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

ABA on Tap is proud to present Brittany Warnke, SLP (Part 2 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

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SPEAKER_01 0:01

Welcome to ABA on tap. A mic review with Dan Lowry. So without further ado, sit back, relax, and always analyze responsibly.

SPEAKER_02 0:32

Welcome back to ABA on Tap.

SPEAKER_01 0:35

I am your ever-grateful co-host, Mike Rubio, and this is part two of our interview with Brittany Wornke. Enjoy.

SPEAKER_03 0:44

I would say getting more repetitions and producing it next to them if they've said it incorrectly, and then just tracking it that it was incorrect, but accepting that it's a you know an effort that production is there. Letting go of that rigidity when it comes to speech production, I think is it's key. Otherwise, you're going to really frustrate your clients. And especially as they're learning how to do backflips with their mouth. Give them a break.

SPEAKER_02 1:17

Learning how to do backflips with your mouth. I like that.

SPEAKER_03 1:22

And giving, you know, the opportunity to do it naturally, taking a little bit of a walk into the next room and doing a trial there in a different way. Just shaking it up a little bit so that it's not the same performative request. It's it's necessary for it to be generalized for sure.

SPEAKER_01 1:42

So it's it's almost saying that you're you're acknowledging the production and you're giving it meaning and you're maybe producing it alongside them and saying, Oh, you said oh, water. I I understand you. And that's the reinforcement that then allows them to produce it again toward then refining that articulation. I think that gets missed all too often in what we do when we try to jump into the the expressive communication part of it, if you will.

SPEAKER_02 2:08

I think the tricky thing about kind of what you're saying is that with most skills, and again, we don't really use much physical prompting, but if we want somebody to do something, we can go up into the point of physical prompting to get it done, to get reinforced, and then the person gets the payoff and they see the value with speech. It's you can't go inside of their mouth and pull out the words. So we can have as many models as we want, which kind of leads me to the next thing that you've talked a lot about is models. And one thing that Mike's really brought to our companies over the last couple years is this concept of linguistic mapping. And I like to tell parents it's like channeling your inner Morgan Freeman, like you're just talking about what you're doing, giving the language. You've talked about that, or at least you've alluded to it with your modeling. Can you talk about your thoughts on linguistic mapping and any words of wisdom, advice, whatever?

SPEAKER_03 2:57

I uh don't know the definition specifically of linguistic mapping, but I can say that being the best model you can in the room, the the most interesting toy, the professional best friend, and providing language to what it is that you want the goal to be, to make it accessible and fun naturally. And that's how I build the models. So I make the if the model is building the production of vocabulary and expressive vocabulary, I'm jumping around the room, finding things, talking about it, and bringing the things to life. I'm making the things around me have drama, energy, and fun so that it can be a part of that exposure and connection within the environment.

SPEAKER_01 3:52

So you, and again, this is something problematic behaviorally for us. What you're saying is you might spend a fair amount of time talking to yourself in a sense with a client. They're not talking back for a little while, but you're measuring other levels of engagement with what you're saying. So a lot of people might look at a speech language session and say, Wow, the the kid didn't say anything. That that was a terrible session. You have a different idea of that depending on what else they did based on what you were saying. The same with the AAC device you were saying earlier. Parents, professionals in our role, we might find ourselves being the sole users of that device at first as we model. And that can be very frustrating again, behaviorally, for people like us who are trying to measure this very specific observable behavior and say, wow, they're not using the AAC device, that's terrible. And what you're saying is, no, it could take a long, a fair amount of time. Yeah, um, maybe beyond our comfort level, where we're gauging other responses, knowing that, okay, yeah, this is getting across, this is successful.

SPEAKER_03 4:56

Talk a little bit about short-term goals, long-term goals, being able to produce something independently, long-term independently over a lifetime, looking at that and how it's built in functionally and allowing for that modeling to happen. So, and also expressive output versus receptive input. Both of them, you know, you're processing. If you're at the table and you're doing something and you have that joint attention, there doesn't have to be verbal expression for there to be understanding and games. There isn't a whole lot of talking and chess, you know, in that in that way. You have to kind of think about it. There are other skills internally that are happening. And to be the the model and the play, sometimes I I would take it as an insult. They're like, all it looks like you do is play with your kids. And I was like, that's not a bad thing. I was like, that means I'm doing a good job. If you can't tell the difference, then that means you should ask some questions. But you I let me explain to you what this is, because you know, it can take a two-year-old, I think it's like 52 years to hear the same amount of language models as a typical developing person who makes verbal productions without modeling without expectation. If you just have your SLP touching the buttons and having fun with you 30 minutes a week, I only see you 30 minutes a week. That that would take 84 years for you to have the same amount of language opportunities as another two-year-old who's exposed to verbal language. So being able to let everybody know the caregiver, that you get in there and you become best friends authentically and you make those connections and you say, Do you want to keep your kids safe? I'm trying to keep your teacher kid the word no. I know that doesn't sound good for you, but it's gonna keep your kid safe. Yeah, I want her to be able to say no when she's six. You know, I want her to be able to do, and so when you bridge that gap for families to see that that using this device together and for them to see you fail, for them to see you problem solve and troubleshoot and be frustrated and make errors is human and natural. And it's a part of this process that they need to see you mess up, they need to see you get frustrated and model emotions next to whatever skill you're building. Like this stinks. I don't want to be here, I don't want to do this. Let's do something else. Just providing that model next to your target is going to provide that buy-in from your client to want to do what you're doing because you're acknowledging them as a person.

SPEAKER_01 7:41

You mentioned my favorite complaint when we start, especially with early intervention. And, you know, we get a few weeks in, and the parents pull me aside and they say, you know, we're really happy with you guys. The child really likes you and it's great, and they're having fun, but it looks like all you guys are doing is playing. Yeah, what else is a two-year-old supposed to do? The other part with negation, too. So I'll have early intervention. One of my favorite things is, you know, they're really misbehaving a lot. They say no to everything. And I'm like, Welcome to your two-year-old. Welcome. Congratulations.

SPEAKER_04 8:15

Welcome.

SPEAKER_02 8:16

Yep. Yeah. So I have a contention, or that's probably not the right word. I have a hypothesis that I want to uh run by you and get your opinion on. So, kind of prevailing wisdom, or at least what I was taught throughout my earlier ABA life, is that individuals on the spectrum tend to learn communication through manding and then potentially tacting. Manding develops first. And that's what you know, PEX was based on. And I taught PEX for many, many years. It was just like the I want. Like teach manding, teach manding, and then maybe tacting will come on. But as as Mike's done this big kind of joint attention push the last five years, I wonder if that's a true kind of core deficit or characteristic of autism. Or and I don't know if we can tease one out or the other, or if it's more the presentation mode of all the therapists just teaching communication through manding and requesting in the beginning, and the lack of establishing joint attention in the beginning. Because in order to tact, you have to really have joint attention, you have to like care to show that person that the car is there, right? You don't get anything, but you get the enjoyment of it, and you need joint attention for that. So, in your professional experience, would you say that it is true that manding comes on before tacting for neurotypical or autistic kids and/or autistic kids? Is that true, or is that just how it we've presented the stimuli to them?

SPEAKER_03 9:43

I think it initially is the exchange of give and take that back and forth that makes sense initially, but I feel like we do not move on from that. And that has been the the difficulty because how? How do you track the other things? You know, language is it's it's not just an external experience, it's an internal experience with many different layers, and being able to tease out a request, we we need things, you know, our basic wants and needs have to be established, but being able to build on that and to share enjoyment and it depends on the people and the places that you're in in that environment, and being able to provide that consistently is it's very challenging. But so that's why we fall back, I think, into the to the easy nouns of manding, being, you know, it's something I can see, I want water versus I like that. What what's in front of me? Oh, it's that engagement, you know, or no, I don't want to. I need a break. It's always goes back to the I need versus like deep breaths might feel good. Providing that internal Jiminy Cricket monologue. I want to have the professional best friend ninja on my shoulder. You talk about that as like talking things out loud, verbally expressing your thoughts in a way that is giving them external narration of the environment is key. It totally helps them. If you're like, I don't really know where the bathroom is, but I need to go wash my hands. Can you help me find the bathroom? You can do that with a two-year-old. They you've given them the word for bathroom. I'm asking a question, I'm providing the mand or the word of the target in different ways. So creating opportunities around your mand to make it come to life in a different way is key.

SPEAKER_02 11:54

And do you also like to concurrently teach tacting with manding? It sounds like you're modeling it. Do you like to do it more linearly? Like we work on manding first and then go to tacting, or do you like to concurrently kind of model everything?

SPEAKER_03 12:07

I I like to model it when it's in that natural experience so that if it's like, you know, however, it can be naturally facilitated by other people and replicated easily. That's what I'm trying to do, building it with the caregivers. If it's just me and that person, I might not, but I I want to try to like provide an opportunity to do to do it in as different ways as possible that also isn't distracting or confusing. I'm not trying to give anybody too many ideas to where they're overwhelmed. That makes sense. So, you know, three activities per target.

SPEAKER_02 12:43

Well, that's something Mike has also been a big proponent of is contextualization of what we're doing versus you know, older school ABAs. We're gonna sit up and we're gonna work on this at the table with this one word, and it's not really contextualized anymore. Where I think newer school or whatever ABA is much more contextualized. You brought up an interesting thought when you talked about the the individuals on the spectrum may think a little bit more visually, and I think Temple Grandin had a book on that, thinking in pictures. And it makes me think about how Skinner talked about thoughts as subvocal speech, so that when we think, we think in words, and then we articulate those words in our head, and then as we become adults, we try to make sense of them and then get them out. Whereas individuals on the spectrum, I mean who knows how they think, but potentially at least Temple Grandin's hypothesis was she thinks in pictures. Thoughts on those differences in thought processes or or things of that nature, because I know you were just alluding to that.

SPEAKER_03 13:50

I would say that's why that multimodal push is important because we don't really know. Sometimes people would say that that picture with the word is distracting and that you should just do one or the other. And as you're teaching, it depends on how the brain fires. Sometimes that can be a distraction. It can be distracting when you're teaching the word fire to have a picture of a fire there, but it also builds symbolic representation. It it provides a different, even if it isn't pictures, you're still seeing the word fire and you're not directly thinking about it. It's still there in your mind. So providing different ways to do the target again, it's it's difficult to tease out and say we're just working on spelling. We're gonna work on the word spelling and just S U N if you don't have a picture there. And being able to take away that picture just to work on that skill has been like a debunked therapy method, rapid prompting, facilitated communication. It's it's not evidence-based, it's not supported. And the pictures can help promote and give access to language more quickly and independently. That's what evidence and research shows in the in the speech world. So providing that is key, I think, for ABA therapists to have too. It's it's building opportunities through environmental engineering, and that is what I think you know, child led needs to be a little bit structured still. You can't just follow around a kid and model language. I mean, I guess you could, but it's not it's not ideal to build and promote the most effective session.

SPEAKER_02 15:36

Gotcha. So lots of models, lots of modes of the presentation models.

SPEAKER_03 15:41

Yes.

SPEAKER_02 15:42

I've got some stuff on collaboration, but let me pass it back to you, Mike.

SPEAKER_01 15:46

Well, I've I've got several things, but I'm gonna start with this one because you've alluded to it. So you sent me this cool text we were exchanging as we were preparing for today, and you said environmental engineering and modeling without expectation. And you've kind of said those pieces throughout already. The without expectation part is the part that I think ABA professionals could learn a lot more about because we're trying to measure, we're trying to measure observable emissions of behavior. So if you're not expecting for those to happen, you know, you kind of lose your purpose. And that's where I think a lot of us get into trouble with over prompting or over-target specificity without expectation. Expound on that for a little bit. A little bit more. You've already kind of alluded to it, but yeah, tell us a little bit more about that without expectation.

SPEAKER_03 16:36

You're enriching the environment, you're doing things, providing that drama and that fun, and having it happening with opportunities and having the mom sit on the floor with you, the brother, and being able to provide ways for it to happen without me, being able for them to see I'm excited about bubbles, I want to play with them, I'm playing with mom with the bubbles. I'm not working on turn taking in you saying, My turn, you go. I'm just playing with mom, having fun, showing you that bubbles are fun. I'm not gonna do that for more than a minute, but once I get that attention and that interest, you're gonna be more apt to produce more verbal output and engaging activities with me for a longer period of time because I'm enriching the environment and providing sensory experiences and the ability for you to play. Modeling play, everybody misses the train on. They want to be smart and cool and you know, too cool for school. Get on the floor, get more cringe, make it weirder, get fun. This is why we're here. Let's get weird more cringe. Get more cringe. That's what I say to 24-year-olds that you know are looking at me crazy. Like I have a horn growing out of my head because you know, I'm doing bear crawls through the gym because it's fun. I have a pogo stick and I put my staff on the pogo sticks because you're showing fun. You're showing a moment and an opportunity for something to happen. And giving that even less than 10 times, you're gonna have such a more successful natural session than just expecting something to happen without you doing anything.

SPEAKER_01 18:24

Wow, that's that's really, really good. I'm gonna shift gears here a little bit, but we're talking about developmental premises and sort of enriched environments. And you've alluded we've alluded to this already as well. But for us in doing a task analysis or breaking down a skill, the idea that developmentally kids are gonna start with sort of single-word emissions, right? And we talked about the nouns and maybe the uh soul verbs, and then developmentally we have this thing called telegraphic speech. So you start putting these two words together, and you've got these weird phrases that come out that are very communicative, and it's very natural for us in ABA to say, well, then you know, uh precisely if it's two words, then the next one is three, and then the next one is four. But that's not exactly the way this works. Talk a little bit to that. What would you tell an RBT, somebody like us, and saying you should structure it this way better in terms of how you expect increased language production, or I guess you guys like the mean length utterance phrase is kind of a good one to bring back in here. We certainly want our kids to start with one single word and then move into sentences, but the idea that we're gonna construct that sentence one word at a time, that doesn't seem logical. Tell us, give us your insight on that.

SPEAKER_03 19:39

A lot of hot topics right now are around gestalt language processing.

SPEAKER_01 19:46

Thank you for bringing that up. I was gonna I was waiting on that one.

SPEAKER_03 19:48

Yeah, so that one is it's a hot topic. There's you know a lot of language about it, and it's this idea that we learn we don't link learn language linearly, we learn it almost in bubbles or pieces, so as gest gestolts, which are pieces and phrases and scripts. So the gorilla roam rode the train to Moscow could be a phrase that means I want to go see dad. And we have to break down that language component, that's why it's so important. It's not everybody learns language the same way. That's why pairing it with function and being able to build it naturally within the environment is key because it doesn't happen like a cookbook. There's no recipe to language, it does happen in different ways. So, this idea of breaking down morphemes, graphemes, and representation of words, we would like to do it, of course, one and two word phrases. That's and then it's phrases for different functions. So being able to have verbal output, but what are you saying? What's it for? Is it just to say that the car is orange, or is it to say something more meaningful? So, not just adding things to build the language, to build the content and the the meaning behind the words. That's what the speech therapist needs to be helping the RBTs, the BCBAs, everybody like language is more complex and it's not cookbook recipe, especially with this population. I it comes in units, it comes in waves, and we have to break down scripts and being able to do these levels of gestalts to be able to see how they're processing things. That's why melodic intonation therapy with language and different parts of the brain receiving music can really help build attention. Singing A B Cs and that tone of voice, which is also twinkle twinkle, and turning it into a sequence. Now I'm tying my shoes, please. Will you go down the stairs with me? So you're building in and fork. Casting a schedule or an activity with gestalt script that they like and a song, but also giving real language to it. And that's what multimodal communication is. It's a little bit all over the place. It's not black and white. It's all the colors of the rainbow next to those that can be embedded to make a speech and language so much more rich.

SPEAKER_01 22:21

So I like that because it's, I mean, I think that really ties it all together. There is a bottom-up process, meaning single words to the two-word phrase to then something bigger. And then there's the top-down process, which is you just don't learn from those pieces solely. You sometimes take huge chunks and then later break them down. Am I getting that right? And it's not to say, is that to say that in this being a hot topic, we're saying that GLP is particular to certain populations, or we're saying developmentally across the board, this pertains to any language learner?

SPEAKER_03 22:56

I think it's it's not everybody that has this. It's hard to tease out when you have expressive language delays, as it is too. We don't know sometimes that delayed ecolalia is there, sometimes it's for different reasons. So I would say that not everybody processes language like that. Sometimes they do do it traditionally in a you know systematic linguistic form, naturally, but I would say that it's not, I would not say one size fits all when it comes to language at all.

SPEAKER_01 23:28

I'll try to explain this very briefly, but I spent way too much time in graduate school. My master's thesis, as it were, was on tag questions. So the idea that, especially, you know, moms of young children pushing the stroller spend a lot of time saying things like, Oh, that was a bird, wasn't it? And if you take that phrase, that tag wasn't it, and you compare it to all the grammatical uh morphosyntactic manipulations you're doing to make it match with the first part of the phrase, it's it's tremendously complicated. Yet you're gonna have any two, three, four-year-old replicating these phrases because they've heard them a million times. So whenever I hear, I don't know enough about GLP, but whenever I hear about it, I'm like, okay, I think I do understand it based on that premise. That based on imitation, kids are imitating all sorts of huge phrases, and sometimes they don't really understand what every component of that phrase means. They just understand the whole part, the whole chunk of it. Uh so I think I that's that's my best attempt. I need to learn more about gestalt language processing, but I do like talking about that bottom-up, top-down interchange, because sometimes in ABA we want to build everything from individual pieces on the way up, and we forget about the bigger structures that might be existing already around us that we can access to promote, you know, a more efficient rate of learning.

SPEAKER_03 24:44

I would say the biggest piece of information next to working on requesting, demanding is body language, being able to read and provide models of without expectation of emotional states that might be there. Like it's frustrating when my shoes don't go on. If you hear a kid, you know, moaning and they can't get their shoe on. Sometimes just giving that internal dialogue and that external narration really helps. And that's what I would like to see more of in this field, just more of that compassionate, expressive, emotional component of just sharing this is hard, or I don't want to do this right now. Something without that that's unexpected, that you're not supposed to say is the teacher, that that you're on their side. And I think that that is really key to to having the kids build that relationship with you and make any progress on goals.

SPEAKER_01 25:46

Right on, right on. So talk to us a little bit more about your day-to-day pioneer. There's what age grouping is it pioneer? These older kids primarily.

SPEAKER_03 25:56

It's really neat. It's we do have an elementary, middle school, and high school campus. Population is 6 to 22, so we can have an elementary classroom right now. It's been really neat. I saw my elementary and middle school kids, and now they're in high school. So I've been working with the same kids for 10 years to see them, you know, come into pre-pubescence and then now they're 20-year-old men.

SPEAKER_02 26:24

We got to check in after. I wonder if the the kid that was his first ABA therapist when he was three. Don't know if he's still a pioneer. We got to check in after, though. He is.

SPEAKER_03 26:34

I know what you're talking about. Yeah.

SPEAKER_02 26:36

What a wonderful kid and wonderful family.

SPEAKER_03 26:38

Love, yes. And supporting them, that would say is why I'm there. I have a small caseload and I'm able to really tune into the family's needs. They're looking for a supported living and being able to find services as this kid ages. And, you know, being a they've been dropped by two companies in regional center because, you know, behaviors are not easy. Mods of your populations cannot find day programs. There's lifelong challenges with this that you're constantly battling with regional center. So you have a kid that has had a family do everything right from two years old, and now this kid is 20, and they're still getting dropped because this kid is perceived as hard. And so it's challenging and being able to text with that family and say, God, you know, can we can we get a break? It's 2026. I thought we were, I thought we were over this. You know, we've we've lived through the pandemic together. Masks are no longer required. There's so many things we've gone through. And to to have that relationship with families that, you know, I I hear what the updates are medically. I hear how their families are traveling over breaks. We talk about, you know, going from communicating and teaching them how to text, teaching families how to exchange pictures and share different ways of learning together as the kids grow. That's why I've been back at Pioneer. I feel like it's the most authentic, real, personable therapy, although it's physically taxing and draining. I find the I'm just wired differently than most people. I don't like when people are like, oh, you're such an angel for being in this field. I'm like, no, I'm just I'm made different than you. That's cool. But you know, some people are just into the the natural way of this. I don't want to do any of the bells and whistles performative clinic trials anymore. I just want to make it real and keep it real. And that's that's why I love Pioneer, making it going into Balboa Park and teaching them about the natural history museum when we're at a museum, you know, being able to get out of the classroom and make it real.

SPEAKER_01 28:48

Oh, very good. Very good.

SPEAKER_02 28:50

So I have a question about collaboration of care because I think that's what we talked about in the beginning is going to be one of the themes of this discussion. So my my question, and I'll preface it just briefly, is that obviously ABAs, ABA practitioners, ABA therapists, we work a lot with speech pathologists. I feel like in ABA, because we work with behavior, we get lumped into everything. And in some ways, we are either expected by the client to be the experts in everything, because everything is behavior. I mean, you know, communication is a developmental delay of individuals on autism. So we got to teach people how to talk or things like that. On the flip side of that, maybe we over go too far in in ABA and extend past our competency. So when I listen to somebody like you talk, and you mentioned in the beginning, what what did you call it behind the the teeth where you put your tongue?

SPEAKER_03 29:52

Oh, your alveolar ridge.

SPEAKER_02 29:54

That thing. Like, I'd never heard of that before. I am not an expert in in talking and teaching somebody how to talk. So can you I guess my questions are number one, can you talk about your experiences collaborating with ABA therapists, just your general thoughts? And number two, positives and negatives in those experiences and what you've seen that you really like and you would advise ABA therapists to do, and what you've seen ABA therapists not do, and like, whoa, don't do that. That's my question.

SPEAKER_03 30:28

So I like the collaboration and being able to get trials in. That is the key to everything. I want exposure of imitations, but it would be like what we talked about before, not accepting a production that they're trying to do because it wasn't on the clipboard to do. And, you know, the language is very complex. How we move our structures and formulate the articulators, we have science classes and you know, a plethora of different phases that happen with your tongue and swallowing. There are components to the motor structure that you have to plan and organize in order to make things happen. So for someone who doesn't understand the process of how to articulate and produce words and expect a child to know how to do that without that model, I think it's difficult. So it's providing that approachability and letting them see that, hey, I'm not expecting you to know every structure and anatomical, you know, happening and firing in the mouth. But if the kid is trying to say open and it doesn't come out is open, say it next to them, give it a shot and acknowledge that they tried. And you know, you can get a little bit closer. You could do a tactile cue, you could have mom say it, just providing ways that it can happen again naturally and being flexible within that. I just think the flexibility flexibility of therapy needs to be there and understand that this is not a simple process. It's, you know, there it takes a lot of schooling, eight years to be a speech language pathologist. It really does. There's a lot of science that goes into how we produce the speech component of things with our mouths, and chalking that up to just be to follow a direction is difficult. Same thing with occupational therapists. There's fine motor neurons happening in your brain that you know are occurring, and sometimes it doesn't happen when we want it to. So I'd say being patient, being flap flexible and collaborating, like if you're working on a certain sound, hey, how do I give this verbal cue when they're not understanding how to do this differently? What can I do differently? You know, problem solving with therapists, we're very good at saying, oh, I got this, I'm fine, I know everything. But it's like, hey, this I've been doing and it's not working. What else can I do? Yes, and acknowledging that you know your stuff, but what else can I do? That's what I'm always looking for that I don't feel like I ever get from BCBAs, ABAs, RBTs. It's like take the good stuff, thanks for the ideas, and then move on. I would like more of like your thoughts on how it went or your opinions and your feedback. So sometimes I look for that dialogue and I don't get as much of that, and I don't know why, but I would like more questions in a way, in that day-to-day aspect and being able to feel comfortable asking questions.

SPEAKER_02 33:56

So patience, flexibility, asking questions. I think, you know, I look at it as ABA. I think our job is to get the client to the table or to the wherever the table's probably an antiquated term, the the therapy session or whatever. And then from there, it's you teaching them how to talk or an occupational therapist teaching them how to move our body, their body. We're not the experts in that, but it's our job to be able to get them to the ability to have the behavioral skills to at least be there and maybe attend a little bit. And then outside of that, we gotta rely on the other experts and listen and work collaboratively with that. Yeah. I do have a couple other questions, but Mike, if uh go right ahead. So one thing that I've seen a lot in my field is that, or my my professional um experience is that actually the insurance company we used to specifically work with exclusively would deny a lot of families speech services. And I thought it was really weird. Um, even more so than OT. Like they would get OT, but they wouldn't get speech. And these would be people that were like completely non-vocal or very, very impacted and would get it at school. I don't know if that's still a thing, but in your experience, is that still a thing? And if it is, do you have any recommendations for families that are getting denied on how they can maybe be successful, either appealing it or what you would recommend that they do?

SPEAKER_03 35:23

For families who have you know, people with high support need, it's an ongoing challenge. It's finding your team and your tribe to talk to about it because it's it's constantly a struggle. It's hard to find the right providers. Therapists leave, they move, they drop, insurances change. So finding, you know, your community and people that literally have the same struggles as you and connect with you, and that's key because I feel like across the board, therapists change all the time. I feel like there's not enough speech therapists, and the allotment that we're given from insurance companies is a joke.

SPEAKER_02 36:09

Yes, in comparison. Some of them, even that would get the services, they'd be like, well, I can have a Thursday 315 to 445, an hour and a half away from where I live.

SPEAKER_03 36:21

I know I've never understood it. It's been, you know, even having my own company, I don't deal with the insurance side of it because it doesn't make sense to me. I don't understand the reasoning behind it. And I think more of it is just about financial incentives, and it's challenging to balance care. But the thing that I like and I find is it's true blue. If I'm there with you for an hour, I'm all the way there with you for an hour. I can do parent training. That's kind of embedded into my session. And I think that, you know, Zoom, the pandemic, and removing things have given more access to families with services, but it's not sometimes with the right services. Sometimes you need different professionals to work together. And I think that that's it's challenging to find finding supports through regional center or any kind of state-funded program so that you can try different clinics, word of mouth, talking to, like I said, other families. All of my referrals come from other people or just people that have seen me do therapy and like the style that I do. But it's very challenging. I wish I had a better answer for you. There's a shortage of us, it's been like this since I've been in the field. Teaching, it's it's very frustrating. There's a high turnover rate. I think it's like seven years before they quit or go part-time. Full-time SLPs are few and far between, especially in this field for this long.

SPEAKER_02 37:52

Okay.

SPEAKER_03 37:53

Just a challenging.

SPEAKER_02 37:54

Sure.

SPEAKER_01 37:57

So I imagine let me see a couple things here. I know there's sometimes a distinction between at least with OT, what OTs do from a medical perspective versus an educational perspective. Is that something that you also have to mind with SLP?

SPEAKER_03 38:14

Yes and no. I would say it depends on your setting, what you're working on. So at a school settings, you know, someone might not want to work on toileting at with a 16-year-old. An OT might not think that that's appropriate for educational access to their environment. So they're looking about independent access. Are you accessing your educational environment? You know, you maybe not you have to access the bathroom at school. So you kind of tease it out between what setting you're in, but I think a good therapist like should collaborate with everybody on the team. So if there is an outpatient OT or an outpatient in-home ABA therapist, bridging those gaps to do that, I always try to do. I think everything is functional across settings. Like words are everywhere, speech is everything, communication is everything. Everybody deserves a voice. So at least in my setting, OTs and speech are very similar in what we work on. We work on attention, cognitive functioning, you know, building imitation. You can do that through, you know, your hands too, of course, if you're doing multimodal communication. But I would say that it's challenging to get other professionals to see that we're using the same words like priming and forecasting. They're the same thing, for example. So priming your client, having an RBT telling me I primed them, I primed them, I primed them. So then turning that into well, priming is forecasting, it's building a schedule, which you can use visuals with that will help you make a sequencing goal and build language. So it's all embedded, and it's just providing something like that to them, a visual schedule to help understand that forecasting and priming are the same thing. It's giving them opportunities to have that Jiminy Cricket on their shoulder and narrate what's happening in their environment.

SPEAKER_01 40:16

All right. So I've got at least two questions left. They're completely unrelated. I'm gonna jump right in.

SPEAKER_02 40:23

I've got one completely unrelated, I'll end with, so we're good.

SPEAKER_01 40:27

Something that can be very confounding for people I know professionally has been confounding for me to understand. Uh, you may or may not have content expertise in this, but people talk about talk about aprexia.

SPEAKER_03 40:38

Yes.

SPEAKER_01 40:39

That is, I mean, that seems like a very complex, very layered difficult to diagnose, treat.

SPEAKER_03 40:47

Yes. Yeah.

SPEAKER_01 40:49

Talk talk just as much as you want to talk about apraxia and you know, the sort of your your best Cliff Notes, if you will, if that's even a thing anymore. Your best synopsis that you might lend to a parent or younger professional as to what apraxia is and and what it might look like.

SPEAKER_02 41:04

Cliff Notes is TLDR now. Oh, very well.

SPEAKER_03 41:09

Thank you for asking. This is something that's very hard to diagnose, usually by a neurologist or a speech language pathologist. It is, I'll describe it to families as the water slide is not lubricated from the mouth, from the brain. So that inconsistent production of verbal output is not lubricated to come out of the mouth. It's not that I don't understand how to say the words, it's just that the the looping and the wiring in the brain is not happening. And you can refin, and it comes out and it is produced differently, and it's neurological. It's not so much that we can even help it. So you can work on it, but the amount of frustration that comes with apraxia because it's an inconsistent motor production that you cannot consistently replicate those fine motor movements in your mouth, it has so many components to it that a lot of our patients have. They have, you know, dyspraxia in their body. They're they're unable to do those cross-midline exercises. And that's where OT and and PT comes in. So there's apraxia in the body, limb apraxia, and the same thing with your mouth. And it's really hard to diagnose because it can look like an expressive language delay, a phonological delay of language sounds, which are the systems of words that are in error produced, or it could be articulation, but it's hard to tell and tease out how it's die how it's treated and diagnosed, because the evaluation process is very grueling and difficult to tease out what it is because you cannot get the same motor productions. That's the biggest finding and the telltale sign for it. They're inconsistent motor productions. So you cannot do pattica, patka, pataka certain motor productions that are consistent and fluid at the same time. So SLPs have an evaluation process to see if they're able to produce a string of syllables or consonants with voicing, with resonance in their nose, and with placement of your articulator. So there are so many different things that we're looking at are not just output, but it's in internal in your mouth.

SPEAKER_01 43:44

So these are this is I'm I'm gonna boil this down probably not well enough, but these are now neural impulses that aren't coordinating.

SPEAKER_04 43:54

Yes, yes.

SPEAKER_01 43:55

That so it's it's those impulses are there, is what we're saying. They're just not. Coming together. They're not coordinating well enough for the person to then be able to produce. And that means that they understand. They know what you're asking them to produce, but coordinating all of those pieces motorically or cognitively or otherwise is the problem.

SPEAKER_03 44:15

And that's when AAC comes in, being able to have that independent, you know, a child who has epilepsy might have the apraxia as a result and the inability they come in after a seizure to not be able to talk anymore and say that they want to play basketball. But because we knew they had seizures, a history of seizures, because they were exposed to AAC and they touched the button basketball and have that visual and symbolic representation, they hear it and they can say it and they can take it to somebody and they know, hey, I can get my basketball. So that's when that speech element is so important to come in with that multimodal component to show how apraxia there's systemic ways that we can target and treat, but everybody's different in how they're producing it and how they're using language and communication. But that is a it's a neurological inconsistent motor function, like you said, yes.

SPEAKER_01 45:16

Okay. So this will be my last one, then I'll pass it over to you to close it. Early intervention, the idea that you're going to use a lot of kids' songs and finger plays. And the notion that from a motoric perspective and a symbolic communication perspective, those finger plays and movements are super important as gestures and things that make sense. And that and then if you take a song like Old McDonald had a farm, you we're talking about semantic categorization here. There's a farm, and there's certain animals in the farm, and these animals make certain sounds. And then there's the refrain of this song. That's what I want you to speak to to speak to. The idea that E-I-E-I-O sounds like fun wordplay, and then it probably means a whole bunch of other stuff to somebody like you in terms of what you're doing with your mouth to produce that refrain. Talk a little bit about that, please. It's one of my favorite things to uh kind of you know cue parents or younger professionals in on and say, yeah, you think this is a silly song, and and but let me tell you all the layers, and then let me tell you that E I E I O is not just a mistake, there's a lot of potential and power to moving your mouth that way.

SPEAKER_03 46:25

Those early vowel shapes that you're making with your mouth that you can see and that you can imitate successfully first. That's why we do it. It it's silly, it is fun, it's building that expression and fun and anticipatory excitement with the sounds that are coming. And because it's in your mouth, that's a great time where I like to pull in sign language. Where if you're this is pig. So if I'm doing, I'm also giving another way to say it. And you know, horse and cow, I'm doing another language dimension while also being silly and using my body play to shape and use that melodic intonation to to jump from one interest to another and making it learning the nouns, the speech production of how to how to say the vowel shapes.

SPEAKER_01 47:24

Those shapes are pretty important, right? Those three shapes are pretty universal and and pretty important to language production.

SPEAKER_03 47:31

Yes. Those are the first ones, and then it you know it goes on to the other shapes. So it's all a matter of them seeing it, exposure to it, turning it into fun, and then imitating it functionally so that it's part of the song, pushing play and pause, turning it up in you know, different languages, doing head, shoulders, news, knees, and toes in Japanese. Is I love doing that with this population songs that they already know. Like twinkle twinkle, you use that intonation and you play it in a different language, and you do the motions in sign language, you just make it more layered and interesting so that they can see how it can be used in different ways and generalized into different words.

SPEAKER_01 48:17

Awesome. Thank you so much, Mr. Dan.

SPEAKER_02 48:20

So, my last question for you is is is ABA therapists, you know, when when I talk to people and I'm like, oh, like I do an ABA therapist, they're like, you're not gonna ABA me, are you? And I'm like, no, not not really, but sometimes like even just in general interactions, when we're watching people or watching parents react to their kids, it's like the ABA brain's always on a little bit, and I'm looking at how situations get reinforced or things like that. So as a speech pathologist, is there anything that you just in just general interactions with people that you tend to notice or look for or quirks or things like that that with your expertise, like just in general conversations you notice or look for that are kind of fun?

SPEAKER_03 49:02

Yeah, I I definitely feel the same way. It's they say about speech pathologists, like I'm listening to how you talk or I'm analyzing the way you speak. But we're all doing that, we're all making hypotheses and you know, mini micro conclusions and judgments throughout our day. And being able to just have that snapshot, you know, I just bring in my empathy. Like everybody's trying their best. I just I would say the thing that I would like from our professional field is just to have more real conversations about about play, about engagement, about connection, about the fun and the magic of why we work with this population. And I think that that is really what I try to come back to over and over again because it's you know, it's really is a professional best friend. That's what we're doing. That's what we're all doing here. So just saying that we're all on the same page doing the same things, using different words, but just remembering there's such a human, diverse, layered element to us, and it's not black and white. So it's very complex and just being patient with one another as it continues to evolve because this is it's new for everybody to be able to have to do this and you know, talk about our professions and inner twinings of how things interrelate because we're learning all the time and growing together.

SPEAKER_02 50:32

On the flip side of that, is there anything so like always conscious about not reinforcing maladaptive behaviors? And I have to not do that sometimes. Is there anything as a speech pathologist you're really either self-conscious of or just really, I don't know, you're like, I always have to enunciate my Ps or like things that just is a not like individual quirks, but things that you're just like really cognizant of as a speech pathologist?

SPEAKER_03 50:55

I try not to have clinic voice or like performative Mary Poppins voice. Good, and then I see this happen. Like you see people when they're you know, they're they're out with their pets or they're out with their kids, and it's like tell them your name, tell them how old you are, tell them say your tell them I love you. It's this performative, hyper anxious say this. The word say is what I always get like say, say say this, like demanding. And I'm like, parents, stop with the performance. A lot of times I get cheeky with the families, and I I always try to like bring that into the therapists I'm working with, and I'm like, Where's your driver's license? What's your number? What's your license plate number? I just start quizzing them on things that they should know. Tell me, do you know your social? Do you know all the numbers? Okay, when did you find your first gray hair?

SPEAKER_01 51:45

Say it, tell me, tell me.

SPEAKER_03 51:46

Yeah, and then I'm like, yeah, it's not fun. What are you doing? Why are you quizzing? So they making sure that like therapists can kind of be disarmed and have fun and just realize like you don't have to. This isn't a quiz, this isn't a test. Like, bring it back, find some fun in the moment, and you know, make it real and natural, be authentic.

SPEAKER_01 52:07

Thank you. Right now, well, this felt like five minutes. It's been a pleasure talking with you. We're we're actually at our end. Anything you want to plug or promote, if you want people to find you, you want to tell them where to find you here, or maybe you don't want them to find you. I don't know, but this is a good chance to put yourself out there if you want to put any information about how people might connect with you in case they could uh benefit from your content expertise.

SPEAKER_03 52:33

Sure. I specialize in multimodal communication and I'm a speech language pathologist. I take private clients, I can work with you, and I like truly building relationships with other professionals, just helping this community and learning and growing together. I wouldn't say one specific thing. I would say make sure you do your research and looking at the tools that you're aligning yourself with and making sure that the therapy practices that you're investing in are evidence-based, meaningful, and helpful for you and connect with your families and build your tribe.

SPEAKER_02 53:13

And if somebody does want to find you, and you said you are taking clients, where would somebody find you?

SPEAKER_03 53:18

You can find me on the internet.

SPEAKER_02 53:21

Okay.

SPEAKER_03 53:21

I would say I have a I have social media. It's Brittany Warnkey. There's an Instagram, it's Tuck Talk Touch and Play.

SPEAKER_04 53:29

Oh, wow.

SPEAKER_03 53:29

Is my company, but you can email me at Bw6380 at gmail.com. But I'm here for questions, comments, collaboration. Anything you got.

SPEAKER_02 53:43

Clearly passionate.

SPEAKER_01 53:44

Yep. Thank you so much for your time. We're so glad to have made a connection with you. If there's anything that ABA on tap can ever offer you, please feel free to reach out. I like to close with uh a few words of wisdom that we gained from our chat with you, and I'm ready this time. All right. Dan, are you ready? Cheers. You're gonna like this one. Suck, swallow, and breathe. Model without expectation, and always analyze responsibly. Cheers, Brittany. Thank you so much.

SPEAKER_03 54:13

Thank you so much. Have a wonderful day, guys.

SPEAKER_02 54:16

Always analyze responsibly.

SPEAKER_00 54:19

ABA on tap is recorded live and unfiltered. We're done for today. You don't have to go home, but you can't stay here. See you next time.