Shared Joy Before Data: A Discussion with Dr. Megan DeLeon Miller, Part I

Episode Transcript
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SPEAKER_05 (00:11):
Welcome to ABA OnTAC, where our goal is to find
the best recipe to do thesmoothest, coldest, and best
tasting ABA or out.
I'm Dan Lower with Microdeal,and join us on our journey as we
look back into the ingredientsto form the best concoction of
ABA on tap.

(00:32):
In this podcast, we will talkabout the history of the ABA
food, how much to consume toachieve the optimum bust while
not getting too drunk, and therecommended pairings to bring to
the table.
So without further ado, sitback, relax, and always analyze
responsibly.

SPEAKER_04 (00:51):
All right, all right.
Welcome back to yet anotherinstallment of ABA on tap.
As always, I am your evergrateful co-host, Mike Rubio,
along with Mr.
Daniel Lowry, Mr.
Dan, cloudy day today.
But a very bright outlook forthis episode for sure.

SPEAKER_05 (01:10):
Yes, yes.
This is a long time in thewaiting.
This was scheduled for a whileago, but uh due to some
circumstances it got postponed,but we are super excited for for
this episode.

SPEAKER_04 (01:20):
So I I've got it I've got to tease you a little
bit, as I like to do here at thebeginning.
We've been working together fora long time.
In fact, we've been workingtogether almost 20 years with a
few breaks here and there.
And a little over ten years ago,we had a a little reunion,
started our reunion tour, whichhas lasted about ten years
around.
And you've been very active inthat time in parent education.

(01:44):
And you've got this, you'veamassed this amazing repertoire,
this amazing library ofmaterials.
And one of those materials is avery important article.

SPEAKER_05 (01:54):
Seven steps to improve instructional control.

SPEAKER_04 (01:57):
And about a year ago, we had this uh we had the
distinct pleasure of moderatinga conference.
And during that process, we madethe connection that one of the
great professionals we werehaving the privilege of meeting
on the that weekend was in factone of the co-authors of this.
Yeah.
It's exciting.
It's exciting to be able to makethose connections.
We've had an exciting seasonwhere we've met a lot of people

(02:18):
that whose work we admire, andand that's where we're at today.
So without further ado, ABA ontap is proud to present Dr.
Megan Dalion Miller.

SPEAKER_00 (02:30):
Hi guys.

SPEAKER_04 (02:36):
Thank you.
Thank you so much.
Perfect, perfect.
Again, we can't thank you enoughfor giving us part of your
Sunday afternoon.
Luckily it is cloudy, as I said,here in uh in San Diego where
we're at, so we're not missingout on too much, but we are
super excited to be speakingwith you today.
Again, thank you for your time.

SPEAKER_05 (02:54):
So there were two people so I I've mentioned this
in previous podcasts.
When Mike and I moderated thispodcast of the podcast, the
conference, we were kind of at acrossroads at our uh at our
career, and I think we were kindof maybe downtrodden on the
field of ABA a little bit,looking at kind of what our
options were, what the field hadbecome, and we weren't very sure

(03:15):
what the podcast or the podcastthe conference was going to be
like.
Jennifer, you know, reallyprepared us for might be might
be interesting, a lot ofcontention and things like that,
and the conference was far fromthat.
But I think Mike and I were sopleasantly surprised and both
very re-invigorated with thefield after the podcast, or
after the conference, excuse me,because it kind of took us out

(03:37):
of the you know daily,day-to-day billable life, and
I'm sure we'll get there.
But there were two people, atleast for myself and I think for
Mike as well, that really,really stuck out to us.
One was Maggie, yeah,Harabuddha, who's been on the
the podcast, and she was amazinggetting the insight from an
autistic BCBA.
And the other was you.
So we've done a lot since then,and we can talk about it, but

(04:00):
with our introduction, thank youfor all that you've done and
probably unknowingly reallyinspiring us in the field to go
out and do some things thatwe've done since then.
So thank you and welcome to thepodcast.
Yeah, thank you.

SPEAKER_00 (04:12):
You are you're so welcome, and I appreciate the
time to words.
And I'm like I said, happy to behere.
I enjoyed when you all weremoderating the different panels
at the conference as well.
It was really nice.
And I know you all put a ton ofwork into that because I think
you were on like every singleone panel every time there was
one happening.

SPEAKER_04 (04:31):
So yeah, no, it was exciting.
I said we we we were uh we werehonored to be able to do so, be
able to uh actually meet youknow folks like yourself.
Let's start with the originstory.
That's the way we do it here onABA on tap.
Everybody has had similarexperiences, and then all of us
are doing something a little bitdifferent, which is exciting uh
toward the innovation andprogression of the field.
But tell us, you know, what gotyou started up until the current

(04:54):
moment, what keeps you driven.
Uh yeah, tell us all about it.

SPEAKER_00 (04:58):
Well, I know you said we have a certain amount of
time, so I'll try to keep thatpart short.
We could probably spend thewhole thing.

SPEAKER_04 (05:04):
Take all the time you need, please.
Don't you worry, we got you.
Take all the time you need.

SPEAKER_00 (05:10):
A lot of my like from the time I started in the
field, and even I still feellike now, if a lot of things are
more what I say would behappenstance or butterfly
effects.
Like, it's not there's notnecessarily I make intentional
moves, like I have my values andI make decisions based off of
those, but where my path goes,it's not like I'm like, oh, this

(05:32):
year, this is what I'm doing.
It's just stuff happens.
So when I was in all the wayback in high school, I read a
book randomly for my one of youknow, language arts class.
We had to pick a nonfiction bookto read and a fiction book to
read, but they had to be on thesame topic.
And I just I liked the whateverwe had different categories to

(05:54):
choose from, and there was oneon autism.
I didn't obviously really knowwhat autism was in high school,
but I was like, this soundsinteresting, and it might not
have I think it might have beenbroader, it might have been
mental health in general.
So I picked that, but the personin the book happened to have an
autism diagnosis, and I was justfascinated by you know the what
the story was that happened inthere and and the way she

(06:17):
navigated things and whatnot.
So then when I was in undergrad,we had to do an internship and
or like a practicum for oursenior year, and there were only
two places to choose from.
There was an autism clinic and amental health institute, and the
autism clinic was closer to myhouse.
So that's what I chose.
It just feels like everything iskind of like that.

SPEAKER_05 (06:39):
Serendipity, I think is what they call that, right?
Yeah.
Were you a psych major in yourundergrad or what were you?
I was.
Okay.

SPEAKER_00 (06:45):
Yep.
I was a psych major and a reallysmall school.
It's funny though, because I wasat a really small private school
called John Carroll up in Ohio,and we didn't have a lot of the
cool classes that you knowbigger universities would have.
However, there was a learningand behavior class, and like
everyone always talked aboutthis one professor and her rats,

(07:06):
but they always made fun of it.
So like I never even tried totake any of the classes because
especially the one semester thatI could take it, the person
teaching it wasn't her, andeveryone said he was really
mean.
And I was like, Well, I don't Iwant to take something else
then.
So I had the opportunity, evenat my small school, to take
classes and I didn't.
So then when I I did thatinternship and I worked with the

(07:28):
Cleveland Clinic as a likein-home like contractor, and
basically showed up to a child'shouse, and the consultant came
and she handed me a binder andshe was like, Here you go, see
you later.
And that was that.

SPEAKER_04 (07:42):
That had to be a three nothing, had to be a
three-inch binder, too, Iimagine.

SPEAKER_00 (07:45):
Oh, yeah, it was real thick and had all his
programs and had to be, butthere was no like, you know,
nothing.
I mean, I had what I knew, likeI had observed, you know, at the
clinic, but that was it.

SPEAKER_04 (07:57):
No, nothing when people say, you know, the amount
of training people need, and I'mlike, well, I just taught myself
that I think a lot of us have asimilar story, and the
three-inch binder is inevitablyand maybe unfortunately a part
of that and the IKEA table andchairs.

SPEAKER_05 (08:13):
That's all you needed.

SPEAKER_04 (08:14):
And it had to be IKEA.
Dad loves that, but maybe somepecs.
Oh, at that at our beginning,yes, maybe some pecs.
Certainly, something laminatedhad to be there.
Otherwise, you weren't doing itright.
Anyway, continue.
Right.

SPEAKER_00 (08:26):
Yeah.
So I just I did that for alittle bit.
I thought I was going to go tograd school for my PhD, and
nobody at the small school Iwent to had prepared me that how
competitive clinical psych PhDprograms were.
Yeah.
So I was like a failure for thefirst time in my life.
I applied to really big schoolslike Duke, Ohio State, that took

(08:47):
five students out of a thousand.
Like no one had ever said, youknow, I figured I had straight
A's, like good scores on my GRE.
I felt like I it was fine.
And then afterwards found outthat like it was basically
impossible.
So I took a year off.
And during that year, I moved onto Columbus and just worked in
home with families.
And I had a really uniquesituation where at that time

(09:10):
there wasn't the BCDA that hadjust started, right?
This was like early 2000s.
So no one in Ohio was certified.
It was consultants who mostlywere trained by people that I
worked with low boss, but therewere other people starting to
kind of branch out and see whatother things might be, other
like strategies and techniquesand styles might be out there.

(09:30):
So I had I think three or fourdifferent consultants, and each
one did things slightlydifferently.
So I never had that like rigid,you have to do it this way.
This is how we do things.

SPEAKER_04 (09:41):
That's kind of awesome, maybe to your benefits.

SPEAKER_00 (09:45):
Right.
I got to see from the beginningthat it's flexible.

SPEAKER_04 (09:48):
That's awesome.

SPEAKER_00 (09:48):
So that was nice.
Same similar similar situationthough, where like with each
family, we were meeting with aconsultant, you know, once a
month, but it really felt likewe were all just figuring stuff
out on our own and trying to dothe best we could for each kid.
So I learned a lot because I hadto, you know, if I wanted to do
the best to support thechildren.
And then I also, like one of theteams I was on, the two people

(10:11):
that were also working werefriends of the mom and had
really unique backgrounds.
So one was an art therapist andone was a play therapist.
And they just brought in, again,really creative, unique ideas,
and the consultant was reallyopen to just doing whatever
everyone was suggesting and justaligning it with the science.
So again, I got to have thatmodeled for me and see very

(10:34):
early on how well that works.
And like when people were tryingto be rigid, I saw that wasn't
working.
And then I saw when we wereflexible and really working with
what would work best while doingthings in a scientific way and
taking data.
So that that worked for me.
And I just fell in love.
I went to Florida State for mymaster's, it was the only school

(10:54):
I applied to.
I had taken, again,happenstance.
I when I didn't make it into theclinical PhD program, I was
like, I want to live on the Gulfof Mexico.
So I went online and I found allthe universities I could on the
Gulf of Mexico, and FloridaState just happened to be one of
those.
And when I found out you couldgo to school for behavior
analysis, they had theirapplication window was still

(11:16):
open, but Ohio State's wasn't.
So I just applied to FloridaState, moved down to Panama
City, got to go to school.
Like we showed up, and Dr.
Bailey, you know, everyone waslike, oh my gosh, it's Dr.
Bailey.
And I was like, who's Dr.
Bailey?
Like, I don't know who this is.
And I always love to tell peoplemy very first ABA class I had to

(11:36):
take at Ohio State because Ineeded it in order to go to
Florida State.
Like I didn't have any collegecoursework and behavior
analysis, and they had a fewprerequisites.
So I took ABA for teachers withDr.
Cooper.
Oh that was my first class.
Oh wow.
So again, had no clue who hewas.

SPEAKER_06 (11:55):
With the Cooper.
Yeah.

SPEAKER_00 (11:59):
And he was so cute at the end of every class.
He would bow and say, Thank youfor learning.
And we would bow and say thankyou for teaching us.
And he was just like thesweetest, best professor ever.

SPEAKER_04 (12:09):
What a cool that that's what a cool little story
you just shared there.
Man, that's awesome.
How great.
I mean, to so you know, youmentioned people being trained
by Lovas.
You're, you know, you're sayingBailey and Cooper from a very
strict ABA perspective.
That that what a cool contrast,right?
Because so many of us are arenow this our experience is based
in some sort of autismtreatment.

(12:31):
So you've got a a much more peerexperience in saying, hey,
Cooper and Bailey, those are myguys.
Yeah.
That's awesome.
That's awesome.

SPEAKER_00 (12:37):
And when I was at Florida State, I was frequently
reminded that I was in abehavior analysis program, not
an autism program.
And I I would tell my like oneprofessor, Dr.
Murphy, I'd say, but Dr.
Murphy, autism brought me here.
Like I wouldn't be here learningabout the science and wanting to
know what was going on if itwasn't for autism.
So you gotta let me have myautism thing too.

SPEAKER_04 (12:58):
Well, we'll get into this too.
I mean, that's that's sort of amodern quandary, right?
What else is our utilitycurrently to a lot of people?
It seems to be the only thing wedo.
So, but we'll we'll get ontothat.
We'll we'll let you continue.

SPEAKER_00 (13:08):
Yeah.
Well, I mean, that's pretty muchit.
Like I went to Florida State.
I realized as I learned moreabout the science and grad
school, especially, that I waskind of a natural behavior
analyst.
I was a lifeguard and swim coachand swim teacher for a while
before like when I was inundergrad and even high school.
And I was using shaping with mylittle ones, like that were

(13:31):
scared of the water, and I justdidn't know what that was called
or anything like that.
And I was in gymnastics growingup, and I recognized a lot of
the things my coaches did ingymnastics.
It was similar, unfortunately,very punishment focused.
But I mean, there was somereinforcement involved as well.
And then I took a few years off.
I went to, I worked at FloridaState as a clinical director,
moved up to Virginia, started anABA company called Navigation

(13:55):
Behavioral Consulting.
As I was doing that, I decided Iwanted to go back to school to
get my PhD.
And I went back up to Ohio, didmy PhD at Ohio State.
My advisor, I had an advisor atOhio State.
Her name's Dr.
Malone, and she works more withsignificant disabilities.
A lot of folks in more of likejust ABA don't really know her

(14:16):
work as well.
But if people in disability,like disability studies and
focus more on intensive, likemore severe disabilities know
her work because she she wasworking with like gaze shifting
and looking at, you know,children with really
significant, like motordisabilities that couldn't in
like physically could not doanything besides use their eyes

(14:38):
to communicate.
So that was her research.
It was really fascinating.
But I also she was very flexibleand I wanted to do my
dissertation on precisionteaching and motor movement
fluency.
So Dr.
Rick Kubina, he was at PennState, but had graduated from
Ohio State.
So he served as my co-advisor.
So that was really nice too.
I was able to have like twoincredible people giving me

(15:00):
feedback on my dissertation.
Then I graduated, moved back toFlorida, and I still have my
company, but I was like, I'mgonna be bored being in Panama
City if I don't have like aphysical job here.
Like I don't want to just bedoing stuff like running a
business online.
So I didn't want to take onclients in Panama City because

(15:21):
there's already really goodservices there, and I just
didn't want to really be doingthat.
So there was a group that'sfunded through the Department of
Education here called the FSUCard.
It's not card like DoreenBrampanisha's card, like here in
the state of Florida, it standsfor something similar but
different, and it's funded bythe Department of Education.

(15:42):
So I applied to work with themand another really happenstance,
unique experience.
They so they they wanted me, butthey were also doing research.
And one of the researchers, hername is Dr.
Amy Weatherby, and she isphenomenal, like huge autism
expert.
But from social communication,she's a speech language, her
doctorate's in speech languageand communication disorders.

(16:04):
So I got to join thismultidisciplinary team.
And I had been at that point, Ihad been at BCBA for eight
years.
I had already been traveling andworking internationally, thought
I knew a lot.
Holy cow, did I know nothing?
Like I was blown away by theamount that I did not know.
So it was really, really coolexperience to get to work with

(16:24):
her and her team and learn somuch that really drives a lot of
what I do now and a lot of thetraining and coaching that I
provide.
Again, just happened to, youknow, I wasn't intentional about
it.
I was just like, oh, here's thisopportunity.
So yeah.
And then I moved to St.
Pete and started doing Do Betterin 2018.
So that's my very long originstory.

SPEAKER_04 (16:45):
That's amazing.
That's amazing.
You you might have noticed thatDan usually gives his little
caveat that he's looking down athis phone because he's taking
notes.
He's actually checking hisFacebook.
He's a little bit addicted.
No, what I'm saying though ishe's got copious notes from that
great story.
So we are prepared to discuss.
If you don't mind, I'm gonnajump right in.
Of course.

(17:05):
You just said something thatreally resonated with me in sort
of the progression of yourlearning and saying, wow, I had
done all these things and Ithought I knew it all, and then
you hit this experience thattaught you a whole bunch of new
things.
Talk about that a little bitmore.
What were those new things?
Maybe pick a few that you knowyou picked up during that time
that are integral to yourpractice right now, and they're

(17:26):
probably a little bit differentfrom what other people are
doing.
So that really resonated with mewhen you mentioned that.
I'm like, oh, I need to knowmore about that.
What is that stuff?
Because that's that's the goodstuff.
That's probably what sets youapart in your practice and the
things that people can reallylearn from, take away from.

SPEAKER_00 (17:39):
Of course.
Before I do that, I'm just gonnamention two things in case you
all want to come back to it.
I completely skipped over thework with Robert Shram and how
that started.
And then we skipped over theinternational work, like how
much how that started.
So a lot often people want toknow like how that started too.
So we can come back, obviously.
Dan's saving the two big thingsin the origin story that I

(18:01):
skipped over.

SPEAKER_04 (18:02):
Dan's already saving that for the third hour of the
installment.
Don't you worry.
We got all right.

SPEAKER_00 (18:08):
No, so the yeah, the research, what what we were
doing is early screening forautism diagnosis.
And so I was working withfamilies where they would come
in for an evaluation, and I hadto be trained on the ADOS at the
research level, which is likevery intensive training.
Some people will go to like alittle workshop and learn how to
do it as to to just do it andthen assist psychologists and

(18:32):
diagnosing.
But this, the research level isa much higher level of fidelity
because you have to be able toscore it in such a way that you
would have IOA and all of thatkind of stuff.
So when I the ADOS part was partof the most eye-opening because
there's it's very well written.
The way you code for thedifferent sections of the ADOS,

(18:53):
the operational definitions arepretty detailed.
But the things that they weredefining, like shared enjoyment
and reciprocity and all thesesocial communication things, I
was like, I don't know what anyof this is.
Like, what are we talking abouthere?
I've never been taught to lookat any of this.
You know, like we sit down withour kids and try to get them to
man and tact and things likethat.

(19:13):
And there's not much of a focuson relationships or that shared
experience.
So through doing the ADOS, I wasable to see how integral that
piece is in what we do, but alsolike how much I didn't know
about even what how to measureit or what it should, you know,
what it looks like or anythinglike that.
And the shared enjoyment,especially, was one that was

(19:36):
really hard for me because I'dbe doing an activity with the
child and they'd be laughing andhaving so much fun.
So I'd score shared enjoyment asyou know, the highest score you
can get.
And then I'd go to the personthat was coding it with me so I
could pass my, you know, littletests.
And she's like, no, that was notgood.
But I'm like, wait, what?
They they were laughing, theywere enjoying it.

(19:57):
And then they would point out tome, they were enjoying the
activity, they weren't enjoyingyou, right?
Like they weren't hating meeither, but they weren't like
they sharing that experiencewith me.
So that's become a really bigfocus for me when I even within
like a few seconds of watching aparent or a therapist interact
with a child, I'm like, there isno shared enjoyment here.

(20:18):
And that's one of the biggestpieces for when we look at
autism specifically, bestoutcomes is the shared
enjoyment.
And like no behavior analystsare trained to measure it,
trained to promote it.
And we were trained to pair, butit's not the same thing.
It's this more like authentic,genuine experience where the
child genuinely wants to beinteracting with you and it's

(20:41):
not transactional.
Like a lot of us set up, youknow, pairing and stuff, like,
oh, well, I'm gonna dangle thisthing and like try to get you to
hang out with me because I'mfun.
But we're doing it so we cancheck off boxes and get through
data collection.
And we're not doing it togenuinely and authentically
understand the child and connectwith them.
So I was able to really see likehow important all that was.

(21:01):
I'll pause there and I'll tellyou one other thing.
I don't know if you all havecomments on that part first.

SPEAKER_06 (21:05):
Uh he does.
You know, I have a lot ofquestions.
We just hold off on my question,the fourth.

SPEAKER_04 (21:11):
I know you just uh um everything you just said just
resonates with me, uh, with us,with our new vision, especially
with the idea of early childhooduh intervention, which is sort
of my bag.
And I think that's where youknow my differences come in in
terms of training.
I was trained in developmentalpsychology first and foremost,
and when I got introduced toABA, it just seemed so

(21:34):
unidirectional, meaning I wasdoing for the child, and then to
your point, there was nothingthat I was supposed to wait to
come back other than thisalready predetermined correct
answer that I would reinforce.
And it just seemed so surgical,it seemed like something was
missing.
And I understood why.
But just everything you talkedabout there in terms of we use
the word rapport very often.

(21:56):
And I don't know that weactually established that a lot
of times with what you'retalking about in terms of shared
enjoyment.
So I don't know if you couldexpand on that a little bit more
or more examples of what that'ssupposed to look like.
What does that mean?
I talk a lot about jointattention, which I think is is
relevant to the idea of sharedenjoyment.
We're paying attention to thesame thing, we're looking back

(22:16):
at each other, and now maybewe're grinning and showing our
teeth and making these sounds aswe tilt our head back, and then
we're doing it again, whichmeans we're laughing together,
and then maybe in our veryesoteric operationalized
definition of shared enjoyment,as behavior analysts, we can
check that box.
I'm being a little facetiousthere, but tell us a little bit
more about what that's supposedto look like.

(22:38):
Or what are the measurable partsand again, I'm gonna ABA it a
little bit and and we don't needto sterilize it, but what are
the measurable parts that peoplecould learn from?
Because I think you're you'rehitting something very
important, especially foryounger professionals who maybe
get a little more training thanyou and I did and don't just get
plunged into it or you know,thrown into it.
But there's still a lot to belearned from this idea of I'm

(23:00):
providing reinforcement versuswhat is the reinforcement
provided by the idea that youand I are laughing at the same
thing.
I mean, there's just so manyimmeasurables there.
Talk to us about that.

SPEAKER_00 (23:12):
Yeah.
Yeah.
And that that's what makes ittricky.
And I think that's part of whybehavior analysts historically
haven't done as much with it.
Yeah.
Like even with joint attention,I went to a conference one time
and the presenter was veryexcited to present their
research on joint attention, andthey were from a very
well-known, reputable researchplace that like produces a ton

(23:35):
of research.
And they showed the video ofwhat they did, and it's a a
person sitting next to a child.
Like they're first of all,they're sitting next to each
other, which in general, ifyou're trying to promote social
engagement and like have that,you're gonna be sitting like
across from each other, like youknow, not next to each other.
But anyway, so the therapist issitting next to the child, and
the therapist is like prompting,like gesturing to the toy,

(23:59):
gesturing to themselves, andthen handing the kid an MM.
And that's how they were theythought they were training joint
attention because they werelooking at it topographically,
right?
Like, okay, three point.
Okay, they looked at the thing,they looked at me, they looked
back at the thing.
We've got joint attention.
It's like, no, no, no, no, no,no.
It's not what it looks like.
This is not based on form, youknow.
It's and I think that's whatmakes it so tricky because it's

(24:22):
like a feeling it's like we'reconnected right now.
I can feel that you want to behere with me.
And it's like, how do youoperationally define that?
It's obviously a lot trickier,and then it's trickier to train
people on that too, which ispart of why when I was doing the
ADOS, it was hard to get peopleto match on their codes with
shared enjoyment because theexperience I'm having is gonna
be different than the personobserving my experience, right?

(24:45):
So it is a very, it's a lottrickier to measure, but it's so
worth it.
So we look at things like youwere talking about, you know,
the laughing, are they smiling,are they reaching, approaching
or moving away?
It's a lot of that kind ofstuff.
But there's still thisqualitative piece to it where
the person and the child in thatengagement that they're having,

(25:07):
it's like what we hear aboutwith pairing, oh, this is this
experience is better with methan without me.
Right.
So like if if I could sit hereand judge, like is if I walked
away right now, would the childhave as much fun or not?
And it's like if I could walkaway and they would enjoy
themselves just as much, thenwe're not having shared

(25:28):
enjoyment.
But if I'm, you know, here andthey're enjoying the activity,
but I'm like whatever we'redoing together and the that
social experience that we'rehaving is making it that much
more enjoyable, then we haveshared enjoyment.
So it's hard, it's like a trickything to again train people or
really measure fully.
But there's again in the ADOS,they have the codes for it.

(25:51):
When I observe people, I havesome data sheets I've made that
look at active engagement andlooking at how the adult is
promoting it, but also how thechild is responding and seeing,
you know, a lot of it's aboutbeing responsive and training
people on how to be responsiveand observing of whatever the
child is doing.
Obviously, Hanley talked abouthappy, relaxed, and engaged is a

(26:12):
big piece as well.
But there's still this piecewhen I hear people talk about
using PFA SBT and like trying toget that happy, relaxed and
engaged with their clients.
They're not talking about thatshared experience though.
They're they're just likechecking the box if the child is
happy, relaxed, and engaged, butit doesn't have to be with
someone.
And I'm not saying it always hasto be with someone, but in the

(26:33):
research that we're seeing, themore we can create those
experiences and really bringmore value to this shared
interaction at a young age, themore likely we are to see better
outcomes because that's whatsets the stage for communicative
intent, for communication to befunctional and meaningful and
have that motivation to want tointeract with people, whether

(26:57):
it's just to get their needsmet, like or whatever.
I mean, the reason why thecommunication happens can, you
know, is going to varydrastically.
Every single one of our clients,some are more extroverted than
introverted, and that's fine,but to at least set that
foundation of hey, when you needsomething, when you want
attention or whatever, this iswhere we get that.

(27:20):
The shared enjoyment and thevarious social communication
skills are what get us there.
And again, a lot of peoplearen't focusing on that.
So I've I've been working on, wedidn't talk about this at the
beginning, but I've been workingon pulling together all of the
research on that's coming out onthese different topics within
the autism research, and thencreating a new assessment and

(27:41):
programming curriculum.
And a lot of it focuses on theconnected relationships piece
because that's something I'vebeen working on since like 2012.
And I've pulled in work I'vedone with clients, but also the
research and the training I hadat Florida State, and to kind of
make a more step-by-step way ofhow do we build a connected

(28:01):
relationship?
How do we measure the getbaseline on it and see if we
even need to be working on it?
How do we train people to builda connected relationship?
Like what are the scores that wewould, you know, show, okay,
yes, a connected relationship ishere, and then we can move on
because a lot of people jumpinto just trying to teach
language right away, but you'renot going to get very far if you

(28:22):
haven't built that connectedrelationship first.

SPEAKER_04 (28:25):
Wow.
So man, so so much to talk abouthere.
I want to I want to let youloose, but one thing I want to
say, and and uh certainly Dr.
Megan comment on this if itresonates.
But enjoyment's almost amisnomer here, and I'm not
saying that it doesn't apply.
We use it as a way to uhimmediately connote and measure
this idea of the the child'shappy while they're interacting.
But you're you could be talkingabout shared focus and problem

(28:49):
solving.
You could be talking aboutanything like that.
It doesn't have to be that thechild's laughing, just that
you're jointly attending andtogether in a way that's clearly
and observably unified.
That's that's reallyinteresting.
I think that that we could talkso much more about that and
train our younger professionalsso much more on that because
it's so easy to think that youjust draw the straight line

(29:10):
between you know, I present thestimulus, you behave, I
reinforce, and that's it.
It's this very linear, you know,one unidirectional interaction.
And what you're describing is amuch deeper, much more involved
choreography of coming in withdrawing, and the child comes in
because they want to be withyou, so they come towards you
and then you re-engage.
I mean, it's a dance.
And we we that that three-partcontingency at its best just

(29:33):
draws this straight line throughit and it misses a lot.
And it's not to say it's notimportant, but you're talking
about something much richer,much more involved.

SPEAKER_00 (29:41):
Yeah.
And there has to be this morelike nuanced, again, looking
closely, observing andresponding based on what you're
seeing from the child.
It's not just this like blackand white, you know, set of
instructions that you'refollowing, but you're you're
coming in and going out based onwhat the child is.
Doing and where their focus is,and being attuned to so many

(30:04):
different things and makingdecisions based off of a
calculation that you're doingagain, not just following like
the black and white steps thatexist there.
What is funny to me though iswhen any of us think about what
how we learn best, it's whenwe're in environments where
people are engaging and we'resharing an experience with them,

(30:25):
you know?
Like when we go in and thepeople like are off putting
right away, we're like, oh, andwe probably just get out our
phones and start scrollingTikTok or something.
Like we're not paying anyattention.
But that like goes into, Ididn't learn about this
necessarily at Florida State,but that would tie into like a
different topic of perceivedsafety, too, like how safe we're

(30:45):
feeling both emotionally andphysically within an environment
sets the stage for effectiveteaching as well.

SPEAKER_04 (30:53):
Wow.
I mean, you know, again, somuch, so much to explore there.
And there's a nuance.
Those things aren't necessarilymeasurable, but they're
certainly very tangible, and andyou can recreate them.
But yeah, Dan, I'll let youloose.

SPEAKER_05 (31:04):
Yeah.
So you said um you you used aphrase that I wanted you to
elaborate on a little bit.
You said set the stage forcommunication when you were
talking about that reciprocity.
And I'm just reflecting back onyou know my history of training,
and a lot of it was more olderschool, I put in quotes, ABA,
and it was more, you know,coming from the idea of

(31:24):
individuals with autismtraditionally don't tact that
often, and we teach throughmanding.
So I remember some of theresearch was we teach through
manding because that's howcommunication is learned.
And then that oftentimes becamevery transactional of like, I'm
gonna teach you to say I wantball because that's what you can
communicate for when you wantthe ball.
But one thing that we've beenreally looking at is like Mike

(31:45):
talked about, enhancing thejoint attention piece to where
maybe you might not speak orverbally communicate as quickly,
but when you do, the languagebecomes much more diversified,
and we do see the tacting, whichagain, and I don't know if the
research proved this initiallyor not.
I just know that that's what thetraining slides that were
presented to me showed, that itwas so much more manding heavy

(32:07):
versus tact heavy.
So, do you have any thoughts onthat?
On if it is a common trait ofindividuals with ASD to be
skewed so high on mans versustax, or if it's actually more of
a product of the way that wetaught it and so transactionally
versus you know reciprocity andjoint attention based.

SPEAKER_00 (32:24):
Yeah.
So that's like a whole an houron five hours.
Okay.
Um with the time difference,it's only two.

SPEAKER_05 (32:34):
I like that.
All right.

SPEAKER_00 (32:36):
For this topic, it's like so much bigger to me.
And it's the short answer isyes, I think it's about how
we're teaching, but that'spartially because people think
that mandning is what comesfirst and it's not.
When you look at the research onlanguage development, the social
communication skills are whatmatter the most.
And there's a study by Dr.

(32:57):
Morgan where no, wait, not Dr.
Morgan.
She did a really cool study.
Yes, it is hers.
Okay, Dr.
Morgan did a study where theywere looking at an intervention.
It's called ESI, it's part ofthe research that was being done
at Florida State and earlysocial interaction, and they're
training parents how to engagetheir children.
And they, at the beginning ofthe study, they looked at a few

(33:20):
different baseline measures, andthey did one measure was a
social communication measure,another measure was a language
development measure, and thenthey did a couple of others.
They provided the intervention,and then they did the post
measures.
What they found was in terms ofthe final language development
that the children had, the thingthat best predicted how much

(33:42):
language development we wouldsee was not their baseline
scores of language development.
So you would think like, oh, thekids coming in with higher
language development scores,would end with higher language
development scores.
No, it was social communication.
So social communication betterpredicts language development
outcomes than languagedevelopment itself.

SPEAKER_06 (34:01):
Really?

SPEAKER_00 (34:02):
That's how important social communication is.
So when we have so much of usfocusing so heavily on we need
to teach them demand, we need toteach them attacks, and we're
doing all this language focuswithout first measuring social
communication and building upthose skills.
If you think about your clients,where sometimes you're like,
man, these clients kind of camein.

(34:22):
I thought they would make thesame amount of progress, but one
really progressed and one'sstill kind of in the same spot.
If you looked back, thedifference was probably that one
had social communication skillsand one didn't really have those
yet.
So the more that we can geteveryone understanding, hey,
this is the critical thing thatwe need to be really measuring
and taking into account whetherwe're working with two-year-olds

(34:45):
or 20-year-olds.
Like it doesn't matter if thatsocial communication part isn't
established, anything we'retrying to do that involves
language is not going to go aswell.
And I saw that really frequentlywhen I was doing assessments
because we'd have kids come inwho were talking, had tons of
words, but they were had zerosocial communication.

(35:05):
Interesting.
And then we'd have kids come inthat had no words, but their
social communication wasamazing.
You know, so there's like thishuge difference that happens.
One other piece to that thoughis the criticism, I guess I have
in general of research that'shappening, even from my favorite
researchers, which is thefailure to also connect with the

(35:26):
unique interests of the childrenthat we're working with.
So when we say socialcommunication needs to be
focused on and socialcommunication isn't there, the
ADOS and other things that aremeasuring social communication
are doing it based off of what alike typical child might be
interested in.
So when we would do ourdifferent assessment items,

(35:48):
we're like playing with a dollor playing with a car, doing
certain things that like atwo-year-old generally would be
interested in.
And the kids are like, no, noresponse whatsoever.
But I watch them and they're,you know, lining up something or
stimming on something.
And if I were to join them inthat and connect with what
they're interested in, we'd seeall sorts of social

(36:11):
communication.
So there's that's the otherpiece of it, is it's not just
about understanding we need tobe measuring and programming for
it, but we need to be doing itin the way that's functional and
meaningful.
Why do young children engage insocial communication?
Because their parent isimitating the what they're
doing, because their parent isconnecting with them.

(36:32):
If we are constantly trying toredirect them to like, this is
what uh you know you should bedoing or whatever, and we're not
honoring and affirming howthey're showing up and just
connecting with that, then we'renot going to see those skills.
And like the research on socialcommunication right now is
pretty much all based on, well,we tried these things that like
a two-year-old would normallylike, and they didn't respond to

(36:53):
that.
And it's like, well, what itwould, what do you think would
happen if you just tried if youbacked it up a bit and thought
about, okay, well, why does thetwo-year-old like those things?
Or like, why does thatexperience happen for the
two-year-old and you emulatethat instead?
Oh, it's happening becausepeople are imitating them.
It's happening because peopleare laughing with them.
People aren't constantlyfollowing them around, trying to

(37:14):
get them to do the opposite ofwhat they're naturally drawn to.
So two big things have tohappen.
We have to understand socialcommunication, but we also have
to connect with the actual humanin front of us and not try to
like fit them into a box.

SPEAKER_05 (37:28):
That makes a lot of sense.
I do have more questions, but Iknow Mike is uh you are talking
Mike's language.
I'm gonna go ahead and pass himdown.

SPEAKER_04 (37:35):
How you've moved my nonverbal imitation program into
my communication section in thisthree-inch binder, Dr.
Megan, that's very confusing.
What are you doing here?
Come on now, that makes nosense.
I let me obviously being overlyfacetious there, I went on a
little uh what should we callit, uh a revival a few years
back in terms of rapportbuilding and this idea of

(37:59):
linguistic mapping andcontingent imitation.
Literally, you're commentatingon what's happening in the
environment, what they're doing,what you're doing, and within a
reason, you're imitating whatthe child does, you know.
And I had a lot of RBTs kickback, well, this is an ABA, what
are we doing this for?
And I said, for one simplereason, so you can pay attention
to what the child is doing.

(38:20):
Because otherwise, we're gonnacome in with all these
predetermined programs that mayor may not work, and you're
gonna run these contingencies ina linear fashion, and you're not
gonna pay attention to whatthey're uh engaging with.
But if I make you imitate themand commentate on what they're
doing, what they're doing,what's happening in the
environment, then you're forcedto pay attention to the child
for a little while.
And then you might build rapportand figure out.

(38:42):
And I have this theory too, ifyou do that enough, which also
makes you kind of be in theirspace and and then maybe they
move away, so you move away andyou come back.
Eventually what ends uphappening is you show up and the
child gets right next to you.
And now because they'reaccustomed to that, that's what
you've built over time.
So now, you know, I'm skippingover some stuff, but it's a
perfect time.
That's what we sort of refer toas instructional control, or at

(39:04):
least the opportunity to have itbecause you've got somebody's
sustained and interestedengagement.
You've you've done for me,you've shown me things now.
When you show up, I want to bein your space.
And then now from a more adultdirected perspective, you have a
chance to demonstrate thoselearning pieces or those
targets.
The other thing I was thinkingabout, this is I'll get to a

(39:24):
question.
What do your targets then looklike, right?
So let's go back to thatthree-inch binder.
If we're talking communication,you're gonna have a colors
program, a shapes program, allthese things that make sense
from an educational linguisticperspective, but you're talking
about something that's waydifferent from that in terms of
targets.
So what do those targets nowlook like in what you're talking

(39:46):
about?

SPEAKER_00 (39:48):
So yeah, that it depends on the child and like
where they are.
So I have this thing calledphases of service delivery that
I've developed based on myclinical experiences and all the
unique opportunities I've had.
And I what I do is I go throughthe phases.
So the first one's connectedrelationships, the second one's

(40:08):
emotional regulation, the thirdone is the big four preventative
skills from the article by AllahRosales in 2018.
And then we finally start tomove in, it's depending on their
age, executive functioning.
And then the last is ifnecessary, a functional
assessment.
So if they're in like thatconnected relationships phase,
the targets are more looking atif I'm essentially following the

(40:33):
child around and joining them,how are they responding to that?
And like, are they allowing mein their space?
Are like how many gay shifts arewe getting?
Looking at that shared enjoymentand reciprocity and just that
kind of like, are we havingthese back and forth
interactions happening?
For imitation, I use reciprocalimitation training, which puts
imitation in that communicationbox.

(40:54):
The research shows imitation isan early form of communication.
So it's it has certain phasesthat it goes through.
And the first one is you're justimitating the child and they
continue to imitate, like, orthey continue to do the action.
Some children, if you imitatethem, they're like, What?
And they move on.
They're like, I don't mind ifyou're around me.
So that means you have to domore to build up and like earn

(41:16):
that you know, respect andinteraction with one another.
But the phases from reciprocalimitation training are really
nicely laid out.
There, it's one of the onlymodels that has group like
randomized control design tostudy its effectiveness, which
is funny because like do thisimitation training has none of
that, but everybody does it.

SPEAKER_05 (41:33):
But how are they gonna do it if you don't tell
them to do it, Megan?

SPEAKER_04 (41:38):
And you better not label the you better not label
the action.
That's too enriched.
You have to say you have to saythis, right?
In order to make sure it'snon-verbal.
Oh my, I love I could talk allday about that stuff.
Um man, I had a question and Iforgot it.
Shoot.
Oh, we took this question.
We did were you referencing, wasthat the Shridman?
What what joint attention uh orreciprocal imitation training?

SPEAKER_00 (42:00):
Reciprocal imitation training is uh Shridman did a
really good article.

SPEAKER_04 (42:04):
I think with Wayland.
Yeah.

SPEAKER_00 (42:07):
Yeah.
There's been a few differentfolks who are publishing the
research, but I think Shridman'slike the main was like the
initial There was an early one.

SPEAKER_04 (42:15):
Maybe she did it with like Weyland or or
Ingersoll or somebody like that.

SPEAKER_00 (42:19):
Yeah, the the three of them have done publications
and like together andseparately.
And then there's been, I thinkLanda might be ones who there's
different people who havereplicated and extended and all
of that.

SPEAKER_04 (42:30):
The uh the reason I it it it resonates with me is
that that Tribeman paradigm orthat protocol is one that I've
adapted to in my training foryounger pros and saying, look,
this is the research-based one.
I'm not expecting you to use itas a recipe.
So I don't want you to be abaker with this.
I want you to be a cook.
These are the ingredients.
This is the stuff you do tosaute and to chop and to mix,

(42:51):
and at the end you're gonna getyou know something good.
And and it it's a lot about youknow presenting the the SD, if
you will, and then maybe there'sa no response.
And then you're gonna try again.
And so it's it's a lot, again, alot more of a choreography than
this straight line, I show you,you do it, I give you an MM back
to your other example.
And I still don't know why MMsare so related to every

(43:13):
behavior.
We we tend to think they'rerelated to everything else in
the MM minis.
Oh, the MM minis were essentialbecause then you when the state
street is fast.
Anyway, we like to be a littlefacetious about some of the
silly things we've done earlierin our career.
And not to say they were, Imean, they they were just a
little misguided, right?
We didn't know any better, andand that's why we want to talk.
We learn better, do better.

(43:34):
We'll get to that in a second.

SPEAKER_00 (43:36):
Just real quick for the target, sorry.
Oh, yeah.
So my ultimate dream, at leastin the autumn space, is that we
eventually can hit a shift inthe field where the focus is
less on targeting the child andcollecting data on like them.
And it's more based on teachingthe staff or the parents or the

(43:57):
teachers how to create anenriched environment.
And we're setting upopportunities based on what we
know from the research topromote these skills and to like
make it more likely and moreprobable that those skills would
functionally occur.
And then we take data, we stillwould take data on whether or
not they did, but it's morewe're we're putting more of the

(44:18):
onus and the responsibility onthe adults to be able to
understand, you know, what to doinstead of trying to measure
every little aspect of thechild.
Because again, we don't it'sbased on my clinical experience,
but I think the research isgetting us there too.
The difference between differentoutcomes is not typically how

(44:39):
many boxes we can fill in on theVB map or the ables or peak.
It's how well the environment isfeeling safe and supporting this
unique person and like beingable to navigate everything
that's happening around them.

SPEAKER_05 (44:52):
I love that.
I mean, that was something thatthat was my tangent.
Like we we were take data onyourself, take data on what
you're doing.

SPEAKER_04 (44:58):
Yeah, you you were big on that for a little while.

SPEAKER_05 (45:00):
Maybe eight to ten years when we ran that company.
We had pretty much creativefreedom.
We had a very unique contractwhere the insurances were we had
pretty much creative freedomwith the insurance that we
worked with, which was amazing.
And so we were able to do a lotof testing and things like that.
And that was something that Icame up with kind of towards the
end of let's take data on theRBTs presenting the trials, more

(45:20):
so than just uh the taking dataon the kids, but let's make sure
the RBT is providing the richenriched environment because
that's gonna be the moreimportant thing.

SPEAKER_04 (45:29):
The idea that the trials by themselves don't
teach, and I think that's whatwe were doing, is we were trying
to teach based on thepresentation of these trials,
and what are we doing to teachthe concept before?
You did really well with that.
So the you know, the RBT arewe're going to present certain
stimuli a certain amount oftimes, and then you had a good
way, I forget how it was, ofgauging that it was meaningful.
That sure there had been somesort of it was right around the

(45:50):
time we were doing the jointattention stuff.
We uh we we got very hereticaland and moved into frequency and
rate data.
Oh, that's what I was gonna say,yeah.
Just percentage of opportunity,which man got you in trouble.

SPEAKER_05 (46:01):
Got me reported to the board because nobody knows
more than a new BCBA who knowsthat if you don't do your 10
trials at across 15 sessions andthen yeah, anyway.
Uh but yeah, that went nice withfrequency because that was
another thing, right?
Of if we have the RBTspresenting the stimuli,
frequency seems to make moresense because if they do it 10
times, now we got stuck onpercentage of opportunities,

(46:24):
right?
Like 80% or 70%.
But if they're doing it acertain amount of times, maybe
we should look at the timesthey're not doing it, and it
might not be a skill deficit.
It might be that they're notpaying attention or that we're
not presenting the stimuli.
So so often we would then put itback on the client and be like,
oh, they haven't mastered theskill.
But maybe they have, and they'rejust tired of us presenting this
trial over and over and over.

SPEAKER_03 (46:45):
Why are you asking me this again?
We call that satiety, don't we?
Is that the word we use?

SPEAKER_05 (46:50):
But I I have a question for you actually,
because I so much resound withwith what you're saying.
So much of the way that, atleast in in our kind of niche of
the world, the ABA's delivered,it's funded through medical
insurances.
And now you're talking aboutkind of rewriting program
delivery and targets and thingslike that.
We recently had a peer-to-peerreview that ended up actually
being pretty positive, but tooka lot of steps.

(47:13):
And, you know, insurancecompanies, a lot of times the
people are BCBAs that arereviewing it, but they're used
to the very traditional, like ifyou want us to improve your
services, it needs to be writtenin this way, and you need to
have a certain number ofprograms, because if you don't
have a certain number ofprograms, you can't request this
many hours.
And our hours recommendationsare very low, you know, maybe
six hours a week or somethinglike that.

(47:33):
So have you thought about that,run into that?
Any thoughts on that largerthing of as you're trying to
kind of rework how the targetsare presented and the procedures
are delivered, kind ofnavigating that insurance realm
to make sure that we getfunding.

SPEAKER_00 (47:49):
So I'm really fortunate I don't work with
insurance.
But I used to see.
But no, so there's there's a fewthings that come up for me
though, because obviously, youknow, I've everyone that's in
the community that I train andcoach, they generally are
working with insurance.
So I do think about it.
And in the the new assessmentand curriculum, or I don't

(48:10):
really want to call itcurriculum, but the assessment
and like programming guidancethat I'm creating, it's going to
be aligned with medicalnecessity.
So hopefully it'll be easyenough to put into like an
insurance focus.
There's a few different thingsthat come up.
One, it depends because like Ithink some insurance companies
are far overreaching whatthey're actually legally allowed

(48:31):
to be doing.
And the more that ABA companiesare attending things like the
Autism Law Summit and learningabout mental health parity and
all the things you should knowfrom working with insurance.
And I know this might reallymake some people mad, but there
are PE backed companies now thatactually have the ability to

(48:52):
fight this stuff and they'reworking on it.
Like as much as people mightcriticize PE backed companies,
that's probably one benefit isthat they're, you know, it's
highly uh in their best interestto get the insurance companies
to do what they're supposed tobe doing, you know?
So we have, I feel like anotherway to push back than like BCBAs
who are trying to operate theirown company and don't really

(49:12):
have the time or resources toreally push against the
insurance companies.
And of course, then we haveplaces like CASP and the
Autobahn Law Summit.
So that's a big piece of it, islike the more we can do to get
insurance companies to take astep back.
Because when you look at likegoing to the doctor and speech
language pathologists and thingslike that, they're not required

(49:33):
to give nearly as much detail assome of the insurance companies
are trying to require frombehavior analysts.
But the other piece, like forthe ones that really are just
requiring what's necessary foryou know providing the benefit,
I think sometimes behavioranalysts are giving too much
information.
Like we're taught to be so clearand write these really detailed

(49:54):
treatment plans, and then we'regiving the insurance essentially
ammunition to use against uswhen all we really need to be
doing is giving them thelong-term goals, maybe the
short-term objectives, and thenour data about progress.
Now, when we go back to the homeand we're using behavior
analytic strategies to obtainthose goals, in reality, the

(50:15):
insurance company doesn't needto know all of those things that
are happening.
They just need to see us, yes,attesting that we're using
behavior analytic procedures,but you know, we've met these
goals, and here's the data toshow we've met these goals, and
here's our new goals, and here'sthe assessment results, and the
data.
That's what they need.
So if that's the case, if I'mworking on training people and I

(50:36):
my focus is more on I'm gonnacoach and train you and set help
you learn how to set up theenvironment better, then the
data I can still collect, and Idon't even need to collect it.
Like we're taught, you know, youhave to collect multiple data
points per session, blah, blah,blah.
In the research, that's notactually true.
When you look at especiallynaturalistic developmental

(50:57):
behavioral interventions,they're not doing that and
they're seeing just as muchprogress, if not more.
Because again, what's thecritical component?
Shared experiences.
How are you having sharedexperiences if you're taking
data every two seconds?
Like you're not.
It's not happening.

SPEAKER_05 (51:11):
Are you gonna report her to the board or do I need
to?
We're gonna have to not evenmultiple.
Wow.

SPEAKER_04 (51:18):
We're gonna have to end here.
Uh I'm not sure that we're Ilike to say if you're texting
who's driving.

unknown (51:25):
Yeah.

SPEAKER_01 (51:26):
That's that's my best analog to like.

SPEAKER_04 (51:28):
I mean, and it happens to us in in modern day
interaction, you know, and we doit to each other, and and that's
not what we want to do with ourkiddos.
That's we're that's not a goodmodel, you know.
Um and it's why we we agree ahundred percent with you.
We used to like to say uh, youknow, uh a point is a a point,
uh two points is a line, threepoints is now a function,
mathematically speaking.
You can you can you can figureout a lot of things from the and

(51:50):
it's not to say that you onlyneed three points, but if you
take those three points at theright time and you sample them
across a span, you're gonna getgood information.
Again, the more data the better.
But the idea that we'vehistorically tried to recreate
sessions through data points,yeah, you know, that that's
that's ridiculous.
It really compromises theinteraction, to your point.

(52:11):
Will and looks like I get thelast word.
As this concludes part one ofour interview with Dr.
Megan.
Please do return for part twoand always analyze responsible.

SPEAKER_02 (52:24):
ABA on facts is recorded live and unfiltered.
We're done for today.
You don't have to go home, butyou can't stay here.
See you next time.

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