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.
All right, all right. Thank you, thank you. Welcome to ABA on Tap. After a long, long break, it's good to be back, and actually good to be back live and in person. I'm not talking to my good friend Daniel Lowry on a Zoom screen today. He's right here next to me. How you doing, Dan?
What's going on, Mike? You look very well rested, considering you have a six-month-old two rooms down.
Thank you, we are in the home studio, in the reptile studio, which is my teenage son's bedroom. And yes, I am officially on paternity leave, which means maybe I'm a little bit out of immediate practice, but I've had a lot of time to reflect and think about our practice and the things we do. We're excited about our episode today. We're coming back with a little bit more self-reflection.
We like to entertain criticisms of ABA, especially when they come from ourselves, and And today's episode is entitled, or we're loosely entitling it, we'll see if it sticks, Strange Technologies. Things that we do, things that I can say, whether I'm in California or in Georgia or just amongst any group of ABA professionals.
terms that will be recognizable as technologies that we all envision in a certain way, and we're going to break them down today and find out why it is we do them, where they come from, what level of effectiveness they seem to present, and better yet, how do we improve our use of these technologies, if not modify the way they're used. So really excited about this level of self-reflection. Are you ready, Mr. Dan?
I'm super excited, Mike, because as you know, I run both new hire groups and case manager meetings as well as parent groups and these are some terms like sensory and visuals that I see you know thrown around our case manager meetings and things like that from time to time oh this client needs visuals or parents will ask during my parent group oh I think this is sensory or oh we need to I want to write a social story or my child needs a social story for this and I think these are some interesting
things while very useful technologies that we can explore how useful they are and can we maybe break outside the box of what that means or first establish what they mean and then break out of the box to figure out how to make them more individualized and more technologically savvy as we continue to progress.
Perfectly stated. That said, let's jump right into one of the examples you provided. Very common phrase. New client. I think if we had some visuals, it would help the child understand what's next on the schedule. The idea of a visual schedule. We'll talk about break time, the idea of a visual that says break time. To follow our little rubric here, what do we mean when we say visuals, Dan? What do you think it is that we're envisioning?
Well, I know what we don't mean. We don't mean the iPad, right? That's not visual. That can't be visual. Is that
because you hold it with your hands? What are you looking at? Apparently, you
take the iPad in through your nose or your mouth or something like that. But visuals only mean things that are laminated, usually about like a three inch by three inch, maybe even less than that, like a two inch by two inch square. It has to be square. Square card with a board maker. A little shout out to board maker. I have no advertisement entity with them, but shout out to them. It has to be laminated thrown on the wall, hard Velcro on the card, soft on the stationary.
That's your visual for ABA.
Hard on the card. Hard on the card. Man, you are pulling out all the stops today. Yes, that's exactly what we mean with the word visuals. Now, where do these come from? Why do you think we've adapted them and We'll break it down a little further. Where are they useful? Where have we overused them? When we think of the 2x2, 1x1 in squares, we think of Boardmaker, which may or may not be the current technology.
I think I've, by and large, abandoned the use of that exact definition of visuals for a long time now, knowing that if you're a sighted person, anything within your line of sight is a visual, per se, if you can take it in or perceive it visually. But if we think of something very useful, I know you like to tease me about this, but we think of picture exchange communication systems. Something that is empirically validated, very useful, very complex.
And that's certainly probably one of the foundations of this term we throw around in terms of visuals, in terms of exchanging these one by one, two by two inch laminated squares. The reason they're laminated is Because our kids will tear them up otherwise. So they don't rip. Exactly. Okay, so just to make clear again, why do we actually do this? Why do we practice these things? We're going to break it down all the way. Also for longevity
of the
specific. Yeah, for the preservation of it. Right, again, why square? No idea.
No, it has to be square. Because A is D and square is...
Maybe because board maker... put out the square grids when you would pick the icons. That's probably why.
Because you could fit, what, 10 icons on a piece of paper if they're square, if they're circle, and it takes longer to cut out if they're circle as well. You can't use one of the slicer things if it's circle.
Now, notice that this technology replicated itself in this manner across... I mean, almost, well, at least the nation. I don't know about internationally. But yeah, for these very reasons that are not necessarily scientifically, empirically validated, just pragmatic reasons. Exactly.
And notice how I know we're being facetious on why they became that way. But I would venture to guess that the reason that they're square is to fit the most amount on the page. And all of a sudden, this technology now has to be that way. like you said, as no scientific reason or no benefit to the ASD community or a visual orientation, just for ease of access. So that's an interesting point that you brought up.
I think it is important for us to think of it that way, again, not to invalidate the technology or its use or its efficiency or its effectiveness, for that matter, but really deposit it as to where it came from and what it's worth. So that now means that, you know, any... page in a children's book for a client can serve the same function and has the same shape, has some sort of visual iconic piece on there, has words that are also visual.
Okay, so we say visuals, we're not necessarily thinking words, we're thinking icons or an icon that has a word underneath it. A very, very specific format that self-perpetuated and then becomes a definition of treatment or a treatment procedure. So now in ABA, we're using visuals as opposed to visual strategies, and we've got this idea, this vision of these squares with these sort of funny icons sometimes, sometimes with words, sometimes not.
And I think the danger in that is that people end up making attributions. So somewhere in a young RBT's mind, the idea of of visuals becomes this magic wand that the child with AST automatically understands, even though we know that that visual icon, that square, is going to take as much teaching and learning as anything else we're going to demonstrate to that client.
Now, yes, they might make a visual match in terms of what's pictured on the icon or the square and some something in their natural environment, in which case then we're taking advantage of that cognitive skill to match item to item in some way and then using that as our kernel toward learning and expanding toward new learning and whatnot. But I don't think that that's the way people conceptualize it. They look at it and say, oh, we need visuals. Why?
Because we're doing ABA and because this child has ASD and naturally ABA has these one-by-one, two-by-two laminated squares with board maker icons because naturally kids with ASD gravitate to these things and they understand them as though they're natural to them. And those things are not true whatsoever. And I think that's the real danger in, or that's the only danger that lies in that generalized phrase of let's use visuals.
Yeah, you sure covered a lot of ground there. I think that the first thing you said is kind of where do they come from? I think that, I think of visuals as, you know, Ikea instructions or speed limit signs or things like that. And the usefulness or where they come from, I think is twofold. One is because oftentimes, at least historically, individuals with ASD either have or have said to have had auditory processing disorders. So that can be an area of struggle. So how do you combat that?
Or how do you communicate to somebody with auditory processing disorders through visuals? But what visuals do provide is kind of a universal understanding. And what I mean by that is I can be on a freeway in California or Maine, Florida, probably other countries as well, and see the white sign and the numbers there. And I automatically know that that's a speed limit sign.
So it does create some universality of like being able to see it and identify it without even necessarily knowing the language and things like that. Even though the word speed limit might be in a different language, I can still understand and conceptualize what that visual is representing.
So I think that's kind of where it comes from or an Ikea instruction, rather than having to write it in 1500 different languages, they show you the picture of it assembled or, you know, typically just assembled and you have to figure it out. But in theory, it would be in many different steps. And that allows a learner to not have to individualize it for different languages, languages and hopefully make it more universal among the understanding.
I think one other thing that's kind of important that you are highlighting is that the ABA is obviously a consumer product as well. And I think as ABA has certain traditions, if those traditions are absent, the consumers then are wondering about the quality of ABA that they're getting.
So what I mean by that is because, for example, my previous company, and I would imagine a lot of the A lot of companies, including ours, we use visuals as well, but there's certain traditional visuals that are established with all new consumers.
And if you have an ABA provider that doesn't come with that new hire travel scale or that new consumer travel schedule, visual schedule, things like that, a parent that's savvy or maybe thinks that they're savvy and has heard all of the visuals that their friend's kids have gotten might look at their provider who doesn't bring those things and be like, well, I'm not getting the quality of ABA that I want because I'm not getting these visuals that my friend's kids got or I've heard that ABA is
attuned with. And that can also probably lead to some curiosity with parents. Just as we went through as the switch from DTT to PRT, when we stopped bringing the table and chairs and parents were like, what is this? You're not doing ABA. Well, if we don't bring the visuals, they might think we're not doing ABA as well. And by visuals, I mean the specific visuals that are associated with ABA. I'll pass it back to you. But as you've alludicated so nicely, that is just one Yeah, again, I mean,
I would assert for a sighted person, the whole world is visual. Absolutely. And that's where I think that we really use a reductionist model. I want to branch off on your point before I forget, because I think it's really at the heart of the matter. When you were talking about speed limit suns, There's a certain orientation to the color of the signs, to a certain Arabic numeral underneath the sign, whether you know the language or not.
But you have to have a specific premise or understanding of the color scheme, the positioning of that sign, the number orientation. And I think that's what I really want to assert here, is that especially younger professionals have this idea that just because they've created this visual icon, now the child's going to understand. And they forget all of the learning that we're going to have every day.
trial of when I show you this visual icon this happens I show you this visual icon this happens just like you had to learn your numbers and then to read before you then took driver's ed and learn that this white square and I think that we gloss over all that as though Visual icons, autism, oh, those things are, they go together, and kids with autism naturally understand these icons, knowing that they could be circular, they could be triangular, we could put, you know, for all intents and
purposes for young learners, we could even not use English on there. It's whatever we teach them surrounding those icons, and I think that's the real part of the matter we're trying to get to, is these technologies have become so blindly implemented that sometimes we forget about all that. There's a whole aspect of learning that that needs to be associated with the use of that icon and what happens in response to that icon that I think sometimes younger professionals especially might miss.
Unless you have any other points to wrap up on there, we can actually smoothly segue into one of those visuals that gets very commonly used, which is the idea of break, break time visual, right?
Because you have to prescribe or preempt some sort of escape behavior with appropriate behavior such that you're not reinforcing the elope or whatever undesired behavior we see at times when we're trying to get a kiddo to sit, to stand in a certain location for a certain amount of time, to attend to a certain part of their visual field.
As we try to put those visual stimuli or present auditory stimuli along with visual stimuli to get them to engage and then respond in some desired form, the idea of break time technology, both from a visual perspective and then what it means in ABA. Tell us your thoughts on that.
Yeah, I think break comes from the negative reinforcement aspect of we're presenting something you don't want to do. And the reinforcement you get is oftentimes a negative reinforcement of getting out of or not having to do more of the stimuli or the activity that we're currently presenting that you don't want to do. And then you get absence of that, which, number one, begs the question of why do we have so many activities that kids don't want to do? That goes back to a teaching procedure.
But the second thing is just this concept of break. And I think... Break oftentimes is, like I said, the absence of something, and that's how it's presented is, okay, you're doing five minutes of homework, and then after that you get a break, which means... Zero minutes of homework during the break. And typically that's also done in solidarity or isolation by the kid. It's like, okay, you get access to your toys or go play because you don't have to deal with the homework.
Not only the homework, but you don't have to deal with me as well because for whatever reason as an ABA therapist, I've now become aversive because I've been paired with the homework. So you get the negative reinforcement of avoiding both of those during your break.
So I would, again, attribute, and I'll pass it back to you, Mike, that when we talk about break, it's really really important that we pair learning with breaks and and we make it more of a fluid idea instead of work break work break work break we're working while we're on break and we're feel like we're on break while we're working it's a good rbt could kind of make that session look
that's um and maybe it's a matter of semantics but i i agree with everything you're saying there in terms of how we're setting up our own language, that part of what we do is going to be unpleasant, and then we stop doing what we're doing because that's going to be the pleasant part that reinforces you and allows you to escape from this torture that we're otherwise subjecting you to in between those break times.
And again, maybe it's a matter of semantics, but I think that one of the things that you often highlight is that from a practice perspective or an implementation perspective, break time also means that I'm doing nothing with you now. I had my program. I ran my 10 trials. Now it's break time. I provided you your reinforcement. You've got your iPad. You're chewing on your M&Ms. And now I fail to interact with you by and large. You made the point just right now.
That means that there's no learning happening during break time. That's just not something that semantically or from a pragmatic perspective we want to promote. I think that learning should be continuous and that if we're taking a break, what that really means is that we're not doing anything at all necessarily. We're putting some things away. We're getting some new toys out. Maybe the child's not allowed to go run around the house for a little while. Maybe that's a good time to go grab a snack.
A snack is a break time where you otherwise stop doing everything else and just eat. Exactly. Exactly. I like that. Point being is oftentimes we also multitask those things, right? I know professionally I'm eating lunch, I'm doing something else. The idea of a break means you're stopping everything to do something else, like eat, for example.
I know we'll get to edibles later, and that has a strange technology in ABA, but it fits right in here that there's this notion that Break time now, we're not interacting, and I think that would benefit from changing.
Now, we know that this comes very wisely, as you were saying, from the idea that you're we're giving you a predictable end to something that might be challenging for you knowing that if we've set up a task that is so challenging that you keep running away then it's up to us to modify that task or to make it seem more accessible or more achievable in order to build that momentum in which now we're reducing the likelihood of some sort of need for escape or a break and then furthermore when we're
breaking it doesn't mean that i'm now not interacting with you it means that we're just shifting gears into something that's not necessarily data oriented or that I'm counting but now we can play something else and it might have a preferred stimulus that you you know again that's providing some reinforcement as a result or coming after these more rigorous learning activity I think you said something that that
really resonated. As you said, after the task, I give you your reinforcement and then you go on break. That just highlights the very traditional structure of ABA, that the reinforcement number one is something tangible. So it can't be something that I am because I can't be the reinforcer. It's got to be something tangible and it can't be the task itself or it can't be the natural consequence of the task itself.
It has to be something tangible and edible, which we'll talk about in just a little bit here, an iPad, something like that. And then you go and enter with it alone. That's the biggest issue. So even if you want to argue and say, well, we can separate learning from table time and break, I'd debate that, but that's not the hill I'm going to die on. The reinforcement would be a hill to die on, saying that after the test, I give you a reinforcement, just because this happens so often in ABA.
A reinforcement is given and the individual engages in that reinforcement in isolation. And then we get an 18 year old that the parents like, well, how come they only do homework to get the Xbox or how come they only brush their teeth to get the iPad? It's like, well, we've never engaged in that reinforcer with them. And then, you know, breaks always been that's how it's always been. So for the last 10 years, you've been having that contingency.
And you expect just one day they're going to wake up and be 18, and that's going to break, for lack of a better term. So I think that's something that you really highlighted that's really important. Reinforcement can be mutual, and it can also be engaged in by both parties during the break.
That's an excellent, excellent point. Just in terms of the balance between positive and negative reinforcement, too, meaning that now because you've completed the task and it goes away, negative reinforcement, now I add more of my attention, more of my time as we engage with something tangible or maybe not, maybe just conversation, maybe just praise. These are all things that, by and large, you're absolutely right.
Because we've reduced our modality, our mode of practice, yeah, even in the first that I was putting forth, there was an assumption that now reinforcement is edible or tangible in some way, shape, or form.
And even the way we do our preference assessments, and again, a lot of this, I don't want to over-scrutinize, we do it as a matter of organization, but even the categories that we look at within our preference assessments or our reinforcement inventories all sort of hit these interesting words of how we see reinforcement primarily as something extrinsic, knowing that we talk a lot about extrinsic and intrinsic motivation and ABA and how most of what we do seems to be extrinsically based.
That's a very, very good point. Leads us very nicely into our third strange technology, and it's more about the way we implement or utilize these technologies with regard to reinforcement. And we originally just had edibles on the list, and then you mentioned tangibles. So I went ahead and did a little slash tangibles on there. Give us your thoughts to start on this.
What is strange about the way, you already started on this topic a little bit, about the way we implement edible or tangible reinforcement?
Yeah, it's just so... divergent from whatever the task is that is being done to accrue the reinforcement.
Completely unrelated.
Unrelated. And Schreibman and Kegel and Kegel with PRT did a really good job of making sure that the reinforcer was a natural consequence of the behavior, i.e. getting good grades for completing your homework or getting a high five for scoring a goal in soccer as opposed to getting the iPad or an M&M, something just totally unrelated. But yeah, it in itself makes sense and is useful and probably necessary, at least in the beginning.
I don't expect a six-year-old to do their homework to get good grades. So yeah, we're going to need some motivating motivator there to get them to engage in the homework behavior. But it's really, really important that we work on fading into that naturalistic reinforcer and fade out those edibles and tangibles so we don't have the 18-year-old only doing their homework to get access to the M&Ms.
I think a big part of this for me, and I alluded to this earlier, is that one-to-one relationship or that particular reinforcement or schedule density, if you will. You give a response, I give you an M&M. Now, in and of itself, there's nothing wrong with that other than if that's the only modality in which we perform or function, then we're creating some poor habits, some habits that aren't gonna transfer well in terms of how one derives or extracts reinforcement from their environment.
So one thing I like to think about in terms of edible reinforcement was, I mentioned it earlier, the way we manage time. So the notion that now we can have a snack time on the schedule or that a lot of times we're seeing kids during mealtimes and there's needs in terms of attention or fine motor and utensil use during those mealtimes, now we have a really good place for edible stimuli to be available.
The other thing that I'll add really quickly there is that we always regard or primarily regard this idea of of reinforcement, especially from an edible perspective, again, with this ratio of you give an answer, I give you the M&M, where if you conceptualize it more as concurrent reinforcement, As long as you're engaging in what I'm doing with you, then now we're just having a snack time while I read you a book.
And if you're reading a book with me and right now you're having a snack time and you're chewing, now the natural social etiquette portion of you chew quietly and don't speak while you listen is very conducive to the listening behavior that I want while I read you the book. And if you're able to have access to the snacks, then the likelihood of you sitting in front of me while I read you the book is also an increase in likelihood.
So you see how those things come together And if we're not careful, in analyzing all those pieces, we might end up with that indirect behavior to reinforce a relationship where the kid makes some important behavior and gets an M&M, which is completely unrelated.
You brought up an interesting term that I've never heard brought up before. You said extracts reinforcement from their environment. And I think that's a really, really important term because we don't want an individual that's 18, or let's say 22, dating somebody and goes up to his girlfriend and starts doing homework Thank you. because he expects her to then take her, you know, take him out to dinner as a result of that. And that's how we've taught him, you know, from the age six to 18.
If you want edibles, you do your homework to get edibles. There's no real correlation there in the real world. That's not how you extract edibles out of your environment. So I think that's an interesting point as you bring up. I mean, that's really what we're trying to do is teach individuals how to navigate their environment, live their highest quality of life, and maximize their access to reinforcers.
And all of the reinforcers you're talking about, these edibles and tangibles, are provided by other people. So if that person's not there, then they're not going to be able to extract that reinforcement. Teaching them how to do it is going to have to be done at some point on that natural reinforcement level.
And I'm glad you mentioned that because there's a sense of enjoyment, I think, that... when we just deliver the tangible or the edible, we might fail to associate. So the idea that something tastes really good as a result of you Performing a behavior which then allows you to complete say your homework.
So now that demand is removed from you and Concurrently you might be tasting something very good in your mouth while your dad pats you on the back and says good job Billy and has a big smile on his face and says I'm really happy with your performance Think about how rich That level of reinforcement is as compared to just the delivery of the candy bar or whatever it was. And I think that's the important part is we have to remember why we're trying to sweeten that moment.
Why is it that I want this kid to taste this M&M as a result of them doing a behavior? because I want them to integrate the entire experience. That it also makes me happy that something good is happening in their mouth because they decided to communicate with a vocal behavior knowing that they might have a communication delay which has not allowed them to communicate with vocal behavior very readily.
Again, if we don't conceptualize it that way, even just as practitioners and as purveyors of that edible reinforcement, we might be missing 90% of the treat.
Yeah, you brought up two things that I think are interesting. One, in addition to the point that you brought up of making the reinforcement more rich, It also creates habit, which I think is important. Maybe without the edible or the tangible, they're not going to engage in the behavior. So we do need to create that habit. But if nothing else, like I've told so many parents in my parent groups recently that we got to make this reinforcement more rich. So instead of, hey, you did your homework.
Here's the iPad. It's, hey, you did your homework. I'm so happy that you did your homework. It makes me really happy and feel good as a mom. When I'm happy, you get the iPad. Just that intermediate step makes it more rich. Now, if you want to throw in some, hey, you did your homework, that makes me really happy. You're going to get good grades, and now you're going to go to a college and make a lot of money and things like that. Now we're making the reinforcement even more rich.
So making it more rich, I think, is a huge... We like to do things that are easy oftentimes and just giving the iPad and saying, good job, here's the iPad. But then we blame the kid when 10 years later they're just doing the homework for the iPad because we got lazy on the reinforcement. Moving... Oh. Moving right along, I think that makes a nice segue into the good job portion of our next technology, if
you wanted to take it back. It does, it does. It was not next on our list, but I think it does make a good segue. So something else... And I remembered what I forgot earlier during our pre-recording discussion. Maybe I'll throw it in here, maybe I won't. But it has to do with phrasing and the things that we provide as vocal stimuli in order to either evoke some sort of behavior or try to reinforce. And we put this all in one category that we called Quiet Hands, Calm Body, Good Job!
And again, very common phrases that everybody recognizes, kind of catchy, you know, quiet hands. We know that kids on the spectrum, maybe from a linguistic perspective, are going to have trouble with idioms, yet we... sort of insist on using these vague phrasings, calm body, what does that really mean? And I'm being facetious and mildly critical. I don't think that there's danger within these phrases as much, again, as to how they're implemented and what we really mean by them.
So I'll pass it over to you. What do we really mean by these things? Where do they come from? How effective do we think they are? And then what could we turn them into?
Yeah, good job's an interesting one. I almost cringe when I hear good job being.
Good job,
Dan.
Good
job. Being used because.
You're not saying it right. You have to say it with. Good job. Thank you. Yeah, you got to have that inflection,
which obviously we would want that inflection if the individual understands tone. So
prosodic, well, and sorry to interject, but from a developmental perspective, prosodic cues being the first thing we understand, right? So that's why especially moms talk to babies the way they do with these words and very in And then you save the other tone for the things that you want them not to do. And prosodic cues are very, very important, something that we should always use for sure. All right, continue.
Yeah, so I guess with good job, I'd argue one of two things. It's either not reinforcing or it is reinforcing, obviously. If it's not reinforcing, then why are we using it? Maybe the kid's not that engaged with us. They don't care that we're happy that they did the whatever thing. correctly or they perform the skill correctly. It doesn't matter. So why are we using it? Or if it is reinforcing, why don't we start changing it and giving them some informative function onto why they did a good job?
Because that's the whole thing that we lost here is this informative function. So instead of you did your five math problems right, good job. You did your five math problems right, oh, you're going to get a good grade or something like that. Giving that informative function, it's almost egocentric from us as therapists to to think that our good job really matters. That's kind of almost like an egocentric, thing for us to do inadvertently.
I know it's kind of abstract because we've done it for so long and we don't really have to go down this rabbit hole, but if nothing else, it does remove the informative function from whatever the task is. Then I just cringe when I hear people say, good job now.
And you make a really strong point. Really, the words by themselves, it could be red, blue. It's the way our face looks. There you go. the way our voice sounds. It's the fact that now the math book and the pencil and the paper are being put away in the backpack. It's the fact that mom is smiling, so the idea, oh, look at your mom's face. She's smiling. That's because you're done with your homework. Now you're done with your homework. We can go outside and play.
All those things, again, the prosodic cues are important. You're absolutely right. All the information, all of the things that are now happening as a consequence of you finishing your homework, just like with the edible reinforcement, when we're not careful, we reduce it all down to a good job. And yes, I'm not saying that it's completely devoid of value, but we're probably losing a good 90% the exchange there. Quiet hands, calm body, right? It makes us feel good to say that.
What are we really envisioning when we say those things?
We're either envisioning a kid squeezing his hands or putting his hands in his pockets. Wow,
those were good phrases. Say those again. Those were very descriptive. Squeeze your hands. Put your hands in your pocket. We don't necessarily use those. Those are very
nice and descriptive. They have to be less than 12 decibels.
Makes much more sense than quiet hands. I interrupted, sorry.
Yeah, no, that's... You nailed it, right? Quiet hands. What does that mean? What if they're... playing guitar or something like that. What does quiet hands exactly mean? Don't clap with them? And what about calm body? So if we have a child who's asleep, is that our end goal? Because a sleep child is really going to have some quiet hands and calm body there.
I like that one. So next time I say that, I'm going to want a child to fall asleep. Because we would not be happy with that response either, right? So again, you made some much more descriptive statements in terms of where do you put your hands. Put your hands on the desk. Put your hands here like me.
So many other things that we could conjure up in those moments that would be much more descriptive, much more declarative, much more concrete, especially for young learners, knowing that from a developmental perspective, concrete language is important for just about any kid under five.
And maybe for some of our clients that are experiencing some delays in receptive communication or understanding, we might want to use that to their advantage so that they understand quickly and firmly, especially in those moments where we're trying to get them into a learning situation, to sit with their hands in a certain place, to sit without making a certain amount of noise with either hitting things or moving things around or with their mouths, and then therefore much more able, at least
within our logic, to listen and look and learn.
Yeah, and I understand as a listener you might be listening to Dan and Mike thinking, oh, they're just curmudgeons picking up random stuff to nitpick. But this is really important because in ABA or in any treatment of any individual, you want to make things as normal as possible and get them in the least restrictive environment as possible. And you're never going to go to your significant other and be like, you know what, honey, you need to have quiet hands and calm body.
Or be in a classroom and see a teacher say, you know, quiet hands, calm body. These are such ABA-specific terms that have just gotten overutilized that are not going to generalize into less restrictive environments, we really need to start looking at other ways to communicate these things that are going to have higher levels of generalization and, like Mike said, understanding as well. Because if somebody came up to me and said, quiet hands, I wouldn't even necessarily know what that meant.
I'm going to mention the one I forgot earlier, but we won't discuss it. But I think stranger danger fits in here. I think it sounds cool and it rhymes. but semantically doesn't necessarily communicate what we want it to communicate, knowing that we want our kids, a lot of our clients, to actually be more social in the arc, and that that phrasing actually just makes all strangers dangerous, which is not completely untrue, but also not completely true if you want to meet new people.
Yeah, well, teachers are strangers, right? At some point, right. And then you reference your parents' response to your teachers and their idea that they're saying this is okay, and that's the stuff that we really need to get to. But again, we won't get into that, and I don't have as much of an issue with that phrase as I do with the ones we mentioned. Moving right along into our fifth strange technology, at least for this episode. This is by no means an exhaustive list.
Okay. Carol Gray is one of the persons in our field near and dear to my heart only because I feel like she's responsible for a very important technology which we've then estranged. We've done some weird things with social stories. I'll say a couple things and then pass it over to you.
Again, the notion of social stories, the information they impart, the formatting which Carol Gray and her colleagues have put forth as a way to make sense of these concepts in a well-formatted, structured story type stimulus, super, super valuable. Much like things like sensory diets, the way we implement them and when we implement them, I think, becomes a problem.
So, you're a child, you... emit some sort of undesired behavior, and now as a consequence, you've got individualized, undivided attention from somebody you prefer reading you a story about how you shouldn't have done what you just did. That sounds like potential reinforcement, an increase in that very well undesired behavior. The other part that I contend is I fear that social stories then fall under the rank of some of those things that are overly specialized in treatment.
Absolutely.
And I wonder where children's stories by themselves, Berenstain Bears, a number of other things that touch upon specific social commentary, aren't enough. Now, the advantage of social stories, to Carol Gray's credit, is these are individualized stories now. But they've become so treatment-oriented and so specialized that I fear that they've been rendered... kind of overly specialized, overly autizified. Is that a word? I don't think it is. You get my point now.
So now we're using these stimuli and these activities with these kids, but only for these kids. These kids can't access regular books. Again, I don't think anybody's intent is to say that as much as if we're not careful, we might practice it that way, and then suddenly regular books aren't enough to impart social lessons to kids that are on the spectrum, and by and large, we know that's not what anybody intends to do.
Yeah, it just goes back to that concept of treating individuals with ASD differently, and are we doing that because they're different, or are they different because we're doing that? You know, it's that chicken or the egg thing, but I see that all the time with both the parents and other staff that I work with. A child's having a difficult time with something? Oh, well, let's write a social story. And that might absolutely be a great option. Absolutely could be a great option.
But maybe there's other options as well. And that's the premise of a social story is to explain a situation. And a social story could be a very good way of doing that. Or you could just explain the situation. Or you could show a video model. Or there's a whole lot of different, you could take them to the situation. There's a lot of other ways of doing it.
And it's, you know, just like any good doctor would say, oh, like you have a I've got an individual that was diagnosed with cancer, and there's this, this, this, this, and this treatment. Let's figure out which one's best. They're not just going to be like, oh, well, you have this. This is what you do. You have this. That's what you do. There's options for everything. And the individuals we work with, there's options as well. And yeah, well, social stories are great.
Like Mike said, we can take the premise of social stories and books are social stories, right? But we get this very inside this box idea of it can only be a learning story if it says, my name is Johnny. I don't like haircuts. When I go get a haircut, this is what happens. That That is the only way they can learn about how to tolerate haircuts.
But if I was to watch a video of it or read a book where the character gets a haircut or something like that or play with my dolls or just even have a parent talk to me about it, that no longer is going to work. So great idea. Again, very, very useful technology, as are all of these visuals. social stories, all of these very, very useful technologies.
It's just when they stay in one format and are never expanded upon that it becomes a little bit, and never thought about the alternatives or ways of expanding that specific technology. I bet video social stories are probably gonna be more effective for kids with ASD now than written social stories, and YouTube's pretty easy to find videos on now. But when Carol Gray made social stories, Obviously, YouTube wasn't around then.
So, again, just always trying to find ways to progress these social stories, progress these concepts is going to be the important fact, in my opinion.
You bring up a really good point. And we've talked about this in ABA, by and large, running the risk of being too linear. And I think that's what you're saying is suddenly... Johnny doesn't get a haircut? Well, let's read him the social story. And this is the only intervention we have is we read the social story as opposed to having Johnny watch dad get a haircut and mom get a haircut and watching the videos. And the idea is that we're always feeding Johnny information about haircuts.
The social story is but one. Yes. But instead of that happening, oftentimes what happens is, oh, Johnny can't get a haircut? Then do the social story. And the social story is the intervention modality. And it's the only thing we do. And then when the social story doesn't work, it's Johnny's fault because we fail to diversify the modality of treatment and just leaned on the social story. So
as one tool, it's yet but one tool, like you're saying. And it could be a very good additional tool. It could even be the main tool. Sure. But it's very limiting when it's the only tool.
I think that's perfectly stated. And I like the way you expanded that to the rest of our technologies. We're not saying these technologies are problematic in and of themselves. We're saying the way we're implementing them and most commonly implementing them across the board is is becoming a problem or has become a problem. Absolutely. Okay. And I want to make that clear because a lot of people, just like you like to kid me, I don't like PECS. Not true.
But I do think that we've bastardized the use of PECS by and large in a way that sometimes renders it ineffective or ends up promoting or perpetuating those misconceptions we're talking about here that, you know, why do we use PECS? Well, because kids with autism have auditory processing deficits.
I think, again, please, anybody listening, feel free to write us and challenge me on this I think that's been largely debunked I don't think the kids have auditory processing deficits as much as from what I understand the research combining the visual and auditory streams is a problem so understanding that I'm looking at what I'm listening to is is where the challenge lies okay I digress a little bit let's go ahead and just brute force in the interest of time move into what I think is the most
important, the most frustrating of these strange technologies for me is when you have a kid who can't sit still and then somebody says, you know what they need? They need some sensory.
Well, should we pause and go to the sensory room to finish up this discussion?
Because you don't have a sensory room. It's not sensory. Is that
correct? You can only talk about or do sensory in the sense that
we have a sensory diet. I don't know if we have a sensory diet. We may not be authorized to actually discuss this without our sensory diet. Is there a sensory schedule? What's going on here? Oh my God. Anyway, we're being very facetious. You get our point. let's answer this from the very beginning. What do we mean, what are we envisioning when we say this child needs sensory? Is this child otherwise suspended in a state of sensory deprivation in some sort of floating tank?
I mean, what have we done to these children that they need sensory? Are they not seeing? Are they not smelling? What's happening, Dan? Help me.
It's interesting because, you know, sensory is defined as any of the five to ten senses debatably who you want to talk to but only those senses provided in certain facets are really attributed to sensory as we talk about it in ABA so sitting on a bean bag that's sensory sitting on a chair not sensory unless it's a sensory chair now it's sensory Or sand. Or like you talked about, glitter and water in a tube. And you can watch it go side to side. That's sensory.
But watching stars on a computer screen, it's not sensory anymore. So the literal definition would be any stimulus that is interpreted within your five arguable senses. But I think what you're talking about and the thing that we want to highlight is Somehow in ABA, only certain ways of providing those sensations became sensory, and everything else just somehow got thrown out the window.
And that's sort of my concern. Again, glitter in a bottle, deep pressure, brushing, a weighted vest, a fidget spinner, the little pop things that are sort of trending right now.
We tend to compartmentalize or put sensory into this interesting... little box and then these trends develop around those little boxes and then these items sell and then we get tired of those items and before you know it the fidget spinners become the very problem that we had at the beginning which is they're making too much noise and you can't have 25 of them going in a classroom anyway with 25 kids so now they're the problem they start getting banned even though they were promoted as the very
sensory solution at the beginning so it's like we go in these cycles of what you know so what We're talking about kids who are flapping their hands, kids who can't wear certain textures, they don't want to wear pants, they want to wear shorts or sweatpants. The idea that the tag on the back of my undershirt, why did Hanes do tagless shirts? Because everybody gets bothered by that tag.
So the idea is how much does it bother you such that you end up... being overwhelmed by that agitation, and then that impairs your function. So we can all relate to this idea of sensory overload or not registering things enough from a sensory perspective. When we see kids that take a big spill and they don't have a response at all, okay, that's not registering. That's I'm losing the word here, but that's not sensory overload. That's an undersensitivity. Hyposensitivity. Hyposensitivity.
Thank you. So there's so many things that we boil down into this phrase, that child needs sensory. Or I love, love when RBTs say, oh, they were having a really hard time, so I gave them some sensory. What does that even mean? Is that even an English phrase? Is that even grammatically or syntactically correct? No, it's not. But we all understand it, right? We all, oh, okay. Yeah, that means you gave them some sort of weird hand pressure. You did something on their head and they enjoyed it.
And because they settled into you, we find value in that in terms of reinforcement or engagement or otherwise. I'm not denying that. I think those things are very valuable. Again, it's the misattribution. It's the misrepresentation. And then the overgeneralization of that as an effective method or activity for kids such that we're using the phrase, you know. So if I never heard that phrase again, it would be too soon, right? Yeah. idea, oh, let's do sensory. What does that mean?
Is this a child that we've got headphones on and blindfold on and we've put them in a sensory deprivation tank? Are their senses not active? I think there's so much more to discuss in that realm.
My concern is that it was somehow correlated with occupational therapists wanting to get in somehow with the ASD and the way they could do it was through sensory. But again, it's just a hugely overgeneralized term. We look Look at the four functions of behavior, right? Sensory, escape, attention, and tangible. And so many parents will say, 95% of the behaviors the kids have is sensory. And that's wrong.
Honestly, 100% of the behaviors that the kids have, in order to engage in a behavior, you have to have some sensory, either hypo, You either have to be over-sensitive or under-sensitive in order to engage in those attention-seeking behaviors because you want your parent or you want the iPad because over-under-stimulated, that's the word I was looking for. So they all have some sensory base, but now we use this term sensory as though it overrides everything else.
And going back on what you're saying, we're all on some level of sensory... There's a continuum of... both individuals and their relationship to stimuli in the environment, and within that individual, their relationship to stimuli at that environment at any given time. And certainly at some point, certain things become problems. Certain people have certain tolerances. My girlfriend hates being in sand or flan because she doesn't like the sensory experience that that provides her.
But yeah, this overall kind of This sensory, I'm going to give a kid sensory or they have a problem with sensory. What does that even mean? And I think it's weird and it might sound like, again, we're being very, picking on semantics here, but when you actually break it down, I think it makes a lot of sense that that term doesn't really make sense in the way that it's being used.
So I'm going to offer, as we get ready to close here, I'm going to offer my general improvement on this whole notion of sensory. And I think that you're right. Part of it is this idea of sensory disintegration from an occupational therapy perspective. I'm going to go from a developmental perspective and talk about the first 24 months of development, which are all were primarily devoted to sensory motor development.
As you learn to sit up and roll over, you learn to crawl, and now things aren't just coming at you, but you're going toward them. So you start figuring out which items or objects are animate, which are inanimate, which have volition, which have agency, and you learn how far you have to reach to hit something. All those things that kids are learning as they learn to... Interact with the world. ...mobilize, It even changes their visual system. Oh, back to visuals.
When you taste something edible, is that a sensory experience? It sure is. So I think that it's one of these things that we've overly task analyzed in a sense.
It's got some good roots semantically to things like sensory disintegration, but for me, developmentally, looking at the first 24 months of life and sensory motor development, I feel that if those parameters don't resolve, then we have things that linger, like stereotypy, like hand flapping, like looking for more pressure than the average child seeks.
These things that if you don't somehow reconcile in those first 24 months of life, they might linger and spill over into continuing development, you know, maybe causing other complications or other challenges along the way.
So I would encourage anybody, it's beyond the scope of our time today, go back to your developmental literature, your Piaget and your sensory motor development phase, those first 24 months of life, and I think a lot of these pieces then start making more sense, especially with how we should integrate them and use them to the child's advantage and in treatment.
Obviously, when we see something that's aberrant or that's undesired... something that might be sensory based, something that's stereotypic, we often think of reducing it where I think the developmental answer usually is find its purpose and then replace it.
Find another way to integrate that sensory perception into their world in a way that now has more social significance or find a way to posit it in its place and time so that it's got privacy or whatnot from a social perspective and it doesn't remain an aberrant behavior. So I'm going to point people straight down sensory motor development in terms of learning more about what it is we might be meaning when we say this child needs sensory.
Yeah, I think like you mentioned when the therapist said, oh, I gave them sensory. Yeah, and hopefully all of session should be providing them with some... Please. Unless you're putting them in a sensory deprivation chamber, everything you're doing, whether you're giving them... Does that mean you gave them homework? Does that mean you gave them the iPad? Does that mean you gave them... All of that is sensory.
So... We'll close on this because you know how much I like the phrase. I think we should do some sort of sensory play. I challenge any of our listeners out there to contact us with any form of play in this world that doesn't involve your senses in some way, shape, or form. I would almost contend that play... immediately invokes the idea of sensory awareness and perception, because otherwise, how can you enjoy or have fun, right? If you're not, from a sensory perspective, engaged.
We've covered a lot of ground today. Really, really excited about this idea of strange technologies and things that we want to redefine and start... maybe utilizing a little bit better. Dan, you've got something else for us?
Yeah, so in conclusion, in case any of the listeners hear this and they're like, well, I really like my sensory, I really like my social stories, or PexWorks is great for my kid. Absolutely, we're not poo-pooing any of these. These are all very useful technologies.
All we're trying to say is can we expand on them and give you alternative technologies and the next time that your kid struggles with a haircut, maybe you have 15 different solutions you can go to or 15 different social stories you can write, or the next time your child struggles with something and your case manager says, I think we should make visuals, you'll say, cool, there's 30 different types of visuals we can make. Which ones are we going to make?
I hope it's not just these three by three laminated icons. Let's put a little bit more thought into the service that we deliver.
I'm glad you emphasized that because, again, these are strange technologies, not in and of themselves, but in the way that we've settled in on using them. It's really about user error or user strangeness, if you will, because the technologies in and of themselves, hopefully we've delineated value and been able to elaborate on the value of the technology itself. As always, thank you very much for joining us.
We're really glad to be back and hopefully here as I'm enjoying some leave, I'll be able to persuade Dan to do a little more recording and get a few more episodes to you guys here in quick succession. Cheers. Cheers.
And remember, always analyze responsibly.
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