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- Okay, so let's get back into Working Memory.

So this was this first study by Lisa Baltruschat that just looked at the Counting Span Task.

And this is an example of where just positive reinforcement alone produced an effect.

And the important point here is it didn't just improve the students' motivation to perform, that would make sense with positive reinforcement.

But even when that motivation was removed, the effect endured.

So it seems like we actually did improve whatever behavioral skills are an important part of working memory performance.

- [Therapist] Okay, I'm gonna try and trick you.

- So here's an example, not from that particular study, but just another example.

Mostly I just need to have videos of cute kids to keep your attention, so.

(audience laughs) - [Therapist] Pay attention.

I'm gonna say three numbers and then you have to say them backwards.

[Student] Okay.

[Therapist] Okay, we'll do an easy one first, ready?

One, two, three, [Student] Three, two, one.

[Therapist] Two, ha ha.

That was easy.

[Student] That was hard.

[Therapist] Okay, ready?

How about zero, five, two?

[Student] Two, five, zero.

[Therapist] Wow, okay.

10, seven, four.

[Student] Four, seven, 10.

[Therapist] Dude! Should I try four numbers now?

[Student] No.

[Therapist] Just three?

(laughs) [Student] I want to work outside now.

[Therapist] All right, We're gonna do in just a second.

I'm gonna do two more, okay?

Let's read letters.

[Student] Okay.

[Therapist] Okay, last one and I'll watch your video.

[Student] Okay.

[Therapist] Can you sit really still?

Thanks, okay.

How about Q, A, Y?

[Student] A, Y, Q.

[Therapist] Let's try that one more time.

Q, A, Y.

[Student] A, Y, Q.

[Therapist] listen to my words, once you're ready.

Q, A, Y.

[Student] Y, A, Q.

[Therapist] Good, okay, one more time by yourself.

Q, A, Y.

[Student] Y, A, Q.

[Therapist] Awesome, how old are you?

[Student] Five and a half.

[Therapist] Is that how you remember these stuff?

[Student] Yeah.

[Therapist] Let me see if you remember.

Q, A, Y.

[Student] Y, A, Q.

[Therapist] Amazing.

- And so for this particular student, you can tell just social praise was really motivating, right?

Like every response that he's doing, he immediately looks to the instructor to see like, are you gonna praise me?

So great, so that's why in this example, we're only using social praise.

Of course, for each individual student, you've got to use positive reinforcement that's effective for that student.

Now this showed an example of analog or contrived practice moving through different exemplars within just that brief session.

And then when the kid had a hard time with one particular example and he made an error, he tried again, made an error again.

She kept going on that same one until he got it right.

And then notice that she went off and did something else.

She asked him how old he was and did some cute stuff.

And then came back to that same trial to make sure he could still do it.

Now, if he could still do that same thing immediately, a minute later or something, that's great.

But it's still again not what we're looking for.

What we're looking for is the ability to do untrained stuff that he hasn't practiced.

So we continue doing that until we see generalization to untrained examples.

And there's different ways to approach this type of multiple exemplar training.

Some people prefer practicing specific examples until the child masters those examples.

So maybe you teach like three examples until the child gets those correct consistently, then you add three more and work on those until they get those three correct consistently.

Then you add three like that until you see generalization to untrained examples.

So that's sort of the traditional method.

Another method is new examples every day.

Never having the opportunity to actually practice the same ones until you get good at them.

Now that second alternative is quite a bit more difficult, but also encourages quite a bit more flexibility from the very start.

Does that make sense?

So when you're customizing this for your students that you're working with, you're gonna wanna just think that one through.

Like, if this is the first time that they're learning this higher order more complex stuff, maybe go with the former procedure where you do let them do the same stuff over and over until they get good at it then you add on new stuff.

If not, if it's a child who has more advanced verbal repertoire and for whom you think it might be successful or effective to practice new examples every day, just go right into that.

Because for a lot of children that works great.

And basically what you're doing by doing that is you're avoiding the child forming a sort of repetitive or rigid habit to begin with by building and flexibility from the very, very start.

[Therapist] Now this time, I'm gonna say.

- Here's another example.

And I think this is the, I can't even remember.

Let's see, you tell me what it is.

- [Therapist] I'm gonna say four numbers, okay?

And then I'll ask you a question, ready?

[Student] Okay.

[Therapist] Listen to the numbers.

Wake up, sit up right.

[Student] No, all the others I'm trying.

I'm tired to remember.

[Therapist] What?

[Student] Try telling me a number.

[Therapist] Sit up, sit up, sit up.

[Parent] Alex, you need to sit.

[Therapist] Thank you, okay.

I'm gonna say some numbers and then to ask you questions about them, so listen really carefully, right?

Okay.

Five, three, nine, one.

What was the second number I said?

[Student] Three.

[Therapist] Good Job.

[Student] It won't be easy if you did something.

[Therapist] Let's do one more.

[Student] Easy.

[Therapist] Let's do one more, say it backwards with four.

[Student] Okay.

[Therapist] With four numbers, last one, right?

[Student] Okay.

[Therapist] Show me your brain.

Okay, we're still gonna say it backwards again.

Nine.

[Student] I heard you.

(laughs)

[Therapist] Nine, four, three, two.

[Student] Two, three, four, nine.

[Therapist] Good job.

- So that was funny there.

That was the student prompting the ABA therapist to be flexible.

He's like, I can hear you.

Just let me lay on my back.

We're gonna talk a lot more about flexibility throughout the rest of the day.

So, this therapist is going back and forth between trials where the child has to repeat the stimuli backwards back to her.

And trials where the child has to answer some question about the stimuli.

Like what was the second stimulus, or the third stimulus, or something like that.

Or categorizing the stimuli, whatever.

I'm not basing this next statement on research at all.

But from my interpretation, I don't think it actually matters too much what the specific sort of processing is that the kid has to do.

I think that the repertoire that we're building here, the skill that we're building, is the skill of paying attention very carefully, and then responding a short time later to the stimuli.

And I think that's an overarching skill that you can strengthen and it shouldn't matter too much what specific, say it backwards, say it forwards.

What's the third letter, fourth letter, what color is it?

Those specific types of responding shouldn't matter too much, except that make sure that whatever those specific types of responding are, is something that is already in the child's repertoire, right?

Like this shouldn't be where the child learns the concept of the second number, right?

Obviously, right?

That would be a very, very bad way to teach that concept.

Right, okay.

So those are examples of just working on the core skill itself without teaching any self-management or compensatory strategies.

But that's not good enough.

We also wanna teach these secondary repertoires of behavior, the self-awareness repertoires to behavior.

The sort of self-directed behaviors.

And so there's various ways to do this.

So we teach of course, writing lists to help remember stimuli.

So like the shopping example.

Teaching the big one that people do all the time.

Well, let me ask you, if you need to remember my phone number five minutes from now, and you can't write it down, what are you gonna do?

You're gonna repeat it to yourself over and over and over.

Right, okay.

And the more that you do that, the more it seems to work.

Nobody knows why, but there seems to be something about active responding to the stimuli that makes you more likely to recall those stimuli later.

So let me tell you a story about parking structures.

So I do a lot of traveling for work and probably about five or six years ago up until then, I would always forget where I parked my car at the airport parking structure, okay?

And I would have to spend like five or 10 minutes searching for my car, so frustrating.

And you would think the natural consequences of that behavior would shape the behavior, right?

But it didn't.

And so does anyone have a solution to this?

What do you do?

(audience murmurs) You take a picture, right?

Who said take a picture?

Raise your hand.

You take a picture of what, like the sign that says 4F or whatever, right?

Okay, take a picture.

And of course, that's fine.

That's a compensatory strategy.

But then what I found really interesting was the more I did that, the less I actually had to look at the picture on my phone.

I would actually just remember it.

I wouldn't even bring it up.

So isn't that interesting.

So then I thought, okay, this next trip that I'm gonna go on, what if I just do this with a phone and don't press the picture taking button, right?

And so I tried it and it worked right.

And now what I do is, I just do this.

(audience laughs) And just actively respond to the visual stimulus, like focus, like pay attention to the visual stimulus intensely for even just a few seconds.

And that in itself is enough.

Does that make sense?

So it's about this active responding repertoire that we're establishing.

Okay.

Let's get to some more examples.

So here's the next study from Lisa Baltruschat's Dissertation.

And this is an example of where we taught a compensatory strategy.

And the task that we taught in this study is called The Complex Span.

And I guess they call it that because it's a little more complex.

And what it involves is you show a stimulus, a picture card to the student, and then you ask them to categorize it in some way.

So there's two different categorization responses we included in this study.

One was, can you eat it?

Right, so foods.

And then the other one was, can you wear it?

So clothing, right?

And so the task, so we said, we had one stack of cards, picture cards, that were for training, just like any other study.

And one stack of picture cards that were for testing only, generalization, just like any other study.

We had one categorization response just for training.

I think it was, can eat it?

And then we had one categorization response that we never trained and was just for generalization testing.

That was the, I can't remember which was which, doesn't matter.

And so the task involved, you hold up a picture, you say, can you eat it?

Yes or no.

The kid would say, yes.

Okay, great.

So then you hold up another picture.

Can you eat it?

No.

Okay.

Then you hold up another picture.

Can you eat it?

And then after the series of pictures, you say, okay, great kid.

Now tell me the pictures I showed you in the order that I showed you to.

Does that make sense?

So again, it's some active responding to the sequence of stimuli that happened within the last few minutes.

Here are, again, we did a multiple baseline across three students.

Here's the data from one student.

And again, real similar graph.

We have the stimuli that we used for training as the black data points.

And the stimuli that we reserved only for generalization testing as the white data points.

We never trained those.

The baseline phase was the same as before, which is we just presented the trials.

And we told the kids, sorry, kid, we actually can't tell you if you're right or wrong, just do your best.

And regardless of what the response to a trial was, we just said, okay.

And we moved on to the next trial.

As you can see in baseline, the child had a real tough time with both the training stimuli and the generalization stimuli.

The next phase was positive reinforcement alone, SR plus.

And as you can see, there was definitely a change in behavior.

There was definitely a reinforcement effect, but still nowhere near what we were looking for.

And we didn't wanna wait a long time, and it didn't seem like it was on an upward trend.

So then we said, all right, let's teach this kid some vocal rehearsal.

So in this phase, the vocal rehearsal phase, we told the kid, look, this is a lot easier if you just tell yourself what the pictures are, right?

So we'd hold up firetruck, can you wear it?

No.

Okay.

Now watch kid, do this, firetruck, firetruck, firetruck.

Okay, then we hold up a carrot.

Can you eat it?

Yes.

Okay, Good.

Firetruck, carrot, firetruck, carrot, right?

Like that.

And so we prompted the child to vocally rehearse the names of the stimuli that we held up, and then we faded out the prompting, so they're doing it by themselves, and it was working really, really well.

Then the child had one tough day, and the team that wasn't involved in the study said, "We don't wanna wait anymore, do something else.

You gotta do something else to make it work better." And so we did, which is a research no-no.

We should not have changed anything here, because look how well it was working there, right?

We should have stuck with that.

But we did anyways.

And I guess the whole team thought, yeah, the kid needs some extra help anyways.

So in this phase we introduced a visual support and the visual support was after the child engaged in the categorization response.

So can you eat it, yes or no, or can you wear it, yes or no.

Then we'd place the picture card face up on the desk, okay.

And then we'd present the next one, and then face up, the next one face up.

So then this correct responding here was basically the child just naming the cards he saw on the desk.

Does that make sense?

So he's not engaging in working memory there.

Really not at all.

He's just naming stuff that he sees right in front of him, okay?

So then we started fading it out.

So around there we started fading out the visual supports and I think we faded out from the first card first.

And so we'd fade out the first card, then the second and the third, across successive sessions as long as he was still doing fairly well, at least 80% or better.

We faded out, faded out, till the very last session with a visual support.

I'm doing terrible with his laser, here we go.

Very last session with the visual support there, there was just a blank card on the desk.

No picture at all, but still somehow that blank card helped for some reason, okay.

Then we faded that out.

All the while the child's still engaging in the vocal rehearsal behavior.

And he's doing great.

Now, doing great.

Now around here, we said to the kid, "Look, I know it really helps when you talk to yourself about what you have to remember, but you can't do it anymore I'm sorry.

you got to just whisper, okay?

So you still say it, but just whisper it really quiet." We did that for a couple sessions.

At first, it was hard.

See that low data point, but then he got great at it.

Then we said, "Oh, sorry kid.

Now you can't even whisper, but you can move your lips.

Just say it silently, moving your lips." "Okay, cool." At first that was hard, then back up to a 100% for a couple sessions.

And then we said, "Okay, kid.

Sorry now you can't even move your lips, you got to just think it to yourself.

Can you do that for me?" At first it was hard, then two sessions at a 100% correct.

So now we're at no visual supports and no external vocal rehearsal.

We think the kid was vocally rehearsing internally, covertly.

We don't really know, and actually it doesn't matter because he's still doing really well.

Does that make sense?

Then we switched to the post phase there, which is no reinforcement, no prompting, no nothing.

Identical the baseline.

Now you might notice that the kid's still doing pretty well, not as well.

So there's a decrease in accuracy from when we were using positive reinforcement to when we're no longer using positive reinforcement.

Then we probed the generalization stimuli that he never had any contact with at all other than when we first probed them with no reinforcement here, and he did pretty darn well, not a 100%, but pretty well.

So if you see with no more supports whatsoever, way better than baseline.

And it persisted for that's about six sessions in that post phase and it's not on a downward trend.

So again, what that looks like is just teaching these skills and using positive reinforcement.

And in this case, prompting sort of self-management skill seem to support continued improvement at least compared to baseline.

And again, what this decker meant here, this difference here, what that says to me is positive reinforcement matters.

And I'm okay with that.

I don't mind that, right?

It matters.

So the performance gets a little bit worse when you remove reinforcement.

And what that might be is the motivation piece.

Does it matter that kids are trying hard?

Yeah, of course, right?

But what's cool about it is there does seem to be some skill acquisition piece that's still present even when you remove the motivation.

So I do think that this provides further support that whatever behavioral repertoires are involved in working memory are amenable to change and are amenable to teaching and support.

(audience member coughs) Okay, any questions on these sort of analog bridge studies on working memory.

So it's not totally obvious how you would translate that into what you do in classrooms, right?

Those studies, that wasn't even the point of the studies.

The point of the studies were to see will ABA principles and procedures actually even help at all with working memory.

Can we even affect that suppose the brain function?

And I think the answer to that was clearly, yes, it makes a difference.

And actually have any of you ever heard of competitive memory people?

There's actually like societies for this and associations.

There's like competitions where there's prize money and stuff.

You've heard of this?

Like professional memorizers or whatever?

And it's interesting.

There's a whole little like subculture of people, like that's what they're into is memorizing, okay?

And they have competitions where someone gets up on a stage like this and they get a huge series of random stimuli.

And then they have, I don't know, a minute or two to memorize them.

And then they have a test where how many of those 100 stimuli can they remember, okay?

And it's like Olympic level performance, where if you can improve your memory by even one or two stimuli, that's the difference between like a gold and the silver or something, right?

And you ask these people, "Okay, what do you do to train?

Or why do you have such a good memory?" And they say, "Well, you gotta train.

You gotta spend a lot of time training, practice, practice, practice." Okay, so how do we put this into practice in real life classroom settings?

Well, we wanna put in environmental supports also, right?

Modify the environment to help.

So removing or reducing distractions can help obviously, sometimes even just proximity makes a difference.

So like, if a kid doesn't have to walk as far to get the item, right, before he forgets it, that could be helpful.

Obviously to do lists, visual and physical cues.

Do you guys use visual schedules in your classrooms?

folks on the spectrum?

Okay, that can obviously be very helpful.

The most important stuff though is real life application.

So you might start with this sort of contrived practice stuff like I was showing you, and then very quickly moved to real life application where you say, and you might even tell the kid, "Remember that silly stuff we were practicing?

Well, this situation is just like that." So the teacher's gonna tell you some stuff.

I wonder if you could try to remember it?

Remember how we practiced that rehearsal stuff?" Or whatever you wanna call it, you don't have to use the word rehearsal maybe that sounds weird to your student.

"But let's do that again, are you ready?

Okay, the teacher's about to tell you something.

what are you gonna do?" "I'm gonna think it to myself." "Okay, cool.

Think it over and over and over until you have the opportunity to go get your backpack and get your book out of your backpack." And practicing multiple exemplars in the real setting until you get generalization to untrained exemplars in the real setting.

Okay, let's talk Sustained Attention.

Which, I should put the sustained attention topic right after lunch, 'cause that's the hardest time to pay attention.

(all laughing) But maybe right before lunch is hard too, we'll see.

Okay, so what is sustained attention?

It's continuing to pay attention despite distractibility, and it's persisting in the face of adversity, or persisting in the presence of environmental circumstances that would normally distract your attention, or disrupt it.

So, from a behavioral analytic perspective, sustained attention is interesting.

It seems to me like sustained attention is paying attention to particular stimulus for longer than you want to.

Does that make sense?

So you've got a stimulus.

You've got maybe a normal amount of attention that you normally pay attention to that stimulus, but that's not enough.

So, and I don't wanna over-generalize here, but for the students that we work with, perhaps the teacher's voice is a stimulus that we want them to pay attention to, right?

And perhaps the normal amount that the student pays attention to that stimulus isn't enough.

And we wanna increase it.

Well, what's interesting about it is have you ever heard, there's different versions of it.

From basic research it used to be the rat is always right.

Have you heard that expression?

Another way to say it is like the student is always right or whatever, there's no such thing as bad students, but just bad teachers.

I'm not saying you guys are bad teachers obviously.

But the idea there is, if we blame the organism, it's not very helpful to change the behavior.

It's better to blame the environment because the environment is what we're able to change, right?

And our behavior as consultants is part of the environment and the teacher's behavior as a teacher is part of the student's environment, right?

So that's the part that we can actually change.

So almost by definition, if the student's not paying attention long enough, it's because there's something about paying attention that isn't reinforcing enough in its current state.

And it doesn't mean anyone's doing anything wrong.

Maybe everyone is doing everything right.

And still for this particular student in that setting, maybe it's just not that reinforcing.

It's not that interesting.

So here's the problem that we seem to be in with sustained attention.

Almost by definition we have a problematic competition between two reinforcement contingencies, and for two different behaviors.

Behavior one, pay attention to the teacher or the education assistant or whatever it is, pay attention much longer than you want to.

And what's the real consequence for that?

Being bored maybe, from the student's perspective.

And again, I'm not criticizing what the teachers are doing, but let's just be honest, right?

For some students that is kind of the natural consequence is lack of reinforcement for the behavior that we want, right?

Now here's this other behavior that they could engage in, spacing out, vocal stereotypy, daydreaming, looking out the window.

And that behavior, which is incompatible with sustaining attention gets immediate reinforcement, right?

It either gets escape from boredom or it gets access to some positive reinforcement.

Now some of you guys might be having that exact same competing reinforcement contingency right now, if what I'm saying is not that interesting to you, it might be much more reinforcing to think about what vacation you're gonna go on, or what you're gonna do when you get home, or what your plans are for this, right?

Does that make sense?

So you've got this stimulus, my voice, and the behavior we want on your part is paying attention all day, right?

Sustaining attention, and you've got these other, right?

Okay.

So it seems like right from the very start, if we're saying that a student has a problem with sustained attention, right from the start, we're also saying there's a problem, there's other reinforcers that are bigger for not paying attention than the reinforcers that are currently present for paying attention for this particular student.

And again, not a value judgment at all.

It's just like looking at what's working and what isn't working.

So, to put it more simply sustained attention by definition is boring.

So we need to make it fun.

So let's talk about some of the approaches we might take.

So if you wanna do the contrive analog practice, we might start with activities that require the student to pay attention for a long time, and at first, make it easy.

Start with something the student actually likes.

Maybe the student likes origami, or likes making friendship, bracelets, or lanyards or whatever that stuff is called.

What are those things?

Those crazy looms were those popular here for a while?

Those were just nuts in the U.S.

like a few years ago.

Like every kid was obsessed with the crazy loons of the rubber bands and stuff.

That's a task that requires sustaining attention for a long time to complete the bracelet or whatever the thing is that you're trying to make.

So maybe when you very first start, start with something like that, that's something that the student's gonna enjoy.

And start building in queues from the very beginning, like, okay, it's time to pay attention, but then give them something that they like paying attention to, does that make sense?

So you're building in a cue from the beginning and you're making it easy.

Okay.

Then of course there's compensatory strategies.

So stuff that you do that might help you sustain your attention.

So, visual cues, priming beforehand, maybe talking through the situation with the student at the very beginning of class, like, "Okay, now we're gonna learn about X, Y, and Z topic.

It might take a while you might get kind of tired.

So what are some things you can do in order to make sure that you pay attention?" A motivator, have you guys ever heard of a motivator?

It sounds like it's from the 1980s.

But it's like almost like a pager or a beeper that the student holds in their pocket and you can set it to vibrate at different intervals.

So you can set it so that once per minute, it'll vibrate for a second in the student's pocket, and you can train that to mean whatever it needs to mean.

So it could be whenever you feel the vibration in your pocket, make sure that you look up at the teacher and think about what the teacher is saying for a second.

And then later on, we'll talk about self-monitoring actually and how those can be useful for that.

But come up with some strategy for queuing the student to to sustain their own and monitor their own attention.

Practice across lots of examples of course.

Environmental supports are really important for this stuff too.

And actually the motivator could be considered an example of an environmental support.

But using the motivator is a self management strategy.

But of course you could do things like seating the student closer to the teacher, that that might help sometimes.

Unfortunately, what's the more common circumstance?

When a student has a tough time paying attention, they ended up getting in the back of the room, right?

Because they're disruptive.

That might be counter productive to paying attention.

But reducing distractions, things like this can be useful as well.

Okay, but the most important thing of course is getting to that real life application.

So whatever your strategies are, you make a plan, you test it out to lots of practice in contrived settings, but then test it out and generalize in real life settings.

Okay, sustained attention.

You might tell actually from the change in my sort of prosody and tone, sustained attention is one of my least interesting topics, but I think it's important so I included it.

But now we're gonna go onto something that I actually find a lot more interesting, which is Cognitive Flexibility.

And before in the very beginning, I think I asked, raise your hands if you've ever met a person on the spectrum who had a hard time with being too rigid or inflexible, right, and literally everyone raised their hands.

Now, be honest.

Raise your hand if someone in your family maybe has a hard time with being a little too rigid or inflexible, okay.

Now if you're willing, raise your hand, if you're that person.

(audience laughs) Right?

Okay.

And I really appreciate, someone in the audience came up during the break and said, "By the way, like I don't even work with kids on the spectrum anymore.

I do this other stuff and it actually totally applies." And I appreciate that comment.

And I really agree with that.

The more that I learned about executive function skills, the more I realize it has nothing to do with autism.

It's just stuff that matters for functioning, right?

And if you have a student who needs help in these areas, then that's why it's useful to learn about it for working with kids with autism.

But of course, that's true with language, right?

Language matters for everybody too.

Okay, let's talk flexibility.

So cognitive flexibility from the sort of general psychology or cognitive or neuroscience literature is the ability to switch between thinking about different concepts.

Or the ability to think about multiple concepts simultaneously.

It's also referred to as set shifting, also very relevant to multitasking.

Okay, so how about from an ABA perspective?

What the heck is this flexibility stuff?

And there really isn't a lot written in the ABA literature about it.

It's funny, it's one of those areas where literally everyone in ABA that works with people with autism agrees that flexibility matters, and that we need to work on it with our kids.

And yet, if you look to the literature, there's really actually not very much.

So my colleagues and I have been working on developing some of this stuff, and I'm gonna show you some of it.

But what the heck is it from an ABA perspective?

Well, so the first piece that seems to me is flexibility by definition involves variability in your behavior, right?

So if you're flexible, well, first of all, let's say if you're inflexible, that basically means you're doing the same thing over and over and over, regardless of whether or not it's working, right?

And so you have students, right, that that will do the same thing.

Even when it doesn't work, they'll just keep doing it.

They're really rigid about it.

So flexibility must involve not doing that, right.

It must involve variability in behavior.

However, here's a really important part.

It's not just random variability, right?

If it was random variability then doing any old weird thing would be being flexible.

But that's not what we're talking about.

You don't want your students in your classrooms just doing any old, random, weird thing, right?

You want them staying on task, right?

You want them paying attention.

You want them working hard in a flexible way.

So it seems like flexibility is behavior being variable and being sensitive to ongoing changes in the environment while being relevant still to the environment.

So it's behavior remaining relevant to the environment and changing with ongoing changes with variability in the behavior.

Some people have talked about flexibility as primarily sensitivity of rule deriving as a repertoire behavior.

Raise your hand if you've ever heard of rule governed behavior in ABA, a few folks.

Okay, we're gonna talk a lot more about it later.

So I'm not gonna spend a ton of time on it now, but rule deriving in short is the ability to create your own descriptions of how the world works and then follow those descriptions.

So for example, oh, it's not working when I have a tantrum.

Maybe it would work better if I asked for a turn instead.

Okay, I'm gonna try it and then do it, ask for a turn instead.

By the way, we hardly ever see that, right?

But that would be nice.

But maybe if it's not involving severe problem behavior, maybe it's some other situation.

Maybe it's like, oh, well I can't fix the toy in this way, maybe I can try it a different way.

And we're gonna talk about problem solving in a minute.

So I'm not gonna spend a lot of time on it now.

But rule deriving is a thing, it's a repertoire behavior in itself.

And it seems like the ability to talk about changes in one's environment and what works and what doesn't is really critical to being flexible.

If you think back to people in your family who are particularly rigid, and maybe they're having problems.

Maybe it's hurting their job.

Maybe it's hurting their relationships with friends.

Maybe it's hurting relationship with their spouse.

If you talk to them about it, don't you notice that they kind of say the same thing over and over, right?

You say, "Well, why do you keep doing that?" And they have the same explanation over and over and over.

And so to me, what that's demonstrating is a lack of ability to come up with new descriptions of the circumstance that might also be useful, right?

It's the insistence on talking about life the same way over and over and over.

So for me, this is all part of that same continuum of repetitive behavior that starts, that the simplest end is rocking or hand flapping, and at the most complex end is really rigid ways of thinking and talking about the world.

And so a lack of flexibility to me seems to be that that repertoire is very weak and that we need to strengthen that ability, or that habit, or that skill of talking about the world in a flexible and variable way, and being willing to talk about the world to yourself in new ways.

Since I'm a behavior analyst, I would sure prefer the term behavioral flexibility over cognitive flexibility, but it doesn't really matter, right?

If we can figure out a way to improve these abilities, that's what really matters.

So it's kind of hard to overstate the importance of flexibility, both in autism and also honestly, just for all of us.

If you wanna be good at stuff, if you wanna be successful, if you wanna achieve goals that matter to you, you've got to be able to be flexible.

In order to be successful without being flexible, you would have to already have the whole world figured out right now for the rest of your life.

You got it all figured out today already.

Does that seem possible?

No way, right?

And the same is true for the students that we work with.

It also seems to be really, really important for creativity, right?

Like artists can't do the same thing over and over.

It's not art if you're doing exactly the same thing over and over.

It's definitely necessary for problem solving, which we'll talk more about in a minute.

Certainly related to the diagnostic features of ASD, like we talked about.

And perhaps most importantly, it really matters for social functioning.

Raise your hand if you have a friend that maybe you kind of don't want to hang out with them, you don't enjoy spending time with them because they're so rigid.

Like I have a few of those and I love them.

I care about them.

I want them in my life and yet I kind of avoid being around them because it's not fun to be around someone who always has to do things the same way over and over and gets upset if things change, right?

So of course it's the same thing for the students that we work with.

If we care about their social adjustment, their ability to make friends in schools, it's very, very important.

So perseverative responding or stereotype responding again, it seems, I've kind of already made this point, but it seems like it there's an inverse relationship between flexibility and perseverative or repetitive responding.

The more flexible you are, the less you're doing things repetitively.

The more time in your life you're spending on repetition, I think the less flexible you are.

So we wanna increase one and decrease the other.

Okay, doesn't that look like it hurts?

It doesn't even look like it's a real picture.

It's incredible.

Okay, so luckily there isn't a ton of research, ABA research on fixing inflexibility with folks on the spectrum, but I'm gonna show you some stuff.

Luckily though, there is a lot of research by Alneringer and colleagues, actually starting with basic research with rats and pigeons and other animals showing that if you just give an animal positive reinforcement for doing something different than the animal did previously, just reinforce doing anything different than the animal did previously, the animal will start to engage in a wider variety of behaviors.

And these are animals with no verbal behavior at all.

They are not humans.

They can't talk.

They're not thinking about what the experimenter wants them to do.

So for example, like with a rat, they'll do a reinforcement schedule where if the rat presses the lever twice, it gets a food pellet, if he presses it twice again, no food pellet.

Now he's got to press it three times or just once.

Or now he has to present really fast if he pressed it slow last time, does that make sense?

They've done it with dolphins.

They've done it with pigeons, lots and lots of different animals.

The reinforcement contingency is you get a reward if you just do something different than you did last time.

And it works.

And they've actually shown some they've done a little bit of research on this with kids with autism too.

They've done things like building block structures.

So if you want a reward, cool, all you have to do is build something different than you did last time.

So the kid builds a block structure, if it's not the same one that he built one trial ago, he gets a reinforcer.

Awesome, that's really cool, good job.

You want another?

All right, let's do it.

And now the kid has to do something different.

So this is kind of the opposite of how we normally think of reinforcement, isn't it?

Normally we think of reinforcement as getting that previous behavior that just happened that produced the reinforcer, getting that behavior to happen again.

Right, this is different.

But actually it's not different.

It's the same.

Because the behavior that we're getting to happen is the behavior of behaving variably.

Does that make sense?

So the topography of the behavior doesn't matter.

It's the larger class of doing something novel, doing something variable that gets reinforced and is able to be reinforced, okay.

Raise your hand if you've worked with a student on the spectrum for whom doing something different than the way it's supposed to be done is aversive and they get upset.

Okay, and again, not just autism, right?

Plenty of us too, right?

You change our routine and it can be pretty frustrating.

It seems to me though that there's a special case for a lot of folks on the spectrum, that it's really frustrating.

It's not mildly frustrating.

It's genuinely distressing.

And there's some behaviors, some misbehaviors displayed by kids on the spectrum where you look at it and you go, "Yeah, right kid.

Okay, sure, right.

Like I get it.

You just want the cookie or whatever, right?

But not all of them, right.

Like I've definitely observed plenty of kids on the spectrum for whom novelty or difference or variability itself is really aversive and it produces the same like respondent response that, a big spider would, or a snake or something.

It's like genuinely anxiety provoking.

Okay, so what do we do if that's the case?

Like, how can we fix that?

You might say, well, that's just, that's part of the diagnostic features of autism insistence on sameness.

And okay, yes, that's true.

And if we blame it on the diagnosis, there's nothing we can do about it, right?

So a much better thing to do is blame it on the environment.

Okay, let's change some aspect of the environment.

So what can we do to make something less aversive?

You guys know some of this.

What do you do if you wanna get over something?

What do you do?

You can just avoid it, right?

But that's kind of just avoiding the problem.

So what else can you do?

Yeah, desensitization, right?

So contact it.

So the best way to decrease how aversive a stimulus is, is to actually have more of that stimulus, unfortunately, right, that's the bad news, but that's true.

There's tons of research on that.

So, exposure and response prevention.

Raise your hand If you here last year when Pat Fryman did his talk.

Okay, and raise your hand if you can remember if he talked about exposure and response prevention, a lot of times he does, did he talk about that, maybe?

Okay, so exposure and response prevention is a research proven procedure.

Again, not a ton of research with folks on the spectrum, but a lot of other folks.

And it's where there's some stimulus where it's an anxiety provoking stimulus, and there's a normal response that the individual would usually have to that stimulus and it usually involves avoidance.

And to do exposure and response prevention, you expose the person to just a tiny little bit of that stimulus, anxiety producing stimulus, but you don't let them engage in the avoidance response.

So that's the response prevention part.

And so the way that we've done this, and I'm gonna show you some data, the way that we've done this is we make a list of all of the different stimuli that the child is gonna be particularly inflexible about.

So maybe it's changes in routines.

Maybe it's changes in what shoes he's wearing.

Maybe it's changes in what pencil he's using to complete a worksheet or the order of activities, whatever, okay?

I worked with one kid and I'm gonna show you some data.

One kid where it was literally movement of any object in his bedroom.

So if you moved his pillow one inch on his bed, he would have a total meltdown and engage in severe aggressive behavior until you let him fix it, right?

Or until you fixed it.

If you wrinkled his sheet, literally, and again, he's not just being a punk or something like that, like it was genuinely upsetting for this kid.

It was like a full blown panic attack for this kid.

So we make a list of all of the different (coughs).

All of the different stimuli that would be problematic in terms of flexibility, and we said, okay, we're gonna target a bunch of these, and we're gonna save a few and not target those, okay.

So here's data from, we're running a treatment evaluation project now.

We've run it with two kids so far, and we're now running it with the third.

Worked really well for both of the first two kids.

This particular child, he had a lot of different inflexibility issues.

One of them, which is kind of kinda humorous is any string out of place in his environment was a major source of anxiety and he would have severe problem behavior until he could fix that string.

So you might be thinking like, what are you even talking about, right?

Well, he had a rug in the middle of his hallway that had about a hundred little tassels on the outside edge of the rug.

And so anytime anyone walked over the rug, it would wrinkle the tassels.

It would move them out of place, right?

And this poor kid would literally like tear up, get desperate and just lunge at the rug.

And if you got in the way and said, "It's cool, man, don't worry about it." He'd hit you, he'd bite you, whatever it took so that he could get down and straighten the strings, okay?

Now it's kind of funny, 'cause like, why did the parents have that rug in that house, right?

But also not so funny because this poor kid that was his life, like on a day-to-day basis, he would have a panic attack and he'd have to fix it desperately, right?

You might be wondering, wait a minute, if that rug was in his house and this happened every day, why didn't he get used to it, right?

That's exposure, right?

And I'll tell you the reason why he didn't get used to it is because he was allowed to fix it every day.

Does that make sense?

So you never really have to get used to something if you're allowed to fix it and make it go away every time it happens, right?

What the process that makes exposure and response prevention work, is sitting with the stimulus longer than you want to, and just relaxing.

And engaging in deep breathing and whatever else you got to do until the moment of panic or whatever anxiety goes away.

So, we made a list for this kid of, I think it was about 70 different stimuli, a wrinkled rug, it was all kinds of stuff.

One of the major ones actually was taking a bath.

He was so rigid about the routine for taking a bath.

The water had to be like this, no it had to be like that, had to have this toy, not that toy, or it had to be this towel hung on that rack.

He was so stressed out about the exact routine that the bath had to go in, that his mom couldn't bathe him.

And this was a great mom who's super engaged, super involved, and when we did this project, the kid hadn't taken a bath in like two weeks because she couldn't do it.

Every single time it ended in a huge tantrum and lots of problem behaviors, someone's gonna get hurt.

She had to give in at some point.

And of course, giving in, it was part of what helped sustain the problem, right?

And I'm not blaming the mom at all, I get it.

It makes sense.

And it was part of the problem.

Okay, so we made that list of 70 or so stimuli.

We took about, I think about two thirds of them that we said we're gonna use to target directly in the intervention.

And we saved about a third of them that we're not gonna touch at all, okay?

In baseline, oh, and the graph shows zero to 100% correct.

And what we're counting as correct here, was that the student just tolerated the inflexibility stimulus without engaging in problem behavior, and without fixing it.

We allowed him to ask once, if he could please fix it, and that would still be counted as correct.

Does that make sense?

Like why not?

Let the kid ask once.

That's still correct, okay?

If he asks more than, and then we say, "No, I'm sorry, kid" And then if you ask more than once, then we wouldn't count that as a correct trial.

It's not like we're punishing him or anything.

It was just wasn't counted as correct.

If he engage in any kind of problem behavior, crying, screaming, running away, hitting, kicking, biting, pinching, whatever, not correct.

So the percentage of correct is the percentage of stimuli that we presented that he tolerated calmly.

In baseline, these are the stimuli that we reserved, these are the about a third or so, the stimuli that we reserved, that we were not going to treat at all later on in treatment.

And you could see that about a third to 0% of the time, he calmly tolerated.

The multiple exemplar training phase, we did exposure and response prevention starting with the smallest amount of the stimuli, but also here's a part that's interesting.

And I don't actually know whether it was necessary.

We taught coping strategies too.

So we taught him a few different coping strategies.

We taught him to take deep breaths.

We taught him to count to 10, and we taught them to imagine that he was someplace else.

And we basically just talked them through it like, "Look, kid, sometimes things don't go the way we want it to go.

And that's awful.

It makes us feel terrible, right?

Like you could feel that in your chest, it's stressful, it hurts.

And that's just how it's gonna be.

Sometimes we can't get out of it.

So to make it better, you might wanna try counting to 10.

All right, let's practice.

Pretend that I wrinkled the rug right now.

What are you gonna do?

Count to 10.

Let's do it." And we practice it with him in role-play.

And then same thing but now imagining that we're someplace else, Disneyland or whatever his favorite place was.

Okay, so we practiced that and train those coping skills.

And then we did the graduated exposure and response prevention.

And immediately we saw an improvement up to a 100%.

But what was important here was we presented new inflexibility stimuli on each data point.

So each data point represents a block of trials that I forget, eight or 10 presentations of these inflexibility stimuli.

And what we wanted to see though, was generalization to untrained stimuli, right?

That's the point, is that the kid can now stay calm with new stuff that he actually wasn't directly taught to stay calm with.

That's the open squares.

The black squares are stimuli that it's not the first time.

It's ones that he's had practice with.

So what we wanna see is the white open squares go to a 100%.

That's when we know we're starting to see generalization.

And with this kid, we saw it really fast.

And so what that's telling me is probably some of those coping strategies that we trained initially were helpful to get him to respond accurately fast.

Now, after about five or so sessions that were successful with us, four or five, we introduced sessions with mom running the sessions.

Immediately, it went down to 50%, right?

And so he was having a tougher time with mom.

But that makes sense.

He's lived with mom for I think it was six or eight years old at this time.

He's had a much longer history of reinforcement for those problematic behaviors with mom, right?

So it makes sense.

However, with a little persistence, mom's stuck to her guns.

She stuck with it.

He immediately started doing better, after the fourth session, he's already doing better.

And then after the fifth or so session with mom, he's up at a 100%.

This last data point was taking a shower or taking a bath.

Sorry, no problem.

Got it done.

God cleaned, and it worked.

The post training phase is where we went back to these stimuli that we never ever did any training on.

By the way, in baseline, we didn't do any kind of training.

We just presented this stimuli.

If he had problem behavior, we'd say, okay, okay.

And we'd let them fix it.

Just let them get out of it.

So the same stimuli that we never did any training on, we presented again later at the end and he did great.

No reinforcement, no prompting, totally did it fine on his own.

So again, this is initial data.

I'm not saying it's gonna work with every child this easily.

But with both kids that we've done this with so far, it's actually worked really well.

And what's important is the generalized ability to tolerate inflexibility that was not directly targeted.

Yes.

- [Audience Member] So I just wanted to make sure I understood.

- Sure - [Audience Member] It sounds like you did do graduated exposure.

- Yes.

- [Audience Member] So you did do a hierarchy of what was hard for him.

- Yeah, thank you for the clarification, yeah.

- [Audience Member] Did you jump in between the hierarchy or you actually went step by step?.

- Yeah, great question.

So, and sort of an advanced question, I appreciate that.

Thank you, so she asked, did we do like an actual hierarchy of graduated exposure in the multiple exemplar training or did we kind of just jump around.

And the answer is we kind of did, but I wouldn't say we did anything like a formal hierarchy of graduated exposure.

We basically used a common sense approach of start with the smallest amount.

So I think like the first day might've been, we probably didn't work on the tassels on the rug 'cause that was like his biggest thing.

We would do something else like moving a couch cushion out of where it's supposed to be.

And on day one, we started with just a little bit of it.

So I think it was something like, if you stay calm when we move the pillow for like three seconds, then we'll put the pillow back, as long as you stay calm.

And then by the end, it's full-blown, full biggest problem, the carpet with the tassels.

And no matter what you do, it's not gonna get fixed.

Even if you behave totally perfectly and you're total sweetheart, and your whatever perfect behavior, it's still gonna stay wrinkled, and you can't fix it, and that's just how it's gonna be.

But we didn't use a real formal process, but we did take sort of a common sense ABA approach, which is start small, right?

And fade gradually when the client is successful.

I don't think I included the data.

No, I wish I had.

We also collected data on an affect because what we were really curious about is are we just getting the kid to do what he knows he's supposed to do or are we actually helping the kid learn to feel better about it?

'Cause that would be really cool too, wouldn't it?

And so we collected data on the child's facial expression using like I think like a partial interval data collection system, where it was presence or absence of smiling, presence or absence of laughing, presence or absence of grimacing, frowning and crying and screaming, okay?

And basically any of the good stuff was a plus for positive affect.

Any of the bad stuff was a plus for negative affect.

What we saw in baseline was high negative affect and low positive affect, okay?

Even though he was allowed to escape, he was still not happy when we were presenting those inflexibility stimuli.

By the time, right around here at the beginning of training, even though he's doing really great, positive affect was still really low.

So at that point he was kind of just doing it 'cause he was supposed to.

But by the end, here, and I wish I should have included the data, by the end, he's actually smiling and proud of himself.

So that was really cool.

And to like, let's say like a mom or a teacher or somebody who doesn't just appreciate the whatever ABA aspects of it, that's what they wanna see.

The kid's actually happier, right?

That's the outcome that really matters and makes the difference.

And we also ask the kid to self-report happiness scales too.

So we directly measured facial expression and crying and screaming and laughing.

But we also had a little, like a happiness scale, or like emotion scale where on one end, there's a smiley face.

on the other end, there's a sad face.

And then, like little cartoon faces and they gradually change.

And in the middle, there's just kind of a neutral face.

And we had the kids circle which face he felt.

After each trial, we'd say, "All right, how did that feel buddy?

You circle it, or you tell us," And again, and same exact pattern actually, his report matched his facial expressions, pretty darn well.

But at first he still didn't like it.

And by the end, he was kind of okay.

And actually what was cool by the end, when he'd see the therapist show up, he'd request it because he was proud of it.

He'd say, watch, I'm gonna do something different, check this out.

That's really cool.

Okay, so that's all examples of sort of analog practice or contrived practice.

But in that case that I shared with you, and there was another kid in Thailand that we did exactly the same thing with same results.

For them, even though it's sort of analog contrived practice, it was also very real-world too because they were real stuff happening in their real life, in their homes that were problematic.

But you can start with something even more analog if you want to.

So for example, stuff isn't gonna evoke a big tantrum or a big meltdown with the child.

So you might say like, "All right, we're gonna do something silly today.

Let's make up some nonsense words.

I'll go first, blathering.

What does that mean?" The kid's like, I don't know.

Well, make up something, what is it?

Maybe it's the sound that the earth makes or something, or maybe it's a sound that a horse makes when he's bored, right.

Okay, now your turn, you make up a weird word.

"Barf." Cool.

What does that mean?

Right, what else could it mean?

And it's just getting variable behavior going with positive reinforcement.

Changing the rules for known games, like start playing.

Oh yes, we had it, yes, a comment.

No, that's fine, I appreciate it.

- [Audience Member] I'm just thinking of all this.

I think it's all really interesting thinking about how, there are things that we do that are, appears.

- Yes, yes.

- [Audience Member] Does this whole idea or approach change the order in which you teach.

- [Audience Member] Yeah, I love that question.

That's such a good question.

So she said this could impact a lot of other things that we do in particular feeding therapy, right?

So feeding is super common, right?

Feeding issues are super common in folks on the spectrum where they're overly rigid or overly selective, right?

And a lot of that does seem to be related to rigidity and lack of flexibility or feeding flexibility if you will.

So yeah, if you built up an overall repertoire of being more flexible first that should help with anything else that's related to flexibility.

Should help with problem-solving, should help with problem behaviors related to flexibility, should help with feeding if it's related to flexibility.

So what's the best order?

I don't know, really, I'm not sure.

I guess my general perspective is every time you work on flexibility, that's another exemplar in multiple exemplar training of flexibility.

So wherever you start, as long as you're doing it, lots, as long as you're being flexible about how you're working on flexibility, right?

It should generalize to all other areas eventually if you do enough practice across enough different examples, it should start to generalize to all areas where flexibility matters.

So feeding, you could start with feeding and maybe that would help other things, right?

My experience with feeding is it's pretty tough.

Like for a lot of the kids that I've worked with, that is their biggest inflexibility.

And that is like the last hill that they're willing to die on before they give up on inflexibility, right?

So that, so yeah, I think maybe it would be smart to save that for later, start working on inflexibility with other stuff first and build up flexibility and then go into feeding.

But of course it's gonna vary so much from Kid to kid.

Okay, let's keep rolling here.

- [Student] I get to the end.

Okay, so here's this cute kid again.

Here's an example of some contrived practice and he's doing a task that's made up and in the middle of the task, and he doesn't know this is gonna happen, but in the middle of the task, the instructor tells him, all right, now let's do it the opposite way, okay?

And see if you can notice, use your sustained attention skills, to notice sort of what he's doing, like what the task is and what the change is and why that might be an issue in terms of flexibility.

- [Student] I'm gonna go back - [Therapist] Okay, on your marks, get set, go.

- Sorry, and I should say there's lightning and there's tornadoes involved.

(thunder and tornado sounds) - Okay, so when it gets to a circle, what does he do tornado, right?

When it gets to a square, what does he do?

Lightning or thunder, right?

Okay, good.

(thunder and tornado sounds) - [Therapist] Okay, guess what?

Now, we're gonna switch.

Now the squares are tornadoes and the circle is thunder.

- [Student] But squares are not same with tornadoes.

- [Therapist] That's okay, we're just pretending.

(thunder and tornado sounds) - Okay, so this is also an example of inhibition, right?

He's having to inhibit the old skill of tornado is circle and square is thunder.

And then do this new thing of the opposite.

So it's working on both flexibility and inhibition at the same time.

And for this particular kid, he thought that kind of thing was fun, running around, making silly sounds.

So it's a way to build that practice into something that's actually fun rather than just sort of boring, drilling over and over.

Okay, so compensatory strategies, we talked about this a little bit already in our treatment evaluation.

Yes.

[Audience Member]I want to ask a question.

- Yes.

- Yeah.

So let's see.

I might not actually have an example of that.

I'm thinking it should work just fine.

Like I said, there was that research with rats and pigeons and dolphins where they're getting them to engage in variable behavior without any vocal ability, obviously at all.

So for sure it should work the same way, but I think our vocal instructions might not work as well.

Or do you mean students who have no expressive vocal repertoire or also doesn't can't follow receptively.

Yeah, very limited receptive.

So yeah, that's gonna be a lot tougher, but I think it's gonna be tougher to do any instruction really, right?

And so I think that like the sort of rule part where you teach them beforehand, by the way kid, here's what we're gonna do.

It's gonna be tough, but you can do it.

I'm proud of you.

That part isn't gonna work as well, obviously.

And you're gonna have to do stuff, you're gonna have to vary visual cues that they actually can't see more so than the vocal cues.

I think, did you have a comment in the front?

No, okay.

Okay, so in the treatment evaluation that I showed you, those data that I showed you, we taught these kids these sort of self calming strategies or coping strategies, deep breathing, counting to 10, imagining or someplace else.

We did not evaluate that first.

It would've been interesting to see what if we had only done that and no exposure and response prevention?

Would that have worked by itself?

Our hunch was, it wasn't gonna work by itself.

So that's why we did the exposure and response prevention 'cause we knew that would work.

The coping strategies were basically just a way to make it kind of easier and more enjoyable for the kid and to give them skills that they could take moving forward in the future when new flexibility issues arose that we weren't there to help with.

But still I think it's worth working on this stuff.

I think we always model positive self-talk and I have no idea if it's actually helpful, it's probably not, but it can't hurt.

So we always say stuff like it's fun to do things different, right?

Or like watch this, I'm gonna do something different or I'm gonna change things up.

Or it's cool to be silly or whatever, some way of modeling language that is within the child's developmental level.

That hopefully by pairing that language with tolerating flexibility and then getting big positive reinforcement, will condition that language to be more reinforcing in itself.

Now here's something interesting, is if what we're doing is really effective, there could be a classical conditioning component too that matters.

So everyone knows about Pavlov's dog, right?

You hear the bell, get the food.

You hear the bell, get the food.

Now, when you hear the bell, you salivate, right?

Works the same way with conditioned reinforcement.

You hear the words, good job, you get the big reinforcer, good job, get the big reinforcer, Praise, get the big reinforcer.

Now praise itself starts to become more positively reinforcing than perhaps it was earlier for the student.

Well, I'm hoping that the same thing could be true with variability.

So in the past something new or something novel is is aversive, right?

It's anxiety provoking.

But now we present novelty and change so frequently and if we're effective at getting the kid to calmly tolerate it, then the kids also getting the positive reinforcement.

So what we're doing is we're pairing novelty, reinforcer, novelty, reinforcer, novelty, reinforcer.

And after enough pairings, the hope is that novelty itself will become less aversive, and maybe for some kids, a source of positive reinforcement, maybe some kids will actually seek out novelty and try to do new and interesting and fun things different from how they were, how they did before, even when they're not asked to or required to.

We haven't seen a ton of that.

We've seen a little bit of that.

And we haven't directly tried to measure that, although we should.

But that's the hope.

At the very minimum though, we're trying to make change per se, less anxiety provoking so that in the future when these students move forward in their lives, they can just function better and have more fun and enjoy the variability and richness that life has to offer.

Okay, environmental supports.

Okay, so here's a really good reminder for us.

Like one of the first things we learned about folks on the spectrum is they like predictability and that consistency is important, right?

That's the first thing you learned on your first day of ABA training is the importance of consistency, right?

And that's true, right?

Of course, we all believe that, and we can really overdo that, right?

So if we're super, super consistent, that also means doing things the same way over and over and over, right?

And so if we overdo that, we shouldn't be surprised when our students overdo that, right?

Like what we're doing as teachers and consultants is certainly modeling for our students.

And so even though it's important to have predictability and consistency and visual schedules and all that stuff, I think it's also extremely important to always, every time we make the student's environment more predictable at the same time we ask ourselves, how am I gonna fade that out later?

How am I gonna turn that not into a problem of rigidity?

And so, even if it is a visual schedule, don't have it be in the same sequence every single day, mix it up, right?

Sometimes unpredictable.

At first, do it in a way that's fun, right?

That isn't gonna cause a big problem.

But generally speaking, make things not always the same from day to day to begin with.

Even if it's not like an intervention for inflexibility, just in terms of how we interact.

Big no-nos that I see all the time is teachers or educational assistants kind of using the same tone of voice all the time, and really poorly trained ABA people kind of talk like robots, like, "Good job, touching your nose." There's nothing about learning that requires talking in a really stereotyped way, right?

If we want our kids behaving flexibly, we need to behave flexibly and naturally.

Even just access to ambiguous play materials, toys that are fun to use in various ways.

Like even just Play-Doh is something you can do a lot of different things with, right?

Access to toys that are fun to interact with in a variable way in itself is likely to support more flexible patterns of responding.

That in itself is probably not gonna fix the problem if we've got kids who are super inflexible, but it's just a good thing to keep in mind.

So, general tips.

Start small with tasks the learner's likely to already be successful with.

Gradually increase the frustration level or anxiety level only as the student is successful at the previous level.

That's the thing with graduated exposure is you don't just move up the hierarchy from small to large.

You do it contingent upon student success at the previous level, just like a fading procedure, just like a shaping procedure, all of that stuff.

you go gradually, start small, do baby steps.

Make sure to continue training multiple exemplars until you see generalization to untrained exemplars.

And always hit the real life application.