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

ABA on Tap is proud to present Dr. Yev Veverka (Part 2 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_04 0:01

Welcome to ABA on tech. I'm Mike Rebeau with Dan Lowry. So without further ado, sit back, relax, and always analyze responsibly. Welcome back to ABA on tap. I am your ever-grateful co-host, Mike Rubio, and I'm so glad you've returned for part two of our interview with Dr. Yev Viverka. Enjoy.

SPEAKER_05 0:46

Well, and historically it just speaks to again that that pressure that parents face to figure something out. You know what I'm saying? Like that. So I I it's it's I think it's a good thing that you haven't been part of those conversations. I think, you know, given, you know, say my work in home, there was a time, especially when that Jenny McCarthy book was out uh where I couldn't go into a home without some mention of a GFCF diet. And my concern to just like you said, Doctor, you have it, wasn't necessarily, well, you know, these uh back then those foods were kind of weird too. I don't think that the industry had caught up, so there was really, really flat, you know, cardboard y cookies and things that just didn't taste very good, but now they do. So for me it was more of like, oh, these parents are just kind of barking up any tree because they're looking for help somewhere. But then yeah, I I saw success stories, especially in those situations where it was embraced as part of a full family routine, and they were all now trying something new, and you know, there was more observ uh opportunities for observational learning, and uh maybe there was more fruit food prep happening around the child. All those things that I think you're alluding to as well as part of this general routine that happens. You hear things being chopped, you might be smelling certain things, you see and feel the heat of the kitchen, or you see the steam off the pot. These are uh might be all cues that we we don't consider enough.

SPEAKER_01 2:01

No, that's a great point. So it's like an unintended consequence, like positive consequence.

SPEAKER_05 2:06

Yeah. And we would probably overly task analyze those cues anyway, as behavior analysts, and uh, you know, I don't know, do something strange with them. But yeah, I think to your point that that idea of a routine is super important in terms of predictability, in terms of familiarity, all those things that might put our our guard down a little bit when, you know, if we're an individual who's having struggles with that.

SPEAKER_01 2:28

And avoiding that like idea of you have to do the right thing. There's not a right thing. So I remember going to an appointment with a family I was working with, and it was in a feeding program. And I worked with them at home, but then they went into this feeding program. And at home, like their dining room table was kind of like the drop spot for their things. They didn't use it for eating, they ate on the couch with like trays, and they get in there to like plan an intervention, and the practitioner starts by thinking about the routine, but she said, Okay, so like help me pick, imagine your meal time. So, like you sit down at the dining room table, and then like who's there and what's on the table? And this mom just flat out lied. Like, and I watched her do that. She's like, just like made something up because at this point, like she couldn't tell this expert who's saying, like, essentially, like to her, this is the right way to do it. She couldn't say, Oh, we eat on the couch with a show we all like. She's twin, twins with autism, like lots going on, and that was their regulating thing that worked. And so instantly she's like, I'm not doing it right, I'm messing up, I need to like rethink everything, and maybe that's a good long-term goal if she wants to, but like in that moment, she needed a routine that fit her context and that worked in a different way, and so yeah, also like really individualizing it in that way. I think it's so important.

SPEAKER_05 3:56

I I I love that in terms of us considering the the the Norman Rockwell painting and this perfect idealized dinner time, and then knowing that getting there for this family is going to involve so much more work that detracts from our actual goal in terms of now feeding and eating. I think I think we we we run that risk a lot as being realists, especially when we start looking at our assessments and we look at milestones, and this is the way it's supposed to look. And then suddenly we find ourselves trying to replicate that vision and maybe missing a lot of the individualization. I let me let me kind of segue that or use that to segue into the idea of early intervention and inclusion in general, which I know is also something that is near and dear to your work. We talked about eating and feeding. Where else do we maybe over task analyze? Where are we too good at the details as behavior analysts as it pertains to early childhood development and intervention? Again, big question. Do with it what you will.

SPEAKER_01 4:56

I mean, it's uh too much to say everywhere. I think we like I said earlier, I've learned I've learned so much from from working on mealtimes and feeding. But I think that this idea of like asking more why and and like not not taking something down to that like function and then like just working with that, but ask I think we just are like you said, overtask analyze. We get to this thing and it's like this is the right thing, and we try to ignore all the noise on the outside, but we're we're missing then is like all the like family specific things, the culture, the skills of the parents, the capacity of them, who the teachers are. Are they in like this, are they in a early childhood center that's based on like a specific culture? Is it like a religious one? Is it and so I think we're we miss so much when we don't think of it holistically? And I don't know, I'm curious what you all think.

SPEAKER_02 6:00

That makes a lot of sense. It seems like a like a rudimentary like use of the matching law. Well, why? Because it's more reinforcing them to not do it. But why is it more reinforcing for them to not do it, right? We just don't really get to that next level. And it's just like, well, just give them more reinforcers. And it's like, well, let's figure out can we look at the value of whatever the reinforcers are in their life before we're just like, well, give them more of if they like iPad, just give them iPad for everything. Because then increase the iPad, right? So I think what you're saying is so so valuable, and maybe that's maybe that's where in our field we can kind of lend out other people's expertise. We can figure out what's going on, but the why piece and and the like how to whether it's eating or talking or things like that, those pieces maybe we can work more collaboratively with other professionals after we figure out okay, this is what's going on. Now let's figure out why, and that's more of the family, and figure out how that's more of whatever other expertise is down in the nitty-gritty of whatever those streets are.

SPEAKER_01 7:01

And we think we're asking why. We say we're right, like our why goes to function. Yeah. But then, like, if I'm like, okay, this is an attention-seeking function, well, like why?

SPEAKER_00 7:13

Exactly.

SPEAKER_01 7:13

What else? What else do we need to know about that and how this family functions? And maybe there's like a cultural explanation for why they're not getting that attention, and we don't, we we need to work within that those confines and not just provide, you know, like there's so many, there's so many questions we could ask. So I've never thought of it this way of like meal, like I think asking, I've been so focused on feeding recently, but like asking it with the feeding and the mealtime aspect is an it's an interesting to think about like translating that elsewhere.

SPEAKER_02 7:46

I think the if we just state the function level too, that actually can lead to some ethical issues that we've run into as a field, right? Why? Because they're doing it for escape. Well, what's that mean? We got to not let them escape. Then you run into the escape extinction, or why because they're doing it for attention. And I'll see even people not in the field, but that have like a little bit of knowledge about it, they'll just say, Oh, they're doing it for attention. So, what does that mean? They ignore them, and now we have this where we're not really ethically interacting with somebody. And think about how dismissive it is to say, oh, they're just doing it for attention, right? Why is Mike doing he's just doing it for attention? Like that just means I can ignore everything you're doing, because yeah, we do a whole lot of stuff for attention. Why do they want the attention? Right. Why do they want the attention?

SPEAKER_05 8:26

And and and how do we give it to them, right? So just ignoring takes apart the whole takes away the whole idea, wait, they were looking for attention, and now we're not going to give it to them, so when do they get it, right? Yep. It it you know again. I I think we've got I I agree with you, Dr. Yeah, we've got the right stuff. In fact, I know that my ABA makes my knowledge of developmental theory that much better, but I would hate to think of myself with no developmental theory and just ABA as a professional because I'd be running much more into those things. One thing that I think of is play. Play behaviorally. I don't know that that we've got a good developmental grip on that, and I can't say I've got any good answers that I can relay. What about sensory play, Mike? Well, that I mean again, that's an there's different types of play, and then yeah, that's a really we've all we've boiled it down a lot of times in terms of stereotypy to the sensory need, and then there's a lot of discussion whether we allow it, don't allow it, how does that progress into something else? Um, I'm dealing with for whatever reason, it might be a trend on TikTok these days, but a lot of little guys with a lot of mouthing and and mouthing behavior, right? You know, you can look at that and it's like, okay, his mom's still breastfeeding. The answer seems to be yes, pretty frequently with that. You know, and then you think of that as from a developmental perspective, it's pretty important in terms of determining different textures, different things. Now, socially, people telling you not to do that, and then now you're a four-year-old who's putting a lot of things in your mouth, and that has a whole different level of significance in terms of how your parents feel about it, you know, how sick you're getting, you're frequently getting colds. Well, yeah, you're putting everything in your mouth. You know, again, it's just so many layers that a simple task analysis wouldn't be but a cut through. I'll think of things like you know, a tripod grip for writing. Well, uh kids hold writing implements so many different ways. How many years did I spend professionally trying to prompt physically this perfect tripod grip instead of just putting the paper and crayons out and letting them go at it? And guess what happens over time? They do the pronated, they do this, and then before you know it, they're watching you and then they're imitating. And we would have never thought of that as a non-verbal imitation, traditional do this SD, right? We would have never done that, but you know, it it we need to let that happen to allow for that developmental progression, and it's not pretty, sometimes it's messy, and with food, especially, you're getting things thrown off the high chair, and it's very frustrating. But there's a normal progression to development which behaviorally can present itself. The optics are like misbehavior, and there's an interesting gray area there. I said a lot, sorry.

SPEAKER_01 11:09

I love that. And I like while as you're saying that, I'm thinking like one thing that we're talking more about in the field is kind of those longer-term outcomes. Like, what are why are we doing this? Why are we adding one food at a time? Why are we changing the grip? And if we really think about like, okay, I can tell you why I'm doing it in this moment today, but like, can I tell you why I'm doing it for this kid 10 years from now? Adding one food at a time and doing escape extinction? No, I can't. But I could explain to you like why some of the method, like I I always tell my parents, I'm looking, I'm thinking about your kid as a 30-year-old, and I want them to be somebody that can choose how they want to eat, choose what they want to eat, make choices that are the right choices for their body. And that is very like that's gonna lead to a very different intervention choice than I need them to eat 10 new foods in six months or something like that. And I think the same thing goes with play, with the way they're holding utensils. Like, what's the end goal? Is it how is it going to promote like connection, inclusion, autonomy, right? Like all of those, those rights of people in the end. And I think that asking that question and feeding has helped me, and I think that could kind of like help with that what you were just saying about holding the the utensil or the drawing utensil.

SPEAKER_05 12:35

It's like we we're really good at at the target at the the targeted goal, right? And what we're trying to change, and and maybe that's our downfall is we're so good at the task analysis that when it doesn't go in that chain of behavior, maybe we're not sure what to do next. And especially not our younger professionals who are deploying these things a lot of the time, like our RBTs, all due respect, they they do so much work, you know. We we love our staff. But you know, without that preparation, they they may not know or have the experience as a parent or a professional or academically how to pivot. You know, we set up these beautiful programs, and then it doesn't go that way. Okay, what next? You know, what are you gonna do? You didn't get to deliver your reinforcement. How are we gonna prompt chewing, for example? Well, you're not, and I'm sure somebody tried in the past and it probably didn't look very good. Yeah, and it probably didn't look very good, and it wasn't very good, and the child was crying, but it was for their own good, and it was because they needed to eat, and maybe they were on the brink of getting a G tube, so it all makes sense. Oh, yeah, we should be doing this, and then when we step back and get to consider it later, it's like, ooh, we probably made some mistakes there. This didn't look good, it didn't do well. We've got neurodivergent community folks coming out and saying, Yeah, that was a horrible experience for me, and it makes us feel bad, and then we can either deny it or say, Hey, we're listening. How are we gonna change what we're doing? And that's that's what I think you're doing, Dr. Yeah. We appreciate that.

SPEAKER_01 14:03

And the GTube, I think that it's a good example of it because they'll tell us, like, I wish you had just given me the G tube. Like, I and families are saying that too. And so, like, that's another pivot. Yeah, another pivot I've had is I used to say, like, I think I kind of convinced myself, like, I have to do this intensive thing because if I don't, the story is that they will continue to drop foods and they will be threatened with a G tube, and I don't want to be part of that. And now there's all this research coming out. There was just actually a few talks at Feeding Matters Conference talking about like the benefits of just choosing the G tube, because then you're not sitting there bite by bite. And I'm not saying it's for everyone, I think it's like an ethical decision-making process. But I think that like saying that extinct escape extinction and non-removal of the spoon is less intensive than a G tube is false. Like, I just don't believe that.

SPEAKER_05 15:00

That's not across the board, it's individualized to your point. That one individual could say, I'd rather do this. The other one could say, Nope, but you know, give me that tube. It's fine, that would have been easier, right? Well, and then now you might be dealing with an individual who may not be able to communicate that back to the parents. They have to make that decision. It makes me think of my my youngest was severely tongue-tied as at birth, and she almost had a heart-shaped tongue and she couldn't feed. And we had to make that decision of clipping it or not clipping it, knowing that either direction could lead to eating and communication difficulties in the future. So if you cut it, it could happen, it could go awry. If you don't cut it, she could be tongue-tied and have uh articulation issues. So that I mean, that's a tough decision.

SPEAKER_01 15:46

We it's tough, but you had the knowledge, you had all of it in front of you, right? Like where I've seen families be told, like, we're going to do this to keep you from this intensive medical procedure without understanding, like, these are the options. Like, I could do this intensive medical thing. And again, like I I think that some people don't have the capacity, the insurance, the financial, like they might choose still choose, like, no, I want to do this inpatient intensive program and then eat orally. But if we present, truly present, like, here are the here's the balance, like, here are the pros and cons. What do you want to talk about? Who do you want to talk to about it? If we truly present that, which I think is our ethical responsibility, then they can make an informed decision.

SPEAKER_05 16:35

Absolutely.

SPEAKER_02 16:36

So let's say you have a client that's just eating the the Lucky Charms marshmallows, or maybe more commonly just eating chicken nuggets from, I don't know, Carl Jr. or something like that. What are your your kind of basics? So, how would you maybe what questions would you ask the family or what treatment recommendations would you recommend them trying as we move away from pure escape extinction? Like what's kind of your playbook that you can share with people on the uh on the air?

SPEAKER_01 17:05

Okay, so when I first have a client come to me, I start by just kind of understanding like what their goals are for feeding support. And often it is, of course, the increasing variety.

SPEAKER_00 17:19

Yep.

SPEAKER_01 17:19

But I ask them this magic wand question. If I had a magic wand, what would your perfect meal time look like? And often it it hasn't, they're not saying I want them to take bites of these new things. They say we're all sitting together, something along these lines. Like it's different for every family. We're sitting together, I cook one meal and everybody eats it. We're not fighting, I don't feel stressed, right? And like each of those can be broken down into its own many, many steps for intervention. So, of course, like we're working on increasing variety, but we're also working on how the family is presenting things, how the caregiver is responding to the child. We're working on making the mealtime environment something that's fun. And so, and we'll prioritize that with the family. Like, what's the most important thing for you right now? And if they say, like, I really don't want to do the G2 route, like I really need them to eat first thing, then that's where we'll prioritize. I always work with a registered dietitian. If it if a child comes in, I've worked with a registered dietitian who's helped me and understand some screening questions to know kind of like, is this an immediate refer for a like a diet inventory and a discussion with them, or can we simultaneously can I start working and then refer them? But always, always work with a dietitian to make sure that they that any food we're working on introducing or changing is going to be helpful for them in from a nourishment perspective. But then, like, as far as I mean, I think some really simple things that all BCBAs can do as far as that, like again, I hate the word rigidity, but like the significant preferences, the Carl's Junior nuggets and only those, or like what that example you gave of the the pizza and like deconstructing it. So I want kids to first learn that nothing bad happens with change, right? So, like we're all we're often jumping in, and this was me too, to like my child doesn't eat fruits and vegetables, they only eat the chicken nuggets, the milk, the goldfish crackers, the riz crackers. And so let's present a banana. But like we can't even cut the chicken nugget into small pieces yet. And so there's a lot of pre-req work if we're gonna not go the escape extinction route to teach that like when we make changes to food, it's fun, nothing bad happens, we're not gonna pressure you. I might like first start with here's your, you know, Carl Jr.'s nuggets. I love that that's our example right now. Here's nuggets as you always have them, and here's the same nuggets, and I'm gonna cut them. I'm gonna use a cookie cutter and cut them into one of your favorite shapes. And like you mentioned before, like we're I'm not saying first this, then this. It's just like these are your nuggets, and maybe, maybe it's a little bit more fun to try the ones that are different. But again, like teaching that change is fun, flexibility is fun. Flexibility doesn't mean new food on a new spoon, and mom is saying, take a bite, or mom's saying, like, if you take a bite, you can have your favorite cookie, or mom's saying, if you don't take a bite, then we're not gonna be able to do your favorite TV show, right? Like, we're teaching, so a lot of this is on parents, like teaching, but we're teaching that this is all okay and it's fun, and that's when we have the luxury of like of time, um, too, of course. So we um I have gotten pushback, and I want to make it really clear that I'm not saying that we're gonna let this kid not eat and like not do well to work on that. Like, this is where my interdisciplinary colleagues come in to make those decisions about does this mean we do this while thinking about a G tube? Does it mean we do it while thinking about a multivitamin or some supplemental nutrition? And I always tell families like, whatever it is, it's not gonna be forever. It's to like, do we do we prioritize, you know, this the autonomy and the fun and like making making mealtime something that is going to be positive long term? Do we prioritize like this kid is not doing well physically and we have to nourish them? But it's a there's not a right answer, it's a balancing out.

SPEAKER_02 21:45

So you're saying you would excuse me, present other stimuli there, but not necessarily with the expectation of eating, just like present the banana maybe with a chicken nugget and no first then or anything like that, have them practice cutting. Them and things like that, or playing with both of them, but not necessarily have them with the expectation of eating. Am I understanding that correctly?

SPEAKER_01 22:08

So, so for like something like a banana, like something so different, yes. But like for okay, I'm trying to think like kiddo that I worked with who only ate Costco pizza, still doing the Costco pizza, but we're cutting it up, still there's still an expectation of eating. Like, yeah, you have your Costco pizza, we're still gonna eat it, we're gonna have fun. Maybe I get a second one. And so there's like a little bit like where if we're worried that they're just not gonna eat at all, um, and make slow, really, really slow small changes. At the same time, we could also be presenting completely new foods and make doing like the food science, food art with a banana. Again, like with other things in mind, like is food waste okay for this family? Is food security a challenge? Is you know, like there's so many questions. So I know.

SPEAKER_05 22:59

It's incredible.

SPEAKER_00 23:00

Yeah, thank you for bringing all that up.

SPEAKER_01 23:01

Yeah, push pull of all of it, but but at the universal level, we can make food positive, we can make mealtime positive. We all know how to do that.

unknown 23:15

Yeah.

SPEAKER_05 23:16

I like the way you describe that. It's it's a matter of uh can I have the extra piece of pizza to mess around with knowing that I may need to preserve a slice or this kid's not gonna eat, where it might be our linear thinking to say, no, we're gonna cut this slice up, and that's what they're gonna eat based on this contingency, because that moves our premise forward. You're saying, no, that's not necessarily what's gonna happen. It depends on the do they have an extra slice to give up, knowing that that might go to waste, or is the parent around to eat that? I mean, that that those are things that you know that's that's knowledge that you have based on your experience that becomes very hard to then disseminate in writing, or you know, these are all examples that are true to life. So thank you so much for for sharing all those. I do want to share that we did get Dan passed the Costco pizza. He's eating a hot dog now, nice, which is really cool. And then we're gonna add mustard. That's the next step.

SPEAKER_02 24:04

Costco.

SPEAKER_05 24:05

His girlfriend's really happy because it was just Costco pizza every day. Yep. Shout out to Costco.

SPEAKER_01 24:12

The grease on that is like all popping.

SPEAKER_05 24:17

Shall I?

SPEAKER_02 24:18

So how do you get though from from A to B? And I get you know, historically, a lot of times it would be the like what touch, kiss, bite, chew, swallow. Like that would be kind of like the five part, and that's I'm not saying that's current. That's you know, the last time I probably worked on a food tolerance program was a long time ago. But how do you get those? So maybe you experience, maybe you have the banana on the plate, but let's say they're pushing it away all the time, or you're trying the food science, and they're they're maybe they're touching it, but they're still only eating the Costco pizza or the chicken nuggets. How do you get them from point A to point B if you have to do that?

SPEAKER_05 24:53

Can I add something to that question? I think you're alluding to the same thing. You mentioned the banana just not being a good fit for the goldfish and the crackers. I I guess I think what Dan's asking is how do you go about choosing that next item? Yeah. Texture, color. I mean, I think all I'm sure the nutritionist has a lot to say about this. Yeah, talk to us a little bit about that.

SPEAKER_02 25:15

And getting them to try it, because a lot of times it's doesn't even matter what the next item is. It's if it's not this nugget, I'm pushing it away.

SPEAKER_01 25:22

Right. Yes. Okay, so and I'm trying to think of some specific examples, but I don't like if I'm introducing new foods, completely new foods that we're not even close to biting. It's it's just for like exposure. And again, teaching new is fine, new is fun, new isn't pressure. I'm not gonna force anything. What I try, what I work with first is like I'll have a family give me a list of like the always foods. These are for the we'll always eat. It's okay if they're a little crushed up, or like what are what are the rules around the foods? And I guess I get stuck on goldfish crackers because that's almost for everyone. So if uh an always food, if our always food list is a list of like beige crackers, it's Ritz crackers, it's cheeses, it's goldfish crackers, then I'm not gonna worry about the banana yet. Like can we can we mix those crackers in a bowl? And is that okay with the kid? And if not, like how the heck would we possibly introduce a banana? Like, um, but if if so, then we're building this like unpredictability, predictable unpredictability. Like, I'm gonna get things that I'm okay with, but like they might be in a different shape. Maybe they're cra like I've done so many, like just so many weird things, but like crushed up goldfish crackers with a spoon. Oh my gosh, so silly. We're gonna eat our goldfish crackers with a spoon, and maybe we make we like have some fun with like I'm gonna take a big dinosaur bite or a little mouse bite, and we make it so fun to present it in a new way. If kids are verbal and able, and or like if kids are at a level where they can help come up with ways to try new ways to try foods and including them in it, and this is where our reinforcement really can come in. Like, I'm not reinforcing taking a bite or eating a certain amount, but I'm re I will reinforce and like do a token economy or whatever, classic reinforcement systems, doing something new and being brave. And like then kids are learning all I have to do is mix up my favorite foods and I get a token, and that was kind of fun. And mom, like or whoever caregiver played with me and it was fun. What if I added another cracker to it? And it just not like a hundred percent of the time, it has just naturally progressed because it's it's fun and it's easy, and we're making such small steps. But then once I get to this point of like, okay, we're we've done all these things, we've been able to add, you know, like a different kind of gram cracker, we've been able to put peanut butter, like a favorite peanut butter on a new graham cracker. Then I might start thinking about the banana again. And I might think, like, okay, we like crunchy foods. What if we like crunch up the banana, a banana chip into our goldfish crackers and introduce it that way? Always with something there that's like you don't have to eat it this way, but here's an idea of something new, and just like slowly raise kind of what the the requirement is for that token chart or reinforcement. So we're still like, I think people think that like I just play with food all the time and like it's not systematic, and I just like hope that it will magically work, but it's so systematic, and we're teaching families to pick things that are new, or like I another example. I just was working with a family who they bring the same food for snack in the car when they pick their kid up from preschool. And then it's like, well, what if you bring like that the very favorite food for snack? Would she eat it? And it's like, oh, I never thought about it.

SPEAKER_05 29:02

So it's things like that, where it's like just mix like mix something else up, get out of your your your like we're always seeing changes adding something that's not part of the repertoire. You're saying we can rearrange existing parts of the repertoire, and that's I I love that. And I love I love hearing you describe it because I can completely relate. What would what would be your min and your max? And what I mean by that is I'm sure you've had situations where you come in and it's like bling, there it is. Now the child tries something new, and then you've had other situations where you've had to try and and and and work through it for months before something takes. And the reason I ask you that is because I think that we're always after that. Well, how do you do it? How do you get from point A to point B? And what you're saying is you keep trying, and then at some point it happens, and then you reinforce, you pounce on it. Is that I'm I'm not trying to overly boil it down, but I I think that's kind of what you're getting at.

SPEAKER_01 29:56

Yeah, you keep trying, but you are systematic about it, right? Like once once I've seen success mixing favorite foods, I might put in something that's like a little bit different, but still really similar. And so it's still, yeah, like we're still upping the the demand. I don't even want to call it a demand. We're like upping the requirement a little bit at a time, but it's still systematic, it's still shaping, it's still changing the reinforcement. And when it when I've kind of hit some of those dot ends, I really want to research this, but something I'm finding is that flexibility is challenging for a child in all other aspects. And so like I'm I'm thinking of a kid right now who was on a G tube and but would eat some like some random crackers and Skittles, but the Skittles had to be like the regular size, the specific color. And so yeah, we we started with like with working on the Skittles, like crushing them or having two like here's your favorite bowl of Skittles, and then like watching me take some of those and cut them up and they're available, like once these Skittles are out, there's Skittles here. And he started working on those, but that was so slow. And what I started to notice in talking to family too is that this challenge with flexibility was everywhere. It was like we have to walk into the house and put the shoes in this specific place. And if somebody moves it, I have to go back and fix it. And so we actually took a step back from the feeding part and just worked on like just little flexibility elsewhere because feeding is like the one, like that's the place we have control. I cannot force anyone to eat something to and swallow it. Um, and so kids are kids who need that like structure in a specific way everywhere. Feeding's probably the last place we want to work on it. So I've done this now with multiple families of like, we're not even ready for and for working on flexibility with food and changing food. Let's work on like where we're putting our backpack or you know, like pausing our show at a different point, or like adding another show to that, like rewind and rewatch the same 15 assignments, right? So, like you guys know what I'm talking about. Oh, yeah, 100%.

SPEAKER_02 32:20

Too familiar with all of it.

unknown 32:22

Yeah.

SPEAKER_02 32:23

That makes a lot of sense. I think too, with um, like with eating, and I know it's not an ABA term, but like I think the vibe is really important. What I mean by that is you were even alluding to it sometimes with with your daughter, you're gonna get stressed and she's gonna feed off of that. And now I'm sure with these families, like you said, there's hundreds of times a month that they broach this subject maybe three meals a day, 30, 30 days a month, and then on top of that, every time their parents probably having some level of stress of oh, here we go again. I'm gonna present this food, it's gonna be terrible. The child feeds off of that, in addition to their own stress of they're gonna ask me to try something that I don't want to do, and there's just this whole atmosphere of negativity around this the food. And it sounds like both of what you all are talking about, because I'm sure one way to not get somebody to try something new is have them be really stressed out.

SPEAKER_01 33:13

Yeah, well, and and then like you're as a caregiver also you're also having avoidant behaviors, right? So, like the going back to our lucky terms example, the reason it became that was because once the kid dropped the little like non-lucky charm, non-marshmallow parts of the cereal, and every time them the caregivers presented it, he had some challenging behaviors. They're gonna buy the bulk marshmallows and and uh prevent their own having to deal with it. So, like everybody's being negatively reinforced.

SPEAKER_02 33:49

Absolutely.

SPEAKER_01 33:50

But but if they had known, like, here's some different ways we can present it, don't give up. Like, let's keep presenting it, but present it in a way without pressure, let's present it in a different way, then they could have kept presenting it and added on, but instead they kept like dropping. And you're not gonna like you're if you know your kid's not gonna eat something, why would you cook it and try for repeated exposure?

SPEAKER_02 34:13

That yeah, no, that makes a lot of sense. Have I this wasn't the question I was gonna ask, but have you ever just had to tell a parent, hey, your cooking sucks. That's why your kid doesn't like it because you talked about parents. Maybe it's your cooking. Have you ever had that discussion?

SPEAKER_01 34:28

I have not had that discussion. We've had discussions of preferences and um, but not quite.

SPEAKER_05 34:36

That's not to say you've that's not to say you haven't come across bad cooks, but you're not gonna go there, I think.

SPEAKER_01 34:41

Yeah, I mean I've I can't say I've sampled a little the food, but um we'll let you off the hook, Doctor.

SPEAKER_05 34:50

Yeah, but it's okay.

SPEAKER_02 34:51

So I have one one last question on that, and then I'll pass it back to you, Mike. Grazing versus sitting down. So sometimes, you know, the families we work with, the kid just comes and grabs and then goes back and plays and comes and grabs more. Kind of, do you have any general thoughts? My guess is it's probably situation specific, but general thoughts on what you would advise parents. Do you advise them to try to have no when we eat, we either sit down or sit down with the family and we eat versus when we eat, you come and grab a little bit back and forth and back and forth and back and forth. What are your thoughts there?

SPEAKER_01 35:21

I mean, this isn't another it's a good question because it's it's changing. It's another one where I think about like, okay, this kid at 30 years old, I don't know why 30, but like that's in some cases that's not gonna work, right? Like you can't go out to a restaurant or you're wherever, like you can't go to a wedding or something and and do that. And so thinking about like I'd have the conversation with the family, like what are our long-term goals? Like right now, they're getting nourished. Is that our first priority? And do we want to work towards it? So it's a it's a conversation with the family. Typically, people want to work towards sitting down, but again, that becomes like a really big demand. And so a lot of times I'll work with families on without food, what can we do to make that mealtime environment positive? And so maybe instead of building Legos in the living room, we bring them like everybody else is either eating or or maybe if we're not ready for that, we all just sit down and build Legos together at the table because maybe that's where we eat and we do favorite activities at the table and then go to grazing and then slowly shift it, right? Like we've got our Legos and we've got your favorite snack. So like we can we can eat while you while we all build Legos, or we've got Legos and we're all eating. So you're getting used to like the smells and the sights, but we're still doing our favorite activity. But again, super systematic. And we're not just saying, like, oh, that's just again, I think this is a misconception about my work, but like I'm not just saying that's just how they eat. Let's be neurodiversity affirming and let them do it. I don't think that's neurodiversity affirming to just like let things be without teaching other ways. But we are saying like we can do it in a way that doesn't cause tears and stress for anyone.

SPEAKER_05 37:08

Cool, thank you. That goes off our very linear path, and I'm gonna set us on our home stretch here because believe it or not, we're we're at an hour and a half. We've been talking so long, and it's great, and we could probably talk to you for another hour and a half. We won't do that to you. It's a beautiful day in Seattle. We're gonna let you go. But this you I think this uh I could not have scripted this better. You describe going back to the idea of a G tube. It makes a lot of sense if a child is to the point where they're about to get a G tube that we might use some very restrictive form of escape extinction to avoid that. We could look at that and say, that's really compassionate care. And then you said actually, we can't necessarily say that across the board. Let's talk about that. Talk about you you recently were part of a very important publication, in my opinion, and talking about compassion as the eighth dimension. I'll pass it over to you, talk to us about that. I think we've alluded to it a lot during this conversation with a very important set of behaviors where it's easy for us to say, Dan's got a famous strawberry story that maybe we'll have him tell later.

SPEAKER_02 38:10

But this idea that she's gonna take my BCI card if she hears this strawberry story.

SPEAKER_05 38:14

I'm gonna withhold this from you because right now it's in your best interest to eat this food. That sounds very logical, sounds like a very typical parenting situation. Maybe maybe you can describe it as compassionate, and then there's a lot more for us to consider. Talk to us about that.

SPEAKER_01 38:30

Well, first of all, shout out to that whole author team. Thank you.

SPEAKER_05 38:34

Yes, didn't mean to exclude them. Sorry about that. Yeah, yeah. Thank you so much.

SPEAKER_01 38:38

I want to make sure it's clear that like. I think our work was intended to kind of present some questions to guide folks to making those decisions without saying like this is ethical and this isn't, because there are so many different contextual variables. I'm trying to like, can you ask? Can you go back to your the original question?

SPEAKER_05 39:50

I was just kind of having it was it was a general premise and in talking about compassion. Maybe another way to consider this, I'll ask a question now, is maybe the more poignant examples for us to consider is where have we clearly missed the mark on compassion despite thinking we were doing so. The G tube might be a good example. What other examples might you share with that given your role as part of this publication, which I think is, I mean, in my opinion, kind of one probably one of the more important papers that's come out in the last several years.

SPEAKER_02 40:19

And I would agree that it's so important. ABA has a marketing problem right now with compassion. A lot of times it seems really lab-based and really, you know, refrigerator parented of you do something and you get something very transactional. And I think things like compassion and and bringing that up and thank you could be one of the saviors or could really help our marketing problem because we definitely are struggling with that.

SPEAKER_05 40:41

And and just to add to that, I I don't think we realize when we're not being compassionate, especially when we're trying to write some wrong. Something's off track. We're the ones that are gonna fix it go.

SPEAKER_01 40:55

Yeah, so I think that the reason we we really wanted to write this was because we didn't want to label something as compassionate or not. And I think we miss compassion. Are we good? Is it okay? I think we miss compassion when we when we try to make it like really binary or black and white. And so I think this goes back to kind of this like the example we were talking about earlier of like why are we teaching play? Why are we teaching the grip on a on a pen or pencil? And like we can say it's socially, we can check off these boxes of the other, the seven dimensions, like it's it's effective, it works. Escape extinction works for feeding, it increases our we now have 10 more foods and we avoided the G tube, but we miss compassion when we don't ask, but like, what are the long-term impacts? What happened to this this child's like motivation to come to the table? Does the family feel good about it? I think we miss it even in like reinforcing, like when you know, our ethics code says we should prioritize reinforcement. And that's not enough when we're talking about feeding, and I'm just gonna stick to feeding examples. But if I like I gave that example earlier, if I'm reinforcing someone for eating something that they don't want to eat and they're accessing reinforcement, is that really compassionate? Is that really leading to that? Like, is that are we really doing no harm? Are we really leading to this person being autonomous and being able to make their choices? And I would argue no. Like if if I'm saying you get this five dollars for taking a bite of something that disgusts you, yeah, it might work and we're prioritizing reinforcement and it's not punishing and it's not escape extinction. But I don't, I think that we still have to ask some questions like, are we truly doing no harm? And I could come up with, I mean, so many different feeding examples. If we don't break it down, if we expect eating something when somebody's not ready to to do that, if we're, you know, like reinforcing consumption over all else, we're missing compassion. So I think yeah, that it fits really nicely those questions with the feeding work.

SPEAKER_02 43:18

And how do you so if it's the eighth dimension, how do you actually define compassion? Um how would you define compassion?

SPEAKER_01 43:26

Yeah, it's tricky. We this was this was one of the biggest challenges, challenges is like it takes so many questions to define it. So we broke it down into these guiding principles, which I won't try to try to name them because I'm sure I'll forget something at this point, but making sure that we are using those guiding principles to ask questions and like find that balance and that nuance of like, you know, are we do who's choosing? Like, do we have everyone's best interests in mind? What is Best interests mean? We've dug into the bioethics literature and like the medical field that has some really great examples of that. Like who gets to decide? Are we thinking about the long-term outcomes? So there it takes a series of questions to label something as compassion. And I think that we really get into trouble. Same with like neurodiversity affirming or whatever it is, we really get in trouble if we try to like say blanketly teaching eye contact is not neurodiversity affirming without asking questions about like, well, if we if we teach eye contact for this specific individual, what's it going to do for them in the long term? Maybe it is neurodiversity affirming, maybe it is compassionate. Like I think about I have an autistic daughter and I've had to hold her down for vaccines or for some um dental things to like go under anesthesia. And I think somebody could look at that choice and see that as physical prompting and the and not compassionate without understanding the whole thought process that goes into a decision like that. And so I think defining it is is tricky, but I think it requires asking these questions that we haven't been asking as a field before.

SPEAKER_05 45:23

I like the way you describe that in your own personal experience because it's not to just blanketly say that holding a child down to receive a vaccine lacks compassion. You have to consider the entire circumstance around that particular vaccine. So that procedure may be an example of compassionate care in one circumstance, and then if it's applied generally across the board all the time to receive some medical procedure, now we're missing the mark.

SPEAKER_01 45:52

Right. Now we're building a traumatic experience. And like the decision that we made in this particular example, I know it's a lot for our daughter was we knowing her knew that like once that building up to it made it worse for her. If the you know, we could have done this thing where we like practice and come home and go to the doctor every time. And there was there was no way that was going to be the best, the best thing for her. And so for her, we held her down, got the necessary vaccines, and she relaxed and she said, Okay, I'm done. I'm done for a year now, and was ready to go home and we didn't have to think about it again. And so, like, for another kid, maybe we have more time, maybe they're not as anxious or don't have that coexisting condition, and we can work on it and we and it's not as urgent, like it's not gonna. We were at this point where there were we got a letter from the school that's like, okay, you're up. You're it's time. So you shouldn't keep going to school. And so there wasn't really much of a choice. But again, like I can see from what the what communities are saying out there when when things are made really black and white, I could see people looking at that and be like, How dare you make that decision? And I think that's where it's it gets dangerous. Same with like goes going back to the GTU versus escape.

SPEAKER_02 47:13

It goes back to, I mean, you use the term best interest, right? And I think that's kind of what it comes down to is that phrase best interest, which is tricky, right? Because a a five-year-old that eats Lucky Charms marshmallows is gonna say it's in their best interest to eat Lucky Charms marshmallows, right? Because their prefrontal cortex isn't fully formed and they don't understand the long-term consequences of doing that. And a parent might say it's in their best interest to eat a well-balanced diet or to sit down and do homework all day so they can get a a good education, and then we come in as therapists and we're kind of like in between, and sometimes we can start forcing what we think best interests are on people as well, which then creates the whole uncompassionate or maybe uncompassionate might not be the best word, where we're now overriding, we're considering ourselves more important in that equation. But I guess the the bet back to the best interest piece. Any thoughts on especially some of the people we work with are not verbal or not vocal, excuse me. Like balancing that best best interest is so tricky, right? I'm sure you even as a parent you can take out a take off your work hat. Like it's hard to balance like best interest, right?

SPEAKER_01 48:25

Yeah, for sure.

SPEAKER_02 48:26

Between you and your child?

SPEAKER_01 48:27

Yeah, who wins in our work, like my amazing interdisciplinary team, not the compassion article team now, but the team that I worked with at our practitioner book for feeding for meal time in early learning settings. We tried to, we talked about this a lot of like how do we recommend something? How do we how do we present things where it's like there's all these choices and we want people to be able to take all of it and make the right the best choice at that time? And so what we did, I just had to pull this up to remember kind of how we conceptualize this, but we put like chat the individual's safety, well-being, and progress in the middle. Like that's our outcome. And then there's this push-pull of all of these other things, including like the autonomy, the nutritional needs that are sometimes in direct tension with each other. So like set early learning setting rules about food, motivation, interests, feelings of safety, inclusion, connection, all of these things. And if you sometimes if you like choose one, you have to let go of another. And so if we say we're going to prioritize autonomy at all costs, then exactly like we're we're saying this child is choosing to eat lucky charms, therefore, and we're prioritizing autonomy, we're completely ignoring the nutritional needs. If we only prioritize nutritional needs, then we're probably doing escape extinction and we're we're taking complete control over what a child's eating and completely avoiding autonomy. And so we have to find this balance constantly, and there's no formula for it. It's really hard to teach like a newer behavior analyst, as you all alluded to earlier. But it all of that is necessary and we have to ask the questions for every single individual case, which is tricky.

SPEAKER_02 50:23

Of course, it's hard to teach a new behavior analyst. Nobody knows more than a new behavior analyst. So that's that's tricky. But what you're saying, like I think a framework, like you're saying, is so useful for compassion. If there's some sort of framework that we could like provide parents as we look to make sure that we're honoring compassion in all circumstances, that I think that'd be really useful.

SPEAKER_00 50:44

And yeah, lots of work to do.

SPEAKER_05 50:47

You put it another way too, which I think I I just want to emphasize in saying, so in in your situation, we could say it was neurodiversity affirming or compassionate to just let your daughter not get the vaccine, and that's not the case either. And I think that's really important. We talk about client or child directed approaches. People will sometimes tell me, Oh, so you just let them do whatever they want. No, not at all what we're saying. It's really circumstance to circumstance, and that is, it's tricky because we spend so much time creating these very linear plans, these very singular contingencies that don't necessarily consider the what-ifs. And I think you very beautifully navigate the what-ifs in everything you do, uh, despite coming in with a plan, you're ready for that pivot, you're ready for something to go off the plan. And that that can be difficult for us as experienced clinicians. I can only imagine how much more difficult it is when we put a younger professional in that situation to figure that out. And uh, you know, you've got the the the historical perspective on having to figure a lot of these things out on your own, and then now we're asking the important question how do we keep those younger professionals from having to do that, knowing that they're gonna we're gonna preserve their individual experience, and then how do we how do we relay all this stuff we've been talking about? It's hard. Hopefully the the podcast helps. Yeah. Dr. Yeah, but Dan, anything else? We're we're at a good stopping point here. You I told you this would fly by. We want to get you back out of that Seattle sun. Anything that you want to promote or that do you just kind of want to put at the end here so that our listeners know where to find you if you want to be found or point them to any sort of article that you think is important for uh our audience to to to you know find and read?

SPEAKER_01 52:25

Oh, thank you for that question. I love that. First of all, I'm always happy to be found. I'm always happy to talk to anyone about mealtime and some of these questions and learn so much from any conversation. So please reach out.

SPEAKER_02 52:37

Careful, we might have to refer some parents to reach out to you then.

SPEAKER_01 52:41

No, please do. I'm actually going to be doing some private practice doing like telehealth family support. So that's great. Families should definitely reach out to you.

SPEAKER_05 52:49

Glad to hear that.

SPEAKER_01 52:51

And feeding matters, I talked to them about them earlier, but just like a great place to find resources from those different disciplines. We are very underrepresented as ABA providers there. So I would love to bring more BCBAs into the that world. Um, and and then I just like it's hard because everybody asks, where do I find CEs on this? And there are CEs in in the ABA field on this, but that keeps us siloed. And so I just want to encourage folks to like, yes, you're not gonna get the the CE for your recertification, but please learn from other disciplines and like go learn about basics of nutrition, go learn about like what do I need to know about oral motor, learn about just like the basics or make some interdisciplinary friends that you can ask. So I will always say I I'm not gonna recommend like a ABA-based CE. I'd rather folks learn from the other disciplines. And thank you guys so much for this conversation.

SPEAKER_05 53:56

Thank you. Thank you, Dr. Yeah, you're a rock star. We are so appreciative of your time. This has been very enjoyable conversation.

SPEAKER_02 54:03

Hope to have you on again in the future in a future season.

SPEAKER_05 54:06

I'm I've I already had an idea. I would love to, you know, whether online or offline, talk about your experience. I'm guessing your child received ABA services at some point.

SPEAKER_01 54:16

Oh, yes.

SPEAKER_05 54:17

And then okay. I I I would love to.

SPEAKER_01 54:19

Well with pride. I've written about it. So have you? Okay. Yes, there's a article through it used to be Spectrum. It's something, it's just like a pop, it's it's an article that got me lots of interesting reactions when I talked about how ABA didn't work for us in the way that it is.

SPEAKER_05 54:40

I I would love to learn more about that because I bet there's a lot of knowledge to be relayed there to the whole lot of us. Uh I'd like to to close with a few points based on what I've learned so far. I've got be mindful of your feeding routine. Think of your child's eating when they're 30. Consider compassion beyond just what works, and always analyze responsibly. Cheers, Dr. Yeah. Thank you so much for your time.

SPEAKER_00 55:05

Thank you. Always analyze responsibly.

SPEAKER_03 55:09

ABA on FAF 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.