ABA on Tap: Lessons from Quarantine

So without further ado, sit back, relax, and always analyze responsibly.

And we certainly have some important things to talk about today with regard to, at least for us, professionally speaking, personally speaking, returning to and home. For a lot of people, I don't think they've ever stopped. So we get to learn from them some of the precautions they've taken over this time as we professionally and personally speaking get ready to deliver services back in home.

And what have we learned from telehealth, for example, and then how does that help us take further precaution for our clients so that we are truly doing the best we can with regard to medical safety practice as well as ABA practice and so on and so forth. So we could probably do much more than one podcast episode on this topic. But we'll start today. We'll give it a go. Give it a good 30, 40 minutes and see what we come up with. First off...

I can think of a lot of clients that aren't going to be OK with complying with wearing a face covering. Let's just start. with that simple premise there. And yeah, Mr. Lowry.

Something I never even thought about with our younger kids and the fact that some of the mess that we might be defeating as we try to present oral models and things like that. So let me pass it back to you. I never even thought about that. I was like, okay, cool, we'll just use a mask. But that might be 60%, 70% of the programs that we run out the window if you wear a mask.

And you're certainly much more open with regard to theirs, knowing that going in with a face covering, it's not an N95. So you're not protected. That's just the way it is. But a face covering is going to give you that 2%, you know, minimal protection over nothing or over just a face shield. I am speculating there. Certainly not using hard data. But I would imagine the cloth is better than just open air. Yeah, I mean, so many things to consider. Again...

Now, that said, that could be a very, very defeating premise. But what have we learned during telehealth, which is, hey, mom and dad, instructional control, staying with you guys, that seems to be working really well.

So now let me tell you what to do, and you make sure they're watching your mouth, which, from a developmental perspective, for a two-year-old, you know, unless you've got some super... kick in fully accredited preschool, they're still getting most of these cues from mom and dad anyway.

So we would be really typifying our instruction in that sense if we start providing the treatment to the parent even though they don't have the diagnosis, which is a topic we've talked about here before in terms of ABA and how interesting it is medically speaking. The child, often the younger client, the younger patient, if you will, has a diagnostic, but really the whole community, the whole family environment, if we're going to be effective, has to receive the treatment.

So it really harkens us or behooves us to put our money where our mouth is with regard to that now, and how are we going to use that new knowledge of empowering parents during this time where we might still have to be limited? So I'll pass that along to you, see if you have any thoughts from that perspective. Little blunderbuss and stream of consciousness I just lent.

I have seen that a lot of the parents have been surprised by the level of rigor that has been required to run an ABA session, which has been good, too, and that I think some of them are hitting their quota. They're hitting their satiation point, I think, on running sessions, and they wanted us to be in pretty much yesterday. So we are running into that.

Something that, back to the mask thing, that actually crossed my mind as you were talking, and I was kind of talking as well along the same lines of presumably there's going to be some level of recommendation or requirement that kids wear masks in school.

So how important is that going to be that we start developing mask tolerance programs for kids that aren't wearing masks and things like that and looking at whatever that new normal is and maybe deviating from some of our ABA programs to look at some of the things that are going to be necessary for kids to get into more of the mainstream or neurotypical environments. What's your opinion on that?

And Here I am also somebody who is a big proponent with a great degree of caution on tactile reinforcement, especially with little guys, rubbing the head, patting the back. No, that's all out the window now. And again, I'm not airing a grievance or sharing a gripe about that. Not at all. It's just it's going to have to change.

We're going to have to find new ways to... get kids to pay attention to people's mouths, for example, as they learn to speak, and by and large, that may not mean our mouths anymore.

So again, transferring that stimulus control, that instructional control to the parents, you mentioned them discussing fatigue and being a little bit overwhelmed, and I think that that's something we'll have to deal with in terms of the new normal, how much more We're asking the parents to do, knowing that we've actually seen a great deal of progress with that new model, and it makes a great deal of sense, and not to make us feel on edge about becoming obsolete or putting us at risk.

It just means that our RBTs have to adapt a new level of knowledge, a new level of practice. Just something different, kind of employing all their current skills and knowledge in a different way, funneling in a different manner. So I'm excited for what's to come. I say that with a degree of caution toward the medical risk, given my age and being male and whatnot. You have to think a couple times and be like, oh, do I really want to give myself 14 days of what people are describing? Probably not.

But we're going to have to face that. We're going to have to figure it out. As I say that, I'll kick one over to you, which is working largely case management or so-called supervision and a lot of parent education, by and large, I expect to be doing this telehealth thing for a long time because I don't suspect we're going to be having a great number of people saying, sure, don't just send one of you in here, send two of you in here.

And then beyond that, you know, again, so these are questions that are still to be answered for many, many of our colleagues and many practitioners, but from a behavioral perspective, as we take caution, things that we're going to have to answer.

I think it's been a lot of parents have seen surprisingly good results. There have definitely been some roadblocks. I think one thing that I would like to get your two cents on, being a parent, is that the trajectory I've seen, so we're in the week probably almost 18 now, somewhere in that range, all of April, all of May, and then probably split March and June. In the beginning, parents were just kind of freaked out and unsure that we're starting telehealth, so it was kind of a crap show.

And then parents really started to participate and things were good. And I think now, like I mentioned earlier, we're hitting that point where parents are ready for us to be in the house. Now, my question to you is, how do we facilitate? And number one, do you see? And number two, how do we facilitate? a smooth transition to say, hey, this is what you've been doing. Let's keep doing it because a lot of parents are just so ready for respite to be in there and ready.

Anyone who can come just deal with their kids so they can get that two hours of escape that they haven't gotten in three months is going to be so welcome. So what do you see that transition looking like?

But just naturally, by circumstance, as we set to reopen, we also have parents... who were largely at home, working from home, now also getting set to reopen.

So I think where we're going to want to play on a real strength of our progress during this time is in our so-called behavior support plans and what we're asking parents to do, now knowing that they can do it and that they're much more capable than maybe even we initially assessed before quarantine, and in all fairness, probably more than we initially tended to assess because we took on a good part of the responsibility just naturally by design.

So I think we're going to want to lean on those parents for those behavior support plans and what we're asking them to do now off camera, now during those times when they're at work and maybe we're providing in-home service with all the necessary precautions along with one of the parents or maybe an older sibling or maybe, yikes, extended multi-generational family member that also lives.

Again, how many homes, just to continue the conversation, how many homes do you go into for supervision where you've got grandparents providing childcare, mom coming in and out for work, other cousins coming in and out? Really a lot of vectors that now we're becoming a part of.

As much as people have different viewpoints on the contagion, we're going to have to take the greatest degree of precaution that science is lending to us, that Dr. Fauci is lending to us, and make people feel fully comfortable. Even the ones that are like, oh, my God, come here yesterday, please. They're still going to look at us once in a while and go, hey, well, wait a minute. I heard there was an upsurge.

Can you make sure that you wear this and take your shoes off and this, that, and the other? And we're just going to have to deal with that knowing that Medically speaking, all of it might not amount to a whole lot of protection, unfortunately. But we've got to take a shot at it. Otherwise, we're not going to know. It's really so many questions to be answered.

I know that I have to in advance admire any of our colleagues out there, and I extend that as widely as I can, who have been actively doing this. I know we've got some people near and dear to us in Arizona, for example, who have not yet stopped throughout this entire time going into people's homes, I think we're really going to be at the forefront of medical treatment in many ways as we open things back up because we're coming into that very direct personal contact with people.

So I don't know that our work has added a new level of importance to to so many things, to how we're going to contribute to special education, to medical practice. Our clients are also going to seek and need medical treatment during this time, many things that we haven't explored with regard to that. So it's an exciting time, but it's very scary. It's very daunting at the same time.

And yeah, I think that I'm looking forward to the contributions that we might lend as a field of ABA to many other questions, not just treating autism, but things like safety practice, precautions, things that are going to affect the general public much more. Not to mention something we won't go into right now, but much more political practice, racial tension, policing, things that maybe ABA on tap will choose to delve into here in the near future because it does involve individual behavior.

And now we've got this cascade or this cascade of antecedents, if you will, to this undesired, I run away from the Zooms because now I'm bored. My friends aren't there. This is weird. And I don't like math to begin with, just to give a hypothetical situation. So we have to begin to learn from that and reconsider what our content is. Again, we're not teaching math. That's the school's role. But can we help kids self-monitor their own enjoyment or practice of math? Absolutely, we can.

So, you know, there's a lot to learn. I'm excited. Again, there's a lot to learn. So it's also daunting. But here we go.

But on a different level, it seems like the most common reinforcer that any, I want to say, ABA practitioner uses, if they're honest with themselves, is electronics. And now we're offering more electronic reinforcers and the kids aren't motivated. So maybe it's showing how often we prompt it and how often we kind of force the square peg through the round hole, so to speak, without even really realizing it.

And now that if a kid doesn't want to do session, they just turn around or they put their head down and we're not there to physically prompt them to do anything and they don't do session, which maybe should be kind of the more ABA way of doing things is. Oh, well, the kid doesn't like this. Let me put on another video. Let me try this. What can I do to get this kid to look up, or individual, whatever, this individual to look up to get their engagement?

Because I'm not going to be able to basically force their engagement anymore. That's been the number one kind of complaint or, I guess, setback that I've been hearing from a lot of my clients. If they don't want to participate, especially in our social groups, they're just not going to participate.

ABA is a product of the environment, and so often I feel like we want the kid to – we're going to send the kid to a breakout room or we're going to talk to them about how they need to participate more. But the environment is us, so it really highlights how we need to change what we're doing to be more motivating, not necessarily make them be more motivated by the same things that we're doing.

And then how much do we force it before we realize, man, we got to change because this is not working. Now, unfortunately, just like yelling at a kid or hitting them, Once in a while, it does work. So then an RBT takes that, or a professional takes that, and they run with it. And now they want to generalize that. And again, that's not incorrect as much as what can we learn about how we modify those things.

And now, use the other techniques that we had a hard time adapting, but I know that I've always loved discussing with you. Things like, OK, so I'll just use some examples from my day-to-day. The kid wasn't engaging with us at all. We helped the parent with some school content and interpret that and ideas to do it. Kids started engaging with us on screen with the parent help. We want the parent to be there, kids young enough that they shouldn't be by themselves.

But they still have this knack of understanding what the school content is. So anything that's not related to, or what we call non-preferred, that's not reinforcement related, she's gonna start crying and leave the screen, right? So what do we do about that? Well, we have to desensitize. Wait a minute, she's crying, but she's not leaving the screen. So how do we get mom to soothe her during that time so she now tolerates that new content?

And then now to what it is now, which is, okay, you're not preferring it and you have this wince on your face, but you're not leaving the chair, You're not crying anymore, which means you can hear more of what needs to be heard from a school content perspective. And now we can reinforce you for, you know, differentially for a new and more desired behavior.

So it was a lot of shaping, much more shaping than maybe we're accustomed to doing, even though we would love to use that technology in speaking. we may not necessarily apply it in the same way, because we want to come in with our own targets and our very clear goals, and how long we wait for those to come about or a rapport to be built, that's something that maybe we learn more about during quarantine. Okay, and pardon a longer than usual pause there if it sounds awkward.

We're not sure at this point. We had a little Zoom blip. Dan, I was wrapping up the idea of rapport building and shaping, and what have we learned during quarantine? quarantine how will we apply that moving forward

Maybe it's just that direct or literal use of technology that it was, okay, so we're away from the table and chair. Now we're at the computer. So what does that mean? That means the kid has to sit in front of the computer, and that's where a session is going to be. The computer is the new table and chair. So I think when you talk about shaping, I'm looking at it. We could definitely talk about how we work to shape technology, parents' involvement and things like that.

I think this was a good conduit for that. It was almost like a blunt force. Parents have to be involved.

No, because this is the way it's, you know, it's like, and I got to do 10 trials. Why? Because you can't divide by any other number? I mean, oh, I'm sorry. Whoopsie. I'm sorry. That was a little bit facetious. But you

So, yeah, you've seen my efforts on building joint attention and really getting... technicians to focus on that as a behavior that we can record or observe use whatever works and make sure you're using sights and sounds and then their eye contact as a response as well as their pointing and then maybe you're going to get them to respond to their name as a singular target not this macro overall arching if you don't do this now you know 8 out of 10 times over some consecutive streak you're clearly,

you know, severely autistic or something. I'm being facetious, but you get my point. It's like, man, we really worked that out nauseam. Are you sure that's the one skill response to name? Or is there a bigger umbrella that we should be dealing with, like joint attention? Ta-da! Response to sounds. Whoa! Orientation of gaze to sounds. Hey! All other behaviors that we maybe have mistaken for targets, like colors or... response to name, for example.

Again, not that it was wrong, but maybe not sorted out as well as we could have. Of course not, because it was a direct transfer of technology, and dear people like Ivor Lovas expected us to expand the technology, not just replicate and get stuck in it.

And I'm saying this, I know I sound extreme, I'm saying this from a company that I feel like is one of the most progressive and least table-oriented companies that I'm aware of. Um, and I still see some of that, that authoritarian, that, that sit down in front of me, kind of, we're going to run through trials. Like you said, the 10 trials, so we can hit all those trials, uh, ABA. So yeah, that's just what kind of came to my head when you said shaping.

And the other thing that kind of came to my head too, is, you know, people saying like, Oh, the kid won't pay attention. They keep wanting to leave. Well, why is that a problem? See where they go? Like what, why do they have to stay right there for the whole hour? Why, why are they incumbent to listen to all that we say? And, and, do exactly what we say when we say to do it.

You know, why can't they leave and go play and we can follow them and make what they're doing a little bit more interesting.

So that's just, you know, it comes to my head when we talk about these things and what I'm going to try to take back from the coronavirus and kind of wrapping this topic up is the lessons from the coronavirus is I want you guys when we're back in person is to pretend we're on the video screen and you're not going to be able to make that kid do what you want because And we'll talk about it in a later podcast as we talk about potentially policing it, how often potentially police resort to the

force because they can use it, while it might not be the best option, but it's one that they can use and is readily available. I feel like sometimes in ABA we do that. I'm not saying we touch our kids, but because we can prompt them or we can block them or we can withhold things from them, it's an easy thing to do. So as we go back into the field, Pretend that your kid is on the other side of a video screen and you can't make him do something.

Now, how are you going to incent him to do it rather than make him do it?

He can do a lot of things. He can cuss. He can do it. They're like, no, he can't. In fact, he did do it. That's why he did it. Our job isn't to make it so somebody can't do it. It's to figure out an incentive to make them not want to do it. And I feel the vocabulary is really, really powerful in how we word things. So I think, like you just said, I just wanted to expand on that. Saying, you know, oh, they're not, they can't do it. Not really accurate.

But it applies here in the very same light, and I want to make that point, from the idea of being authoritarian or being authoritative. There are few situations in this life, I would say, where a parent needs to take what I like to say a hard no. And a lot of times we want to enforce a hard no when it's not necessary. So, hey, you're three years old, you're four years old, you're unaware, you're running in the middle of the street. I don't care what argument or tantrum you throw.

I'm not going to give in to that. Okay? So that's a hard no. Let's fast forward a few years. Your teacher's asking you to write your spelling words three times each as practice. You hate writing from a mechanics, from a fine motor perspective. And you suck at spelling. So how are we going to get them to write? Well, you have to write it. Well, you have to write it. No. What if they look at the sheet, they spell it out loud while you write it in highlighter, and then they trace over it?

They've actually encoded the word two times. They spelled it out loud, and they've traced it. And maybe they've watched you spell it. And maybe you spell it back to them after they spelled it. Now there's a third time they've had to encode every word. That's the entire reason the teacher asked them to do that. But as parents, we might also get stuck into an authoritarian perspective and not consider all these other options that we have available to us. And just getting our kids to encode.

In all fairness, we're trained in this. It's easy for us to think about this. And maybe it's not so easy for parents, which is one of the functions we may serve, hopefully, to be a helpful resource. But the idea is more, don't get stuck. Don't get stuck in the idea of, I said jump. And I told you how high. And if you don't do it now to that exact height, now you've failed. And I'm not going to give you anything to promote any approximation toward that greater goal.

I'm just going to go ahead and say, nope, x. Nope, minus. Are we guilty of that? Maybe. Maybe a little too black or white, not enough differential reinforcement, not enough gray that we're sort of building up on from a much more human perspective. You know, again, I'm on my soapbox now. But you get the point. What have we learned? What have we learned?

And we work on ways of promoting behaviors with increased distance and reduce physical prompting and things like that. So that's what I took from it. I'll pass it to you if you want to comment. add any additional COVID-19 getting back into the house tips?

You know, thinking of this like a dental procedure, if your kid is young enough and they're getting a root canal, yikes, this may be a bad example, but you're not going to leave the dentist there by themselves. You're going to want to be in there, you know? And that's kind of what we're saying now. Hey, you kind of want to be in here because, in fact, you're kind of like the dentist in this case. Once we leave, we need you to be running these procedures.

So that's the only thing I would add to your very full list is let's just remember that this is now a hybrid model. The new normal doesn't mean... Back to what it was before mid-March, it now means a hybrid. It means a little bit of both with one last thing, a whole bunch of social skills now redefined. Are you looking at my mouth? Am I uncovering my mouth for a second, covering it back up? Am I lending you more gestures?

More importantly, am I putting it back to your parents to make sure you're looking at their mouths? Because now I got to keep my mouth covered. How safe are you along with testing? Do I wear a face shield? You know, so on and so forth. So many variables. I do admire our colleagues in our field for staying on top of this, especially those of us who, you know, like me, like you, haven't had the luxury of telehealth this entire time. We are very grateful for that.

And Looking forward to learning from the rest of our colleagues how to stay safe. So please do provide feedback on Facebook, Buzzsprout, any of the avenues that we've provided. Our Facebook page gives a phone number and email address. Please do give us your feedback, send your questions. We want to start proliferating more important information to that nice core of you listeners that has been listening. Thank you so much.