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Text Transcript: Teaching Executive Functions (Part 1)

- Good morning.

It gives me great pleasure to have the opportunity to introduce Dr. Jonathan Tarbox.

Dr. Jonathan Tarbox is the regional clinical director and director of research at FirstSteps for Kids in Greater Los Angeles area.

And most recently he has become the director of graduate studies in applied behavioral analysis at the University of Southern California.

Dr. Tarbox has produced two books on evidence-based interventions for individuals with autism spectrum disorder, and has authored more than 60 peer-reviewed publications.

He has served on the editorial boards for a number of prestigious journals, including the "Journal of Applied Behavioral Analysis", "Research in Autism Spectrum Disorders", "The Analysis of Verbal Behavior" and "Behavior Analysis in Practice." Dr. Tarbox's experience includes working with children, youth, and adults with ASD and diverse needs.

We're very pleased and honored to have you here today.

We thank you for taking the time out of your busy schedule and please join me in providing a warm Atlantic Canadian welcome to Dr. Jonathan Tarbox.

(audience applauding) - Okay.

First of all, I'd like to start out by just saying thank you very much to Shelley McLean and the gang at Autism and Education and APABA.

Really great hospitality.

Thank you for bringing me out here and taking good care of me.

You know, one of the biggest things when you do these traveling, speaking things and you come out here to a place you've never been before, is you kinda wanna know that everything's taken care of and the details are figured out and everything, and they've done a great job, so I really appreciate it.

It's also a really big privilege to come out here and speak with you folks and get to talk about topics that I'm really interested in.

Stuff that I'm passionate about, stuff that I love.

And hopefully will be useful to everyone in the room or to at least somebody.

And really it's a privilege to get to do this work because I know that everyone in this room is here because they care about making the world a better place for people who are challenged by autism and other disorders, which is kind of special.

It's not, you're not in it for the money.

I know that.

None of us are.

We're here to help people and to make the world a better place one kid at a time, one classroom at a time.

That's really what it's about for me too.

Recently, as the introduction said, recently I started, I created a new master's program in ABA at the University of Southern California.

And so now I'm spending most of my time training the future generation of folks who are gonna be in the classrooms and in the clinics and hospitals and everywhere else, working with folks on the spectrum.

So I'm still very much in the trenches, but now I'm training folks that are in the trenches.

I wanna give you a little bit of background on where I come from.

I started in ABA, working in a living room of a mom in Vermont.

It's actually not that far from here.

In a home-based program for a child with autism who had really really severe aggression and self-injury.

And for whom there really were no support services available in classrooms or in clinics anywhere.

So the mom had to just figure out what to do herself.

And so she had heard about this ABA thing and she bought a couple books and some VHS cassette tapes, remember those, and she hired some college kids and trained us the best that she could, which now looking back was pretty awful actually.

But even under pretty bad quality circumstances the kid was making progress and his aggression was decreasing and his language was increasing.

And it was a really neat experience and I got hooked.

So I've become kind of a research geek.

I would definitely say that's the best descriptor for my sort of professional repertoire.

Mostly a researcher and also a professor.

But I started out helping a kid who is slapping me in the face and yelling at me, because it made a difference and it worked.

So that's why I'm in it.

Okay.

So I'm gonna stand here and talk for eight hours and you're gonna sit there and listen for eight hours.

It's kind of crazy right?

And what's funny about this, if you wanna just be humorous for a second, is research on behavioral skills training shows us that the worst way to learn stuff is to sit there and listen passively.

So what we're gonna do is have each one of you individually come up and role-play with me.

No, I'm just kidding.

But we're gonna start with you, that's okay, right.

No I'm joking.

So yeah, so like the ideal circumstance would be for someone like me to come and mentor you and supervise you like an hour a week in your real-life practice and role-play and directly train you on this stuff, right.

Of course that's not possible.

It would cost too much, it would take too long.

So this is the best approximation to it that we can do.

So in order to make it maximally effective, because hopefully it's about you guys learning tools that will actually be useful, I do wanna make it interactive.

I do talk a lot, so I really could actually just talk for eight hours.

But this'll work way better if you guys do some talking too, right.

So I'm gonna talk about a whole bunch of different skill areas and how to address them from an ABA perspective.

And what I'd really love to do is have you folks raise your hands, share examples from your practice and from classrooms that you've worked in, and maybe tell me how I'm wrong or how I'm missing something important.

And we can have a dialog back and forth.

I think that'll make it way more useful and frankly, less boring for everybody.

So let's give that a shot.

Oh, also just by way of introduction.

So I have kind of two main presentations.

The first one is on teaching executive function skills, and you have the handouts, I think, right, in your hand.

So we're gonna start with that one.

And then the second one is on teaching non-literal language skills and perspective taking skills.

And so we'll see how fast we move through all of that.

There's a lot of content there.

I think it's about the right amount for eight hours or seven hours, we'll see.

But that's the order we're gonna go in, I guess we're gonna take a break at 10:30 and a break at noon.

Okay.

Before we get going here, I like to get an idea for the audience.

Last night in the car ride from the airport at about midnight, Shelley was telling me a little bit about the background and the work that you all do, but maybe I could see a show of hands of folks who are kind of primarily ABA folks, maybe BCBAs or primarily training ABA, okay.

How about a show of hands of folks that are primarily trained as teachers?

That's your background.

Excellent, okay, fantastic.

How about, if you're willing to share, folks who have a family member on the autism spectrum?

Few folks, okay.

When I first started doing this, I don't know, 18 years ago, whatever it was, that was almost none.

Now it's almost everybody has someone either in their family or their neighbor.

So things have changed a bit.

How about SLP?

Speech, oh excellent, very good.

So a lot of the stuff that I'm gonna talk about today, you guys are gonna say, yeah, obviously, duh, like ABA should've been doing this a long time ago.

So I appreciate having you in the audience.

How about any occupational therapists?

Are there any OTs?

No, okay.

Okay, licensed psychologists or like family therapists, anything like that?

Social work, a little bit, okay, not a whole lot.

Okay, great.

So I'm not gonna spend a lot of time on what is applied behavior analysis.

I think you folks, most of you folks have already had some exposure to that.

I don't think it's necessary.

But just as a, to sort of set the stage, as you all know already, applied behavior analysis is the application of principles of learning and motivation that have come from, gee I don't know, almost a hundred years of research now actually, all the way back to Edward Thorndike.

Basic principles of learning and motivation.

Applying those to problems that matter.

Problems of behavior that matter to society.

And of course, autism is the main challenge that's relevant to society that we're gonna talk about today.

So everything that we're gonna talk about today, so my training, I forgot to mention my training.

So I have a PhD in behavior analysis from the University of Nevada Reno, where that was my main focus was behavior analysis, but I've worked in educational settings.

I've worked in group homes.

I've worked in supported employment settings.

I've worked with typically developing kids.

I've worked with kids with autism and adults with autism.

I've really done, I've worked in a variety of settings with a variety of folks.

But the basic underpinnings of what I've always done, my background, is applied behavior analysis.

And of course, as we already know, the basic foundation of everything in ABA is positive reinforcement.

And we have these other principles called like stimulus control, conditional discrimination, programming for generalization.

Everything I'm gonna talk about today applies to both structured, more structured and less structured teaching formats.

And so I'm guessing that a lot of the kids with autism in the classrooms that you work with spend some amount of their day doing discrete trial instruction, is that right?

Discrete trial training.

And then some amount of their day doing sort of less structured teaching, right?

We would call it like incidental teaching or play-based intervention, pivotal response training.

Is that term used out here very much, PRT?

A little bit, okay.

And one of the main things though, and this point is, I think, particularly important to what we're gonna talk about today.

One of the main principles from behavioral learning research that really really matters a great deal, is practice.

The issue of learning opportunities.

And so we know this when teaching basic skills, for example, if you wanna teach manding, like the ability to request something when you want it.

If the child has one exposure to that opportunity, so they say milk and they get milk, that's great.

But if they have a hundred, that's gonna work a lot better.

Yesterday you guys talked about AAC, right.

Alternative, augmentative communication.

So same thing there.

Like one learning opportunity, okay, great.

10, better.

A thousand, way better, right.

What's the best way, and actually, this is a great setting for that.

A lot of you guys have bilingual education from the very beginning, right?

That's just a normal part of public school here.

That's really cool.

We don't really have that in the United States, hardly at all.

I wish we did.

But the reason why that works so well is because there are tens of thousands, perhaps hundreds of thousands of learning opportunities to learn that second language, from the very, very beginning, right.

That works way better than just taking a class in a second language an hour a week or something.

Right.

So same thing with anything that we wanna teach in ABA.

And again, I know this is obvious with more simplistic skills, but with the stuff we're gonna talk about today, executive function skills, perspective taking, and non-literal language, it works the same way.

And a lot of these skills are actually kind of harder to teach and take longer to teach.

And so people often fall into the trap of practicing it kind of every now and then, but if you wanna get good at something, you gotta do it a lot.

That's the basic, basic idea.

And it's equally true for these complex higher order skills that we're gonna spend the day talking about.

Okay.

So let's talk autism a little bit.

Everyone here works with folks on the spectrum, right.

Raise your hand if you don't work with folks on the spectrum.

Okay.

So we don't need to spend a lot of time talking about autism.

As you're very familiar, the DSM-5 diagnostic criteria involve symptoms in two major symptomatic areas, right.

Social communication, and then restrictive and repetitive behavior.

So just relevant to executive functions, I wanna spend a little bit of time sort of rethinking about the restricted and repetitive behavior domain of the diagnosis.

So to get a diagnosis, you've got to have at least two of the following clinically-relevant challenges in at least two of the following areas.

So stereotyped or repetitive motor movements.

Use of objects or speech.

So this is really obvious, right?

This is what we usually think of when we think of autism.

Things like hand flapping, staring at ceiling fans.

Lining up objects, things like that.

But the second one, insistence on sameness, inflexible adherence to routines or ritualized patterns of verbal or non-verbal behavior, is really relevant to what we're gonna talk about today.

It's almost sort of more like higher functioning stereotypy, if you wanna think about it.

And then same thing for number three here.

Highly restricted fixated interests that are abnormal in intensity or focus.

So when we think about stereotypy or repetitive behavior in autism, I think it's worth thinking about sort of a continuum, ranging from really sort of simple stereotypy, like motor movements, all the way up to really complex sort of higher order stereotypy, that is actually what most people consider cognition.

So, in the simplest area we might talk like hand flapping and on the most complex area we might talk about things like rigid patterns of thinking.

Like not being willing to think about stuff in a new or different or flexible way.

And you might say, well, wait a minute, no that's not the same thing.

This is motor behavior and that's cognition.

But I think actually it's worth considering, from an ABA standpoint, that it's basically the same problem.

It's just a matter of more complex, less complex, but the same issue of rigidity and insistence on sameness is there.

So that's very relevant to pretty much everything we're gonna talk about today, is about getting kids out of this.

Is about creating more flexibility, more willingness to try things differently and creatively.

Okay.

Now, if you're willing to participate, we got to get the audience verbal behavior going.

Someone's gotta do something and I'll reinforce it.

I promise, I'll be nice.

You gotta say something.

Where would you say you spend the majority of your programming?

Like when you go out there and you consult on a case and you wanna make sure that the child's program is well balanced and is addressing all of their important educational goals, what's the number one area that you work on, like the top priority?

- [Woman] Language development.

- For sure, language development, right.

Of course.

And it should be the top priority, right?

Because we know all of the bad things that happen when people don't have functional means of communication, right.

We get more problem behavior, we get less socialization and social adjustment, et cetera, et cetera.

What else, after language - [Woman] Self-regulation.

- Self-regulation, okay, great.

You're jumping the gun here.

You're making my point for me.

What about before that?

- [Woman] Social skills.

- Yeah, okay.

So basic social skills.

Sharing, turn-taking, right.

Super critical.

Without those you're gonna have a problem socially, right.

So very important, foundational social skills.

How about like daily living skills, right, like self-feeding, hand-washing, things like that.

Safety skills.

Super important.

Without those skills, you're gonna get sick, you're gonna be less independent.

All those things really matter a great deal.

And if we spend the vast majority of our time programming those skills, there might be some areas that we're missing out on a little bit, or not addressing as much.

And so those are the areas that we're gonna talk about today.

And I'm gonna make the point that some of these more complex areas of functioning are directly relevant to the diagnostic core features in the area of the repetitive restricted behaviors.

And that animation was not supposed to do that but, oh well, woo-hoo.

Don't know what's going on with that, but we'll take it.

One of the main points I'm gonna make today is about flexibility.

So this is a great opportunity for me to model flexibility by just not making a big deal out of the animation that doesn't work.

Okay.

So let's talk executive functioning.

Oh, one more quick point that I wanted to make is we're gonna talk.

I think most of the stuff that I'm gonna talk about today, you probably rarely, if ever, have heard an ABA person talk about before.

And if you're a sort of indoctrinated, hardcore, ABA-trained person, might be a little rigid, might be a little inflexible about your ABA training, you might be getting uncomfortable when I start talking about stuff like executive functioning cognitions.

And that's okay.

That reflects your hardcore ABA training.

I had that too, and it's good and it's useful and it's helpful in a lot of ways.

But I will get to how we address all this stuff from an ABA standpoint.

For those of you who don't have that sort of rigid, hardcore ABA training, hopefully you'll appreciate that I'm talking about a lot of stuff that you already know really matters a lot.

And so that's kind of the purpose of today's workshop.

Okay.

Someone who's willing to speak out loud.

How'd you get here today?

You showed up on time, right.

How'd you do it?

(talking faintly) What's that?

- [Woman] Cab.

- You took a cab.

Okay, great.

How'd you get in the cab?

How did that happen?

Oh you engaged in some planning behavior.

Okay, cool.

What did that look like?

- [Woman] Setting your alarm.

- Setting your alarm.

Okay, so you did that last night.

Okay, very cool.

So now that's really interesting.

So you're saying that a behavior that you engaged in last night, arranged the environment so that you engage in some other behaviors so that you got here at the right place at the right time.

Have you ever been in this room at 8:00 AM to attend a talk called Teaching Executive Functions by Dr. Tarbox before, in the past in your life?

No way, right.

So was that a behavior that was under like specific stimulus control, right?

No way.

That's never happened.

So you engage in an incredibly complex, derived, emergent performance.

A creative performance that's never been directly trained.

So when you think about it, from an ABA perspective that's kind of magic.

That's kind of incredible that you're all able to do it.

And yet that's just called like normal human functioning.

Right.

That's what we all have to do every day, but it's incredibly complex.

EF skills are all about, basically all of the EF skills we're gonna talk about in this workshop are what you did in the last 24 hours to get here on time.

And what you're gonna continue to do to stay on task and pay attention and hopefully learn stuff during a long workshop.

Okay.

So what is executive functioning?

So executive functions, and so throughout the workshop today, first I'm gonna talk about a concept from a sort of general psychology perspective or give the sort of like general definition.

And then I'm gonna go back and try to analyze it from an ABA perspective.

And I guess my specialty within behavior analytic research has kind of become addressing crazy stuff that doesn't sound like ABA, but doing my best from an ABA standpoint.

That's what I'm gonna do today.

And a lot of the definitions and functional analysis from behavioral perspective that I'm gonna give you, are not done.

They're my best shot at it.

Again, I'm being flexible.

I'm being creative, doing my best.

But it's a work-in-progress.

So that's what I'm gonna give you.

I'm gonna give you the general psychology definition or approach, and then we're gonna take a shot at doing an ABA analysis.

The most important thing is that we come up with practical steps that you can actually implement in the classrooms that you consultant in and work in.

Okay.

So, what are executive functions?

So executive functions is the umbrella term used to describe sort of the chief operating system or the boss in the brain, that's responsible for goal-directed behavior.

So any time you're doing something now that's oriented towards the future, there's supposed executive functions in your brain helping you do that.

So common terms are working memory, sustained attention, inhibition.

Cognitive flexibility's a big one we're gonna talk about today.

Planning and goal-setting, someone mentioned already.

Organization, persistence, self-monitoring, problem-solving.

All of these are things that the executive function mechanisms in our brain enable us to do with our behavior.

Now research has certainly shown that there's, the prefrontal cortex of the brain is critical to executive function performance.

So if you get in a car accident and you damage that part of your brain, you can darn well be sure that those areas of behavior relevant to all of those things we just talked about, working memory, planning, inhibition, all those, that will produce an effect if that part of your brain gets damaged.

So there's no question that the prefrontal cortex of your brain is involved in these really important repertoires of behavior.

And research has clearly shown that there's clinical populations that have deficits.

As a group, like every individual person obviously is a unique person and is different.

But as a group, folks with ADHD, with autism especially and traumatic brain injury, suffer from challenges across these areas of executive functioning.

All of the executive function skills I'm gonna talk about today are interrelated and build on one another.

I'm sort of going from simpler to more complex, kind of, but it's not that simple.

It's not as simple as like first do addition and then multiplication or something.

It's quite a bit more complex and there, we're gonna talk about really complex repertoires of behavior, really complex skills that overlap and support each other.

Okay, so let's get to an ABA perspective.

Only talked about the brain so far.

So I think one of the reasons why ABA folks have neglected these higher order, cognitive skills, things like executive functions, is because we're always trying really hard to take a natural science approach where we're only talking about learned behaviors.

And so when something is really clearly ascribed to the brain, for example working memory, a lot of ABA folks feel really uncomfortable with that.

Like, well, I don't know what to do about that.

That's a brain function.

That's not a behavior, right?

So what is it, brain or behavior?

Traditionally, and most people would tell you that executive functions are brain functions.

However, I will say, and I think a reasonable behavior analytic perspective, actually just a reasonable anybody perspective, is that any time you're engaging in a cognitive function, any time you're using your brain, you're also doing stuff in the environment.

So literally every single time they've ever measured working memory in anybody, the person was doing something, right.

Any time that you're not dead, you're doing stuff.

Even in your sleep, you're engaging in mild forms of behavior with dreaming, muscle movement, things like that.

But basically if you're awake, you're behaving.

That's just a fact of being an organism, a live organism.

So every single executive function involves some amount of behavior.

If even a small percentage of executive function performance is behavior that's modifiable or supportable by learning in the environment, even if a small percentage of executive function skills are amenable to improvement, by what you folks do in the classrooms, then we better figure out what's going on with those skills right?

From an ABA perspective.

We'd better figure out how to support them and teach them.

Even if it's only 10%.

What if memory is 90% brain, 10% learning, right?

Well then man, that's even more reason to maximize that 10% and to be as effective as we can with that 10%, right?

The fact that there's less to work with doesn't mean that we can let it go and ignore it.

It means we better work even harder on that.

So in everything that I'm gonna talk about today, I'm by no means denying the participation of the brain.

The brain is critical to all executive function skills and the brain is critical to walking and the brain is critical to eating.

And the brain is critical to literally everything we do all day, right?

So it's critical and we, there's something we can do about it in education and from an ABA perspective.

So how do we address cognitive events or cognitive skills or activities or brain functions, from a behavioral analytic perspective?

So Skinner, starting in 1945, B.F.

Skinner proposed what we now call radical behaviorism.

He didn't call it that back then.

But all that radical behaviorism means is, if an organism is doing something, if a person is doing something, it involves behavior.

And so we should be able to talk about that and deal with that from an ABA perspective.

So, let's do a little experiment.

Would you be willing to talk out loud for me?

Will you say the word pizza out loud?

- [Audience] Pizza.

- Oh everyone's participating, that's even better.

Okay.

Now, so do you agree that that just happened?

Did you really say pizza?

Are you sure?

You could hear it, right?

Were you engaging in behavior?

Yes, right, obviously.

Okay.

Now I want you to do it again, but don't say it out loud.

Just think it Do it right now.

Okay.

Did you do it?

You promised and you definitely did it, right.

It was a real thing.

Did you hear yourself do it even?

Okay.

So that's what, from a radical behavioral, which is a silly philosophical term, from a radical behavioral perspective, that's what we'd call private verbal behavior.

Also known as thinking, right.

Imagine that.

So what Skinner proposed in 1945 and what I actually think is a reasonable perspective, is there shouldn't be any real major difference between behaving overtly and behaving covertly.

There shouldn't be any real difference in principle between talking out loud and talking to yourself privately.

And Skinner proposed that probably a lot of cognitive skills, a lot of thinking or mental activity, we learn to do publicly first as children, and then it gets punished down to the private level in the course of regular child development.

So, who has met a kid who is saying out loud what they should just be thinking to themselves?

All of us, right! Everybody went through that stage.

And so Skinner said that's probably evidence that look, they're learning to think.

That's how thinking gets shaped.

That's really cool.

And then at some point the verbal community doesn't want everyone walking around just thinking out loud, constantly, right.

And so we tell kids oh, don't say that out loud.

Like oh, can you just think that?

And so we all learn to engage in this verbal behavior privately.

But there's no reason to think that just because it occurs at a private level now, now it's suddenly some special brain thing and we can't touch that.

Right.

If it was learned through interaction with the environment and principles of learning and motivation matter to how it was developed overtly, then those same principles should still matter, now that it's occurring covertly.

And if there's a kid who doesn't have a cognitive skill and that we're seeing that that deficit is a problem in the classroom, and we want that kid to develop that cognitive skill, we should be able to teach it overtly first and then hopefully help support the kid to then engage in that same sort of talking or self-talking or thinking behavior covertly.

Or at least less obviously.

So that's the sort of conceptual philosophical foundation for pretty much everything we're gonna talk about today.

So again, for you few ABA folks in the audience who've been hardcore indoctrinated to not sound like a mentalist or not sound like a cognitive psychologist, if you're getting uncomfortable, that's fine.

But I will say, there's a reason why hardcore ABA folks are indoctrinated to be afraid of sounding like a cognitive psychologist.

And the reason for that is that mentalistic words, or mental or cognitive constructs, if they're used as an explanation for behavior, they actually can be detrimental because they stop the analysis.

And so, for example, if you say well why is this kid forgetting stuff all the time, and you say well, his short-term memory store must be dysfunctional.

Well, okay.

Done.

I guess that's all we can do, right.

Can you access the short-term memory store?

Uh-uh.

Can you?

Nope, okay.

So the main objection to coming up with, or to using hypothetical constructs, is just if they're used as an explanation for behavior.

But if they're used as a starting point for which behaviors we wanna actually address and try to teach and support, then that's fine and they're not problematic.

Okay.

I'm going to very briefly talk about relational frame theory.

Raise your hand if you've ever heard of relational frame theory.

Two people, four or five people.

Okay.

So relational frame theory is an ABA approach to cognition that treats relating, like responding to the relation between two or more things in your environment, that itself as learned behavior.

So any time you're responding to the relation between two things, instead of just responding to one thing itself, it's learned behavior.

And this theory posits that that ability to relate things is at the core of most complex human language and cognition.

So there's been a ton of research now to show this skill this relating behavior, across a lot of different ways of relating objects.

So two things can be equivalent.

So like the name and an object can be equivalent.

So what's this?

Cup, okay, good Now if I put it down on the table and I say point to the cup.

Come on, somebody do it, help me out.

Good job.

Here's a token.

M&M, whatever your reinforcer is.

Coffee.

Very good, okay.

So that's an example of an equivalence relation, where the name and the object serve the same function, are basically the same thing.

You can also have relations of distinction.

For example, are these the same or different?

Different, good, excellent.

You can have relations of opposition.

So, for example, what's the opposite of hot?

- [Audience] Cold.

- Good.

You can have relations of comparison.

So there's a zillion different ways that our verbal community compares stimulating our environment.

So for example, what's better, a Ferrari or a Hyundai?

Okay.

What's more expensive?

What's actually probably more reliable?

Probably a Hyundai.

So any time you're comparing two or more stimuli, and you're responding to the comparison of those, that's a relation of comparison.

Hierarchy is an interesting relation where one stimulus is a type of or part of another stimulus.

So, for example, name, will you do me a favor and name some fruits.

- [Woman] Watermelon.

- Watermelon, apple, great, okay.

Relations of hierarchy are interesting because they're not bi-directional in exactly the same way.

So an apple is an example of a fruit, but fruit is not necessarily an example of apple.

Temporal relations are relating events in time.

So what happened first this morning?

Did you eat breakfast or did you wake up?

Hopefully you woke up first, right, okay.

Conditional and causal relations.

One thing is the cause of another.

So if you, why is your friend Jimmy in the classroom, why is he crying, why is he sad?

And being able to identify what happened as the cause of that.

Or if you want to predict how to cause something good to happen, how can you make Jimmy happy, right?

What can you do to make him happy?

And then there's dielectric relations, which are relations between oneself and other stuff.

And so all of these, so, for example, like I might be taller than you or I might be shorter than you, or you might've been born before me.

Any relation that involves relations between yourself and someone else.

Particularly relevant to perspective taking, which we'll talk about later.

The basic point here is most of the stuff that we've been talking about on this slide is considered sort of cognitive or sort of intellectual or reasoning abilities.

And there is an ABA approach to all of that.

It's called relational frame theory.

Mostly it's not, the way that it's taught in the literature is mostly pretty horrible and impossible to understand, but I do recommend checking it out if you have the time and you like self-torture.

But a really good book, a good resource, and I should have included a picture, did I include it, no I didn't, is it's called, a book called "Learning Relational Frame Theory" by Niklas Torneke, and I can email that out to folks afterwards.

So the most important take home point though from relational frame theory is that all of those cognitive abilities like causal reasoning, temporal reasoning, all of these things, perspective taking, is learned behavior and it's generalized operant classes of behavior.

Which is just a fancy technical jargon term for a learned ability that extends across circumstances and across time.

So it's a concept, it's a conceptual ability.

But here's the important point for what we're gonna talk about today, is that it's learned through multiple exemplar training.

Raise your hand if that's a term that you've heard of or has used.

Okay.

Multiple exemplar training just means teaching lots of examples of the same concept.

So the simplest thing would be like if I wanted to teach a kid to name the color gray, I could hold up this object and say what color is it?

Prompt the kid to say gray, good job, you're so smart.

Awesome.

Right.

And if I did enough trials of that, then for sure, the kid would start calling this object gray, right.

Now what if I held up a different, what if this is the only thing I use to teach the color gray?

Maybe some of you did that, the very first time you ever worked with a kid with autism, right?

And then tomorrow you pick up another gray object and you say, what is it?

No idea, right?

Or you pick up a pen that's pink and you say, what is it?

Or what color is it?

And the kid says gray, right?

Because maybe they were actually attending to irrelevant feature of the stimulus.

The fact that it's long and skinny, or the fact that it's a pen.

And so to teach the generalized concept of gray, you need to teach lots of different gray objects, right.

And how do you know you're done teaching gray?

(talking faintly) Yes.

When kids identify novel objects as gray, right.

So that's sort of the simplest possible example is like tacting or labeling an object or a color, a feature.

But the complex conceptual skills that we're gonna talk about today, work exactly the same way.

Everything we're gonna talk about today is you train lots and lots of examples in different settings at different times of the day, with different teachers with different peers, with different stimuli, until you get generalization to untrained examples.

So generalization to untrained examples is the definition of mastery, right?

So who here has heard that in ABA, we teach stuff until you get 80% correct across two consecutive days, right.

That's mastery, right?

Well no.

Not with complex cognitive skills that we're gonna talk about today.

Mastery is demonstration of generalization to untrained examples.

That's how you know the skill's mastered.

So generalization is not an afterthought, right.

The traditional thing in ABA is you do a whole bunch of training until mastery and then kind of hope for generalization afterwards.

And if you do a good job, you're actually programming for it.

But let's face it, people don't program for it enough.

Right?

Well, with these skills we're gonna talk about today, that's not it.

Mastery is the demonstration of generalization to untrained behaviors.

Okay.

So the reason why I'm interested in this stuff is, number one, because it's important to help people.

I hope that everything we're gonna talk about today, you've met at least one student with autism in a classroom who would have done better, would have had a happier, more independent functional life if they had some of these skills.

Another reason why I, as sort of a science geek, behavior analysis geek, am interested in this stuff, is that the idea behind behavior analysis was always, always to form a comprehensive science of human behavior.

All the way back to the 1930s and Skinner's first book, "The Behavior of Organisms", was not called the behavior of simple organisms or the behavior of three rats, which is the research subjects that the book was based on actually.

So the idea is a comprehensive application of basic scientific principles of learning and motivation to everything humans do.

Push ABA out of the simple mands and tacts and tantrums.

All of that stuff is super critical, it matters a great deal.

And there's kids who need help on a lot more complex skills as well.

So we have a tradition in behavior analysis of moving very, very slowly in our research.

So we progress from simple to complex in very, very slow baby steps.

We're very, very conservative.

And we're very concerned with minute details of science, that man, if you mess with those, that's bad, don't do that.

So basically do the same thing that everyone did before you with just a very small twist.

And that's not just behavior analysis, that's most science.

That is generally how science works.

And that's great because we don't lose our natural science foundation, and it's not so great because we're making very slow progress.

So this is where behavior analysis, where ABA came from.

There's a rat in a box with the lever.

Press the lever, get food.

Couldn't be any simpler, right?

Then they discovered discrimination, or stimulus control, right?

That if you have, if the lever only produces food when you press it, when the green light is on, and when the light's off it doesn't produce food, now the rat figures out, cool, the light's on, I'm gonna press the lever, I get the food.

Very very small step forward, but actually really groundbreaking when you think about it.

Then research progressed to now there's a rat in a box with two levers.

It's a really big step forward in complexity, right.

Press the right lever and you get a big food pellet.

Press the left lever and you get a small food pallet.

Guess what?

The rat presses the right lever more than the left lever.

People spent entire careers researching this.

The minute details of how you mess with positive reinforcement on the right lever versus the left lever.

Very interesting stuff.

It does tell us a lot about how to shape human behavior and make the world a better place.

But again, nowhere near the level of complexity that we're operating at on a daily basis and that your older and more verbal students are operating at every day in the classroom.

Raise your hand if you've heard of Brian Iwata and functional analysis of challenging behaviors.

Okay.

So that was a step forward and basically what his research showed was one particular type, or one particular form of behavior might have different functions.

So his research was mostly with adults with severe developmental disabilities engaging in self-injurious behavior.

And what his group's research showed very clearly is sometimes that behavior is reinforced by attention.

Sometimes it's reinforced by escape from task demands.

Sometimes it's reinforced by access to tangible or preferred items or activities.

So now we have the same behavior, three different possible reinforcers.

A small step forward in complexity.

Still nowhere near the level of complexity we're talking about.

Then we've got Skinner's verbal behavior.

Do you guys talk about verbal behavior in the context of ABA?

Do you do verbal behavior programming?

You teach mands, you teach tacts, things like that.

Super critical, right?

If a kid doesn't know how to mand, that's a big problem.

And if they're not manding independently, right, if they're only manding when the teacher says what do you want, first of all, that's not a mand, that doesn't count.

And it's not independent communication, right?

So it's really, really important to establish independent, spontaneous, real, flexible manding and tacting.

But still, we're talking very, very simple stuff.

So we have tremendously powerful interventions.

And I know that the work that you folks do in the school districts is based on research that's been published in the last 40 years in intensive behavioral intervention.

We've produced some incredible outcomes for kids with autism, made incredible advances.

There's no question about that.

And yet we're still nowhere near a comprehensive science of psychology.

ABA is not supposed to be, so okay, so raise your hand if you've heard the myth that ABA, and just be honest here, you're not gonna offend me.

If you've heard the myth that ABA turns kids into robots.

That's not very prevalent here.

Usually in the U.S.

every single person raises their hand.

Okay.

How about, raise your hand if you've heard the myth, or maybe you believe, that ABA is mostly for teaching simple skills and then you have to go do some other approach when you're teaching more complex stuff.

No one wants to admit it, or you're not hearing that so much.

A few people, okay.

So I've worked with plenty of families where the kid makes a lot of progress in basic skills, but then once he gets to stuff like executive function skills or perspective taking, the parent says well, I guess we're done with ABA now.

I guess we gotta go do something else, you know.

We've gotta go do the social skills group or something like that.

Which may well be helpful, but it's as though complex skills are somehow different fundamentally than simpler skills.

And I'm here to tell you, if I'm gonna tell you anything today, that I don't believe that that's true.

I believe that from the time we're born to the time that we die, everything that we do is influenced by basic principles of learning and motivation.

And so they're either working for us or they're working against us.

And if we're aware of them and we know how to apply them to everything we're trying to teach, then we're making those basic principles of learning and motivation work for us.

Okay.

Some geeky research slides that I'm gonna skip over, but this is the essence of the problem in why research is so slow in developing ABA approaches to the complex behaviors that you folks wanna teach your kids and your students, is that there's a big gulf between basic research and bridge research, and then real-life practice.

So raise your hand if you've ever met a student who has a problem with not being flexible enough.

Okay.

Raise your hand if you've met a student who can't put themselves in somebody else's shoes, like doesn't understand where their peer's coming from.

Okay, good.

Raise your hand if you met a student who forgets stuff all the time.

How about problems with like organization and self-monitoring, okay, all right.

Right.

So you get the picture.

All of that stuff that we just mentioned, you've been dealing with here in the area of real-life practice, right?

Like you go out to these classrooms and you're working with these kids and man, you better figure out a way to deal with that stuff, right.

And you do.

I'm sure you've figured out strategies and there's some curricula available, some workbooks and things, but not a lot.

Right here is where the vast majority of research is.

So if you open up scientific journals, there'll be more than a thousand studies published on the application of ABA to children with autism.

And I would say 95% are in really simplistic behavior.

No, more than that, probably 98%.

Probably less than one or 2% are on the application of ABA to really complex cognitive, so-called cognitive skills that we're gonna talk about today.

This is a problem.

So what I've been working on for the last, gee I don't know, 10, 15, is something that looks more like this.

So doing some basic research, doing some lab research, but doing some applied research, but then also having all of this influenced by real-life practice.

So I worked at the Center for Autism and Related Disorders for 10 years in Los Angeles, and they had developed curricula for teaching executive function skills and perspective taking skills.

And actually it's available, you can buy access to it if you want to, it's called skills and it's online.

It's a membership service.

So you need to buy an individual membership for every student that you work with, then you have to continue to pay that every month.

So that's maybe not the most flexible option.

It's not like a book, a curriculum book that you can buy or copy or access as much as you want, but it is available.

And a lot of what I'm gonna talk about today actually is available through there.

I'm not affiliated with them at all anymore so this is not a sales pitch.

I have no bone to pick either way.

But a lot of what I am gonna talk about today came from my work, working there with the clinicians that developed that curriculum and then developing research studies, based on that curriculum, that were influenced by the curriculum, but then also fed back into the curriculum.

Okay.

I'm gonna skip some of these slides 'cause I wanna get to, probably you guys wanna hear about like what do we actually do with kids, right.

Enough of this introduction stuff.

Okay.

So, sorry, little more introduction here.

But this actually does matter, I promise.

So Skinner talked about, so basically I like to think about executive function skills, all of these executive function skills, as skills that we humans develop that are directed inward to ourselves.

So they're sort of like self-awareness, self-monitoring, self-management.

They're skills that we develop to manage our own behavior.

And so how do we talk about this from an ABA perspective?

And Skinner talked about secondary repertoires of behavior.

And this is not just of theoretical and philosophical interest.

We're gonna return to this all day.

So secondary repertoire behavior is a repertoire behavior that you learn to manage your other behavior.

So Skinner talked about your normal ongoing behavior as the stuff that you would just do, if you were just interacting directly with the environment.

So like let's say you need to buy some stuff to make dinner, okay.

Or for a party that you're hosting at your house.

And you go to the grocery store and you kind of just interact with the grocery store in your normal way.

And then what happens when you get home if you didn't make a list?

There's some punishment that happens, right, because you didn't get all the stuff that you needed, right?

So your spouse is upset or your guests get there and there's no food or whatever, right?

So your normal behavior of shopping, your normal ongoing behavior of shopping, if it wasn't supported by some other behaviors, would not be very successful.

And so we all learn to engage in some other behaviors that make the shopping behavior more successful, right?

So making a list is the classic example.

You could write it on a piece of paper, you could put it in your phone.

There's probably an app for it these days, whatever.

But there's a secondary behavior you engage in to make your ongoing behavior more likely to be successful.

Let's talk about a problem behavior that some of you engage in.

Is anyone willing to share like a, let's say a habit that you'd like to decrease a little bit?

Anybody willing to share bad habit?

It doesn't have to be, what's that?

(talking faintly) Eating cookies.

Okay, great.

So that occurs at a higher rate than you wish it did.

And so are there any other behaviors that you've learned to engage in, that help decrease the rate of eating cookies, your behaviors.

- [Woman] Buying fewer cookies.

- Okay, buying fewer cookies.

So that's perfect.

So your normal ongoing behavior probably would have been keep cookies in the house, right.

And that doesn't work to decrease the behavior of eating cookies.

So you've learned to engage in this other behavior which is like not buying cookies as much, right.

You see the cookie at the store and keep walking.

Buy cookies at a lower rate.

Does that make sense?

So you've got your normal ongoing behavior that's maybe not so great.

Maybe it's a bad behavior you want to go down.

Maybe it's a good behavior that you want to do more of, but you're not, and so you've developed these other behaviors that help support that behavior.

So sort of self-management or secondary repertoires behavior.

We're gonna return to this concept over and over throughout almost all of the EF skills that we're gonna talk about today.

Okay.

I'm not gonna talk a lot about typical development of executive function, but except to make the point that the simplest EF skills start developing very early on, five years old or younger, in typical development.

And as any of us who are parents of teenagers know, the more complex, more advanced executive function skills don't stop developing until like 20, 21 22.

So things like anticipating long-term consequences that really matter, and planning your behavior accordingly, isn't fully developed in teenagers, right.

And that makes sense.

That's why teenagers make a lot of bad choices, right, that are influenced more by the immediate outcome, right.

I'm gonna have fun now.

My friends are gonna think I'm funny now or whatever, rather than uh-uh, what's the implication of this behavior for the future.

Okay.

Research has shown executive function deficits in autism, however, just like everything else in autism, if you've met one child with autism you've met one child with autism.

So research showing that as a whole, folks on the spectrum have trouble with EF skills, isn't that relevant.

What's relevant is does your individual student that you're consulting on or working with, do they have challenges in specific EF skills?

There is a little bit of research, I'm gonna blast through this too, a little bit of research on teaching EF skills from cognitive psychology, and actually the evidence is not very strong.

And I'm gonna say that it's because it's not guided by basic principles of learning and motivation.

It's kind of like they come up with an idea and test it.

Some ideas work, some ideas don't.

The nice thing about having principles, scientific principles of learning and motivation that guide what you do, is that it can problem-solve failed interventions with things like reinforcement.

Maybe there's a reinforcement problem.

Maybe there's a problem with generalization or stimulus control.

Most existing EF research, intervention research, has not been informed by basic principles of learning and motivation.

Okay.

Let's get to how do we actually do it.

We're gonna talk very briefly about assessment.

Then we're gonna talk about teaching procedures and general recommendations.

And we're gonna go through lots of different areas of programming for EF skills.

There's plenty of standardized assessments for executive functions.

The Behavior Rating Inventory of Executive Function, or BRIEF, is just how it sounds.

It's a brief questionnaire format that doesn't take very long to do, and it can help identify deficits across areas of executive functioning.

And there's a preschool version of it as well.

The TOPS and the Wisconsin Card Sorting tasks, the NEPSY, the Stroop test.

These are all standardized assessments.

Do your students that you work with, do they get batteries of standardized assessments from a school psychologist or somebody like that?

They get like an IQ test?

So occasionally they'll already get some of these assessments that identify executive function deficits.

If so, it can't hurt to take a look at the results and the reports of those assessments.

They can be helpful.

The brief can be helpful.

I'm gonna go kind of quickly through this too.

It gives you sort of like global scores across inhibition, set shifting, emotional control, initiating, working memory, planning and organizing, self-monitoring.

It'll give you a score basically to compare to the mean.

So like compared to the average typically developing child, where's your student in these areas?

And if the score is different enough from the mean then that might tell you, yeah, okay, we need to work on that.

The problem is it doesn't tell you anything specific about what to actually do.

And that's of course, a limitation of all standardized assessments.

The point of standardized assessment is to compare an individual to an average population.

It's not to tell you what specifically to do with that individual.

There are some questionnaires that get to specific curriculum targets.

One is a book called "Smart But Scattered" by Dawson and Guare, has anybody heard of that?

It's quite a useful book and it includes a questionnaire, sort of an assessment tool.

It's worth looking at.

You have the teacher or parent or whoever is familiar with the child.

Actually, I wanted to get a quick idea at the beginning that I forgot to ask.

Can you raise your hand if you primarily work in schools?

Pretty much everybody.

Can you raise your hand if you don't work in schools?

If you work maybe in a private clinic or something like that.

So there's a few.

Okay.

So I'm mostly going to be giving examples from classrooms, just because that's the primary audience, but please don't think that I'm ignoring folks that are working in clinics.

It's just more efficient if I kind of use one category of examples.

But for this questionnaire you'd go to the classroom, you'd have maybe the teacher, the classroom teacher, fill this out quickly, or the educational assistant that works with the child, fill it out.

Or if you're really familiar with the child you could fill it out yourself.

But it basically asks a bunch of questions of specific behaviors in particular circumstances and it allows you to score 'em.

So definitely check out this book, if you haven't already, it's worth looking at.

It's not written from an ABA perspective, but it gives you ideas for intervention, and then you use your ABA skills to figure out how to teach those curriculum targets.

And then of course the most important part of assessment is direct observation in the natural environment.

So if you wanna know what EF skills to teach, then obviously observe in the natural environment, in the classroom, where those EF skills matter.

So looking for red flags like retrieval task failures.

Trouble remembering quick facts.

Difficulty remembering rules governing specific tasks.

Or struggling with mental manipulation tasks.

Frequent off task behavior, inattention, can also be partially due to lack of some of these EF skills we're gonna talk about.

Impulsivity.

Lack of personal awareness or safety skills.

Perseverative behavior, difficulty with transitions or rigidity and inflexibility is a big one.

Rushing through tasks or making sort of careless errors.

Raise your hand if you have a student who makes careless errors and doesn't, yeah.

And it's not that they couldn't do the work if they were really paying attention, right.

It's something about paying attention that's off.

Failing to initiate tasks without sufficient direction.

Approaching tasks in a sort of haphazard fashion.

Okay.

So I wanna get into what to actually do about it.

So we're gonna talk about sort of a four pronged approach that we've come up with at FirstSteps for Kids.

That's the clinic where I'm, as a part-time gig I'm the director of research.

And basically think of four different areas that you can intervene upon, or four different approaches that are complementary.

They're not one or the other.

You can even do all four at the same time.

But sort of four areas to consider when you're addressing EF skills.

So the first is sort of core skill building.

So can we make them just get better at this particular skill that's lacking?

The second area is teaching the child compensatory strategies, sort of self-management strategies.

And these are these secondary repertoires of behavior we're talking about.

So if your memory is only gonna get as good as it's gonna get, what other behaviors can you do to help yourself function better?

The third approach is environmental supports.

Sometimes it's a lot easier to just change some small aspect of the environment, and then that makes the student be more successful.

And then of course the thing that matters the most is real-life application.

So a lot of the skills I'm gonna talk to you about today are areas that you can work on and build skills with the child.

But what really matters is now are they actually able to function better in the classroom?

So that's where the rubber meets the road, and if you're not seeing changes in that environment then nothing else that I'm gonna say today matters at all.

Everything that I'm gonna talk about today involves both what we might call like sort of contrived or analog practice, and real-life practice.

So analog or contrived practice is when you're working on a skill in a more controlled setting, there's lots and lots of practice opportunities.

It's easy for you to control the difficulty of the task because you're contriving it, you're creating it to begin with.

It's easy to control the anxiety level for the student because you actually are manipulating that basically by changing aspects of the task.

But generalization is a major concern.

With real-life practice, it's more natural, in a less controlled setting.

It happens in the real-life setting.

So, for the most part, in the classroom or on the playground.

There's gonna be fewer opportunities if learning is purely happening in natural opportunities.

And it's difficult for you to control the difficulty level for the student because it's natural, it's what's happening naturally.

It's also difficult to control the anxiety level that the student might be experiencing, but generalization is more likely.

So I don't know if you have this here in Eastern Canada, but in some places in the United States there's still sort of a controversy between discrete trial training versus pivotal response training.

Or between discrete trial training versus natural environment training.

And some people think you really only have to do the natural environment stuff, you don't need any of the structured discrete trial training.

And some, very very few, but some people still say, ah, you don't need any of that touchy feely stuff, just drill and kill.

Lots of discrete trial training.

There's very very few ABA folks who actually believe that anymore.

Definitely less than 1%.

But that was kind of what Lovaas was doing in the 1970s, was just discrete trial training endlessly, right.

And man, that got compliance but it didn't get the best generalization.

What I'm gonna talk about today is always a balance.

You have to have both.

So think about analog practice or sort of discrete trial training or sort of contrived practice, as like a musician practicing scales.

A great jazz musician, I think it was John Coltrane, when someone asked him, how do you practice, how do you get ready for or train for these incredible solos that you do where you're improvising for hours at a time.

He said, I practice scales.

I practice doing just the same thing over and over.

And the reason for that is because practicing the fundamentals makes the fundamentals fluent, so that when you need to improvise, the fundamentals are right at your fingertips and it's easy.

So you gotta have that.

But naturalistic training, think about that as like a musician rehearsing a whole song or if you wanna use a sports analogy, analog training is like practicing free throws or practicing drills, whereas naturalistic training is like scrimmaging or practice games.

So you gotta have both.

Professional athletes, professional musicians spend lots of time doing both.

If we want our students to be successful with these EF skills, we probably have to do both.

It's not enough to just practice memory once a day when it happens to come up as a problem.

And it's also not enough to just practice like a really contrived memory game, over and over and over, and then hope that it generalizes.

Neither one of those is enough, you gotta have both.

Okay.

One last point that's really, really important.

And I know this is obvious, but I'm gonna mention it specifically when we're talking EF skills 'cause people forget it, is if we want the child to learn and be successful with learning these skills, we've gotta make it reinforcing.

We've got to bring the fun.

That's how we call it at FirstSteps for Kids.

Bring the fun.

There's generally two approaches that we know from research in ABA to bringing the fun.

First of all, just have fun, obviously, duh.

We don't need research to tell us that, right.

But when you're thinking about procedurally, okay, what do we actually do to make sure it's working, you can use big positive reinforcers.

That's sort of the consequence side.

So big, positive reinforcers that the student really cares about.

It's not enough to just practice a skill.

It has to be practice with feedback.

That's what causes learning.

Practice with meaningful feedback.

The ABA term for that is reinforcement.

And then on the antecedent side, make sure that the task itself is fun.

So change the antecedents, like making the task fun, so building EF skill practice into games is great, if that's possible.

Interspersing with other fun tasks.

Incorporating child choice as often as possible.

And making sure that instruction is upbeat and fun.

And I know, again, this should be obvious, but a lot of the EF skills that we're gonna talk about today at first blush seemed kind of boring.

Like it's probably not fun to practice memory, right?

But the point is, don't even bother doing it, if you can't make it fun for the student.

If you can't motivate the student, there's no point in wasting your time or their time.

And of course, focus on generalization.

We already talked about this.

The way you know you're done teaching a skill is when you get generalization.

It's not mastery of the specific targets that you taught.

And multiple exemplar training, we've already talked about this too.

Super critical.

We're gonna return to it throughout.

Very quickly, and I'll return to these later in the presentation too, but these are, the first book, "Flexible and Focused", is a book that was just published a month or two ago that's specifically an ABA treatment manual for teaching executive function skills to children with autism.

So if you like the stuff that we're talking about today you should buy this book.

It's very affordable.

I think it's like 30 or $40.

Adel Najdowski is the author.

It's part of a book series that I'm editing for Elsevier Publishing Company on specialties within ABA for autism.

It's not a bunch of research-y, boring nonsense.

It's all practical, real-life stuff that you can put to use right away in the classrooms that you work in.

There's worksheets, there's data sheets, there's program plans, all of that stuff.

Very, very useful.

And then the "Peak Curriculum" I highly recommend also.

Raise your hand if you've heard of the "Peak Curriculum." It's pretty new.

Okay nobody, all right.

Well it's pretty new and, if possible, you guys should get Mark Dixon, or maybe you did already have Mark Dixon, I was talking to somebody about this, do a webinar.

Bring Mark Dixon out for a training at some point.

He's really, really bright and he's come up with this "Peak Curriculum" which is a four volume series for teaching children with autism, from an ABA perspective.

But really, again, teaching these more complex, more advanced skills.

And it's quite affordable.

And I'm not involved with the peak in any way, I'm not getting kickbacks or anything like that.

It's just good work, so that's why I'm recommending it.

Okay.

Let's talk about how to teach some of this stuff.

Okay, these are the main areas that we're gonna look at if we have time, we'll see.

We'll spend more time on some, less time on some.

I'm gonna show you some examples of publications that I've published in these areas.

And I'm gonna show you some examples of clinical data that have not been published.

They're just data from kids that we've worked with that have worked particularly well.

First area we're gonna talk about is inhibition.

Wouldn't it be great if we could get ourselves to stop doing all the behaviors that aren't working for us, right?

All of us here in this room, everybody, this is a problem.

A human problem is inhibition, or self-managing one's own behaviors that aren't working so well.

So let's talk about inhibition in students with autism.

So it seems like, so people talk about inhibitory control as including the ability to inhibit, resist or sort of not acting on impulses.

So kids who are described as impulsive are not so great at inhibition.

It involves maybe the ability to stop one's behavior at the appropriate time.

So raise your hand if you have any students that just can't stop doing some particular behavior, even though they know they should.

Okay.

Have you met a student who actually wants to stop doing the behavior?

And it's not just because they're trying to like be compliant or be a good student or something, but they actually get it that they want to, but they keep doing the behavior anyways.

Raise your hand.

Yep, okay.

Do you have anybody in your family?

Right, okay.

Do we have any behaviors, cookies, right?

Yes, sure.

Okay.

Let's do a little audience demonstration task here.

So I want you to tell me the name of the color, don't read the word, label the color.

Everybody.

- [Audience] Red.

Yellow.

Blue.

Orange.

Purple.

Black.

Pink.

- Okay.

That was kinda tricky, right.

At first it was easy because the color and the word matched right, it's a Stroop test.

The color and the word matched.

But then when the color and the word didn't match anymore, it became more difficult.

And so you guys just demonstrated a difficulty with inhibiting one highly likely repertoire behavior which is reading, right.

You have such a long history of reinforcement for reading words, you almost couldn't help doing it.

Even when I told you not to, I told you name the color, right.

But you had a very highly likely behavior, a very strong behavior of reading.

And it's not that you couldn't inhibit the behavior, but it was hard, right, at first.

Once you got a little practice, you got better.

So let's talk about inhibition from an ABA perspective.

Inhibition is sort of interesting because it's kind of the lack of a behavior, right?

How do you know someone's inhibiting?

Well they didn't do the bad thing, right.

But if we wanna talk about it or conceptualize it as a skill that we can actually teach, it's not just the lack of a behavior.

Have you ever heard of the dead man test in behavior analysis?

So the dead man test in ABA is if a dead man can do it, it ain't behavior.

Okay.

So like not doing the repetitive behavior or whatever that you want your student to stop doing, the loud vocalizations that disrupts the class let's say.

Well, if the kid just stops doing that, okay that's great, that's good, that's important for the class.

But that doesn't mean that we've taught the kid a behavior, right.

It doesn't pass the dead man test.

A dead man also doesn't do a bunch of loud vocalizations, interrupting the class.

So just eliminating behavior is not what we're talking about in inhibition, at least today, in this context.

What I'm interested in inhibition, or the reason why I'm interested in it, is because it seems like it's doing something other than doing the behavior that they shouldn't do.

So it's engaging in some behavior that influences your own likelihood of doing the behavior that you shouldn't do.

So it seems like teaching inhibition skills is about this.

It's about teaching our students to engage in some other self-management skills.

So let's say you're in a conversation with someone who's really making you mad.

They're being really unreasonable.

What do you want, and let's say it's in a social situation like this or something.

What do you want to say to them?

Like what behavior is very likely and very probable and very strong?

You wanna something like shut up, right?

Or you're being a jerk or something.

Right, okay.

But if you did engage in that behavior you'd likely have some aversive outcome for you, right.

So what do you do instead?

Maybe just smile or whatever, right.

Maybe just nod, whatever.

But is there any other behaviors you do to manage your own behaviors?

Is there anything you say to yourself Sometimes, right.

Like what, give me an example.

There's no right or wrong answer here.

What are some of the things you do?

What do you say to yourself to coach yourself through not saying the thing that's inappropriate.

(talking faintly) Don't say it, yeah.

It's not worth it.

He's just a jerk, whatever, right.

Okay.

So there's other behaviors you engage in, I think, that decrease the likelihood of you engaging in the saying the thing you really wanna say.

Does that make sense?

So I think if we're establishing inhibition skills for the students we work with, students with autism, it's like that.

We're teaching them some other behaviors that they can use to inhibit their own behavior.

Really important note here If we use punishment or differential reinforcement of other behavior, so rewarding the absence of a behavior, to eliminate a problematic behavior, and it works, fine.

That might be an important outcome for that child educationally.

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

It's not teaching a skill of inhibiting the child's own behavior.

Okay.

So it seems like inhibition is closely related to flexibility, because it requires inhibiting old rigid ways of responding.

So if your student is very used to always engaging in some inappropriate behavior in the classroom, then not doing that, inhibiting that behavior, requires some flexibility.

Definitely seems like it's related to stereotypy or repetitive behavior too, because by definition, doing something new requires not doing something old.

It requires doing something different.

So I think this might be why inhibition can be quite challenging for a lot of the students we work with.

So let's talk about some ways that we might go about teaching these skills.

First, let's talk about just getting the kid to inhibit some behaviors.

So we might start with some analog practice that's sort of low stakes, where the kid is not likely to get very upset and we make it easy.

So we might say, well depending on the student, they may well get upset.

But when you're programming for your individual student, pick something that's not likely to evoke challenging behavior, right.

Something that's gonna be hopefully even fun.

So, for example, you might put out crayons and paper and say all right bud, draw a tree but don't use green.

Make sure the green crayon is there, so they can do it, right.

But the instruction is don't do it.

And as long as they don't do it, they draw something and they don't use green, reinforce.

Sing the ABCs without saying the letter M or whatever letter and change it, a different letter every time you practice.

Playing Simon Says is an inhibition game.

Bop It is an inhibition game.

If it's a student that can read, you can get passages that they're able to read and randomly underline different words, and just give different instructions about that.

Like don't read the underlined word aloud.

Jenga is an inhibition game, right?

Like not pulling the one block that's gonna to make the whole tower fall down is a demonstration of inhibition.

Here's an example of a kid, I think he's singing, he's singing a song, and there's some word in there that we've told him not to sing.

Not to say in the context of the song.

Let's see if this video works.

♪ Happy cupcake to you ♪ ♪ Happy cupcake to you ♪ ♪ Happy cupcake dear Danny ♪ ♪ Happy cupcake to you ♪ He's pretty cute, huh.

So what behavior was he inhibiting there.

Saying birthday, right.

And so he has a long, strong history of reinforcement for saying birthday when you sing happy birthday, right.

So this was just a very simple, very easy first step in teaching him to inhibit something.

And again, is this gonna generalize to the classroom with some problematic behavior?

No way, right.

But it's just a very, very first step to teach, to start getting that repertoire, that habit of being able to inhibit one's own behavior going.

Okay.

More important though than that contrived practice is teaching some compensatory strategies.

There are some sort of self-management or inhibition repertoire per se.

So self-talk is one that the audience already gave an example of.

The behavior of planning some alternative behavior.

Stop, think, do, do I have a picture for that?

Sometimes I include that.

Yeah.

Raise your hand if you've heard of stop, think, do.

Okay.

Growing in popularity.

So yeah, so stop, think, do is where we use visual supports to teach the child to talk to themselves about the relationship between what you think, how you feel, maybe what you wanna do and what you say and what you're actually gonna do.

And so we can use visual supports like cartoons.

If the child is able to write, then you have them write it.

If not, you write it.

If they're able to read, great, then you write it and they can read it.

If not, maybe you use pictures, right.

So obviously you adjust the visual support to the appropriate level of the individual student.

And you train in analog setting at first.

And so you might say, well, let's say Jimmy, you really wanted to use the swing, but when you get out to the playground, Johnny already has the swing.

Okay, stop, hang on.

And like let's say this is a situation where normally the student is gonna throw a tantrum, right, 'cause they don't get the swing.

Okay, stop, hang on.

Let's think about the situation, like what's gonna work for you and what isn't gonna work.

Let's plan it out.

So you get out the cartoon and let's draw it out.

So let's see, and what are some things that the student might say, like what is he thinking?

My swing, my turn, I want the swing.

Gimme, okay.

So you write down whatever the student says.

And then you say to the student okay, well, it's kind of hard, right, when someone has the thing you want.

So how does that make you feel on the inside?

What's the kid gonna say?

(talking faintly) Maybe mad, frustrated right.

Okay, so you write that down in the little heart part of the cartoon.

Okay.

So if you want to have the swing, what should you do?

Or what do you wanna do and maybe the student'll say something like I'm just gonna grab it or I'm gonna push him off the swing, right.

Okay, well how's that gonna work out for you, right.

Not so great.

You're probably not gonna get the swing then, right, if you push the kid.

Okay.

So what can you do instead?

Well, I guess I could wait.

Okay cool.

So you write that in, wait.

Or I could ask for a turn, right.

Okay, perfect.

So that's what you're gonna say.

Can I have a turn please, right, and then I wait for my turn.

At first you practice this stuff in analog settings in a simple way that's not gonna evoke problem behavior, but that's not enough.

I guarantee you just doing that at the table, one-on-one, is not enough.

Then you gotta go out and say all right, cool, let's actually do this.

Right.

And so then you go out onto the playground or whatever the environment is and actually do it for real.

And you run through the cartoon right beforehand, have the student actually go have the real experience with an educational assistant there to provide the necessary prompting and reinforcement, to make sure that they're successful.

And then they get the natural consequence of actually getting to have the swing or whatever the preferred thing is, when they behave appropriately.

So that reinforces all of that.

And then afterwards, immediately you do a debrief too.

Okay, how'd that work out for you?

What did you do?

Did you follow this?

Awesome, really, really cool.

The important thing though is, multiple exemplars, right.

It doesn't matter if the child can inhibit tantrums with swings, who cares about that?

That's only one problem.

We want this child to inhibit difficult or challenging behaviors in general, right.

So practice across multiple exemplars until you see generalization.

What do you do?

What should you do if you wanna stop eating fast food on the way home from work?

- [Woman] Take a different route.

- Take a different route, right.

Modify some aspect of your environment.

And so it's the same thing.

With all of the EF skills we're gonna talk about today, if there is something you can do to modify the environment to make the student more successful, that's great.

Keep in mind though that if we're doing too much, if we're relying too much on environmental modification, we're also kind of avoiding the problem.

Does that make sense?

Because the student is not gonna live in a modified environment forever.

Probably not, right.

And so we want them to be as flexible and as independent and as functional as possible, whatever environment they engage in.

Okay.

And then of course the thing that matters the most is real-life application.

So maybe, before you start with inhibition training, you make a list of here's 10 or 20 behaviors that are highly likely to happen under these 10 or 20 circumstances.

And it's not helpful for the student and it's not helpful for the classroom.

And so these are things that we wanna see change.

That's your actual sort of like outcome that you're looking for is improved inhibition skills across those different circumstances, and with new ones that weren't directly trained.

So obviously always focusing on real-life application.

Okay.

I said I was gonna make you guys participate but now I've just been blabbering on and on the entire time.

Does anyone have an example of a child that they've worked on, a student that they've worked on inhibition with?

Maybe we can talk about it for a minute and problem-solve or illustrate what we've been talking about.

So basically identify, so a student who is not in school because of anxiety issues was gonna come back in school.

Identified a list of problematic situations like meeting the administrator, being in the cafeteria, made a list, talked through that list with the student beforehand and said okay, cool.

So these are gonna be tough.

So what are we gonna do?

What are some ways that you can be successful?

What are some maybe behaviors that aren't gonna be so successful?

Okay great.

Can we commit to doing some of these behaviors that are more likely to be successful?

And then they went and actually tested it out and it worked pretty well.

Maybe a little bit of issue with flexibility and adapting what they did to circumstances that weren't exactly what was discussed.

And that's a perfect, but that makes sense.

And that's a perfect example of why we do need to practice multiple exemplars across different situations and settings, until we get that generalized, flexible application.

Okay.

Let's talk briefly about working memory for about 10 minutes and then we're gonna take a quick break for caffeine and snacks and potty.

So what is working memory from an ABA perspective?

I really am not sure.

There's very, very few ABA folks who've even tried to talk about this.

So I'm really not sure, but like I said, it's clear to me that stuff happens in the person's environment, always a sequence of stimuli, never just one.

Almost never.

And then there's some protracted amount of time, not too much, few minutes, and then there's some opportunity to respond to these stimuli that happened back there.

And usually you have to process those stimuli in some way.

So that means you have to engage with those stimuli or respond to those stimuli in a way other than you did exactly then at that moment.

Usually there's some processing going on.

It's very complex stuff.

Okay.

So it seems like responding correctly in tasks that measure working memory involves really good attending behavior.

Did you guys notice the change in your behavior as soon as I said we're gonna do a working memory task, are you with me?

Are you willing?

What I saw was this.

(audience laughing) Right.

Which I appreciate by the way.

So suddenly everyone's engaging in pretty strong attending behavior, and yes, attending in itself, attention is a behavior.

It's something we do.

Some researchers think there's no real legitimate distinction between working memory and attention.

It's basically the same thing.

So regardless of whether or not that's the case, clearly improving working memory involves strengthening the behavior of attending, paying attention.

So let's talk about how we work on this stuff.

So in terms of just working on the fundamentals, sort of the analog contrived practice, there's a lot of different ways to do this.

So you can just work on digit or letter or word recall reversals, following multi-step instructions.

Everyone does that with kids with autism, right.

First you teach one-step instructions, then you teach two-step instructions, right.

I'm sure you have that in your curricula.

Delivering a message to a friend, running errands, spelling bees, all kinds of stuff like that.

Card games.

There's board games that are specifically for this.

So there are ways to kind of do the contrived practice and to make it fun.

I wanna share some research that Dr. Lisa Baltruschat did for her dissertation.

She was from a university, it was the University of Frankfurt, and no is that right?

Yeah, University of Frankfurt.

She was getting her PhD there.

She came out to California to run her dissertation with me.

And she did three studies on the application of ABA procedures to improving working memory performance in children with autism.

And as far as I know, these are the first three studies that applied ABA to improving working memory.

So this is a very new area of ABA work, and she published all three experiments out of her dissertation, which is not bad.

Two of 'em in 2011 and one in 2012.

So I'm gonna share sample data from two of those studies.

So the first study we did was we worked, oh and the point of all of these studies was can we improve performance on a test that everyone outside of ABA would pretty much agree, yeah, that's definitely a test of working memory.

Can we use basic ABA principles and procedures of positive reinforcement?

If that alone doesn't work, we'll teach some kind of self-management strategy.

So the first working memory task we did was called the counting span task.

Counting span task involves presenting a stimulus card to the student, and the stimulus card has quantities of stimuli.

We had two different sets.

One set, we save for generalization testing only.

The other set we directly trained.

And we took quantities one through 10 and randomly assigned them to either generalization or testing, with an equal number in one through five versus six through 10.

So the difficulty of those two stimulus sets was the same.

And one stimulus set was blue circles and squares.

The other stimulus set was green triangles and ovals.

You present a stimulus card and we'd say, okay, tell me how many ovals.

So if this was the card that we present, what's the correct answer.

Good job.

Then we put down the card, we'd hold up a different stimulus card and say okay, now tell me how many.

And the student would have to look, count the ovals, report the number.

Good job, put it down, hold up a different stimulus card.

Okay, now how many.

The kid would have to count 'em, report the quantity.

Awesome, doing good.

Then we'd say, okay kid.

Now you gotta tell me all those numbers in the order that I presented them to you.

Does that make sense?

So the rationale behind this task, in the general psychology literature, is that the requirement of having to count on each stimulus should mess with your ability to remember the previous quantity, right?

You can't just keep that in mind because now you have to do this.

Okay.

So we trained, so here's a graph, we did a multiple baseline across three students with autism.

They're between the ages of, I think, I'm forgetting now, five and seven or so.

And what the graphs, I'm just showing you a graph for one participant.

We had pretty similar results across the three.

And basically what this graph shows is percent correct from zero to a hundred on the vertical axis.

And then each data point represents one block of trials.

I think we did about, I think 10 trials per block or eight trials per block, something like that.

And the black data points are the stimuli that we trained directly.

And the white data points are the stimuli that we never ever trained or gave any feedback on.

So in baseline, we tested both those stimulus, both those stimulus sets there, and showed that the kid could get about 20% correct.

So having a pretty tough time with this task.

In the positive reinforcement condition, which is the next phase, all we did was give highly preferred positive reinforcement for correct responses.

No prompting, no other feedback of any kind, no error correction, nothing.

Just positive reinforcement of correct responding.

For this specific student, that's all it took to get his, this laser, there we go.

All it took to get his responding up to 100% was just positive reinforcement.

The last phase, that maintenance generalization phase, we discontinued all reinforcement and there was no consequence at all.

So whether we got it right or wrong, we just said okay, and we presented the next trial.

And what you can see is his performance was basically the same.

Then we tested the generalization stimuli that we had never directly trained, and the kid did just as well with those two.

So what this showed was just positive reinforcement for performance on a working memory task, really substantially improves performance on that task.

And that in itself is not so surprising.

You might even say, well who cares, it's just memorization But here's the cool part.

This shows it's not memorization.

There's no way the kid could have memorized that because he had never been trained on those skills before.

Does that make sense?

There were different quantities, different shapes and different colors.

So there was something about his overall ability to pay attention and remember that was strengthened.

And the other cool thing, another objection is well yeah, obviously if you give positive reinforcement someone's gonna do better.

Well, again, after this phase line, there was zero positive reinforcement.

And the kid knew it, he's real high functioning, very verbal kid.

It's not like he forgot that he should be getting a reinforcer.

Said sorry kid, can't tell you if you're right or wrong and you're not gonna get anything for it.

Just do your best.

Which is exactly what we told him in baseline.

And so just an experience with positive reinforcement made a real substantial improvement on that task.

Now the point of this series of three studies was not to produce a socially important improvement in the kid's actual life.

It was just to put a first footprint of ABA into the area of working memory, just to see if we could even move performance on these tasks.

If you ascribe working memory to the brain only, this should not be possible.

This should be impossible.

We didn't do anything to the brain, right.

What we did was we altered behavior, the child's behavior of paying attention, and it worked.