ABA Clichés

After entertaining Chloe's criticisms and doing so seriously, Dan and Mike take a chance to explore ABA clichés--all those little overused misconceptions and stereotypes we hear out in our daily work about why ABA doesn't work. All the while, ABA touts empirical validation. How do we reconcile  between what is proven and the possibility of user-error--how does ABA work for many and yet have such a vocal opposition? What are the grievances and which are legitimate? Which grievances are more based on misunderstanding and user-error? Sit back, relax and sip on something good as you imbibe this episode. 

Transcript

SPEAKER_00: 0:00

Welcome to ABA on Tap, where our goal is to find the best recipe to brew the smoothest, coldest, and best tasting ABA around. I'm Dan Lowry with Mike Rubio, and join us on our journey as we look back into the ingredients to form the best concoction of ABA on Tap. In this podcast, we will talk about the history of the ABA brew, how much to consume to achieve the optimum buzz while not getting too drunk, and the recommended pairings to bring to the table. So without further ado, sit back, relax, and always analyze responsibly.

SPEAKER_02: 0:56

Okay, and welcome yet again to another episode of ABA on Tap. Exciting day today. I am Mike Rubio, your gracious co-host, along with Mr. Daniel Lowry. Dan, how you doing?

SPEAKER_00: 1:10

Back in the studio, brother. Good to be back, man.

SPEAKER_02: 1:13

See, you notice the clarity in that voice? We might be about five and a half feet distance with ventilation, decent ventilation. Internet connection very stable. And no Zoom glitches. We are back in the same space, feeling comfortable. And that means that we're back live, as always, but in front of our virtual studio audience, which means they might have to make a more prominent appearance from here on out to make sure we all mark the occasion. So it is good to feel this sort of sign of progress. We're coming fresh off of a two-parter of our episode seven, which delved right into criticisms of ABA. And from that, we have... surfaced sort of four points four common tendencies four things we hear out in the field primarily from parents perhaps that we're certainly responsible for we've cultivated a certain culture if you will that maybe has led to certain erroneous thoughts erroneous applications assumptions about ABA. And we've narrowed it down to four really good ones that Mr. Dan has put forth for us. So without further ado, Dan, I'll let you take the microphone here and introduce us to our topic a little further.

SPEAKER_00: 2:39

Sounds good, brother. We can call these the parenting cliches that we get. Along with the number one, reinforcement doesn't work with my kid, are the ones that we'll talk about today. The first one being... Well, my child should just do it. I shouldn't have to give him something. How come he always has to get something for, he or she always has to get something for everything they do? His siblings do things. How come he has to get something? So that's the first one. I don't know if we want to talk about that one right off, Mike, or if you want me to introduce the rest of them.

SPEAKER_02: 3:10

Let's go through sort of the quick laundry list here, and then we'll dive right in after that.

SPEAKER_00: 3:16

Perfect. So number one, why should my child have to get something for everything they do? They should just do it.

SPEAKER_02: 3:21

The bribe. The bribe. We're going to call it the bribe. Okay.

SPEAKER_00: 3:25

Number two, they should change their behavior before I should change my behavior. i.e. my kid has never done this, but he or she should start doing this tomorrow, and then they'll get reinforced.

SPEAKER_02: 3:35

We're going to call this one, which comes first, the chicken or the egg?

SPEAKER_00: 3:40

Or the egg. The behavior or the behavior. Number three, I'm a parent, not an accountant. How am I supposed to manage all these contingencies and token systems? And that one's kind

SPEAKER_02: 3:54

of on us. That one's a really good opportunity for us to understand Really, what does that mean, and how can we maybe modify or change? We'll

SPEAKER_00: 4:03

call that the CPA or the Enron. The Enron. Yeah, got to keep your books right as a parent.

SPEAKER_02: 4:10

Yes, you do.

SPEAKER_00: 4:11

And number four. As any good ABA methodology would end on, is sensory. The reason my kid is doing that is because it's sensory. So we'll introduce that maybe a little bit today, and then in further episodes we'll talk more specifically, but the good old S word.

SPEAKER_02: 4:27

That one's called, it's sensory. Ba-da-da-da-da-ba. That's it. Yep, that's it. Perfect, perfect. We didn't even rehearse that, man. Nice work. Nice work. Okay, let's go right into number one, the bribe. Okay. Yeah, kick us off.

SPEAKER_00: 4:44

Yeah, so let me ask you, Mike. I'm a dad or a mom or whatever, and I have taught my kid to do the chores that they earn Xbox time or tokens or M&Ms or something like that. And now my kid is not doing the chores unless they earn their M&Ms or their tokens where his siblings do chores just to be part of the house and be part of the familial unit. And my child who's potentially on the spectrum or getting the ABA therapy only does it for the tokens. What do you have to say about that?

SPEAKER_02: 5:21

Well, I'm not going to be very happy with the ABA. I'm going to be a little bit disappointed with the process here. Yeah, why do I have to bribe my kid? How come I have to offer them something outside of my unconditional love? A little shelter, you know, a burlap sack, some bread, some water. Why must I provide anything on top of that to get this sort of baseline relationship basic citizenship, contributorship to the household behavior. I know exactly where you're going, but yeah, as a parent, I'd be a little bit disappointed. I'd be like, well, okay, this isn't cool. Am I going to have to always stock Hershey bars? Depending on how dense the reinforcement schedule has become, Am I going to go broke? You know, going back and looking forward into the accounting piece here. I know that's not what we were alluding to, but yeah, so you'd be a little bit disheartened, but there's obviously a misconception there. What's the problem?

SPEAKER_00: 6:20

For sure. I think there's a couple of misconceptions. Number one, I think that oftentimes the parents don't ever look introspectively and look at how maybe they are doing the same thing for their kids so everything that they're providing for the kids is now contingent on something that they want to get out of their kid so just as they want the child to clean the room nicely with no Hershey's bar maybe the kid wants a Hershey's bar without having to do his homework or something like that so that kind of plays both ways the second part of that being that I'm sure a lot of bosses you know my boss clinical director I'm sure would love if I just came to work as part of the cohesive, you know, work unit and didn't get paid. But my guess is those parents that work, they only do it to get paid. If you remove that tangible or we might call artificial reinforcer, that currency, that behavior is going to stop. So, again, one of those situations where it's really easy to say others should do for us without reinforcement when we don't do for others without the external or artificial reinforcement behavior. And the third thing, and then I'll pass it back to you, Mike, is just going into this concept of fading the artificial reinforcement to the natural reinforcement, which I think is honestly something that ABA has struggled with over time. Because ABA oftentimes hasn't progressed as well. And if we can get a behavior to occur for the iPad or the Xbox, why ever try anything else? If it ain't broke, don't fix it. If Johnny's cleaning his room to earn the Xbox time, let's make a contingency, clean your room, and then you get the Xbox. But then Johnny's 18, only cleaning the room to get the Xbox, and now the parents are concerned. So I think having a conscious effort from day one of how we're going to fade it to the natural reinforcement, what is going to be the natural reinforcement, why being a of the familial unit and keeping the house clean is gonna benefit the kid should all be kind of forefront in addition to the extraneous reinforcement. I know I've covered a lot of ground there, so let me pass the ball back to you, Mr. Mike.

SPEAKER_02: 8:17

Man, I wanna grab on to so many of those pieces you just put out there. But let's see if I can do this justice. We're certainly part of the quandary and, of course, the solution here in this problem you're citing. And then we do have this tendency toward being to these linear contingencies. So when you talk about cleaning your room and then receiving some sort of tangible reinforcement, we'll use Xbox time because you and I are both very familiar with that precise contingency. A lot of times parents, they see it as a bribe. And then the bribe doesn't work immediately or every time. It doesn't work like it does in the mob movies where it's pretty consistent unless somebody gets taken

SPEAKER_00: 9:10

out. Well, that's because the kid's going to retain all of their fingers even if they don't do their chores.

SPEAKER_02: 9:14

The unconditional love part, right?

SPEAKER_00: 9:17

So

SPEAKER_02: 9:17

the idea that who needs to understand which part? So maybe we can go tit for tat on this. So parents need to– we need to better explain to parents– The gradual nature of this change. The fact that the contingency might not work immediately every time all the time. If it doesn't, then we're analyzing different consequences later. But we have to start trying. Meaning, so one thing that parents feel is that once we establish a contingency, we focus on every time it doesn't work. And now my bribe's not working. And further, I don't know how to remove all of the other parts that might be inadvertently reinforcing this behavior in terms of my attention, my constant reminder about are they going to do it or not. And one of the things that's really difficult for us to teach and for parents to do is this idea of extinction in that moment. We set up the contingency. You don't clean your room, you don't get the Xbox. But as a parent, I have to be able to sit there and accept that unclean room. Because if not, then I'm not holding my part of the contract.

SPEAKER_00: 10:42

That's a good point.

SPEAKER_02: 10:43

And I don't know that we ever communicate that very effectively, but also something that I would lend to parents here and now who are hopefully listening along with other professionals, that we have to wait that out. And then maybe... find a different match. You know, maybe we haven't offered enough. Maybe we're expecting too much or haven't offered enough reinforcement in that. So I don't know if you want to.

SPEAKER_00: 11:06

That's a great point. It's just like the boss has to accept if we call out in the morning, if the matching law doesn't equate that day and the reinforcement isn't strong enough for the task demand, the boss isn't going to come to my house and pull me out of bed and yell at me and berate me until I do it. He's going to say, okay, do you want to get paid for the day? And if not, And he's got to be okay with me not coming to work that day. Yep, that's a great point, Mike.

SPEAKER_02: 11:32

So let me further decipher something else you mentioned. When parents... And again, it's a logical complaint. Why do I have to always offer something to get something? I guess a general question could be, and you can riff on this for a bit, is there ever... something that isn't under a contingency. So I guess in the general question of cleaning your room, we have this general behavior of I'd like you to contribute by cleaning your room. This is a point of contention for us. Right now, you're not cleaning your room. So in a sense, I've got two basic contingencies. I'm going to ask you to clean your room, and there's no change in experience or consequence for doing so, or I'm going to ask you to clean your room, and then I'm also going to offer... a change in experience, currency, however you want to put it, reinforcement in order to enact a certain behavior such that I might then work to add to that behavior more expectations for the same reinforcement or as we also make an effort to, I guess, fade or thin reinforcement. We have a tendency to always look at that in a static fashion, like it's never going to change and it's always this pride. What do you think about that? That's something that maybe we can improve in terms of our instruction and our adaptations with parents.

SPEAKER_00: 12:58

Yeah, that's an interesting question. And I think one of the words that pops into my head that you brought into my vocabulary is the term multivariate and that you mentioned the term linear. We tend to look at things as linear in that if I ask a child to clean their room and then they get the Xbox, that's the contingency and that's the only contingency operating at that time. But there's a plethora of contingencies operating at that time. That is one of the contingencies. But what about the contingency, what are you going to do if your kid says no? That's another contingency. What if he says no appropriately versus what if he yells and says no inappropriately? You're going to respond in two different ways, and those are two different first-then contingencies. And even if he says no and runs away, you're going to have a contingency for him going to his room appropriately versus hitting and kicking or breaking a wall. At some point, there's a contingency that might involve getting police involved or something like that. So when we look at these contingencies, they're multivariate. There's all sorts of contingencies. So when we're always looking at how to reinforce the appropriate behavior, maybe Johnny's not cleaning his room at that time, but there's probably some contingency that he is doing. Maybe he's not even appropriately protesting Amen. Amen. Amen. There's always various contingencies that are occurring at once, and I think sometimes we get hyper-focused on the one, and we lose sight of all of the other things that are being done correctly at that time. I guess the last thing I'll say, and let me pass it to you, is it's kind of when I ask parents during assessments, what percentage of the time do your kids follow instructions? And they're like, 0% of the time. Well, in that example of a kid not cleaning the room, yeah, they're following 0% of that instructions. But think of all the other instructions that they're following. They might not be jumping on the couch at that time or, like I said, coloring the walls. There's a plethora of instructions that that kid is following that we're not highlighting or bringing to our attention.

SPEAKER_02: 15:01

That's an excellent, excellent point. So as I hear you discuss all these things, it naturally brings me to the idea of differential reinforcement. So in being linear, we often see one antecedent, one SD, one behavior, one consequence. And yes, I think that we can certainly get better at how we explain that, how we apply that, and it might help parents or clients, on the other end, teachers, whoever we're trying to work with, effectively, how to differentially reinforce every approximation of that final consequence or that final behavior that we're trying to consequence or reinforce. And yeah, I think that a lot of that gets missed because we're often, excuse me, really fixated on not just this ideal response in this super contrived ideal linear contingency, But then often our better motivational speaker gets the best of us and the child does some decent behavior, but we want a little more because we know they can do it. So then we string them along, we string them along, and then suddenly they express some behavior of frustration. And we turn our watches on. Oh, there's a freak. Oh, there it is. Of course, the child has a diagnosis. Of course, they'd be protesting. Well, man, you just strung them along. Maybe we created that behavior. So as you were explaining all that, I think that's certainly one area where people might think of this as a bribe. And we can get better at explaining it, better at applying it, better at the way we also operationalize and define in a dynamic motion, apply this idea of differential reinforcement, which isn't easy. And it's certainly not easy to quantify from a procedural standpoint. So to replicate that as a technology has been a challenge that maybe leads to some of this feedback that we're talking about today.

SPEAKER_00: 17:03

That's a great point, Mike, on the differential reinforcement. I always kind of cringe. or when I do my ABA trainings, because I'm the trainer for our company, and I'll ask the staff, tell me reinforcement without differential reinforcement. They'll think about it, and they'll all struggle, because you can't reinforce without differential reinforcement. Differential reinforcement says you're reinforcing certain behaviors and not reinforcing other behaviors. Well, by virtue of us reinforcing, that means we're reinforcing certain things and not other behaviors. So I think it's important that we almost exclusively use this term differential reinforcement because it does highlight the specificity that you are trying to acknowledge that we are reinforcing certain things, even if we're not reinforcing other things at that particular time.

SPEAKER_02: 17:52

Okay. I think that leads us nicely into your second topic here and... Which came first? Who changes first? The parent, the child, the teacher, the student,

SPEAKER_00: 18:07

us, or the

SPEAKER_02: 18:09

client? And this is us, right? RBT, case manager, BCBA, or the client? In this case, the child and the parent. So we have kind of a nice round robin to discuss here. Give us more of your insight, Dan.

SPEAKER_00: 18:22

Yeah, I get this extensively from my parents, and they'll say, oh, Johnny, in order to get reinforced, Johnny has to engage in the behavior. So Johnny's never cleaned his room, so as soon as one day he just spontaneously wakes up and cleans his room, he'll get reinforcement. I'm waiting for that to happen. Or Johnny never reads social cues, so he needs to learn to read social cues. So as soon as he learns to read social cues, he'll have friends. It's like, well, the best predictor of future behavior is relevant past behavior. And if there's been no occurrence of that relevant past behavior occurring, it's probably not just going to spontaneously occur. That would violate determinism. Probably it's on us because we're conscious of the behavior and have the skill set to change it, to change our behavior first, contrive opportunities. So if we're talking about the room, for us to change how we're going to present cleaning the room, or we're going to make it easier for he or she to clean the room, or if we're talking about reading social expressions, to bring that to his or her attention overtly. Like, hey, what do you think Susie's face is saying? rather than just expect him one day to walk into the room and understand what Susie's face is saying when he's 16 and 15 years and 364 days of his life, he's never figured that out.

SPEAKER_02: 19:39

Okay. So in the example of cleaning one's room, which is sort of stuck to this episode here, and I think it's a nice example, what I hear you saying then is a reasonable intervention could be Well, the first step we're going to do is we're going to set up a contingency that when Johnny's room is clean, and that means it looks like this, when we need an exemplar, he needs to be able to see it, he's able to have access to some defined reinforcement, tangible or otherwise, that we've hypothesized will serve as reinforcement. And you can sit there and wait for it to happen even though it's never happened, But what I hear you saying is maybe then as a parent, I would walk Johnny through the entire process of cleaning the room. And then at the end of that, we might enjoy a Hershey bar together. And then the next day, I might say, hey, a Hershey bar is waiting. Did you need me to get you started? Need me to get you finished? I think we call that chaining somewhere in there. That would

SPEAKER_00: 20:49

be okay. Absolutely.

SPEAKER_02: 20:50

Okay.

SPEAKER_00: 20:50

Or maybe you just walk in and you're like, hey, Johnny, can you hand me that toy that's on the floor? And then you put it away. Now you've got some momentum built. Okay.

SPEAKER_02: 20:59

And I think those are the things, and obviously I'm asking facetiously, but those are the things that sometimes maybe we're not only not so good at communicating, but then, I'll throw this at you and give me your insight, parents are now saying, wait a minute, this is your job, man. I'm not doing the therapy. So what's our quick good answer there in terms of modeling or the parent involvement?

SPEAKER_00: 21:23

That's a good point, right? Because they didn't come to our services for us to tell them to start cleaning Johnny's room first. They came to our services for... us to get johnny to start cleaning his room

SPEAKER_02: 21:34

that would be the impression yes

SPEAKER_00: 21:36

that's a great point i guess it just comes down to the abc the three-term contingency of of that b is not changing unless that a changes under the same environmental antecedents the same behavior will occur so i think that's what it comes down to how are we going to change are we going to i can almost guarantee that if you say johnny clean your room at the same time in the same vocabulary in the same vocabulary or the same tone of voice every day, you're going to get the same response. So how do I change clean room to, hey, can you hand me that? Or what's that? Or bring that over here. Or hey, any sort of other antecedent manipulation like you mentioned, you're participating with Johnny hypothetically in this example. That's going to be of utmost importance. We change the A and then the B will change. But without changing the A, the B is not going to change.

SPEAKER_02: 22:23

From the lab to the living room. Something else we like to say is change the script, right? And we know Johnny's not going to change his lines. That's why we're in home. We're providing services because Johnny won't change his role. He keeps repeating the same role we don't like. So then the only other logical option in that ABC script is we change our role. We change our role in the script and watch the ensuing change in Johnny's behavior and then adjust accordingly.

SPEAKER_00: 22:55

So that's a great point. So I guess as ABA therapists and behavior analysts, our job isn't so much to get Johnny to change his behavior. Our job is to be like directors and just notate to the parents how they can change their behavior. Obviously, if we could get Johnny to change his behavior, then that would be the easiest thing and we could do that. But remember, Johnny's the one with the diagnosis here, so presumably... the amount of trials it's gonna take for Johnny to change his behavior is gonna supersede the amount of trials it's gonna change for the parent. So if we can be the director, because Johnny's got his lines and the parents got their lines, and the parents' lines is, clean your room, and then Johnny, cut. Johnny doesn't clean his room. And then parents' line is, Johnny, I said clean your room. And then Johnny's line is, I don't care what you said. And then you just get into the script without somebody external from that environment coming in and, like you said, rewriting the script Those lines are going to be the same every single time.

SPEAKER_02: 23:55

Okay. When we come in, we implement all our interventions. And now, Mom and Dad, I need you, every time Johnny does A, to write down X and Y. And then when he does B, you need to write down X and Y. And then when he does that, we need you to go ahead and do this, that, and the other as we give you... You know, this paperwork and this behavior plan, this ABC contingency, and if he does this, you do that, and if that didn't work, then what do we do? I'm not sure. Maybe you call the PERT team. You know, I'm being a little facetious there, but, you know, bringing me into your next point. We throw a lot at families, and we expect a lot from them. And one common grievance we hear is, not an accountant, token systems... data tracking, behavior plan review, and then following through with that, talking about one of our other points and modeling how you follow through with the contingency. Now I've got to go to 7-Eleven, I've got to go to the store, I've got to buy this, I've got to buy that. I need to make sure that I've made time as I'm cooking dinner to get the Xbox ready to have I put it away. We certainly put forth a big commitment list of expectations so it's a it's a reasonable and logical grievance where is it necessary where do we respond to the uh logical grievance and get better

SPEAKER_00: 25:26

so i'm gonna give a short answer and then i'm gonna pass it back because you're a parent and you can speak more from an area of expertise than i can i can just speak from the clinical area of expertise But what we do run into a lot of times, and it's the whole reason we don't use punishment, we use reinforcement, is trying to avoid this situation of helplessness. So if we have, say, a three-strike system, that we're going to give a child three strikes before they lose a token, and now the parent's got a five-star token system and then three strikes per token. Now that's 15 things a parent has to be accounted for. Or maybe the child earns five stars and then they get the Xbox. But if that's out of the... the child will not be able to earn their five stars by the end of the day. We have a competing token system because that child theoretically has no incentive for that time. So there's another token system, maybe a weekly one or something like that, to try to maintain so the child doesn't lose their crap and destroy the whole house for the rest of the day because they've already lost their Xbox. So we've got one token system, and if that's not attainable, oftentimes we have some sort of modification to it or additional token system for other behaviors And I could see from a parent's perspective saying, all right, I'm going to give Johnny, you know, we've got deal breakers, right? So if he engages in physical aggression, that's a deal breaker. But then there's not deal breakers, things that are nuisance like cussing or disrespectful attitude and things like that. And they now have, you know, strikes that they get, but it's not an immediate deal breaker. Eventually, parents feel like they're monitoring tokens for appropriate behavior and strikes and things like that. And as an ABA therapist, I'm trained to do it. I have two hours of undivided attention. I have all the materials I need, and that's feasible. For a lot of the parents, I don't know if it's feasible or not. Let me pass it back to you. But that's one of the criticisms that I get is that they are like, that's too much. And they'll either flat out tell me it doesn't work or they'll try it and then just completely butcher the token system and it won't work.

SPEAKER_02: 27:26

So I think these are necessary procedures. And I'm trying to quickly gather my thoughts here so that I can communicate this semi-effectively. One thing that I think applies here is What is the difference between a token economy and a token system? And which one is actually necessary at which point for which purpose? And what I find what has happened, unfortunately, is that maybe even an application, we've confused that a little bit. And, you know, hey, we've got a new kid, startup. Okay, they need a token economy.

SPEAKER_00: 28:08

Five stars.

SPEAKER_02: 28:08

They need five stars. I'm not saying that's wrong. All I'm saying is that it clearly demonstrates a pattern of inflexibility, maybe a standard of operation that we can modify here a little bit because it has led to some misconceptions, maybe the ones we're talking about here and the idea that now you're accounting. Now, what is a token economy really for? It's like a timer, right? And we like talking about this. And maybe, again, this is where I know that they are necessary procedures and not necessarily for the child. They're actually more necessary for the teacher, for the parent, us, to keep us honest. So that if we say, you get to do this for two minutes and then you get, we are actually true. Going back to your earlier point, we're modeling how to deliver on the contingency effectively because as parents, as adults, we're not very good at that. So the question then becomes, do you need this overt timer? Do you need these five stars to be overt? Or based on our schedule of delivery, just like the slot machine giving the payout, is that what's controlling the behavior? And I think the answer is that there's a hybrid here. We need those systems. We need the procedures. Perhaps they've taken a certain... feel and aesthetic now that we can consider

SPEAKER_00: 29:39

varying a little bit. Startup materials.

SPEAKER_02: 29:42

And again, that's very, very necessary evil, if you will, when you're accustomed to huge caseloads. And the idea that you have to have all these certain therapeutic things, it presumes it implies a certain system of therapy, intervention. It's not incorrect. It is a very easily replicated technology. How diverse is it? How individualized is it then? And these are all questions that I think that we're nicely... trying to weave through certainly have improved and progressed over the last 20 years of my experience for sure. And I know that just kind of looking back at things historically have had a huge impact and changed our approach and sort of our humanity toward these principles and ideas.

SPEAKER_00: 30:37

Yeah, I think you touch on a great point of that token systems holding us accountable just as much as it holds the client accountable. One of the things I see in our field is that the token system is meant to be a fixed ratio reinforcement schedule and it quickly turns into a variable ratio reinforcement schedule so a child will be getting tokens for attending and the child will have attended for five minutes just fine, and then they start to get wiggly and squirmy and all over the place, and now the therapist is like, well, if you sit for 10 seconds, I'll give you a token. Well, that child just sat for a whole lot of 10-second intervals and didn't get a token. That fixed ratio wasn't really being implemented, and the therapist wasn't holding themselves accountable, and all of a sudden, We can almost say the child is holding the therapist accountable at some point. That child's hitting ratio strain and letting the therapist know, hey, I didn't get my first token like I should have. So that's the first thing that I think is super relevant to what you said, that holding us accountable and coming to more of an ambiguous variable reinforcement schedule. And the last thing, and then let me pass it back to you, is that the whole point of this accounting, the whole point of token systems, token economies, whatever, goes back to the conceptually systematic approach dimension of ABA. And everything's based on reinforcement and punishment. And in this case, reinforcement. In order to get a behavior to occur or to keep occurring or to occur more often, it has to access reinforcement. So sometimes you have to break these behaviors down to get them to access reinforcement. And then when they occur, we don't necessarily want to reinforce them every time. So a token system or token economy is a great way to do that, is a great way to delay the reinforcement. And as is giving kids opportunities so they don't just lose it all. Because that definitely happened I can't tell you how many parents I have that the kid does one thing and then they've lost all the reinforcement for the day and the week. And now they want to know why the kid won't do anything appropriately. Well, they've got no motivation. So it comes down to accessing the reinforcement and how are we going to contrive certain ways to make sure the kid gets reinforcement and is always continuing to a more progressive skill.

SPEAKER_02: 32:45

Right on, right on. Well, we've covered a lot of ground. And oddly enough, we've left ourselves with ample time for... I mean, for sure, you saved the best for last here. And we might even have to spill this one over into a whole separate episode, as you know. So we're going to allow ourselves approximately 10 minutes, Dan, to open up this can of worms that we have termed It's Sensory. Thank you. So give us all here your best anecdote, your best little story, vignette about something going on and then, oh, no, that's sensory. Somebody else is taking care of that. That's not behavior because it's sensory. Now it's not behavior. It's got to be occupational therapy. That's what covers this. And I'm not mocking that. There's... constant expertise there that we do not have without a doubt but certainly they get pulled into this conversation of it's sensory and give us air your grievance sir

SPEAKER_00: 34:00

so great question I have you know an almost limitless amount of parents that everything is sensory so Two examples, you can pick whichever one you want. Number one, Johnny can't attend to his homework assignment or if you want to do a specific ABC, I present time, I present homework and Johnny all of a sudden is really distracted and wiggly and needs to move around a lot and spins in his chair all the time, that's sensory. Or number two, Johnny's in a Zoom meeting and all of a sudden the screen lights up green when someone else is talking or when he's talking or doesn't light up green when he's talking because he's muted, and that causes a behavior, and that's sensory. Gotten those from parents, so let me pass it back to you.

SPEAKER_02: 34:49

So there's a ton of other questions that come up here. I'm going to, I guess, add to the quandary a little bit because one of my favorite pieces there is the phrase sensory play. Man. Begs the question, back to what you're talking about, is I guess other than being in a sensory deprivation tank, can you name an experience that is not sensory-based?

SPEAKER_00: 35:19

I don't know. Maybe astronauts jumping out on the moon?

SPEAKER_01: 35:22

I

SPEAKER_02: 35:25

guess to some extent, weightlessness is what we're talking about. They're still seeing things.

SPEAKER_00: 35:30

You're

SPEAKER_02: 35:31

still feeling some sort of temperature change or pressure change.

SPEAKER_00: 35:34

They're getting some sort of sensory

SPEAKER_02: 35:37

input. We want to find good answers here. What is it that parents actually mean? One thing that we can make a safe assumption is they heard this somewhere. Again, I I call on our colleagues on the occupational therapy side of this because it's very common language within that field. And I don't know enough about exactly what it means from their perspective other than there's a certain sensory motor, on one aspect, development that maybe they feel was missed and now we have to revisit because it's leading to to certain reactions. So, hey, the kid's having an awful tantrum, and they're showing self-injurious behavior, and they're headbanging. Well, that's sensory. Okay, great. How do we stop it? What do we do? I'll pass it back to you there. I know you had some thoughts sparked up there.

SPEAKER_00: 36:37

I did, and I think it all comes back to the operant-respondent interactions of... So if I– I hate heights. So if I go on top of a building and I look down and I am shaking and things like that, that's sensory. If I'm leaving the– if I leave the area, that's sensory. If I hit somebody, there could be a sensory component to that. There's some sort of sensory discomfort. We would call that some respondents. But almost any of the maladaptive behaviors arise from some sort of sensory discomfort. Now, whether that's a pure physical sensory discomfort, like I'm hungry, or I can't communicate something, that's a sensory discomfort. Or you take an iPad from a kid who is playing the iPad, probably going to have some increased respondents at that point in time. they're probably gonna tense up and their body's gonna be like, what the heck just happened there? Now they're in a level of discomfort. So almost any behavior is gonna have some sort of level of discomfort or sensory component to it.

SPEAKER_02: 37:46

Now, behaviorally speaking, we wanna work collaboratively. And in all fairness to everybody involved, parents have to hear a lot of different suggestions from a lot of different people. So in your scenario, here is Johnny. Again, man, we're picking on Johnny. Johnny starts hitting his mom. This is sensory-based. And the OT's now, or pardon me, somebody's now recommending, well, when he does that, it's a sensory diet. We're going to use a sensory diet to reduce this aggressive behavior. So now our contingency looks like this. Hey, Johnny, do your homework. No, I don't want to, but Johnny, it's time to do your homework. Boom. Aggressive. Bam. Consequence. We've got some soothing, some massaging, a little physio ball activity. What's wrong with that?

SPEAKER_00: 38:41

Not done proactively.

SPEAKER_02: 38:43

Okay. Let's talk about that a little bit so that we can maybe dispel some of that misconception or some of that misunderstanding. And then in that effort, work toward being more collaborative with our Are there partners here?

SPEAKER_00: 38:57

Yeah. No, there's definitely, like you've talked about with our kids with GI issues and things like that, a lot of our kids that we work with probably have an increased level of respondent or heart rate, if I want to quantify that, blood pressure, things like that. So, sure, it would benefit them to have some sort of sensory regulation independently. That would certainly benefit them. For example, if we're trying to say, hey, by taking deep breaths, you can decrease your heart rate five beats a minute, that's probably a heck of a lot better if you're going from 65 to 60 than if you're going from 165 to 160. So clearly, I think any ABA practitioner would say that if a child is in the best sensory– has the best physiological state to perform a task prior to presenting the task, the chance of them being successful with that task is certainly, certainly going to be of anyone's best interest.

SPEAKER_02: 40:03

Now we're cooking, right? So now we can really combine behavior practice with this idea of sensory integration. Something that I've been getting very comfortable with is what I'm kind of calling brain oxygenation. to my kids that I feel can understand this, and even being able to teach some of these techniques to clients who maybe expressively can't do so much but receptively understand a whole lot. And I know that maybe we've mentioned this on the show, and I've talked to you about things like spirometry, things that make breathing techniques that... have largely been sensory or OT-based or something else in our field, have been hard for us to quantify. But now we can. With things like spirometry, you can actually quantify your breath. Or with techniques that I've recently been exploring more and more with sort of late childhood, middle childhood clients, and this idea of 4-7-8 breathing. It's a really simple pattern of breathing that works very effectively to... almost reset, I guess, your autonomic response, kind of bring you back down to baseline. Super enjoyable experience and something that actually does work. And now from a sensory perspective, something we can quantify that we can teach, we can provide an informative function. I can teach a lot of these clients what's actually happening physiologically in your brain. Why does it help you from a self-monitoring perspective? And now we have put all of these things together in a way that from a more empirical basis makes hopefully more sense. Again, you know, things that have been very common, breathing techniques have been very common, but maybe misused, misconceived, maybe not with the right behavioral application or in the right order for an effective contingency.

SPEAKER_00: 42:00

So we actually just, I know you've been on the train of getting a spirometer or a heart rate monitor for years now. We finally just had one parent that I'm aware of get a spirometer, still waiting on some of the parents we work with to get a heart rate monitor. But that quantification of the sensory is so important. And let me ask you this, Mike. So let's say you're in a room There's a kid in a different room, and you're in a different room from this child, and this child has a heart rate monitor on, and all you can see is the reading of the heart rate monitor. Do you think, obviously not 100% accurate, but do you think with a reasonable accuracy you would be able to determine whether that child is upset or having a tantrum or not, or a baseline?

SPEAKER_02: 42:52

So that's a great question, and I don't know that I would phrase it the way... You just did, and I'm almost afraid to answer the question fully, but I'm envisioning this idea with a little kind of watch on a kid's wrist, and suddenly as a parent you get this little, wait, there's a heart rate increase. What's going on? Oh, siblings getting close to the toys. I think that some of that is true, and I wouldn't necessarily wanted to be applied that way but maybe for some of our clients who are now in a different realm of life this is now disruptive in that sense to be you know clinically relevant um maybe that that would be a good clinical application of this technology but yeah to answer your question while it wouldn't be predictive in that sense i do think it could help us be preemptive and be more aware and get certain cues without having to have our eyes 24-7 on the child, be able to move away and get some sort of reading. And then to just expand on that a little bit in now using this from a self-monitoring perspective, the empowerment of knowing that you feel better, get more attention from me verbally, visually, and not just physically as you're You help me. help myself bring these readings down on these monitors or whatever it is we're using by employing these techniques that you've taught me. So again, there's a lot to be explored there. I certainly don't want to minimize or oversimplify it, because this is something that while you and I have been talking fairly for several years now, we're just able to get people to practice. So we're just kind of seeing how effective it is. And fortunately, that parent you're speaking I think is, or the particular... circumstance you might be referencing, it seems to have been effective or it's taking, so that's nice.

SPEAKER_00: 44:58

Definitely. I guess kind of what I was getting at there, Mike, is that if after a while you determine that the child's baseline is 80%, the heart rate's 80%, or 80 beats per minute, excuse me, and then you see spikes to 120, 130, with reasonable accuracy, you could assume that that child's in some state of escalation. Now, maybe they're doing some sort of strenuous sport or something like that, but assuming they're they're in a room, we're going to go ahead and assume with a reasonable certainty that that child's in some sort of escalation, probably stress, maybe even de-stress. And so the point is we would be able to determine that just from a heart rate, from a sensory component, but would you know whether the function is attention, escape, tangible? No. Not by itself. It wouldn't matter, but they all will register the same on the sensory component. So when we tease sensory out, It's kind of undermining. Sensory isn't, I mean, it's kind of its own function, but more so it's involved in all of the functions. So I feel like as ABA practitioners, we're kind of, you know, we're still at the kiddie table in a lot of regards. And we get defensive because everything gets related to sensory and parents say that everything is sensory. We get defensive and we're like, no, it's not sensory, it's attention maintained or it's escape maintained. Okay, true, but is sensory maintained too? Any of those behaviors are going to be sensory maintained. So maybe some level of acknowledgement of the role that sensory does play, but with that level of acknowledgement, Also acknowledging that the sensory has a behavioral component as well. So we don't need these, you know, it's not voodoo that only occupational therapists can work with. Nothing against occupational therapists. They've done some great things. Just like ABA isn't voodoo that only, or behavior isn't voodoo only ABA people can work with. Anyone can work with behavior. They just have to understand the premise of it. Same thing with sensory. We can work with sensory skills, too, because any behavior that we're working on has a sensory component.

SPEAKER_02: 47:11

I like that. As long as the client we're working with has some level of central nervous system, then anything at all we're dealing with will have an antecedent of a sensory system.

SPEAKER_00: 47:24

There you go.

SPEAKER_02: 47:25

I mean, and that is bottom line. So... So yeah, somewhere in there, we don't like to hear that phrase, but we've got to work with it. We've got to work with it and better understand it and gain better language to behaviorally explain it. And then, yeah, fall right in line with it however we can, knowing that going back to maybe eating behavior... The sensations on the tongue and the use of the teeth and all that might come into OT and speech therapy, and now the food might come into the idea of a nutritionist, but the chewing, that's ours. The swallowing, to a certain extent. Those other content expertise or the bringing of the fork or the hand with the food in hand to the mouth, that's ours. That's behavior. And so is chewing and swallowing even though speech therapy might have more to say about that or speech pathologist might have more to say about that and being okay with that. That's certainly their content expertise in an area that we certainly don't want to necessarily spend so much time in outside of what we need for our particular clients and to build this expertise where they're much more specialized in those specific areas. So, yeah, where as much as we cringe to hear it's sensory, and I had my little theme song at the end, I think you make the best point. We have to understand what that means. And as long as you've got a working brain and spinal cord, then there are sensory antecedents and consequences, hopefully, happening all around you all the time. Hard to tease apart.

SPEAKER_00: 48:57

Yeah, I mean, think about, let's take the most common example, the iPad example, right? The kid gets upset because someone's taking the iPad away. How do they know that the iPad's getting taken away? They have a visual reference of an iPad leaving. That's sensory. They have an auditory cue of, my turn. That's sensory. They have a tactile cue, probably something leaving their hands. That's sensory. There are all sorts of sensory components. Once it leaves, now their body kind of goes into fight or flight mode. Once their amygdala triggers, now they're in higher blood pressure and things like that. Those are sensory. These are all sorts of sensory components that come into place before we can get to the behavioral part of taking deep breaths or asking nicely for the iPad or doing their homework so they can earn the iPad back. Those are all sensory components. things that need to be acknowledged and dealt with before we even get to the behavioral stuff.

SPEAKER_02: 49:49

Lastly on that, and we can maybe wrap it up here, the idea of deep breaths, we often use it as a consequence base when in fact it should be almost entirely proactive. Getting your sensory systems prepared for that fight or flight mode so in that moment you remember to keep your breathing steady and in there and therein mitigate your behavioral response. So yeah, I think there's so much more to explore there. Just to wrap up, Dan, number one, it's not a bribe. It's not a bribe. It's a matter of a motivating operation. It's a matter of some modeling. It's a matter of some chaining. What else do you have for us there to close?

SPEAKER_00: 50:35

How are we going to make whatever the natural reinforcement is reinforcing enough to maintain the behavior? Because the bribe is the artificial reinforcement that the parents hate. So how do we fade this artificial bribe into more natural reinforcement? Why do you, thinking about as a parent, why do you clean the house? What maintains that? When did you learn that?

SPEAKER_02: 50:57

Right, right. So in therein, you facilitate your child's success so that you can achieve success. that reinforcement, enjoy it together, and then cultivate from there toward independence, back up from a backward-changing perspective, for example. Get the job done with them, enjoy that reinforcement together, give them a taste of it, and then start backing up, making it day by day.

SPEAKER_00: 51:20

I just want to highlight one thing you said that's awesome. Enjoy it together. In ABA, so often it's, oh, you did it, you get the reinforcement, now go play with the iPad over there. Enjoying it together, that's one thing that in ABA we can really work to improve is Instead of being you do for me, then you go play over there with the reinforcement. Let's enjoy the fruits of both of our labor together because it was difficult for the kid to clean the room, and it was difficult for the parent to deal with all the kid's crap until they got through with cleaning the room. So let's enjoy it together.

SPEAKER_02: 51:48

Now it's not a bribe. It's achievement. It's achievement. Enjoying achievement. Nice. So secondly, who goes first, parent or child?

SPEAKER_00: 51:59

We do. The parent, the therapist, the teacher. The adults, the

SPEAKER_02: 52:01

parent,

SPEAKER_00: 52:01

yep. The person without the diagnosis?

SPEAKER_02: 52:05

So we set the example. We adjust the A and the C. And then... measure the ensuing changes in the behavior because there is no switch. There's no pet on the back that's going to make the magic wand that makes the magical behavior just change. I like to talk about my English child example. Yes, ma'am. Yes, I'll get to that right away. I've seen that a few times in my career and even then it's been odd. Wait a minute. Maybe this is too much. We've gone too far here. The adult always goes first.

SPEAKER_00: 52:36

Everything is better in proper English. Let me just correct myself not necessarily the person without the diagnosis that's not what i meant i meant the you do um what it could be you know uh with a significant other or something like that they're not going to change until you change so the person listening to this and trying to uh change someone else's behavior before someone else's behavior changes your behavior has to change

SPEAKER_02: 53:01

and i can appreciate that we we certainly work with um individuals who who've got diagnostic labels but this applies one of the things we love talking about on this podcast is how the universality of ABA it applies to everybody and that's what We find it makes it so cool in working with our clients who are challenged with disabilities that it levels the playing field in terms of learning capacity. So thank you for circling back on that. Dan, in terms of the CPA, the public accountants giving parents too much, requiring too much in terms of data tracking or token economy systems, final words on that?

SPEAKER_00: 53:42

I'm an ABA practitioner, not a parent. Let me pass that back to you for your final words on that.

SPEAKER_02: 53:47

I think that what we came up with here is the idea of thinking what the procedure's worth and what outcome you're expecting, and then what tools you really need to teach and or implement those procedures effectively, knowing that token economies and timers really don't work to keep the child honest. We're teaching them based on our delivery of those schedules. So you made the best point that in most dynamic life practice outside of the lab. It's not like our technicians have these beacons next to them, and every five minutes they're looking up to see if Johnny's sitting, and if Johnny's sitting at that time, they deliver reinforcement. No, it becomes completely variable, which is kind of what we want anyway from a reinforcement perspective. That is the most powerful type of schedule. But in that, we do also have to become systematic. So remembering that the timers, the idea of five stars, that's just to make sure that we remember to reinforce five different approximations or emissions of the desired behavior, and then we're acknowledging with some attempt to deliver reinforcement. That's all it means. It doesn't have to be a laminated sheet with the five Velcro dots and the stars and what's their favorite icon. Yes, it can look like that. Absolutely. All that work is beautiful, and it's very effective in teaching... everybody to be systematic, to expect certain outcomes at certain times. But again, knowing that If that's not practical for parents, then we can also change our methods, our approaches, because at the end of the day, it's more about a procedure and not an aesthetic.

SPEAKER_00: 55:26

One thing that you said that I just want to highlight for that is the difference between a token economy and a token system. You again alluded to it going back to a few podcasts ago, the difference between a schedule and a routine. A token system or a schedule, they're just representations of a larger idea of a routine that you're trying to establish or a token system is a representation of a token economy. It's like you can have as much money in your pocket as you want. If that doesn't get exchanged for anything, if it's worthless, the system's still there, but the economy's broken. So I thought you made a great point in differentiating those.

SPEAKER_02: 55:59

So you carry a token system in your five fingers every time, you mean? So that's one, Johnny. Hey, that's two, Johnny. That's three. That's four. That's five. Boom. Now you get access to something bigger that we talked about.

SPEAKER_00: 56:10

It doesn't work. It's not five stars and laminated. I can't find the five stars on my fingertips. There you go. If you get tattoos of stars on your fingertips and you laminate them, there you

SPEAKER_02: 56:20

go. Little thimbles. There you go. Okay. So let's see. Where are we at? Oh, finally. Certainly last. Certainly not least. The idea of sensory, I think we came to some really good points there in understanding that, yes, in fact, everything is sensory. But now using that as some soul-maintaining factor in behavior is where we get ourselves into trouble. Tell us more.

SPEAKER_00: 56:45

Yeah, everything is sensory in some respect. Occupational therapists do a great job of highlighting that. And everything is sensory and everything is behavior. ABA practitioners can dip our feet into that water as well. And we often have, and yeah, I think that's what we talked about. And we can be successful in using the same three-term contingency with a lot of these sensory behaviors as well.

SPEAKER_02: 57:14

I think I'm sure at some point we'll delve into the idea of escalation and de-escalation cycles and autonomic arousal, sympathetic and parasympathetic nervous systems. Those are all very important. sensory parameters that actually help explain a lot of what we see as tantrum or escape behavior, prolonged crime behavior, are actually right at the heart of it. So yes, understand that things are sensory, but what does that mean? And going a little further than that, especially behaviorally speaking, Dan.

SPEAKER_00: 57:43

Yeah, I think you brought up a great point of just, it's really important that we be careful with these buzzwords and we define and we know what we're talking about. So when parents say, oh, this behavior is sensory, well, What does that mean? I know we talked to the colleague a few days ago about trauma and what does that mean? There's a lot of these buzzwords, but just what does it mean? Can it be operationally defined? And tell us why you believe it's what you believe.

SPEAKER_02: 58:09

Can you put it into that three-part contingency? Can we explain it behaviorally? And just because we can, it doesn't mean it gets discounted or now it's just a parameter of behavior. It might mean that, but professionally speaking, it means that now we have a better collaboration. Professionally speaking with our partners, we have a better understanding of what they might be looking at and also a better understanding and a chance to improve our methods and techniques toward de-escalation, toward our teaching of breathing techniques and things that do allow for more autonomic regulation or less quick or... volatile autonomic arousal. Dan, we've covered a lot of ground today. And

SPEAKER_00: 58:53

also with the sensory, can we make it measurable, quantifiable? Can we make it, like, put it into our scientific philosophies? Can we make it empirical? Can we make it deterministic? Can we notice environmental things that happen both before and after the individual gets stimulated, either external or internally? And then we can start to quantify it, like you said, with spirometers, with heart rate monitors, things like that. Once we can notice those core and quantify it, then we can address it.

SPEAKER_02: 59:20

Yeah, I think there's a lot to be discussed there. Maybe we'll circle back there, too, in terms of the future of quantifying some of these... Vital signs, if you will, are some of these physiological signs or readings. And then how do we use that, as you were sort of alluding to, in terms of realizing that outside of rigorous physical exercise, such an increase in heart rate, for example, might be indicative of some other behavioral change. So that's really, really important frontiers to explore. Sir, we've covered a lot of ground today, gone over our usual time a little bit. But that's okay because it was worth it. As always, stay safe out there. Always analyze responsibly. Good to see you and be in person. A little six-foot cheers,

SPEAKER_00: 1:00:06

sir. Good to see you, Mike.

UNKNOWN: 1:00:07

Cheers.