Parent Support University Week 10

June 3, 2020

AnswersNow Chief Science Officer, Adam Dreyfus, speaks about the topic of Naturalistic Intervention as a part of the Parent Support University series.

Transcript:

Speaker 1 (00:02):

Hello  AnswersNow friends.  Adam Dreyfus here, chief science officer of AnswersNow back for our latest installment of our parent support university that we've been doing during the pandemic. The goal of AnswersNow from the outset we've been in business for about four years now is to reduce the barrier of entry for parents and caregivers, to all the stuff that we know just really works for kids and adults on the spectrum. What is AnswersNow that's a great question. You can go to getanswersnow.com to find out a little bit more about it. That's our website. But at the crux of it is we are a mobile app a mobile app that you can download off of your App store or your Android store just type AnswersNow in the search engine on your phone, no spaces just AnswersNow, and it's a little purple icon with the butterfly on it.

Speaker 1 (00:55):

And what we do is we connect parents and BCBAs,  board certified behavior analysts through our platform. For those of you who get ABA services or have been doing it for a while, you know that there's huge wait lists, it can be 12, 18 months. You might see your BCBA once a month, once every couple months. And we just think that that's not sufficient for parents. Parents are exhausted, they're overwhelmed, they're stressed out, let alone today on top of everything else. And so we want to put a BCBA in your pocket. So go, you can also go to getanswersnow.com and find out more about us. You can see some of our clinicians, you can check out blog posts see what we're all about. You can tune into some of our online stuff like you're doing now.

Speaker 1 (01:39):

So what we decided to do when everybody went into a kind of stay at home orders is do a series of these videos about the interventions that we know, we know work. And why do we know they work?  Well about, I want to say eight years ago the National Professional Development Center, which was a sort of a series of universities around the United States decided to sit kind of stop for a second and say, all right, there's tons of misinformation out there about autism. Anytime a parent kinda gets the new diagnosis, they go and they type autism and, and they, they get all kinds of competing narratives. So we're just going to stop and we're going to look at what do we know works right now. And they called those evidence based practices.

Speaker 1 (02:23):

What are the evidence based practices that we're not arguing about? We're not testing. Like they just, we know they work and they came up with a little bit more than 20. And you can go to their website NPDC National Professional Development Center and learn more about these evidence based practices. They've got a series of free training modules called the afirm modules, A F I R M afirm modules. And we've just been going through in order. We've done antecedent based interventions, discrete trials cognitive behavioral intervention. And today we're gonna be talking about naturalistic interventions, which unlike a lot of the other things in our field that is what, what it sounds like is what it is. Naturalistic interventions just mean interventions that we do kind of naturally. Most of you who have had an ABA therapist either in your home or you're taking your children to the clinics.

Speaker 1 (03:17):

I know that ABA, a lot of it looks like a kid sitting at a table with one instructor doing, doing flashcards, doing drills that's called discrete trial training DTT. We talked about it a couple of weeks ago. There is some folks kind of push back against that a little bit. They're like, Oh, that's a, that's a lot of sitting still and teaching kids how to sit still. True. There's some of that, but a better way of thinking of it. We should probably call it mass trials, which means we're just gonna, we're gonna, we're gonna kind of work really hard in a, in a, in a small space, a small space, but a small timeframe. So instead of like, kind of waiting for a kid to like, say, you want to teach the kid the word book so if it was a hundred percent kid guided, right?

Speaker 1 (04:04):

Like you were waiting for an opportunity, they might not pick up a book. They might not get anywhere near a book. They might not do anything like that. And so you would have zero opportunities to teach them about a book if it was a hundred percent up to them. And the typically developing child learns the word book through hundreds and hundreds and hundreds and hundreds and hundreds of trials, right? Like hundreds of times they come into contact with it and the parent says it, or a teacher says it. So mass trials are important to kind of close that gap a little bit. A lot of the kids on the spectrum don't get all those opportunities. So we need to manufacture them so that they can learn how to talk and learn social skills and learn how to tie their shoes.

Speaker 1 (04:46):

They're they generally don't get it just by being around others. Otherwise they be doing those things. They generally don't get it. If they only get one or two chances to learn it they need hundreds and hundreds of chances. So that's my little pitch for discrete trial. But it's also really important to remember context, right? You don't sitting at a table or in a clinic with somebody even, even though that is important and you're working lacks a little context, you know, if you're trying to learn about farm animals, sitting in a clinic, learning about farm animals is a little disconnected. If you're trying to learn about washing your hands, sitting at a table to learn the sequence of washing your hands is maybe not the best way of doing it. So naturalistic intervention is just a fancy way of saying we're going to take all that stuff that we would work at at a table or in your living room.

Speaker 1 (05:43):

You know, if you have ABA in your home and we're going to do it in the context of where it makes sense. So if we're going to be talking about swings and things like that, we're going to go to a playground. I've said this before on here the two sort of main avenues in which I've been successful, getting kids to talk is either using their affinities, right? The things that they really, really want, whether that's Thomas, the tank engine and Mario brothers dinosaurs, whatever that thing is. If we can use that to pull language out of them and get them talking that's probably the number one way, cause they're already motivated. The second way is finding something they really like to do in the world and seeing if you can get them to say something around that and the place that we really see that a lot is on swings.

Speaker 1 (06:35):

Kids love swings. It's very few kids that don't like swings. And so you get them to a park, you push them on the swing for a little bit. You stop, they look at you, you look like you're going to push them. And then you pause for a second and you say, push. And I can't tell you how many times that's the first time I heard a word push swing, or if they don't have that, they can't say a full word, PA, PA, PA. And I'll take it. I will take it communicative intent pup. That's going to get you some swing time, my friend. So think of that as this is, this is really where parent training should come in. Naturalistic intervention is, Hey parent, or caregiver or grandpa or grandma, or brother or sister or whatever. ABA you don't have to do ABA applied behavior analysis.

Speaker 1 (07:26):

The way that it looks like in your living room, where you're like, well, that looks like a lot of work, right? This person comes in and they spent two hours. They got all those materials. You have all the materials you need, whether it's in the kitchen or the bathroom or wherever, whenever you're doing some especially high preferred, highly preferred activity. Maybe that's bath time, maybe that playing outside with sticks, like who knows. Those are the perfect opportunities to naturally try to work on social skills or language. And so shopping is a great one, right? You've got the kid in the shopping cart. They really like pineapples. You start getting close to the pineapples. They recognize the pineapples are coming. This is the pineapple aisle, right? Like you turn onto the pineapple aisle, you reach out for the pineapple and you just pause for a second.

Speaker 1 (08:17):

You say pineapple. And that might be the first time you'd be surprised. Like sometimes their first word is some complex, like long or like that, like pineapple. So naturalistic intervention it just means you doing it in the flow of things. If you're the kid wants to go outside, right. It's a, it's a nice day. You get on their shoes. They, all the signals are in place. All right, I'm going outside. There's I got my shoes on. Dad's getting the backpack. There's snacks in there. We're good to go. You get to the door and you just pause for a second. You say open, right? So they're all motivated. You have all this natural motivation and you're not trying to drive him crazy. You're not trying to have upsets. That's the thing, like a lot of parents were like, Whoa, they'll get very upset.

Speaker 1 (09:00):

We're talking split seconds here. Just that little pause open. And they look at you and if they don't, this is not, don't die on this speech. Don't just say open and open the door and out you go. What you want is you want to just capture that moment to the best of your ability. But even if they're just sitting on the floor like my kids right now are into Mario brothers. So I got them these little Mario brothers figuring. So they play with the Mario brothers figurines. So if that's happening, right, like your son daughter sitting on the floor, they got their Mario brothers figurines. And you know, that they don't really appreciate if you just come and start grabbing their toys and trying to play, you've tried it. It's it's it didn't work. So it's called parallel play.

Speaker 1 (09:45):

And it's a, it's a naturalistic intervention, right? You're doing it in the natural flow of things. You're not having the kid come to a table. You're not taking the clinic. They're just in their natural kind of state playing on the floor. So instead of trying to interact with them, like, Hey, I'm going to take your Mario Mario, I'm jumping over here. You just play next to them, right? You use the same if they do have any language, and they're saying anything, you sorta copy that, right? Like, what you want to do is just mirror what they're doing without interfering and what has happened that we've seen happen over and over is this begins to get the kids' interest, right? It's not invasive, you're not interfering with them. And they'll kind of look over, see what you're doing. And probably wondering, are you going to take my toys?

Speaker 1 (10:30):

You're going to do that thing where you try to play with me and no. All right. You're just, you're kinda doing what I'm doing. Which is respectful. It's not a, they're not a doubt. They're thinking this. They're like, Oh, look, dad's being very respectful. But you're, you're not applying a bunch of pressure on them and just making them do what we want them to do, which is a lot of frankly, a lot of parents, right? Like, sit up straight, close your mouth, working on manners with my kids right now. So what that does is it permits the kid to initiate. So what you'll see is you'll plan. It usually doesn't take too many times doing it. Like the first couple of times, it's going to be kind of novel. They're not going to know exactly what's going on, but once they kind of get like, all right, they're just, they're present.

Speaker 1 (11:12):

They're doing something that's of interest to me. And they'll come over, they'll come over and begin to interact with you. And that's gold that, that, that movement towards you, instead of always being in the one, like the parents are always being the ones like I got to go, kind of, I got to get in his face, I got to get in his field of vision and I've got to take away his iPad so that he'll kind of pay attention to me. Having them come towards you is the key to the kingdom because that gives you opportunities to say hello, to practice greetings, to see what they want to play with them to and to not have the upset. We know the parents, like that's a big one. How do I avoid the upsets? Well, if they're initiating it that's pretty good idea that you're probably not going to end up with an upset.

Speaker 1 (12:01):

This is a, these are all called naturalistic interventions, but basically we're just taking the really structured things that we do during work time, right? Like time to work. You've all seen that. And, and taking those out of the world, taking those into playgrounds stores, shops, churches, bowling, alleys, you name it. And this is really where AnswersNow probably is at it's at it's most useful where a parent says, Hey, I'm going, going to Walmart. What can I do to kind of work on this stuff, to help my kid, listen to me a little bit better interact with his brothers and sisters a little bit better in the context of the world is really the best place to do that. So one of our sort of really early successes was we had a parent who said that their child would have explosive behavior issues around automatic flushing


Speaker 1 (12:56):

toilets started with the sound of them, right? Like, they'd be on public. They go into the bathroom, they'd hear it, they'd run away. But it got to the point where they wouldn't even go in any buildings where they reasonably thought there might be an automatic flushing toilet. So the kid's world got really small, right? You're not going into stores. You're not going into malls. You're not going into any place. The kids like, Hey, I, I know there might be an automatic flushing toilet in there. So we worked with the parent on, Hey, next time you're out. Don't wait until you have to go to the bathroom. Don't wait until there's kind of this sort of anxiety and pressure, but just go to, into a building that like maybe a library, maybe that they, they, they are not going to resist going in and just walk up and touch the bathroom door.

Speaker 1 (13:33):

See if they'll do that, just walk with their hand, see if they touch the the bathroom door. So you're doing it in kind of a natural environment so that you can practice it. And it took about a month. Once, twice a day, they would try it. It wasn't they would do it within the, sort of the context of their normal routines. And he got used to it. And not only did he tolerate the automatic flushing toilets, but he could use the toilet. So it was a full parents were beyond happy, right? Like not only could they go out, but they could use the toilets and it wasn't an issue, naturalistic intervention. So we definitely want you to check those out. There's a whole module for it on the NPDC website. The afirm modules, A F I R M under naturalistic intervention and it really unpacks it all and talks about it in detail, but it just, the short of it is practice this stuff out in the world.

Speaker 1 (14:27):

Feel free to give your clinician a call, check us out at, getanswersnow.com. We were going to continue doing these, our parent support university as we go through our courses. You can see what we are up to. We want to thank you for taking a couple minutes to listen to us. I'm Adam Dreyfus, the chief science officer of AnswersNow find out more about us at getanswersnow.com or download us on the Apple store or the Android store. Just type AnswersNow, all one word. It's a free download. We have all kinds of free resources, but the key to this is we want to put a clinician in your pocket. Thank you very much, and we'll see you next week.


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