Parent Support University: Week 14

July 1, 2020

AnswersNow Chief Science Officer, Adam Dreyfus, speaks about Pivotal Response Training as a part of the Parent Support University series.

Transcript:

Speaker 1 (00:01):

Hey AnswersNow, family and friends, Adam Dreyfus here doing our weekly parent support university. I'm the chief science officer of AnswersNow, and also one of the co-founders. You can learn more about us at getanswersnow.com. But I highly encourage you and it's absolutely free to just go to your phone open up your app store, whether that's your iPhone or your Android phone, just type AnswersNow, no spaces in the search function, and you will get you'll be able to download the app for free. We've got all kinds of stuff on there that you can do for free. Talk to the parents, you can read the blogs, we've got all kinds of information. But our main product, the main thing that we do is we connect parents directly to their own BCBS. So you have a BCBA in your pocket whenever you need it.

Speaker 1 (00:49):

A lot of our folks get ABA services, either their kids go to a ABA school, applied behavior analysis school or get in home supports, but we're here to support parents and kids. I provide that wraparound service that has been lacking in the industry. The other thing we want to do is we want to just reduce the barrier of entry to these services. As you're going to hear today, and this, this particular episode might get me in a little bit of trouble. We are very frustrated that here's all this great information for parents, and yet parents still feel isolated, overwhelmed and really disconnected from the process. And we've been doing this 30, 40 years. We've really demonstrated that we can help severely impacted kids out. And it is most of the interventions and most of the stuff we do is really well understood.

Speaker 1 (01:37):

It's not brand new, we didn't just invent it. We're essentially doing most of what you see when you see somebody really helping these kids out is a variation or a modification and stuff that was sorted out in the late sixties and early seventies. Certainly the techniques have improved but it's a lot of the same core stuff. So check us out at get answers now.com or again, go to your app store and download the app for free. So what we've been doing ever since the pandemic started is one of my favorite resources for parents is the afirm modules. AF I R M. The affirm modules are a series of two, two and a half hour long modules that helped unpack the evidence based practices. That's a fancy way of just saying the pile of information that we know works.

Speaker 1 (02:26):

So each evidence based practice, it sounds like it's a kind of it's individual thing, but it's really the toolkit. So if I was a carpenter and I came to your house and I opened up my toolbox, right, there's all the tools that I've got to help build your house, a board certified behavior analyst has a toolbox, and those are evidence based practices. Everything's based on evidence. And so a really neat thing that National Professional Development center did a few years back. They put them all in one place and create these kinds of training modules and as greater resources it is it's still not super user friendly. It's not super parent friendly. You don't see a ton of parents leveraging it cause it's really, you could just kind of like a little university for parents. So we've talked about I think we're about 18, 19 in we've talked about, and these are some of the terms that, right.

Speaker 1 (03:13):

People like, I don't know what this guy's talking about in a scene based intervention, extinction, reinforcement, these are all very clinical terms and they mean very specific things, but they also, it's kind of like saying, handing someone a book in a foreign language and saying, Oh, this is amazing book. I mean, it's in French, but here's this book and I hope you enjoy it. And you're like, wow, I'd like to enjoy it, but I don't know French. So probably not. And everybody I run into just keeps giving me more books in French. So not super useful today. We are going to be talking about P R T pivotal response to treatment or therapy. It is an evidence based practice and when you hear people describe it pivotal response treatment or pivotal response therapy, they will say, well, it's like ABA.

Speaker 1 (04:03):

But it's a little different, right? It takes into account different things like development or motivation, which is a ridiculous thing to say, I'm sorry, this is going to be a weird one. But every behavior analyst, that's sort of the main thing that we're trained on. So to say that somehow there's this thing called pivotal response treatment, that's different than ABA because it takes into account. Motivation is just nonsense. All of the sort of the behavioral analytic interventions take into account motivation, they'll say, well, well, it also, it takes into account child development,

Speaker 2 (04:41):

Sodas,

Speaker 1 (04:42):

The interventions there is no distinction. It is not different than  ABA. And this is where probably I'm going to maybe be a little controversial. So pivotal response treatment was developed at UCSB, university of California, Santa Barbara. I wanted to make sure I got it right. Sometimes I say UCLA UCSB by doctors Koegel and at the Koegel Autism Center. And it's a fantastic place. And they are tremendous clinicians who have added quite infinitely more to this field than I ever will. But pivotal response treatment is not some kind of special thing and here's my problem with it. And I usually am not gonna, you're not gonna hear me say anything about a problem I have with evidence based treatments. This one is anytime you hear sort of a brand or somebody put a name on a treatment package that's a problem because it creates another barrier of entry to this treatment for parents. So say you're a parent and you want pivotal response treatment. Sounds great. I read about it. I saw a video about it. It's fantastic. What do I have to do? Oh, I know, you know, only people who have taken the course are allowed to do pivotal response treatment, which is crazy making to me crazy making a, because none of their treatments are outside of the Canon of ABA treatments. So the pivotal responses that they're talking about, there's four pivotal responses that are, you know, crucial. That's what pivotal is, crucial responses motivation,

Speaker 3 (06:21):

Any, any

Speaker 1 (06:22):

ABA person is going to be taking into account the motivation of the child initiation, do they, how do they initiate self-regulation and multiple cues, having the kids be able to register multiple cues, any good programming done by a behavior analyst should incorporate all of those and well-trained behavior analysts just do them as a matter of their course. One of the criticisms of pivotal response treatment, and I think it's a legitimate one is they go out of their way to describe it as parent driven, right? It's not parent driven child driven child initiated well as someone who's been doing this for decades. And as a, if you are a parent or a caregiver of someone diagnosed with autism, you know, that you can't just wait for them to want to play with you or to be interested in something that you want to talk about.

Speaker 1 (07:17):

That's part of the problem is that just doesn't happen naturally. And so if I go into a room and I might have all my toys out and I'm doing pivotal response therapy, and it's a session in which I'm just going to let the kid I'm going to follow the kids lead well, what if the kid just wants to play with the fidget the entire time? And if I go to take the fidget, they have a huge upset that is not an uncommon experience for most of us. Who've been working with folks on the spectrum. And so that that element of it I want, I don't want to say differs from ABA. But most practitioners recognize that to engage a child on the spectrum, especially a severely impacted kid on the spectrum. You can't just wait for them.

Speaker 1 (08:02):

You have to manufacture opportunities. Whether that's interfering with something that they're playing with playing with something that you know, that they like, so that they're kind of being drawn over to you. And again, I don't want it to sound like I'm so critical pivotal response therapy. I am critical of somebody taking some piece out of the big pile of information that is super useful to parents putting their name on it, charging additional money for it and saying that it's a necessary treatment or really that that's the only way that your kid could possibly get better is troublesome for me because it just makes it harder for parents to get help for their kids. If they feel like, Oh, here's this neat thing.

Speaker 3 (08:48):

I've got to find it. And there's not hardly anybody trained in it,

Speaker 1 (08:51):

Pivotal response therapy, go ahead and look on their treatment, look on their website. A better way of saying it. And this is, I say this about everything is structured, play produces results. So ABA applied behavior analysis is essentially structured interaction, right? It's not random interaction. Whoever's working with your kids should have a plan. They should have goals. They should have strategies. There is a structure to it. So applied behavior analysis is when applied to working with students and adults with children and adults disabilities is structured interactions, structured play would probably not the best way to describe it, pivotal response therapy, same thing. Other than, yeah, it's got its own trademark and cost money. And if you want to get certified in it, you've got to go to their special place. And there's three levels of certification. So frankly, three levels of three barriers of entry to this information.

Speaker 1 (09:50):

So what we're trying to do here at AnswersNow is reduce that barrier for you and for everybody because this stuff, again, it's all publicly available, researched interventions, you can go onto Google and type in ABA interventions, and you will get thousands of research articles that you can print up. And in the methods section of that article, it will describe to you how to do what it is that they did that resulted in better social skills, better language skills more vocational skills. So you can do it all yourself. And that's really all a BCBA is, is someone who's read a whole ton of articles and then been trained in those specific interventions so that they can do them with a high level of accuracy and help other people. That's what we're here to help you do is to not have to read thousands of articles but to access that information in a much more easy way.

Speaker 1 (10:49):

So we have text-based support, video support, a lot of different ways of doing that. Again, I'm Adam Dreyfus, I'm the chief science officer AnswersNow. You can find out more about us at getanswersnow.com. At some point there's probably a little, it comes on the screen here and says, getanswersnow.com. You can also go to the Apple store or the Android store the Google play store, if you would, if you would have it and type in AnswersNow, no spaces, ANSWERSNOW. And you will get, be able to download the app for free. We were adding all kinds of features right now, making it much more useful for the delivering instruction, which wasn't originally what we had done, but the pandemic has definitely backed everything sideways.

Speaker 1 (11:35):

So you can get on there. We are taking insurance now we're going to be taking Medicaid pretty soon. This is a pivot for us, but it's a wonderful for you as we try to come up with come up with, reduce the barrier of entry to these services for you. So yeah, check us out at, getanswers.com. We are talking about evidence based practices. Today we've been talking about pivotal response treatment or therapy. Terrific. It's a terrific package. It's a, if it was, if it was as advertised, kind of like this different kind of thing, I'd be much more enthused I ask about it. But it is a bird of a feather. It is applied behavior analysis, wearing a different coat, and I understand it because for totally understandable historical reasons, some people don't like the term ABA. It's associated with some negative things especially early on when we were first kind of determining the efficacy of applied behavior analysis to help severely impacted individuals.

Speaker 1 (12:37):

There was a lot of punishment procedures that were used to try to reduce behaviors and change behaviors. Things have changed a lot. It doesn't mean we don't use punishment procedures. But so does everybody, like if before I get myself in trouble, like timeout is punishment taking away something is a punishment ignoring somebody as a punishment. These are all things that your average parent and certainly therapist use to try to result in socially significant behavior is usually the term that is used. I like to say it is how do we help this kid or this adult behave in a way that opens their world up maximum? So that can mean giving them language teaching them social skills, teaching them things to do in their leisure time. If the only thing you do in your leisure time is poke a wall.

Speaker 1 (13:29):

You're probably not going to have a whole lot of friends, although I'm pretty sure that you could find a group online where it's just the poke, the wall group. I'm being a little facetious. What you're trying to do is let them have the most independent life possible and left to their own devices. They may require a hundred percent of support, but with expert intervention they might require only 50% support. The goal is always zero support. They don't need any support. They might be a little different. They might be some kind of weird. They might have their own sort of idiosyncrasies, but they get to choose where they go. They get to choose where they live. They get to choose who they're friends with. That's the goal. And again, left to your own devices. A lot of these kids are not going to develop those skills. So tools like, I mean, God bless the Koegels. Pivotal response treatment is a wonderful package. But it is ABA by another name. So with that I'm going to end probably my most controversial of these podcasts II things. I'm Adam Dreyfus, I'm the chief science officer of AnswersNow I'm a board certified behavior analyst, and I'm also one of the cofounders of AnswersNow. And hopefully you're having a great day and you and your family are safe.


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