Words that Work: Brittany Warnke on Effective Language Interventions (Part I)

ABA on Tap is proud to present Brittany Warnke, SLP (Part 1 of 2):

In this episode of ABA on Tap, hosts Mike Rubio and Dan Lowery are joined by Brittany Warnke, MA, CCC-SLP, a dedicated Speech-Language Pathologist from San Diego, California.

Brittany brings her specialized expertise in bridging the gap between speech pathology and behavior analysis to the table. Currently serving at Pioneer Day School, Brittany focuses on collaborative, interdisciplinary approaches to support learners with diverse communication needs.

In this episode, we dive into:

• Interdisciplinary Collaboration: How SLPs and BCBAs can work together to create more comprehensive and effective treatment plans.
• Functional Communication: Strategies for prioritizing meaningful, real-world communication goals that empower students.
• Bridging the Jargon: Navigating the different professional "languages" of SLP and ABA to foster better teamwork and outcomes for families.

Whether you’re a practitioner looking to sharpen your collaborative skills or a parent navigating the world of related services, Brittany’s insights offer a fresh, compassionate perspective on how we can better serve our learners together.

Pull up a chair, grab a cold one, and let's talk shop. Cheers, and always analyze responsibly!.

Transcript

SPEAKER_00: 0:01

Welcome to ABA on tap. I'm Mike Rebio with Dan Lowry. So without further ado, sit back, relax, and always analyze responsibly. All right, all right. And welcome back to yet another installment of ABA on tap. I am your ever-grateful co-host, Mike Rubio, along with Mr. Daniel Lowry. Mr. Dan, good to be back. How are you, sir?

SPEAKER_02: 0:46

Great to be back. Very excited for 2026, starting the year off with the bang.

SPEAKER_00: 0:50

Running a doubleheader today. It actually worked out. We talk a lot about collaborative treatment in ABA. And then actually arriving at good, solid collaborative treatment can be very difficult. And there's a lot of barriers to that. So we're going to get into that today because our guest is going to provide us her content expertise as far as collaborative treatment is concerned. I also find a lot of overlap between what we do and what our guest does, especially when it comes to the early childhood realm. A lot of the things that we do are very similar, although we call them different things. Everybody's got good intent. Everybody wants to take the lead. And then again, we're talking about working together. So ABA on Tap is proud to present Brittany Warrenkey. Brittany, how are you? Good afternoon.

SPEAKER_03: 1:49

Good morning.

SPEAKER_00: 1:51

Good morning, good afternoon. I'm not sure what time it is.

SPEAKER_03: 1:55

Happy to be here. Because a lot of it, like you said, is the same thing with different language. So providing that you know interconnected approach is why we keep doing this. So thank you for having me today.

SPEAKER_00: 2:16

No, thank you so much for your time. We I mentioned collaborative treatment, and then I didn't mention who we're we who we're collaborating with today. So you're a speech language pathologist by training and trade, and I'm sure you've got a whole bunch of other things you're gonna tell us about. Mr. Dan, I might have interrupted you there.

SPEAKER_02: 2:32

I was just gonna say Brittany is somebody that we've been meaning to have on. We were introduced almost a year ago, probably now, by a mutual colleague. We were like, gotta get you on the pod. Weren't able to make it work last season, but we're starting off this season, so super excited because this has been a long time coming.

SPEAKER_00: 2:48

You're our second guest for the new season. So again, what an honor. How cool. Thank you for your time. A quick shout out to Tanya. Our colleague, yeah, the Yeezy. Tanya Valentino, who made this connection. She actually came to us and said, I've got somebody for the podcast. You guys have to have her on, and you have to meet her, and you've got to collaborate. You guys talk about the same things. So we're really excited to do that today. The way this works is we like to give people an opportunity to tell us their origin story. And what we find throughout these seasons, and as we've been working with more guests, is everybody's got these cool happenstand stories where I did this early on in my career and I had no idea that it would then play out and fit into what I'm currently doing. So we like all those connections. Let's pass it over to you. Tell us how it all started for you, past, present, and then we'll look at prospects at the same time. What's your origin story, Brittany?

SPEAKER_03: 3:46

Thanks, Mike. So I am a graduate from Ball State University in Indiana, where I did my undergrad and master's program there, which is highly clinic based. You get in there and you're 100-level classes and you start making connections in the clinic and supervision, and you have a lot of hands-on opportunity to get in and explore. And as somebody that wanted to be in the education field, but have a little bit more, I guess, direction with one person at a time, I wanted to go into the therapy realm. So healthcare was initially my thought, going into the hospitals and working with the dementia population. And then in clinic, I fell in love with the autism population. And I had such a fun experience with just doing some nannying here and there through grad school to make some extra money and meeting families and going in and just really truly embedding naturalistic approaches with just seeing people at the human level and you know, working with people to make it real for them. So I worked in a hospital setting out of my graduate experience and came out here and did some field work, Tri-City Medical in Oceanside for a bit and some in-clinic treatment, outpatient treatment. And then I worked at Sharp for a little bit with pediatrics and geriatrics. So everybody from two-year-olds coming in, speaking to Gallic, raised with their grandmothers to Parkinson's and were on projecting your voice, it's doing different modifications of swallow studies, so a wide spectrum of things. And I about 10 years ago came across Pioneer, which is a program in Ocean Beach that I can't find anything else like. And it specializes in a community-based approach to facilitating language and making life connected in a real functional way and going out in the community, going and enjoying the beautiful sites of San Diego and making therapy very real for the families that we serve. So I've been there for about seven years now, but in practice for about 20. And I've done everything from schools to hospitals to therapy treatment centers to in-home. But I find that collaborating with other professionals, whoever it may be, it must be there. It's pertinent and it's vital for any kind of improvement. So just breaking down that barrier between performative Mary Poppins, I know more than you, you know what I know. And, you know, just getting on the same level and the same wavelength and just making the connections real for the families. That's how you can kind of make the biggest thing for your buck therapeutically, I've found.

SPEAKER_00: 6:54

Sure. So you mentioned dementia patient patients. Were you also working with like stroke patients or people who had lost function? Tell us a little bit about that.

SPEAKER_03: 7:03

Brain injury, stroke, people that have lost functioning from certain parts of their brain and their ability to swallow. So teaching them compensatory strategies on how to gain skills in their mouth again through muscle exercises to be able to go from a liquid diet to a hamburger again and playing cards with 80-year-olds and building that connection through playing war and asking questions and getting down to that human element of just connection so that you can talk about, you know, what do you want to do when you get out of here? Do you want to go to Taco Bell? Are you feeling, you know, more like steak? What are we working towards?

SPEAKER_04: 7:44

Wow.

SPEAKER_03: 7:44

So it really is it's such a fun field. And then you have people a lot of times who don't want anything to do with you, they're against therapy, they don't want any kind of medical interventions, and you have to really tread lightly with that. So knowing your population and how to dance with the language and keep it person-centered is key.

SPEAKER_00: 8:07

Wow. Okay. So you you immediately mention cool crossover behaviors. The idea that swallowing might be very specific to speech and communication and to eating, and then that's in and of itself a behavior. Will you tell us a little bit about some of those exercises? What is it that you have to encourage people to engage in? And I'm sure if you've lost some of that function, that's got to be excruciatingly difficult for people to engage in these exercises. So you're really having to find a way to motivate folks, and you know, steak or taco bell, whatever it is, you're putting something out there to say, hey man, do these things, and then you're gonna be able to get there. So tell us a little bit more about that. That's super cool.

SPEAKER_03: 8:48

I would say it's getting the buy-in first, building that connection and understanding that this isn't just a sheet of paper. This is a real treatment procedure that goes and takes work like anything, like shooting a basket basketball using, you know, a methodology of the tip of your tongue and placing it on your alveolar ridge, which is behind your two front teeth, and sweeping it in the back of your throat can help strengthen the muscles and bring oral motor awareness to how you swallow and how you breathe. So it's a pattern of uh of breathing, respiration, talking, eating, the social element, anything from the chest up with this cognitive element, I feel is so important to keep in mind and crucial and just telling them this is this is something that you would do if you had physical therapy. If you want to be able to talk and be understood because your speech is slurred because a part of your brain has lost some blood flow, we can reconnect those patterns and those firings in your brain and the neurons and where things, why are they fire? So you doing these small micro movements, although they seem kind of silly, will build your ability to have your natural smile back, your ability to swallow foods again, the ability to take small sips and bites and using these compensatory strategies to make it naturalistic for you to have a conversation at the same time you're having a crunch wrap supreme.

SPEAKER_02: 10:26

So shout out Taco Bell. Please uh look for the sponsorship uh sponsorship opportunity.

SPEAKER_00: 10:33

We're glad to receive them here. Absolutely. They can help out. And these are, I mean, these are behaviors that were now involuntary, and you're having to have people voluntarily engage in them in order to, as you said, engage or incite some level of neuroplasticity related to experience. That's that last piece there is exactly what got me into what I do every day is the idea that I can have people engage in certain behaviors, and that's going to change the way their brain is wired, and that's gonna lead to greater outcomes, hopefully. So that that's that's really interesting. So you you got geriatric populations, and then within those medical settings, you were introduced to pediatric populations as well. Tell us a little bit about what you were treating there.

SPEAKER_03: 11:17

I've worked with pediatrics basically since I've started, from undergrad to grad. So I feel like you're your classic two to three-year-old who's building receptive and expressive language skills since you're teaching through a toy or a therapeutic material like a ball, as much as you're building the language with what the ball is, what it can do, how you play with it, you're building that motor imitation with speech. So you're using the strategies of bringing the ball up to your face, and you're saying ball, and you're slowing your rate, and you're providing models without expectation. And that is what kids with any kind of delay, any kind of difference, they need to see and experience so that it is natural and fluid for them to produce in real time themselves independently. And that's what we're always pushing for, whether it's a two-year-old or it's an 80-year-old working on trying to gain language skills and use an AC device to produce speech sounds. So it's gaining independent skills to eat, talk, swallow, and produce language the most independent as possible.

SPEAKER_00: 12:41

Right on, right on. So going back to the idea of swallowing and eating, and there's a lot of crossover here then, especially maybe with pediatric populations with regard now to eating and feeding. Will you kind of clarify the distinct roles there? That's something that we also have to traips into, and sometimes I know I kind of back up and go, no, no, let those folks deal with that. And uh maybe I'll deal more with the idea that I can help you sit at the table for longer periods of time so that you might access the food. Or so there's a there's a nice split there or distinction that we have to make, and then there's the collaborative part of the crossover where we all have to, you know, kind of traips into. So tell us a little bit about how you work, but maybe with occupational therapists or the swallowing, eating, feeding part particular to the SLP portion.

SPEAKER_03: 13:28

So speech therapists work collaboratively with nurses, lactation specialists, and OTs to just establish the suck swallow breathe pattern in infancy to begin. So there is that crossover in the hospital with latching on and creating the swallowing, the breathing, and that mechanism and that wheel so that it becomes natural. So as you develop that breathing pattern, what I have found is so many of our students, our patients, the mechanism is a it seems immature, their palate seems immature, and it's a mouth open resting posture that I see so much of the speech development needs to be. You need to provide more interventions and services because people are not breathing through their nose. And if you're not breathing through your nose, you're not developing your muscles and your motor patterns in your mouth to develop your swallow in your chew, and what your chew provides everything in your mouth and your dentition so that you can use your structures to produce speech sounds. So if your tongue is not effectively raising and lowering, doing a word like umbrella feels like you're doing backflips. So sometimes providing different mouth exercises to make your tongue produce certain speech sounds is a crossover between the speech element and also a swallowing phase as well. So there it's so embedded with other therapists when you're working on feeding as well, because there is this aversion of RFID, I believe is the term. And it's the sensitivity to food and an incredible aversion to the sensory system that becomes just completely overloaded. So I used to do feeding groups with an OT, and it was so much fun. It's exposure and basically explaining it as a visual pyramid for families to see that, let's say fruits or something that they're not interested in exploring. So writing on a banana, making a banana a person, you know, and then slowly peeling the banana and throwing the banana away. Then it's getting a tool and interacting with the banana and it's breaking it down and desensitizing the food to the person so that it can become tolerable. So that's more of the element in speech. It can be social, it can be fun, it's connection-based. You're breaking down that element of anxiety and fear around food and you're making it fun. So OTs can do that when you're working on exposure therapy and being able to have them go through the process of even just bringing it to their tongue, touching it, smelling it, tasting it, biting it, playing with it, you know, putting it on a tower. Those are things that are really fun to do, but it can also be very scary. So for families, food is a safety thing, and you have to tread really lightly culturally and understand that people have their lifestyles or their food is something that's very safe and secure at times. So making sure that everybody's on the same page with what it is you're introducing food-wise, so that it's, you know, you're able to transfer those skills.

SPEAKER_00: 17:11

Just one one closing comment, I'll pass it over to you. But I love that you we can sometimes very easily draw a straight line, say behaviorally, if the child's having eating concerns and the idea that we need to get this food into your mouth. You just gave us a whole circuitous pathway before we even have to think about perhaps caring about them touching some food to their mouth, or let alone chew it and then swallow it. So there's a whole bunch of other things you described there, which we'll get into, I'm sure. But I think that's very important for us to realize, especially in ABA, when we get called in to help with with these concerns, again, it can be a very easy straight line. Oh, you're having trouble eating, so then we're just gonna get that food in your mouth, and you just described a whole other process that's gonna be it's gonna be a longer road, it's the long play, and then at some point maybe you arrive at that success of of the child actually ingesting the food.

SPEAKER_02: 18:11

So you mentioned kind of in your earlier days, you were then exposed to individuals with ASD, uh, you autism at the time, probably now ASD, and that you took a particular liking to them. Can you speak to why? What about this particular demographic was so endearing to you?

SPEAKER_03: 18:28

I would say there's you can't phone it in. It's the most real population you'll ever explore. It doesn't matter what you look like, it doesn't matter what's happening if you're there and you're present and you're showing and giving respect a hundred percent of the time if they're able to regulate and co-regulate with you, you're with a friend. There is this mutual respect that I have found through my own probably neurodivergence, ADHD, OCD, autism, they're all branches to the same tree. That's how I like to think about it. So for me, it makes sense. There's so much masking that we all do, whether it be around food, whether it be around social skills, whether it be about, you know, our careers, that I just feel like there's none of that. It's not the even ability to do that. And that's what's always disarmed me. It made me feel so at peace and confident with whatever I'm doing because it's real.

SPEAKER_02: 19:30

That's interesting because Mike always used to have this saying that there's a certain honesty you get from people on the spectrum because a lot of times they may struggle with theory of mind, so they're not gonna necessarily mask or act like they like you if you don't. So there's like a gen genuineness, if that's a word. Yeah, and authenticity would probably be a much more appropriate word that you get from these individuals, which is interesting because I imagine as a speech pathologist, individuals on the spectrum could be a potential potentially challenging demographic to work with, both from an engagement and a speech development perspective. Any any thoughts on that?

SPEAKER_03: 20:08

It is very challenging to work with speech sounds in particular with this population because you have so other co so many other comorbidities with this and mental health things going on, anxiety around. So you have language deficits next to speech sound deficits. So you're working on a sound the way your parents don't like, the way that you say, when in reality, as a speech therapist, my bigger concern is not how you say rabbit. It's if you understand what a rabbit is, how to spell it, when to use it, and be able to understand the cat, you know, the concept of what a rabbit can do language-wise. That's more important. So being able to give that to families and prioritize the hierarchy of need, sometimes it is speech sounds you want to focus on. And if you have a child with ADHD and other things going on, and you're trying to work on a speech sound, truly you're having to get through so many different barriers and layers before you're even able to target that behavior. So it is a constant shift and change that you have to do as a speech therapist to keep in mind what's the biggest priority for the for the family and for the the patient.

SPEAKER_02: 21:37

So it sounds like you take a pretty like almost function over form kind of approach. And that's something that I think is very pertinent in ABA Skinner, who's kind of like the the people, the the guru, the originator of ABA and verbal behavior. He talked about, and and I want to ask you this because I want to ask when you talk about a speech therapist, how You define speech. Yeah. In our field, we define verbal behavior as any behavior reinforced by someone else. So when most people think verbal behavior, they think of talking. But we would look at pointing, throwing a tantrum if it consistently gets you something hand leading, all of that is verbal behavior, and then vocal behavior being actually making sounds to communicate messages. So ABA is a little bit different. So I'm curious from a speech pathologist, because I'm sure you work on things primarily talking, but also speech devices, handle. I'm sure you expand past that. Can you talk a little bit about what actually speech means to you as a speech pathologist?

SPEAKER_03: 22:41

So SLP, speech language pathologist, the speech is the articulation and motor production of what the sounds are broken up syntactically. So the form, the grapheme, and being able to put the consonants and the vowels together to shape it. And then the language behind it is the content of the word and how you use it and the form. So being able to describe the importance of both speech and language, I think in the early intervention population, we have to tread very carefully when we're trying to work on imitation skills, because you can reinforce anxiety and vocalizations that are not true speech production. They're just vocalizations. And sometimes that can create other complications when you're looking at developing language naturally. So using a multimodal approach to language, using whiteboards to write, to draw, using tablets and AAC devices that are high-tech that have voice output, using laminated sheets of paper with pictures on it to use low-tech to touch and point and communicate and model language. It needs to be a variety of learning opportunities that we're providing naturally and embedding throughout the environment. So if we're working on bubbles, it's not this teacher give and take. It's I'm saying the word bubbles. I'm using my lips and I'm making bubbles. I'm finding other B words to embed within the environment. So I'm trying to take not just the target word, but the language and the environment around it to help promote, expand, and shape so that it can be something that's facilitated naturally and independently. So it's not just this, you do this for this. For for language, the building the opportunity to expand and produce independently throughout the environment, hearing bubbles in a different language, having Dora say bubbles, just bringing in different elements and senses so that the speech component can just be a part of the development that you're working on, so that it can also be language as well.

SPEAKER_02: 25:16

Okay. So speech is always going to be the auditory piece, but the language part is the broader piece. So under that part, and you can include multimodal communications and things like that. Okay. Thank you for clarifying that. That's really useful.

SPEAKER_00: 25:29

You mentioned something very important, and we can probably talk a lot about this, and maybe we won't do it all right now, but you said AAC. And that's very, very exciting technology, and I find in my experience that it can also be very misconstrued. You mentioned the idea of voice output, which is what I think most people think about that. Oh, these kids that are non-vocal, there you go, now speak using this. But what you were describing had nothing to do with expressive communication, it had a lot more to do with a whole bunch of other things. Will you talk about that? Especially when learners start using AAC devices. And uh, you also mentioned the word modeling. I think that these are really important topics that I certainly don't know enough about, but that you can uh educate our audience here in terms of the use of said devices and very exciting tech that you know I find sometimes works really well, and then sometimes it's just a really, really nice, expensive device that just isn't being utilized effectively.

SPEAKER_03: 26:30

The the biggest reach and the most important key aspect to using AAC is that it has to be done together. There has to be a communication partner. This is not a pacifier. This is not, you take this and you go learn this. The the pet peeve that I have is everyone says, well, they don't use it. Well, you need to use it and build it with them. Nobody knows how to independently navigate a system. It's knowing how to speak Korean. Well, if you're not fluent in Korean, shouldn't you pick up the device that speaks Korean and work on it together? So touching and talking at the same time. I like talking with you. So being able to use it naturally and having it near them to make it feel safe, to make it feel like you're not being quizzed. Touch yellow, touch green. It's not a performance tool. It's there to enhance the moment and provide pictures and elements to language that may not have been there before. You're allowing a little bit more access. That's what you're really providing it. You're giving pictures to the language so that it can be expanded upon. And the most important thing about augmentative alternative communication, which is AAC, thank you, is it can be anything. It can be a piece of paper, it can be a notepad, it can be a picture, it can be your phone. It's anything that expands and enhances the component of speech. It's not just your voice with words and your mouth.

SPEAKER_02: 28:01

So it can be pecs. Yeah. I said, so it can be pecs, right?

SPEAKER_03: 28:07

Yeah, so Mike's favorite symbols. You can just say icons, picture icons. That way you don't have to like brand yourself to one.

SPEAKER_00: 28:15

Thank you, thank you, Brittany. I he was trying to rib me over here. So one thing that I know you're gonna be able to shed some light on, I think this is a very important uh premise, is I'll have parents tell me, you know, they want to they're recommending an AAC device, but my child uses words, and I don't want them using that machine to talk, and I'm like, we're missing something here. Tell me your best advice to a parent who says that because I again I think that that's a a very valid concern, but it's also very misunderstood at that point. So, what would you tell a parent who says, no, no, no, Brittany, I don't want that AAC device. They're actually using words, and I'm afraid that they're gonna stop using words to use this thing.

SPEAKER_03: 28:54

I would tell them and explore the American Speech and Hearing Association and pull up the research and evidence to show that augmentative alternative communication in any form does nothing but promote verbal output. So the research shows using AAC makes your kid talk more. It sounds wild. It's like, why would using an iPad and touching a button that says bubbles? But if you think about it, there's not another person there. It's not, you're not relying on a communication partner. You're being able to hear that auditory feedback and output without a person there to make a request and make it independent. So I would say the biggest misconception and myth is that AAC will somehow inhibit speech production when it does the exact opposite. It promotes verbal output, it gives you more language and it's independent language that's produced. So just telling them that is a complete myth, it's been debunked. If there's any research that shows from SLPs how important it is to keep bringing this around, sometimes it's heavy, it's taxing, you don't know what you know, if it's charged, where it's at. There's a lot of barriers to using it. But the truth is, all of that doesn't make sense. You're focusing on your client. There is a the communication bill of rights, is something that I reference. Everybody has a right to say no. Everybody has a right to say, I like this, everyone has a right to say, Brittany, go away. I don't want to talk to you today. That is a self-advocacy skill, and I honor it.

SPEAKER_02: 30:43

And that is my girlfriend's really good at that one.

SPEAKER_03: 30:46

Right? Take some space, get out of here, not right now. One more minute. Like giving that opportunity to communicate independently and showing them these kids are able to do this almost at one year old. It's not here, take this tablet and go figure out how to communicate. It's using it naturally together to build skills, it's using it as an output device to build connection. So it can be something as a tool to use for speech output for language as early as one year old. And it can obviously help when you're working with people, you know, way into the geriatric population with, you know, the inability to talk, with ALS, with Lou Gehrig's, with different inabilities to communicate, and they have language, they just can't verbally speak anymore. Stephen Hawking uses AAC. So there's all forms and types of it, and it should be a crucial team member to have a speech pathologist and an AAC specialist evaluate and just see what tools will help this person be more independent with their production of language.

SPEAKER_00: 31:58

Yeah, so hence the alternative or and or augmentative part of this communication basis. So for some people, it might be the sole voice output, Stephen Hawking being an example. And then for a lot of other people, it's just gonna be an augmentative, not an alternative, but something that's gonna help you sort things out. All of these devices, at least in my experience, and maybe you can speak a little bit to this, because I think it speaks to the cognitive part of communication or language production, they're all semantically organized, which I think is also a very important part of it. Talk a little bit about that, or whatever you want to mention about that, because I think that's something else that parents and professionals alike, we can probably remember that a little bit more from our Psych 101 class or whatever, or developmental psychology class back in undergrad, to realize the importance of that learning premise, the idea that you've got levels of semantics and semantic organization, and those are all really important. You've got animals, and then you've got animals that are birds that fly and have wings, and then you've got all sorts of different birds, and not all of them fly. And that's something pretty important then that probably comes into your realm. What would you say about those things?

SPEAKER_03: 33:06

The key to using AAC to build language, to build communication is the word core vocabulary. So there's core vocabulary and fringe vocabulary. 80% of all language that we produce is core vocabulary. Look at that. Look at that, being able to visualize and create and build language and a mean length of utterance by recognizing the symbolic representation of the word look at that building word, and that being able to represent that across almost like a universal core language, is very difficult to represent symbolically with a picture. So being able for people to see that it's very easy to teach categories, like you said, get a folder, here's animals, here's vehicles, every single kid on the autism spectrum most likely can produce nouns. They know what a cup is, they know what a bird is, they know what a train is, but it's the connecting words that go into building the verb, using adjectives, and creating language so that it's structured. And you're not just requesting, there's reasons for communication. It's not just manding. I want requesting, it's protesting, it's making comments, it's sharing, and it's the exchange of information, it's making jokes and building that and showing that on the AC device. You need to have 50 models an hour, is what I tell my staff without expectation. You touch the buttons, that's funny. Did you just hear mom burp in the kitchen? Ha ha, that's funny. Touching the button, funny while you say it, letting them have that pause and interaction to hear it in a different way. Those are the things that you have to build, not just matching colors. What color is it? It's not a quizzing tool, it's not a calculator, it's there to enhance and provide an opportunity to build language like a system. And that's what you're saying. So it's the reason in which your communication, the function of language and using core vocabulary is 80% of what we say. So even the word water, I want water, right? That's that three length utterance. I want that's a request. There's a lot more we can say about water than I want it. The water is wet, the water is cold, no water, empty, the cup is empty. So you can build so many language skills around the noun, but being able to be flexible to know that there are there's language that needs to be modeled and represented that is not just the category and the noun and the flashcard, it has to be real.

SPEAKER_00: 36:02

Well, and that that speaks to something that I I know we we're very critical of traditional ABA therapy because we can be so target specific. So, to use your example of water, we're gonna sit there and drill the production of this word, and we're gonna be missing everything else you just talked about, which enriches the context around the concept of water. So that thank you for explaining that. That's super cool.

SPEAKER_02: 36:26

You talked uh about the the manding, and I mean you literally use the the saying, I want water. Let me let me ask you this, and I'm trying to reflect back on maybe a little bit more older school ABA, but I think this would be valuable for any ABA practitioner to listen to and get your perspective on. Historically, we would target you know, one word, then two words, then three-word mans. So we would have these intraverbal visuals that say I want, and then insert whatever noun, car, water, ball, whatever. Right? And we would just drill. I want whatever. I want whatever. And then they would learn that, and then we would almost have to get them to unlearn that because then now we want to teach, give me that, or can I have that? So I think we would run into a lot of generalization issues with that, and then we would have these robotic kids that everything was I want ball, I want water, very robotic. The benefit of that though was that we were able to get a good amount of behavior reinforcement within there so that they did learn that behavior. Versus if we started with ten different things, it would take a lot longer for them to get enough of those trials of each one for them to learn the value of it. I think now in practice, it seems like we tend to go more of just teach a bunch of them and sacrifice the quickness for the generality. Hopefully, that makes sense on what I'm saying to you. And what is your recommendation on how to teach such a skill?

SPEAKER_03: 37:52

Making the noun come to life and removing please and thank you from your vocabulary. It is not a functional skill. Manners are not necessary. All of my kids from back in the day, I want water, please. They think that that is going from a two-word utterance to a three-word utterance because they say please afterwards. It's not a functional word, it's not real. So I think please and thank you should be abolished in this field. So I'd say I don't teach nouns. They're a part naturally of what's going on. I model them and I model without expectation and I give a lot of language and I give a lot of pauses. So sometimes it's hard to find the targets if the person's not interested in your target. You have to work with what the language is. If you're targeting water and the kid's not thirsty, go in the bathtub, go wash your hands, go flush the toilet, go look at pictures of waterfalls and pools and videos, making it everything about water, but not water. So getting into the senses of how you explore it so that you're building skills around it. Now, how you track that is why everybody with a clipboard looks at me and says, How am I supposed to write that down? And I said, Well, you can put what you did and you provided models to, and then you can see independent responses and track those. So into independent language productions after given, you know, a bunch of models. That's but then I don't know how to embed that. That needs to happen because if there aren't language-rich models and you're looking for productions, you're not gonna get them. And that's where I don't know if it's not on the clipboard and not in the schedule, it's not happening.

SPEAKER_02: 39:42

So let's say they do want water when you model and you train your staff on how to model it. Do you stick to a small number of I guess requests, you know, the I want or the whatever in the beginning for them to learn the skill, or do you start with a lot of different ones?

SPEAKER_03: 39:56

I start with a lot, depending on if if we're in the house, I'm just that's the theme of what we're talking about. Everything is kind of related to that, so that it becomes just part of the environment and it reduces that anxiety. It gives everybody kind of the playing field of what we're doing. So I would say in a 30-minute session, if we're targeting three words, I would probably want to get like 20 attempts, you know, that I would be looking for for them to produce something from an imitation that I'm giving them. If they do that, I honor it, even if it's you know, or it's not a perfect verbal production because it's an attempt and it's a trial. I think it's very difficult to have you recorrect someone's production and say it's not good enough when you're like building imitation and motor skills. So providing, yeah, you said water when they said water, so that it gives them the model again and the self-esteem to want to keep doing it, even though it's a little bit more of a slurred production, you can still write that down. That's just not you having to tell your patient that.

SPEAKER_02: 41:14

So if that makes sense, it does. I think that's still focused more on the noun itself, though. Let's say they can say water. I'm talking about the carrier phrases that go with it. Are you gonna model various different carrier phrases or are you gonna stick to one or select few in the beginning and really dial those in and then start to expand from there?

SPEAKER_03: 41:34

I would say I would look at what their attention is. Where are they interested in in making the water? Where is it coming from? Are we going to the fridge to get it? Get, are we going to pour it? What verb are we gonna work on next to it that they care about? Not that, you know, is easiest for for them to produce, but going to give it to their pet, going to give it to somebody else so that it can be transferred across people and places. That's the key. If you know they're doing it with me and mom, and brother comes home trying to get brother to see that we're pouring water for the dog and embedding it in a different way.

SPEAKER_02: 42:14

Gotcha.

SPEAKER_03: 42:14

That's what I would do. I would practice on the verb that they care about.

SPEAKER_02: 42:19

I like that. I like that a lot. One other question on the the multimodal piece and something that Mike's always been a big proponent of, and it's kind of come in when we talk about eye contact later, but the development of speech at a younger age through all of the different sensations, right? So not just hearing the word, but seeing the word the way that the mouth moves when somebody makes the word, feeling the way that it feels when you blow out. So including multiple senses, and then Mike, please chime in if I'm butchering the way that you say it. But the reason I bring this up is how important would you say eye contact is into initial speech development? And then as a result of that, where do you stand? Because a lot of individuals on the spectrum struggle with eye contact, up to the point of some even saying it can be aversive.

SPEAKER_03: 43:08

It's a really good question. I find that that takes away that pressure that they have to do it their way. So even if I'm holding a tablet or my own mirror, so that and I'm sitting next to them, I have never been a fan of eye contact. I'm either really intense with it or I'm a little aloof with it. So it's a very inconsistent thing for me. However, I know if you're trying to work on micro movements and that motor pattern with multi syllabic words, it's important initially. But I don't think with this. Population that eye contact is important after a certain point. Once it's understood how it's produced, to make it have to be a part of the exchange, I think is unnecessary. So initially, if you're looking at a video model of how to say the word pizza, pizza, I could point to my lips, I'm looking away. I'm not having them look in my eyes if that's uncomfortable. I'm having them look at my mouth. And then I teach where they can look on my face if they want to. But if they're very averse and they don't like it, just it's also based on your client. That's when I would give a mirror, a handheld mirror or a tablet, so that they can see the model themselves and reproduce it, so that you're taking away that expectation.

SPEAKER_04: 44:53

Yep.

SPEAKER_00: 44:53

I like that. I like that a lot. Yeah, I agree that having some visual observation of how somebody's mouth is moving, your own or somebody else's is probably the biggest developmental piece toward that to learning how to imitate that motor movement. What, as far as you know, and I don't know anything about this, it just made me think about it, but we focus a lot on the motor imitation toward that production, and then maybe secondarily we think about the idea that you're hearing the word to. Does somebody have to look at somebody else produce that word to do it, or can they do it just from an auditory model? Do you know?

SPEAKER_03: 45:34

It depends. It depends on the person. Interesting. You can exaggerate. So, like a stop plosive is like a it's a P and a B production. So it's got the sound behind it. You can look at it, you can hear it, you can see it. But I find for this population, it is so difficult to imitate motor speech that it becomes very difficult to replicate multiple times if you're not in a regulated state. It is extremely difficult to build motor imitation skills and turn it into language, even at a young age, without embedded multimodal communication, also. Just expecting someone with only verbal input who is not a verbal communicator to only verbally communicate is ridiculous. So that's when you have to explain. You're not giving this person the opportunity to communicate in the same way that you are. So giving them other tools and showing them how to do that. That's just the key.

SPEAKER_00: 46:40

So that's to say that you could produce that imitation if you just saw somebody make the movements without sound. You could do it by just hearing and not seeing them. And then maybe if we have both streams working together, it gives us some advantage.

SPEAKER_03: 46:56

Yes, absolutely. And even if it's not hearing it, hearing it in a different way, using mouth to make the same shape and getting that your structures together. So like blowing through a straw, blowing bubbles, making vocalizations and turning things into play so that you're building awareness of your oral motor structures at the same time that you're working on it, and finding other syllables that are similar. Like if you're working on P and B, M would be the next one you would work on because they're your lip sounds and you can kind of see them. So those are why we work at those in those early develop developmental because you can see them. And then after K and G are in the back of your throat. So mama and papa are early developmental imitations because you can see them, but with our population, it's not necessary, and I'm not really sure how our population receives visual input. I feel like it's more their memories are different and things are more images. So it's like a photographic representation. That's why I don't think they have to look at your lips to do productions.

SPEAKER_01: 48:13

Interesting.

SPEAKER_03: 48:13

Because they know what it is. I don't need to see you, I don't need to see your lips. Yeah, you know, but that that's hard to explain to others that they don't have to to look. It can just be in a different way. You can give them a tactile cue. They can do the tactile cue on themselves. There's just different ways to build in that skill so it's not just the same request over and over.

SPEAKER_00: 48:35

Yeah, I like to talk a lot about the aspect of joint attention with what you're talking about. And you mentioned earlier, too, the idea that you might have an object of interest maybe up to your face to give that possibility of seeing you produce the word. But the idea that a child is not just staring at your face, you're they're hearing you, they're watching you, and they're watching an object. And how they shift their gaze or their attention from those three points, I like to consider that behaviorally, right? That's uh super interesting. One of the things that I guess becomes somewhat problematic for us as behavior analysts as we trai into this idea of reinforcing now sound production is the idea, again, the target specificity versus the approximation. So if I'm teaching you water to use that example, and you say, Whoa, a lot of younger professionals or more rigid professionals are gonna say, Well, that's not the target. I can't reinforce that. And you're saying, No, you gotta reinforce that, because that producing that sound in succession is ultimately what's gonna lead to the full production of that word. Tell us a little bit more about that concept. Hey, I ask a question, and then I have to pause, as this concludes part one of our invigorating interview with Brittany Warnke. Please ensure you return for part two and always analyze responsibly.

SPEAKER_01: 49:57

ABA on tap is reported 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.