

I love that. I mean, that was something that that was my tangent. Like we we were take data on yourself, take data on what you're doing.

SPEAKER_04 44:58

Yeah, you you were big on that for a little while.

SPEAKER_05 45:00

Maybe eight to ten years when we ran that company. We had pretty much creative freedom. We had

Coaching Adults And RIT Foundations

SPEAKER_05 45:05

a very unique contract where the insurances were we had pretty much creative freedom with the insurance that we worked with, which was amazing. And so we were able to do a lot of testing and things like that. And that was something that I came up with kind of towards the end of let's take data on the RBTs presenting the trials, more so than just uh the taking data on the kids, but let's make sure the RBT is providing the rich enriched environment because that's gonna be the more important thing.

SPEAKER_04 45:29

The idea that the trials by themselves don't teach, and I think that's what we were doing, is we were trying to teach based on the presentation of these trials, and what are we doing to teach the concept before? You did really well with that. So the you know, the RBT are we're going to present certain stimuli a certain amount of times, and then you had a good way, I forget how it was, of gauging that it was meaningful. That sure there had been some sort of it was right around the time we were doing the joint attention stuff. We uh we we got very heretical and and moved into frequency and rate data. Oh, that's what I was gonna say, yeah. Just percentage of opportunity, which man got you in trouble.

SPEAKER_05 46:01

Got me reported to the board because nobody knows more than a new BCBA who knows that if you don't do your 10 trials at across 15 sessions and then yeah, anyway. Uh but yeah, that went nice with frequency because that was another thing, right? Of if we have the RBTs presenting the stimuli, frequency seems to make more sense because if they do it 10 times, now we got stuck on percentage of opportunities, right? Like 80% or 70%. But if they're doing it a certain amount of times, maybe we should look at the times they're not doing it, and it might not be a skill deficit. It might be that they're not paying attention or that we're not presenting the stimuli. So so often we would then put it back on the client and be like, oh, they haven't mastered the skill. But maybe they have, and they're just tired of us presenting this trial over and over and over.

SPEAKER_03 46:45

Why are you asking me this again? We call that satiety, don't we? Is that the word we use?

SPEAKER_05 46:50

But I I have a question for you actually, because I so much resound with with what you're saying. So much of the way that, at least in in our kind of niche of the world, the ABA's delivered, it's funded through medical insurances. And now you're talking about kind of rewriting program delivery and targets and things like that. We recently had a peer-to-peer review that ended up actually being pretty positive, but took a lot of steps. And, you know, insurance companies, a lot of times the people are BCBAs that are reviewing it, but they're used to the very traditional, like if you want us to improve your services, it needs to be written in this way, and you need to have a certain number of programs, because if you don't have a certain number of programs, you can't request this many hours. And our hours recommendations are very low, you know, maybe six hours a week or something like that. So have you thought about that, run into that? Any thoughts on that larger thing of as you're trying to kind of rework how the targets are presented and the procedures are delivered, kind of navigating that insurance realm to make sure that we get funding.

SPEAKER_00 47:49

So I'm really fortunate I don't work with insurance. But I used to see. But no, so there's there's a few things that come up for me though, because obviously, you know, I've everyone that's in the community that I train and coach, they generally are working with insurance. So I do think about it. And in the the new assessment and curriculum, or I don't really want to call it curriculum, but the assessment and like programming guidance that I'm creating, it's going to be aligned with medical necessity. So hopefully it'll be easy enough to put into like an insurance focus. There's a few different things that come up. One, it depends because like I think some insurance companies are far overreaching what they're actually legally allowed to be doing. And the more that ABA companies are attending things like the Autism Law Summit and learning about mental health parity and all the things you should know from working with insurance. And I know this might really make some people mad, but there are PE backed companies now that actually have the ability to fight this stuff and they're working on it. Like as much as people might criticize PE backed companies, that's probably one benefit is that they're, you know, it's highly uh in their best interest to get the insurance companies to do what they're supposed to be doing, you know? So we have, I feel like another way to push back than like BCBAs who are trying to operate their own company and don't really have the time or resources to really push against the insurance companies. And of course, then we have places like CASP and the Autobahn Law Summit. So that's a big piece of it, is like the more we can do to get insurance companies to take a step back. Because when you look at like going to the doctor and speech language pathologists and things like that, they're not required to give nearly as much detail as some of the insurance companies are trying to require from behavior analysts. But the other piece, like for the ones that really are just requiring what's necessary for you know providing the benefit, I think sometimes behavior analysts are giving too much information. Like we're taught to be so clear and write these really detailed treatment plans, and then we're giving the insurance essentially ammunition to use against us when all we really

Data Practices That Enable Engagement

SPEAKER_00 50:00

need to be doing is giving them the long-term goals, maybe the short-term objectives, and then our data about progress. Now, when we go back to the home and we're using behavior analytic strategies to obtain those goals, in reality, the insurance company doesn't need to know all of those things that are happening. They just need to see us, yes, attesting that we're using behavior analytic procedures, but you know, we've met these goals, and here's the data to show we've met these goals, and here's our new goals, and here's the assessment results, and the data. That's what they need. So if that's the case, if I'm working on training people and I my focus is more on I'm gonna coach and train you and set help you learn how to set up the environment better, then the data I can still collect, and I don't even need to collect it. Like we're taught, you know, you have to collect multiple data points per session, blah, blah, blah. In the research, that's not actually true. When you look at especially naturalistic developmental behavioral interventions, they're not doing that and they're seeing just as much progress, if not more. Because again, what's the critical component? Shared experiences. How are you having shared experiences if you're taking data every two seconds? Like you're not. It's not happening.

SPEAKER_05 51:11

Are you gonna report her to the board or do I need to? We're gonna have to not even multiple. Wow.

SPEAKER_04 51:18

We're gonna have to end here. Uh I'm not sure that we're I like to say if you're texting who's driving.

unknown 51:25

Yeah.

SPEAKER_01 51:26

That's that's my best analog to like.

SPEAKER_04 51:28

I mean, and it happens to us in in modern day interaction, you know, and we do it to each other, and and that's not what we want to do with our kiddos. That's we're that's not a good model, you know. Um and it's why we we agree a hundred percent with you. We used to like to say uh, you know, uh a point is a a point, uh two points is a line, three points is now a function, mathematically speaking. You can you can you can figure out a lot of things from the and it's not to say that you only need three points, but if you take those three points at the right time and you sample them across a span, you're gonna get good information. Again, the more data the better. But the idea that we've historically tried to recreate sessions through data points, yeah, you know, that that's that's ridiculous. It really compromises the interaction, to your point. Will and looks like I get the

Insurance, Medical Necessity, And Goals

SPEAKER_04 52:13

last word. As this concludes part one of our interview with Dr. Megan. Please do return for part two and always analyze responsible.

SPEAKER_02 52:24

ABA on facts 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.