A Perfect Pairing Toward the Eighth Dimension: Compassion and Food with Dr. Yev Veverka (Part I)

ABA on Tap is proud to present Dr. Yev Veverka (Part 1 of 2):

Grab a tasty libation, a comfy seat and sip slowly.  In this episode of ABA on Tap, hosts Mike and Dan are pouring out a fresh perspective on the evolution of behavior science. We are thrilled to welcome a powerhouse, Dr. Yev Veverka, PhD, BCBA-D--a world-class researcher, and educator from the University of Washington. Yev is also well versed as a parent of neurodivergence. 

We are tackling the flaws in traditional ABA delivery and diving straight into how we can reform the field without abandoning the proven science. Dr. Veverka breaks down the concept of compassionate care as the "Eighth Dimension" of ABA, exploring how practitioners can move from being rigid experts to collaborative partners who actively center client autonomy and well-being. Plus, as a leading feeding specialist, she serves up some highly actionable strategies from her work on making mealtimes positive and manageable for families.

On the Menu Tonight:

• The Compassion Reform: Why the current application of ABA can feel flawed to families, and how shifting toward person-centered, empathetic care can reshape the future of our field.
• The Dual Perspective: What happens when a BCBA is also an autism parent navigating the daily realities of therapy.
• Meaningful Mealtimes: Dr. Veverka’s practical, evidence-based tips to prevent and handle common mealtime challenges without the battle of wills.
• Client Autonomy & Assent: Shifting the focus toward meaningful participation, social justice, and asking the critical question: Whose lives are we actually improving?

Whether you are a seasoned BCBA, an RBT in the trenches, or a parent looking for real-world support, this episode delivers high-impact behavior science with absolutely zero boring jargon.

Tune in, Drink up, and ALWAYS ANALYZE RESPONSIBLY.

Transcript

SPEAKER_03 0:01

Welcome to ABA on Tap. I'm Mike Rebio with Dan Lowry. So without further ado, sit back, relax, and always analyze remarks. 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, how are you today, sir?

SPEAKER_02 0:44

I'm doing great. How are you doing, man? I am super excited. I know, and we say that all the time, but sometimes it's a little more excited than other times. And this is one of those times.

SPEAKER_03 0:54

So, you know, I play music. My son's a you know an aspiring musician, and you you sort of admire certain musicians, and you you grow up with you know posters on your wall. So if I had ABA posters on my wall, today's guest would there would be a poster uh of her for sure. She she's done she does all the stuff that I'm interested in. I can't wait to learn more about her or origin story. And I I always introduce myself as the ever-grateful co-host, and I am ever grateful today to have Dr. Yev Viverka. Dr. Yev, thank you so much for your time on a Sunday morning. Uh, and thank you for your flexibility and changing your time. We had some scheduling changes and uh you were right there with us. How are you doing today?

SPEAKER_01 1:43

Uh thank you for having me. I'm doing uh great. It's it's nice to be here earlier, looking outside at the sunny Seattle weather and excited to chat with you all while watching um all the all the spring happenings outside. So doing great.

SPEAKER_02 1:58

You gotta cherish the sunny Seattle days, right? Because they're few and far between.

SPEAKER_01 2:02

Everybody's out today. It's so funny. Everybody like comes out of the woodwork when the rain stops.

SPEAKER_03 2:07

We're gonna get you back out there, and hopefully it's not like one of those uh comedy films where as soon as you step out, then the Seattle rain starts again or something like that. So we'll try to we'll we'll get you back out there, and I promise these two hours will fly. We've got so much ground to cover. We like to start with the origin story. We're gonna cover, I we kind of talked about this before hitting the record button, but feeding intervention and early childhood integration or inclusion, and then the general idea of compassion. And we're so excited to learn from you on all these topics. But tell us how it all got started for you, and then right up to where it culminates now, and we'll go from there.

SPEAKER_01 2:42

Sure, yeah, it's a long story, I guess. And I I think that everybody has like a non-traditional path to where they are in this field. Well, maybe it's not non-traditional. Um but I I started working in the field of ABA right out of undergrad. I took a class with Dr. Eric Larson just by hoping stance. I've never had never heard of applied behavior analysis. I worked in an after-school program with kids with disabilities, but didn't really know anything about ABA. And as soon as I took that class, I just fell in love with the field. So I went right in from undergrad into my career and knew nothing, as we as we all have as BTs. And this was back in like that time of before insurance coverage and when we would be hired by families, and then there's like this outside B C BA. So there was a lot of time on my own trying to figure things out, and which leads me to kind of how I got into feeding and mealtime support. So I noticed that all of the families I was working with as a BT, thinking about I was at this point of thinking about my master's program. I was still very early. And as a BT, I noticed that everybody was dealing with some feeding challenges. Um and I when I say everybody, like I mean literally every single client I worked with had some sort of feeding challenge, and I knew nothing about it. So I started my master's program and in that time told my advisor and my instructors that I want to learn more about this. And they said, well, start reading the literature and start going to the conferences. And so I did that, and I'll talk, I'm sure, later about all the mistakes I made because I think that's what led me to this. So one of the mistakes I made is I the literature I absorbed was all behavioral, and the conferences I went to were all behavioral, and feeding is so much more than that. And so I was watching these conferences, conference talks and reading these articles where the results were so great. And I was like, oh, I want to replicate that. And so that's what I did for my capstone and um as part of my work as a behavior tech. And I always tell people it it worked and that the data looked good. Kids were eating more foods, but as far as how few people felt about it and how I felt about it, like kids were running away from the door instead of running to me. When I was used to them running to me and ready to play, and parents weren't sure, but they really wanted their kid to eat more, and kids were crying at the table, but the intervention worked, it was effective. And I I got to this point where I was like, I don't like this. This isn't a this doesn't feel like the ABA that I uh fell in love with. And like, what do I do from here? So finish my master's program. This is a really long story. Should I keep going?

SPEAKER_03 5:46

Please. Oh, we we are we are soaking up every word.

SPEAKER_01 5:49

Um like this is like 20 years now.

SPEAKER_03 5:52

I wait, I I've got like uh 50 questions already. This guy's great at questions, so you're you're just feeding in the flame. Don't worry, go ahead. Yeah.

SPEAKER_01 6:00

Okay. So finished my master's program with that knowledge, still was really interested, but not feeling good. Came to my incredible mentor and doctoral advisor, Dr. Eileen Schwartz, who I chose to, I was so honored that she said I could work with her, but I chose to come to the University of Washington because I wanted to learn more from her and her work on inclusion and working with children, kind of where they're at, and like this early intervention and support model of kids with and without disabilities working together. So I was like, okay, maybe I can get something from this that will kind of feed into feed in.

SPEAKER_00 6:40

I I use a lot of unintentional the feeding work I was doing.

SPEAKER_01 6:47

And so I asked her what to do, and she sent me to this like intensive, interdisciplinary, really comprehensive feeding program. And I learned so much from the like nutrition fields there, the nurses, the speech language pathologists, and all the medical providers. And at the same time, I was still seeing this like trends that I felt uncomfortable with, where by the time kids were coming in, they were like seven, eight, nine years old, sometimes older. And they were at this point of like I always tell the story of this kid that was eating lucky terms marshmallows, only the marshmallows, drinking some milk and eating like some goldfish crackers, and his family was buying them in bulk. And I watched an escape extinction procedure. And again, it was it worked. And I was standing there behind the glass, and and he was crying and he vomited and he stripped down, and at the end, he ate a bite of whatever it was that the goal was. And the person that was running the program is brilliant. The and everything I say, like it's not putting blame anywhere. People were doing the best they could.

SPEAKER_03 8:01

Oh, we understand exactly what you're talking about. We I can think back in my career and think of all those things that I did and went like, oh, I shouldn't have done that.

SPEAKER_01 8:10

For sure. Yeah. So, so this is said without judgment, but she said, you know, sometimes this is really hard to watch and it's the only way. And I was just like, but is it? Is it the only way? So I went back to Eileen and I said, Is this the only way? Because I know that these parents did not start solids with Lucky Charms marshmallows. Like, how did we get to this point from like transitioning from bottles, starting solids, eating at school to we eat three things? And she, if anybody knows Eileen, like they can picture this, but she kind of was like, Well, figure that out. That's your doctoral work right there. Just like figure it out how. Um, and she did she introduced me to so many people that I'm so grateful for that were practitioners in the field, and they were working at the early learning the developmental preschool at the University of Washington, where Eileen directed the program. And so I started talking to practitioners, not researchers, not ABA folks that are doing, you know, writing up their studies, but people who are in the classrooms working with kids all the time. And we started asking families and kind of going back in time to like to figure that out. And what we learned was that families were not getting the education they needed.

SPEAKER_00 9:25

Yeah.

SPEAKER_01 9:26

People who eat with kids, so teachers, childcare providers, birth to three providers did not know about pediatric feeding and and feeding development and when what's a red flag and what's not. And they were stressed. And the wait lists were crazy long. And so by the time something was flagged as bad enough to be referred, then they had to wait for another two years. So we're having like this two, three-year-olds saying, like, oh, this is concerning, being told this is normal, just wait.

SPEAKER_03 9:57

Wait it out, give it time to play out.

SPEAKER_01 9:59

And by the time they get on that wait list, they wait two more years. And by the time they come in, they're eating the Lucky Charms marshmallows and they've dropped everything else and require a superintensive program. So that's how this all culminates. I've really taken on working with practitioners, with I love working in early intervention and with early support providers, but also with just like your general preschool teachers. It doesn't have to be autism specific or developmental disability specific, but really asking the question of like, what are some universal things that everybody should know to prevent this from happening?

SPEAKER_03 10:36

Wow, that's that's an incredible journey. University of Washington, a really strong psych behavior neuroscience tradition in general. Is that Geraldine Dawson? Is I I know she was there, yeah. I never was there. Because she was part of the Early Star Denver model, which I know started out of the University of Denver, but then she became involved. I have a great admiration for her work in the sense that I, you know, as a developmentalist myself, and then I did my graduate work in neuroscience and neuroimaging, and she was also uh very well published in that field. So it gave me hope that maybe despite my scattered path, uh, it was gonna come together to something good, and luckily it did, and you kind of have a similar experience. So you would would you say that the pediatric feeding part uh or the the inclusion part kind of just expanded from the pediatric piece? You found that you were working with that age group and then it it sort of spilled over into doing other things with that particular age group, or what's the distinction there for you?

SPEAKER_01 11:32

Yeah, I don't I think it's all kind of merged together. I don't know if there's a distinction. I think that I was always interested in feeding, not as necessarily my primary thing, but it realized over the years how big it is that it's enough to be all that I do. But I throughout, I mean, I still work just in kind of early intervention and just general development, caregiver coaching and support. And I I think that like it's interesting thinking about mealtime, it's it's so mealtime is so indicative of like everything, right? Like if you look at a mealtime with a family, you see all the skills, you see the parent and child or caregiver-child relationship. You can see where things are not going well or where things are going well. So I always tell people like for anything, whether you're a feeding or whether you're supporting feeding and mealtime or not, like just watch a 20-minute meal time and you will learn so much about a family. So I think it just like all meshes really nicely.

SPEAKER_02 12:32

So I have two clarifying questions just for our listeners of things that you had talked about. So you said that when you first got into the the feeding side of things that you felt like it was a little too behavioral, which I think I know what you're talking about, and it makes sense to me, but I'm not sure the listeners know exactly what you mean. So can you elaborate on when you say it was too behavioral, what you mean by that? Or there are other approaches outside of behavioral approaches?

SPEAKER_01 12:55

That's right. Okay, yeah, good quite great question.

SPEAKER_03 12:57

We could probably talk the rest of the time on this question.

SPEAKER_01 12:59

We probably couldn't.

SPEAKER_03 13:01

We probably will. No, no, we probably will. Go ahead.

SPEAKER_01 13:04

Sure. So I guess I always start like when I'm teaching on this topic now by just asking folks to imagine like what it takes to eat, right? And like so many of us, like I don't have any problems with mealtime. I love mealtime. I don't have problems with chewing or swallowing or the social aspects. But if you think of all the things that come into taking a bite, chewing and swallowing, even, we need to make sure that our oral motor skills work well. So if somebody can't use this is beyond ABA, right? Which is, I guess, the question. But if somebody can't use their tongue to move things around because they have low tone, for example. And that's kind of like where my expertise ends. I just just knowing the these other parts. But if they can't move food around, then feeding becomes really scary and unpleasant. And every single bite might hurt or might feel scary, like they're going to gag or choke. And so that's just one example. There's also like the sensory parts, the relational parts. If if I'm not sure what is expected of me, like if I I think of like traveling and eating at mealtimes where maybe different utensils are used, or we eat on the floor, or or just like all these different norms. And if I don't know what's expected of me, my appetite changes. I don't want to eat. I'm looking around and trying to figure it out and observe. And so I have to have those skills too, like those observational learning skills and the social skills. And so if just one thing in that process isn't working, like making like bringing it all down to refusal behavior is just completely losing all of that, like all of those other pieces. So like if we if I do an FBA on food refusal, it kind of makes me laugh, honestly, because like if I do an FBA on feeding and the kids refusing to eat food, like what's my what's my function? What am I going to get out of it? Like, we all know it's going to be unavoidant, right? So so like we have to ask another, like, but why? Why are they escaping? Because it's scary, because it hurts, because they can't, they have lung issues or like breathing issues, and we have to be able to breathe while we eat. And this is a child maybe that was born premature and never learned that. And so they're like literally, like I've I've seen kids who struggle to to breathe and turn like their color changes, and it looks, it looks scary. So we can't just be like, okay, but first take a bite and then you get reinforcement when we haven't worked on. Let's let's make sure that it feels comfortable. And so that's where all these other fields come in, like the the folks that work on oral motor, the folks that folks that work on the sensory piece, like bringing food, like hand eye coordination, bringing food to the mouth, gastroenterologists, pulmonologists. There's so many people that work on this. And I think that we owe it to the families we work with to understand that there's so many reasons why the escape.

SPEAKER_02 16:03

One last so thank you so much. I think that really clarified. Uh, one other just clarifying question for what you asked for our audience. So you said that you kind of got, I don't know, disenfranchised by the whole methodologies or that the way that people were approaching eating. You didn't like the interventions at the time. I think it's kind of how you can you speak to the interventions that were being used at that time and why you didn't like them, and then I'll pass it to you because there's a lot we want to talk about, but I just want to make sure that everybody understands exactly what you were talking about.

SPEAKER_03 16:33

In a sense, maybe do you want to describe escape extinction in the way it looks too? That you uh that you observed it, and then I think that might give a really good overview to anybody listening as to why that probably looks terrible. Or other methods.

SPEAKER_01 16:50

Yeah, so uh well, escape extinction, and I'll describe kind of like what I was trying to do, which was I mean, there was an escape extinction component, but maybe not to the point that like what we think about with the literature on escape extinction, but the conferences I was going to, the videos that were being shown were like, you know, baseline, little child in a high chair, food presented in front of them, and they're, you know, like turning their head and spitting and pushing the spoon away. And and then the intervention is the escape extinction, is that the food it remains there, and the only way they can move on and get out of the high chair and be and end the meal is to take the bite. So that's the only way to remove the spoon. So, and of course, like combined with other things, shapings, like differential reinforcement, all the it's not just escape extinction.

SPEAKER_02 17:45

Sure. But and you say the only way they could get out of the high chair is to take the bite.

SPEAKER_01 17:50

How long did some of your more challenging clients hold wait out for before they so I know I personally never did that version of it, but I I did do like kind of a first then. So sure we can be all done, but first we're going to like take a bite of this one, and then we've got our gosh, I hate saying list, but I'm gonna say it for to like in the interest of transparency. First we're gonna take a bite of this, then we get our favorite food, our MM or whatever, and then we're gonna take a bite of this next food, and then we get our MM. And they like cried their way through it, didn't even want the MM at the end, they just wanted to be done. And that did take, I mean, it it did take I I don't know how long, like more than your typical meal just to get those five bites or exposures in. I didn't last very long doing that because it just didn't feel good. There was a second part of that question.

SPEAKER_02 18:47

No, the question was just you said that you didn't really like the interventions that were being used, or you felt that they were traumatizing. So I was just asking for you to kind of explain what those interventions were so the audience could know. So maybe when we talk about the ones we're using now, they can juxtapose that. So what were you running away from? You were running away from like the more blanket escape extinction of I'm gonna wait until you do this kind of thing, or what would what were you running away from?

SPEAKER_01 19:10

Yeah, the the kind of pressure to eat. And I kept picturing like what if somebody did this to me? And if it was a food that and I taught I again ask people, like, you guys can do this exercise if you want, but like I think about a food that disgusts me, and disgust is a real thing. So do you wanna do you have one?

SPEAKER_03 19:30

I I can't, so I was already thinking about this. I can't do raw oysters, and I'm sorry for it, because I know that's gonna offend a lot of sensibilities out there. Um but if I think of dropping one in my mouth, like I see people do, just the idea of having it sit there for even a tenth of a second before I swallow this whole I can't I'll gag right now.

SPEAKER_01 19:48

Just talk like I'll that's how I get too, yeah. And so I started thinking about that. Is there another one?

SPEAKER_02 19:56

Oh, my girlfriend hates raw oysters as well.

SPEAKER_01 19:58

Oh, okay, yeah. I do too. I have I really want to like them and I have tried and I cannot. But but thinking about that, like I would think about, you know, what if it was something like that for me? Like my parents, I I am Russian, and for some reason we'd like had a lot of like slimy pickled mushrooms. Like, I like mushrooms, but not those. But even just thinking about that, like I'm able to say, no, I don't want it. That's not my preference. And I felt bad. Like I felt bad that I wasn't teaching kids that they can have those preferences too. I'm like, why am I choosing, why are we doing this food? Why are we doing, why are we forcing this? And how would I feel? I would say, forget the MM, forget the chocolate. I don't, I don't want it because I'm feel gaggy. Like you don't, if you're thinking of that raw oyster and picturing eating it, and I'm talking about your favorite food, it's not gonna like over, it's not gonna make the gag or the disaster.

SPEAKER_03 20:55

That's a great point, right? I love chocolate, but I'm not gonna necessarily enjoy it after I've had the oyster experience.

SPEAKER_02 21:00

Will you eat oysters for if I it's if it's first oysters, then casa Gabriela? Will you will you do it? No.

SPEAKER_03 21:06

Oh, okay. Let's get a restaurant here that Dan just experienced, but getting away, continue.

SPEAKER_01 21:11

That's awesome. I I to I the last big talk I did, Hoosier ABA, I decided to try something new and it worked. But I had pickled pigs' feet. Oh, and I had audience members come up and like I paid one to I was like, how much could I pay you to eat this? And some people said, like, you know, hundreds, a million dollars. I'm not touching that. And somebody else was like, I would do it for five dollars. I was like, okay, we can do that. And so she did it. I gave her the five dollars, and I was like, okay, are you gonna do it again now? She's like, No, I didn't like it. Like, exactly, like the re it doesn't, it just reinforcement the way that it might work for teaching other skills doesn't work in this like very different context.

SPEAKER_03 21:56

Wow. So so many cool things that you just said there. One thing that you s sort of keep alluding to, if if I and I think I'm interpreting it correctly, I guess one question that comes out is what percentage of parents sitting in a pediatrician's office do you think are there for some sort of feeding-eating reason? And then where are pediatricians actually equipped for this, knowing that the general system is set up to, oh, they'll grow out of it. We're waiting until it's this huge problem to then s refer to a specialty, and then you'll have to wait for that specialty a few months. And then by the time your kid walks in that door to use your verbiage, we're down to the lucky charms of marshmallows or you know something that the parent is is going crazy over every night. It's the only thing they eat. So I'm going to keep feeding them this thing. So how common are these challenges? Have you ever had lucky charms? I have lucky charms the only reason to eat lucky charms is the marshmallows. And they make the milk all pink and stuff. Oh with the sugar milk at the bottom okay something sugar. Yeah you throw the other stuff out there those little whatever they are alphabets throw those things out of there.

SPEAKER_01 23:03

But how can I catch my kids? No you can't dig for the marshmallows. And then I go in and dig for the marshmallows.

SPEAKER_02 23:09

Right exactly those are for adults mommy's marshmallows.

SPEAKER_03 23:13

Those are mommy's marshmallows Lucky Charm yep all of those all of those cereals what how common are these difficulties across the board and then where do they end up you know on that more tail end of the normal distribution where they're really really challenging. I know I'm giving you a very general question there but I know you can answer some semblance of that.

SPEAKER_01 23:34

It's a it's a really hard question and like researchers have tried to understand prevalence. As far as like a diagnosable pediatric feeding disorder the prevalence is estimated one in 36 or 37 something around that of all kids. Then you take kids with developmental disabilities kids who are born premature and that it skyrockets that prevalence but because we don't have I mean it's such a new field and we don't have very clear definitions nor like a line for where it's it switches from typical to clinical. And I don't think we should have the line. I think we should just like as soon as somebody says I don't know how to do this we should support them. Actually before that we should just be preventatively giving them that information. But it's it that makes it really hard because pediatricians from what I've I'm learning and talking to my brother who's a primary care provider they don't learn anything about pediatric feeding disorder one because it's newer and two because they have so many other things. And so they've got it like one of you mentioned kids right you've you've probably gone through the does one of you have kids too okay I live vicariously through Mike's kids. Okay. So you also have three Mike but so you've been through yeah yeah um I I do as well and so you've you go to those well child checks and they say like they they check in on like how's sleep going what are they doing and there's one question there's one question that says is your something along the lines of like is your child eating a variety of foods including fruits and vegetables and I don't know like people are either going to lie on that and say yes. They're going to be a small percentage of people whose kids actually eat a variety from the start or they're going to say no but then and like I've said no for every single one of my kids despite being in this field it's just like that is a common thing a common challenge and it is a slightly typical but then when your pediatrician comes in they're like oh like this is I'm supposed to flag this they don't really know what to do next. Like they'll ask some questions and they'll that's where we hear some of that like this is really normal. It's okay like let's add a multivitamin let's do let's just make sure they're getting enough iron you know like just keep trying keep presenting there's all sorts of well-meaning advice and for somebody like me that's fine like I can figure that out it's not stressing me out but I've heard from so many clients that they hear that and then they're like I one mom story stands out in particular she said there's they said he's fine he's growing fine it's normal and then I went to the grocery store and I all of a sudden I'm like in tears over my groceries because I don't know what to buy him to like keep trying. And so gosh like we could we could do so much by just giving that information earlier like four years before she's crying in the grocery store aisles. So that question about like prevalence and how often it's happening is so I I want to say almost always but it's so hard to say.

SPEAKER_03 26:47

Well and that's kind of what I was after I think is at you know for for all of us to realize like with kids this is an overall common challenge. And and even I I feel very fortunate with my five year old for example who I would say eats just about anything. And then once in a while there's an evening where she's having trouble at dinner. And then my parent instinct kicks in and I'm frustrated. How dare she she always eats stuff and now I'm worried about her not getting enough calories at dinner even though she ate the rest of the day all these little pressures motivators if you will toward now forcing the issue as a parent despite my better professional knowledge right so now I'm creating this subversive experience and dinner time isn't as fun as it used to be and so now I'm I'm saying this happens once every two weeks.

SPEAKER_01 27:37

That is a lot I counted it once it's like hundreds of negative experiences in a month. I have the number somewhere where it's like how many times per day and then per week and then per month our family's dealing with this and it's it's it's interesting that we support it so little because it's the one thing as parents that we cannot skip. Like everything else we can be like okay we're not gonna do summer camp we're not gonna do toileting whatever we'll just keep them in pull-ups until they're ready okay we'll co-sleep we're not gonna do anything about that we can't not feed our kids we can't skip it we can't not worry about it because it's like I mean it's it feels sometimes like not to be dramatic but it does feel like life or death sometimes like if I don't feed my kid dinner if they go to bed hungry because they were having a rough time like I'm I'm not gonna sleep well because I'm gonna be like are they gonna like are they are they gonna be ill am I did I mess them up?

SPEAKER_03 28:34

So well and they they could get hangry right you might end up with a child who's now agitated because they're hungry or they're not gonna sleep well because so yes I mean I think that we borrow that worry and then as parents we've experienced that so we're also worried because hey this could happen. You mentioned something and I think you explained it pretty well but I think it's important to to think about a pediatrician who's now say tracking height and weight on percentile and you're a parent like oh they're they're tracking just fine here so there must not be a problem and that's kind of outside of the question you mentioned you know do are they eating enough fruits and vegetables? I think that's about it. I think that's all that any given pediatrician again with all due respect that's those are the questions they need to know where does that tracking on the height and weight how is that misleading to the rest of what you're seeing? How does that not actually speak to a potential problem despite those two metrics being okay yeah I I love that question.

SPEAKER_01 29:28

And also want to plug here the the organization feeding matters I'm involved with them as a volunteer on their conference committee and other other initiatives but they just had at their international conference and the keynote was beyond the growth chart like what are all the other measures to be thinking about and they had some folks with lived experience of RP diagnoses who spoke to this issue too. So the growth chart is like so it's so outdated and it's so it's kind of funny too because they are taught to like if they're following their trajectory on the growth chart we're okay but they don't really because they're not registered dietitians. I mean that it can't be everything so they can't dig into like well what are they eating to stay on the growth chart and I can I guarantee you like I could keep my kid on the growth chart with goldfish crackers and milk. Lucky charms but yeah and and that's what folks with lucky charms that's what folks with our foot are telling us that like when we're hearing I was above the growth chart and nobody was worried about my survival but like my nails were brittle my hair was falling out I didn't get uh didn't have any nutrients I didn't feel good and everybody said I was growing fine and so it misses it misses so much unfortunately and like in my magic world I would say that in addition to our well child visits that everybody would have access to a registered dietitian preventatively to like plan and make sure that that is something that like is part of the conversation of like what are we eating one thing really quickly I'm gonna pass it to you because I know I've been I've been hugging the stuff right now I just have one you mentioned something very important about hair and nails and then now maybe I'm having behavioral issues.

SPEAKER_03 31:20

How much of that is correlated would you say and again I know I'm asking you a huge question but just kind of speaking generalities some of those behavioral issues might now then be actually related to a general you know not feeling well and then we're using the same motivational contingencies to address those behavior issues though they're not or they're now related to something that we shouldn't be using those contingencies for anyway. I don't know if I'm making any sense but it's almost like we're four degrees of separation from our actual science now and we're just kind of plugging this in.

SPEAKER_01 31:55

And again the contingencies are important but we're kind of missing the mark on the general problem in that sense yeah I mean a lot I everything I'm again like I don't know the numbers on the research but like from an intuitive like human perspective if you think about any time that you've been ill and how it changes your appetite anytime that you missed a meal and how that changes your sleep or like when you just like the the when you eat too much of the something that is not what your body needs how you feel sluggish right like all of all of the things so when we and when I'm sluggish I refuse I have more refusal behaviors right like and so intuitively it just makes sense. So it's interesting to me that we're not like talking about it like like just were but I think the technical term for that is uh being hangry. Yeah being hangry yes it's a medical term one of my kids uh when he's hangry he also is like very much like I'm not gonna do anything you say so like we have to like trick him into thinking it's his idea to eat and like I like literally leave things around him until he finally eats and then we're like my husband and I like oh thank goodness but we have to be we have to get ahead of it and he has all sorts of behavior challenges if we miss that piece like we have to be constantly feeding this kid snacks so we don't get to that point. But if again this is like where it boiling it all down to this idea of refusal behavior inappropriate mealtime behavior is completely missing the mark because then we don't know you like you said it's all it's all connected.

SPEAKER_02 33:39

So we miss on the function in many ways we the refusal's correct the why is the the the part that we're just not we're not equipped to be well informed uh why yeah not yet not yet okay so you mentioned our fit a few times and I want to have you maybe open up a little bit on that one of the families that I worked with became pretty pretty big advocate into the the feeding community if if that's the right term. Her child was very aversive to eating you actually were the supervisor and maybe you can speak more to it if you'd like because you know more than I do. I know she got this diagnosis of RFID so maybe you could speak to what the diagnosis is and she felt that it was game changing for her. I'm not sure why getting the diagnosis would be game changing because you could probably do the same interventions with and without the diagnosis but very ignorant to the uh the eating scene so can you maybe speak to the diagnosis of RFID what it is and why it might be beneficial to people to receive it yeah yeah so there's two different feeding diagnoses so maybe I'll just like kind of go over both because please it's helpful.

SPEAKER_01 34:46

So before RFID like there is the pediatric feeding disorder diagnosis is a medical like an ICD diagnosis and that is looking at four domains. So like your skill your nutrition your medical and your psychosocial and that is more like I what I see more with PFD is kids who are born premature and have like a very clear medical reason for their feeding difficulties. RFID is a DSM diagnosis. It stands for avoidant restrictive food intake disorder and it's probably more of like the profile we see with autistic folks we work with. So it's maybe like limiting the variety it's feeling nervous about anything new or change like some of that I I'm using terms that are in the diagnostic criteria but I don't love the word like rigidity it's it's preferences but feeling very specific like I don't feel safe unless I have my food this way. And it's so like I said it's in the DSM but it's not a it's it's not like a body image eating disorder. It's but it does impact psychosocial functioning. And so you could have both PFD and RFID you could have PFD that leads to RFID so like imagining that like in kind of what I talked about earlier if we have like premature baby who never learns to like coordinate their breathing and their eating and feeding becomes really scary and then they become really avoidant and restrictive with their intake and have that psychosocial impact they could have both diagnoses. And honestly like there's still a lot of discussion in the feeding world about what's what and do we need to and some people don't believe we do. And so and so like there's there's still a lot of discussion. So all that to say is we don't fully know um I do know that folks are appreciative of the ARFA diagnosis because it makes it feel like it's not their fault. Right? Like this is real. This is in my body I'm not choosing this and I think it makes it easier for them to explain to others like I have this condition. Like this is this is something it's like you know being born with a some other sort of difference. I don't know I don't have a good example but it makes it easier to and and like it almost gives like an identity to it.

SPEAKER_02 37:15

So I think that's why we're seeing folks appreciate that I know this parent definitely did with you know with my ABA brain it kind of seemed like a circular diagnosis right so the child didn't want to eat so they got the diagnosis of RPID which says the child doesn't want to eat so it kind of became circular. I didn't know if there was anything like deeper than that of like maybe giving access to certain things or any further explanations that that diagnosis provided besides the fact of just like this child wants to avoid certain things. Like I was just trying I was trying to wrap my head around why this diagnosis was so beneficial to the family but maybe it's the last thing you said that it felt like it was no longer purely their fault and even if it is circular it gives them something to kind of attribute it to and maybe more motivation to seek a a therapy to reduce it.

SPEAKER_01 38:10

Yeah and there's RFID specific intervention out there now. People are talking about it more so personally I work with a lot of kids who don't have a formal RFID diagnosis and if they went to pursue one they'd probably get it and nothing changes about the way I work with kids it's still kind of the same same goals but I do like I just did a consult with a family a couple weeks ago and the RFID has become like a TikTok thing now. I don't know that's kind of yeah stuff like that I mean every yeah so like everybody has everything now they were they were feeling so frustrated with their 14 year old son and the mom found came across RFID on TikTok and started wondering like oh is this what it is and we we started talking about it and he wasn't really wanting to talk at this point he was on the meet on the call too and then he his dad kind of looked over and he's like oh he's looking up the RFID diagnosis and the kids kind of like brightened up like he's like oh this kind of sounds like me and and just really seemed to benefit from this idea like that again it's he didn't do this and and like he can say something to his family when they're feeling frustrated because they thought that they presented a food exactly how he wanted but they missed the mark in some way he can it kind of like helps explain it that like it's not I'm not trying to be difficult. I'm not just re being I'm not just doing refusal behaviors.

SPEAKER_02 39:42

That makes a lot of sense. Yeah this client that you worked with I think you ended up having a fair amount of success but I know this individual is very resistant. I don't know if you want to speak to because you did cooking and all sorts of stuff with this individual.

SPEAKER_03 39:54

So I stayed away wise and and wisely by the guidance of the parent initially there was a feeding specialist and the OT and there were a number of other very well qualified professionals working on the eating part. So I was like yeah the ABA service doesn't need to touch that you've got plenty of cooks in the kitchen pun intended but um but um oh should I do it there it is I had to do my little uh dumb test there. And I came across one of the sessions where I was talking to the parent and realized that she had abandoned the other services because they weren't seeing much success. So I was like oh so maybe we can give it a shot. And uh admittedly it was one of those moments where I was like look I'm I'm not qualified to this I'm gonna take a completely behavioral approach. But my developmental brain told me and along with the ABA part just kind of told me that there was too much pressure around the idea of putting something in his mouth for eating. So I decided that we were just going to take that pressure away. But I knew that the child liked certain foods like pizza. So I said okay we're gonna deconstruct the pizza so when he eats the pizza he eats it as all one thing and then I noticed that sometimes he'll pick the cheese and the pepperonis off so we're gonna make pizza and I told the family there's no press there's no bastardization of pre-mac principle here. There's no pressure at all to eat it. We might model it as we cook and put things in our mouth and we did that for several sessions. We called it food science and we would talk about the states of matter and solids and melting and temperature and all that.

SPEAKER_02 41:31

He was a really smart kid.

SPEAKER_03 41:32

Yeah super smart super smart shout out to pop pop out there he he'll know they listen he'll know who I'm talking to and it was by happenstance and that was kind of my general aim again I was out of my league here but it was my kind of happenstance that by taking that pressure away he might find himself like the rest of us who are modeling it cooking and kind of popping things into his mouth and that's kind of in general what happened. I haven't checked in as of late I I think that there was some success and those things now led to like you know the child invited me over for a cheeseburger and and things that we never thought would happen. I don't know how that's maintained but that was my general notion was kind of going I bet there's a ton of pressure because I've done that in the past if you if you touch it to your tongue if you put it to your lips I'll I'll give you the we'll have the negative reinforcement you'll get to escape. So I knew you know that that was being done whether by somebody else or whatever I knew that that was part of it. And again it makes logical sense and then there's everything else that you're mentioning that my instinct told me that we we gotta remove that pressure.

SPEAKER_01 42:34

And it it worked again real real uh yeah shot in the dark there but well I know that I mean again intuitively it makes sense and it's still explainable by behavioral principles what happened right like and I I was just thinking like I when I say like I've read all the behavioral things and it wasn't working like I still believe in the science at play. I think it's just like a a different way to apply it.

SPEAKER_03 43:00

Yeah I I think we're missing the little bit of information on the function the the why are things why is there an avoidant or restrictive behavior why right I think that's at least for me when I hear you describe it is not understanding enough of the physiology behind that from a behavioral perspective because the rest of it is still you know even swallowing as a behavior chewing as a behavior I think at least I I I can admitly say wholeheartedly my understanding of those things is way limited. Yep I mean I know from a developmental perspective I know from a personal perspective but those specialists that you've had access to are I mean they know so much about the way your tongue works or the way your teeth you know combining with your tongue and speech language pathologist oh my goodness they know uh they have a wealth of knowledge that we just don't have as as BCBAs.

SPEAKER_02 43:49

Yeah yeah thank you for uh clarifying the R fit I think that really helps. The last thing I'll do and then I'll pass it to you Mike is circle back. So you all were talking about the pediatrics piece and how the delay in service provision and maybe the fact that a lot of the pediatricians might not even know how to respond to eating abnormalities might lead to some difficulties and maybe resulting in lucky charms eating for four plus years. That kind of opens up the door to your behavioral pediatrics piece. Uh not mine. Not yours. But you're just interested in it. Your your venture of what you want to do.

SPEAKER_03 44:22

So I don't know if you want to I was alluding to that earlier in that question about you know how how common are these troubles and then you you sort of alluded to that. So where where would you see an and Patrick Freyman has talked about this pretty extensively but the idea that a pediatrician could be in consultation with a parent and child learn about these challenges that might be more common than the rest of us you know care to to consider. Excuse me. And then instead of waiting for the problem to get bigger before then referring to the specialty they were to then have the on the way out hit up the behavior analyst office you know on the way out. Again we're lacking a whole ton of information still we'd have to get better we'd have to go back and uh do some of the work you've done to really understand not just about eating or feeding but now things like aneuresis and encaprices and you know wetting your pants during the day that's more common than people think if you look at the research and the idea that a kid is you know wetting their pants at school till they're age 12 because our medical system doesn't necessarily have the setup to address it earlier. I mean I don't know I don't know what what do you think of the general notion of that or where could we fit in on the way out of the pediatrician's office to do a quick consult.

SPEAKER_01 45:39

Yeah I love that idea and I've always had that dream too like I wish I could just like have a day a week at a pediatrician I'm trying I'm trying so hard. Are you yeah so there's an initiative with Feeding Matters right now too about primary care provider education. And there's they there was just a call for a research study where there's this kind of like the this doesn't answer the question of like where where does the BCBA fit in but or like somebody else fit in but it's like before that that prevention piece of what do they need to know to then be able to give the right kind of information. And so there's some modules that have been developed and they're doing I don't remember actually who maybe children's hospital of Atlanta doing modules to or doing some pre and post work to kind of see what does this do for primary care providers. So it's just like building knowledge everywhere. But then also like I think that they don't know what we can do as far as feeding support. And so I've been trying to connect with pediatricians and say you know like here we can do just like the short term consult just to get them get fam mostly working with parents but like helping them understand how to respond to their children how to set up a meal time and that's something I think all behavior analysts are capable of doing we know about environmental arrangement we know about you know like setting up for success how to give instructions how to lower demands. We don't have to jump to that like escape extinction but we can all be a source of knowledge if we're already working with kids especially of setting up a mealtime routine that fits the context of the family without going into that like how do I chew how do I swallow we don't have we don't have to all know all the things we can just like take our behavioral science and apply it to this and not just say like oh this is out of my scope I'm moving on. I don't think I answered your question.

SPEAKER_03 47:37

There's so many it does it well and I mean it was a again I've been asking you these huge questions.

SPEAKER_02 47:42

I have a lot of respect for your work so I I I I trust that you're gonna add some you're gonna uh enlighten us I was just gonna say you keep using the term meal routine which is something I think is important for people to hear and I know you've been a big um proponent of that and talking about even if you're talking about like gluten-free diets or whatever just the fact that parents are aware of the child's diet and now the meal becomes more of a routine regardless of whether it's the gluten or not that they're consuming, the fact that it becomes more of a routine I think you've been a big proponent of trying to make that more of a consistent routine right?

SPEAKER_03 48:16

Yeah and I mean we're again we're asking huge questions. Let me piggyback on that what in terms of routine so I think what Dan's alluding to is in the past you know I can think back now 20 years and the advent of say uh GFCF diets and me as a young professional kind of trying to understand all these things and knowing that you know there was the quick judgment of the but those aren't empirically validated. It's like well wait a minute somebody's got an anecdote about it. It might have worked for them let's see what that means. And I at that point in time I you know I came to the conclusion that whether it was the gluten free or not I would see families dive in head first with the parents and the rest of the family taking the lead and then all of a sudden they were sitting at the table and they were consuming foods in comma and it was like okay was this the gluten free foods or the fact that we've created such a routine around or both which is wonderful right so I think maybe you you know kind of speak to that as a general premise and then I would be interested in knowing you know sort of the progression of those more specialized diets where that gluten sensitivity maybe is a thing where it isn't what's your general feel on that you know I've been very removed from conversations about those like specialized diets even in this work.

SPEAKER_01 49:31

So that's interesting that's a good thing. Yeah I think that like I've really been stressing individualization and the importance of building routines that fit the family's context. And so if that's part of that then fine that we can we can work with that but or any specialized diet but when I talk about mealtime routines I'm more thinking about like before we're working on chewing and swallowing a new food are we even like enjoying coming to mealtime together do we want to be there together or is this just like such a source of stress and pressure and something I think that I think that's a question that all BCBAs should ask of like if feeding is an issue like well tell me about your mealtime routine just like if sleep is an issue we say tell me about your bedtime routine like let's go through it and find those pain points and a lot of times I'll find things like I know I'm straying from your question but like this is this is where I'm at go right ahead please a lot of times I'll find things like it's chaos at dinner time and nobody knows what like who's doing what and I mean this is in my house too sometimes and kiddo is like on their fate playing with their favorite Legos or on there watching their favorite show and all of a sudden it's like okay dinner time and we have to end this favorite routine and we have to come over all behavior analysts know what that is right like we know how to break it down we know how to put in like a more preferred item we know how to make the table or wherever we're eating fun and we know how to use pairing. Like that's what I mean when I'm talking about routines is like just how can we build something where people can learn first. And so yeah with the with the specialized diets or anything like that like that that's a such a small like though it's funny because like what we're eating is such a small part of the routine for me.

SPEAKER_03 51:33

And then I build that in okay and I've got to stop Dr. Yeah there as this concludes the first part of our interview please do ensure you return for part two of our interview with Dr. Yeah Viverka and always analyze responsibly ABA on tab is recorded live and unfiltered and we're done for today you don't have to go home but you can't stay here see you next time