Psychiatry & Psychotherapy Podcast - Turn Autism Around with Dr. Mary Lynch Barbera

Episode Date: January 18, 2022

On this week's episode, Dr. Puder interviews Mary Lynch Barbera, Ph.D., RN, BCBA-D, creator of the approach and book titled Turn Autism Around. Dr. Barbera began her journey in the autism world over 20 years ago, when her first son, Lucas, was diagnosed with autism. Dr. Barbera made the incredible transformation from a confused parent to a doctoral-level behavioral analyst, best-selling author, and a tremendous resource for health professionals and parents of children with autism all over the world. By listening to this episode, you can earn 1 Psychiatry CME Credits. Link to blog. Link to YouTube video.

Hello and welcome to the Psychiatry and Psychotherapy Podcast. I'm here to talk about getting rid of burnout, increasing job satisfaction, and feeling like an expert in what you do. One thing that created a lot of burnout and angst for me was trying to get continued medical education right at the last minute. So why not join the CME membership and do CMEE while listening to this podcast. Go to Psychiatrypodcast.com, sign up, sign in, take the test, and the certification is email to you in seconds. All right, welcome to the podcast. I am going to start by talking about conflicts of interest because we offer CME. So Dr. Mary Lynch-Barbara has several conflicts, including book sales for her books on autism

and online courses for parents of kids with autism. I have no conflicts of interest at this time. Secondly, I would like to make an announcement about a webinar I am giving February first on the Big Five personality types. So if you have wondered, maybe for my episodes, what your Big Five personality type is, you can sign up. You will get sent the gold standard Big Five inventory, the Neo, and you will have a chance to take that. You will be emailed the results. And then in the webinar, we can discuss.

And so hopefully you learn about yourself and think about some ways that you might grow in this new year. And I think also as you take that, then you can go back and listen to the A&A, or so episodes I've done on the Big Five, and you might come away with a deeper understanding of this very important way of understanding personality. So link for that in the show notes. All right, let's get to the episode. Welcome back to the podcast. On this week's episode, I am interviewing Dr. Mary Lynch Barbera. She is a PhD, a nurse. She is the author of a book titled Turn Autism Around. She began her journey in the autism world over 20 years ago with her first son, Lucas,

who was diagnosed with autism. She has talked about it publicly on her podcast. And she has been living it and then went back, got her doctoral level, behavioral analyst, has written, you know, what, two books now on this topic. Yep. and has tremendous resources for parents of children with autism. And she really wanted to focus in on why it's important to catch early autism, why it's important to catch this early.

What's the data supporting early intervention? We're going to talk about that. We're going to talk about how to diagnose it. I think it's really helpful just to go through your 10 main things you're looking at. A lot of people who will be listening to this, well, let's just imagine they know a little bit about autism. but they might not know how to sort of decipher, you know, is this language delay autism or is it something else? So we'll talk about the 10 different symptoms that early autism, that can be seen in early autism.

And then we'll talk about kind of your approach on how to turn autism around. What kind of interventions are we looking for? What type of school? What type of, you know, people who know how to work with autistic kids? what are we trying to look for? And so I'm really excited to have you on. Well, thank you for inviting me. I'm excited to be here too and really passionate about helping parents, but also getting the word out to professionals and really working with a multidisciplinary team. So I'm excited that you offer credits for different types of health care providers.

I come from a health care background as a registered nurse and I'm married to a physician. and my typically developing son is also in med school. So happy to be here talking with you today. Great. And I'm also here with Caden Page. He is a pre-med student who has done a lot of digging for this episode. I always have someone who kind of works with me and helps me write up the summaries and stuff. So Caden, thank you for being here.

Yeah, third to be here. Yeah. So let's just jump into why is it important to catch autism? early? Well, back when my son Lucas started showing signs of autism, he developed typically, he was born, you know, had a typical birth and no problems in the first year of life. And I got pregnant with my second child pretty early on. So we didn't really notice any signs of autism or anything. And this is back in like 1997, 98, when he started showing early signs. And when my second son, Spencer, was born, my husband, at the two-month visit, I was taking just the baby to the doctor.

And my husband, who's a physician said, well, ask the doctor how many words Lucas should have. Lucas was staying home with my husband. I took the baby for the well check, asked the doctor. and the doctor said at 21 months of age, Lucas should have about 25 words. So on the way home, I'm driving and I'm thinking, okay, let's count E-I-E-I-O as five words. Let's count this little script, he used to say, which was delayed e-A-Lia, but I had no idea what that was or anything. So he used to come home back from the museum where we would read the sign to him. Another phrase he said sometimes was, please do not feed the ducks, quack, quack, literally eight more words.

So like grasping at straws, words that maybe I didn't hear for a while. I now call them pop out words. So I got back and so my husband says, how many words? I say 25. He says he doesn't have 25. I say, oh, no, he does. I counted. And then he drops the bomb, the A word and says,

so you don't think Lucas has autism. And I was like, what? This is early 1998. And I have a two-month-old baby and Lucas, and I'm like, what? Because my only experience was I was a junior nursing student, and I rotated through this residential placement for teens, and some of them had to have autism back in the 80s, you know? Right.

And it was like, that is not autism. Like, are you crazy? Like, no. No, it's not autism, and I never, ever want to hear the word autism again out of your mouth. So I went into a deep state of denial, and Lucas didn't get diagnosed until the day before his third birthday, and he didn't start treatment until he was not 39 months old. Now, we didn't have him in the closet. I mean, he was gone for speech therapy. He was gone to typical toddler preschool without support.

So he didn't look that bad, right? Yeah. And he was doing speech therapy weekly. But that wasn't enough. He continued to fall further and further behind. And so that, you know, sealed his fate in some ways. And I have, you know, I had a lot of guilt about that because then I started reading like all of this turnaround could happen for kids with autism if they were caught early, if they started ABA early. And ABA is applied behavior analysis treatment.

And it was back then, still is, the most evidence-based treatment for children with autism. And so in the end, I became a board certified behavior analyst back in 2003. I became a big advocate. I was a founding president of the Autism Society in my county. I like, I really went all in. I had a master's degree in nursing. I was used to managing people and processes and projects and stuff. but I went all in not to just help Lucas, but also to help gain awareness.

Like the pediatrician was missing these signs. Yeah. I know it was important to point. He didn't know the difference between the speech delay and autism. And I felt like it wasn't just my fault that I was in denial. People didn't catch it. And so now I'm really on a mission, especially with my new book called Turn Autism Around, an Action Guide for Parents of Young Children with Early Signs of Autism,

to empower people, it really doesn't even matter if it's autism or if it's going to possibly be autism. We have to empower parents to treat any kind of delays seriously. Yeah. Yeah. I think that's such an important passion of yours, an important message. And it's so important to get perspectives, especially when you're like the parent in the trenches. You know, you like have so much emotion and attachment sort of intertwined in labels or not labels or, you know. And so it's really hard to see clearly what's going on. You know, I just did an episode before this on dyslexia. And it turns out I have dyslexia.

I didn't really fully realize that until my daughter got diagnosed. And it wasn't me who diagnosed my daughter despite being a psychiatrist as my wife. I'm like, no, she's doing great, you know? And my wife's like, no, like she's inverting her letters, blah, blah, blah, you know. And so I think that we want to see our kids as normal. And yet if we can clearly identify it early on and get past that resistance, and I imagine as like professionals, we want to see these kids earlier than later, right? Because then we can actually sort of get that window of time where huge changes can happen.

In the book you mentioned, there was an experimental group that jumped, they gained an average of 30 IQ points more than the control group. Can you tell me about that a little bit? Well, there's been over 500 studies on applied behavior analysis showing that, you know, when it's control group versus experimental group, that's not just one study, but it's multiple studies, starting off back in the late 1980s. with a study that showed that 47% actually of kids in the experimental group that received 40 hours of ABA treatment actually became indistinguishable from their peers by first grade compared to, I think, 5% of the control group. There were two control groups, one that got some treatment, but not a lot, and one that got just whatever was available.

40 total hours, or is that? 40 hours per week for two years. Oh. And the control group was like 10 hours per week? 10 hours per week of ABA. And the other, the third group was just whatever was available in California in the 1980s, which was one hour speech, one hour O.T., one hour teacher time. But the problem is, is that right now, that's a lot of what kids are getting early intervention-wise, right? they might be getting one hour of speech, one hour of OT, one hour of teacher time.

And especially if these kids do have autism, severe autism, and they need more intensive treatment. In Lucas's case, we did the research, you know, and he was diagnosed in 1999 the day before his third birthday. And then we got ABA treatment 40 hours per week. You did 40 hours a week. Yep. How do you, how do you like, I wouldn't even know where to refer a client for that level.

Well, back then, I mean, we have a couple more problems here because back then, the rate of autism was thought to be one in 500. And now the rate is one in 50. Back two decades ago, ABA was not covered by insurances. luckily in the state of Pennsylvania where I have lived and still do live, there was a loophole so that kids with autism diagnosis could get on medical assistance regardless of family income and could get ABA paid for. But most families back in two decades ago were second mortgaging their house and that sort of thing.

But with the advocacy work over the past decade, all 50 states, states now require insurance coverage for ABA treatment with employers over 100 people and if you're not a PPO. And there's still a lot of, you know, co-pays and things like that. But now there are ABA companies. The other problem that we face is that all ABA is not created equal, just like all psychiatrists aren't created equal and all, you know, medical schools aren't created equal. Like there are different, quote unquote, flavors of ABA. My first book was called the verbal behavior approach. So we couple that research that's done in the late 1980s, but we add BF Skinner's analysis

of verbal behavior so that everything is centered around a child's ability to request their wants and needs and is not just kind of drilling. kids and and, you know, getting wrote language that is hard to undo. So even still, we've got lots of issues. So now we have waiting lists, you know, for a diagnosis, waiting lists for treatment. We've got waiting lists for ABA providers. We've got ABA providers who are doing what they've been taught to do, but it's, it's not as child friendly. And so my approach is taking all the science, but making it very child and parent friendly to empower the parents that it's not all, it's not about getting a two-year-old in 40 hours of an ABA center. It's about recognizing

the signs, empowering parents to repair any kind of social dyad situation where, you know, that's, that's really the first place it starts, is a typically developing infant will, will, will, babble back, will smile, will, you know, kind of really start attending and having that, what we call joint attention. You know, they might be looking at bubbles and looking back at you. And even though they can't talk yet, babies will indicate that they want more in a playful way. I mean, sometimes through crying and things like that. But kids that have autism kind of lose that. that social reciprocity, the joint attention, all of a sudden they want to look at fixate on objects,

fixate on iPads and iPhones, and are not babbling, are not, so then they are requesting using problem behaviors, like crying and whopping on the ground. So then it's hard to tell, is this terrible twos, or is this something more serious?

Is this a speech delay? Now we add COVID, it on top of the situation, which has blown up the waiting list and have more social isolation, less kids going to daycares and things where you can actually even know what's going on. Right. I mean, a lot of kids, like, is this just social isolation? Is this COVID isolation that's causing these delays or is there more going on? And at 18 months or two, you might not know if it's autism.

I'm just like, let's get the social reciprocity and the babbling and the imitation. Let's work on that every day with the parent as the therapist. Yeah, that's good. This meta-analysis did conclude that there's this tremendous window of opportunity in the early years of development, specifically in the first two years, due to like neuroplasticity, the growing brain. So there seems to be like this urgency. And I think what you're saying now is like it's complicated by like these kids are not socializing like they used to because of COVID.

And so you're having all of these parents noticing their kids are behaving differently. Right. And even separation anxiety is, I mean, and that's bad with typically developing kids. at one, 18 months, you know, two years. But now they haven't even gone out of the house. They haven't gone to the grocery store because of COVID. They haven't been dropped off at daycare. Now daycare drop-offs is everybody's in masks, drop them off at the car.

You can't even see the classroom. It's like that's hard. That's hard for any child, let alone a child with any kind of delay. Oh, yeah. It's really, really complicated. things. But yeah, I think the paper that I have found really helpful is this one by Clint and colleagues is called affording autism and early brain development redefinition. And it has, it's really saying, like, we need to start treating early signs of autism much

more seriously, you know, and we need to, maybe we can't prevent or reverse autism, but we can prevent or reverse speech delays, behavioral disorders, and intellectual disability, which will often co-occur, especially if we don't repair those basic joint attention, language, imitation, behavioral skills early. Yeah, take me through, um, take me through the study, since we have a bunch of clinicians who listen to this, just to kind of make that sort of the higher level argument for why this is important. Yeah. This, I actually saw Dr. Clint present every year at Penn State, well now it's been virtually the last couple of years, they do the National Autism Conference and Dr. Clint and other researchers present there. And I saw

Dr. Clinton in 2019 for the first time. And he was talking all about, he works at Emory and he has a patent pending on this new diagnostic machine where you put a baby in a car seat type contraption and they actually watch videos. And so they're tracking their eyes to see what they're paying attention to. So part of his research has been two toddlers in a toy wagon and a plastic wagon. and they're fighting over the plastic door being open and closed. Like the one wants it open, the one wants it closed. And so they're going back and forth. And it's a video.

And so the eye tracking studies, and he's done eye tracking studies on, you know, twins, twins with autism, one without, one with, siblings, little kids that turn out to be typically developing. I forget the exact age, but they're small. They're like strapped into a car seat kind of. into contraption when they do this. And they're just watching the videos. And so a typically developing baby will be looking for toddler,

we'll be looking at the eye contact and the faces of the toddlers mostly. They'll be looking at the interaction. Meanwhile, a child who is going to go on to develop autism and get a diagnosis, we'll be looking specifically at that door just being open and closed, open and close, open and closed. And so if that is five minutes, If you think about like kids that want to watch the same thing over and over again, if they are just focusing on the same thing over and over again,

that's their brain is not being developed, right? Right. So that's a lot of his research. Like I said, he and a colleague have this patent pending on this machine to basically catch autism early. But in my opinion, I mean, that's great and he is brilliant. But it's not even about the diagnosis because the exact same things work for kids with speech delays, for kids who are going to maybe go on to get a diagnosis of ADHD or dyslexia like your daughter. Or, you know, if there are any delays with talking, with imitation, with pointing.

Pointing is a huge red flag that typically developing kids will point. five, nine months, 15 months, definitely by 18 months, a child should be pointing with their index finger, not only to indicate they want something, but to show you something that they enjoyed, like pointing in the air to see an airplane. However, pointing is just one of the red flags. Like I had, I interviewed a speech therapist who said her child was pointing. So the pediatrician or developmental pediatricist said, you know, said, no. it's not autism because he's pointing. Like, it's one sign. You could have somebody with a motor

condition that can't point. So like, you know, you have to use your judgment. But pointing is a big thing I look for to decide. And I can't diagnose autism. I don't have that credentialing. But I have screening tools. I was certified in the stat, which is a screening tool for autism and toddlers created by Dr. Wendy Stone at Vanderbilt. I also was trained in the A-DOS, the Autism Diagnostic Observation Schedule. There's also a free M-Chat, which I talk about in my Turn Autism Around Book. There's a free M-chat available online, which is just 23 questions. That is usually used at pediatrician's office at the 18 and or 24-month visit. Let's go through some of these top 10 signs that parents should be aware of when they observe their child falling.

behind of the first years of life. Number one was pointing. So you've talked about that. You've talked about how, like, normally kids point to kind of show or share pleasure, show, you know, concern. This is in chapter two of my new book, signs to watch for pointing. The second one is speech and language delays. The definition of from the DSM-5, which has been used, I believe, since 2013,

we switched from the DSM 4 to the 5. And now with the DSM 5, it's social communication deficits. Before, it used to be, you know, language deficits, and then another category of social deficits and restricted interests. But speech and language delays almost always happen early on. But if you don't catch those,

some people think, well, it's not really a delay. but they are talking like a little adult. They're not socializing with kids. But language delays are a huge one. How do you differentiate like a non-autistic language delay and an autistic delay? Yeah, it's hard, especially with COVID adding to the mix and the lack of socialization. But, you know, some of the ways are if they don't have the other signs, like if they're good with There's also language delays. Is it expressive language delays like talking or is it receptive language delays, which is like understanding like going to the banana, which one is, you know, I remember early on we had, I think Spencer was six months and Lucas was two and we had a photographer come to our house to take pictures and it was, you know, the old film canister and the guy. And I mean, the pictures went okay. Sometimes kids freak out with pictures.

and, you know, it was an okay thing, but I was a little on edge to get a two-year-old and a six-month-old dressed and ready for pictures and everything. But the guy just handed him an empty film canister and said to Lucas, throw this in the trash. And I remember Lucas just standing there, like, what are you talking about?

Like, Lucas had no idea what he was talking about. Like, he didn't understand, Lucas didn't understand that I was having a new baby, that he had a big brother, or that he was a big brother. Like at 18 months, there should be some awareness. Like literally we could have brought home a plastic doll for as much as Lucas cared or had any idea.

So Lucas had a mixed, expressive, and receptive language problem. He also couldn't imitate. Imitation is big, and that's one of the things on the list here. So if you have a speech delay child who can imitate, plays okay, doesn't have a whole lot of tantrums and has pretty decent receptive abilities, that's more likely to maybe be not autism. Let me, okay, so we have pointing speech, language delays. The third one is excessive tantrums.

Yeah. The excessive tantrums are like beyond what's normal. I guess like how would you define what is normal, what's not normal here? And it depends on the child's personality, you know, if they're, if they're a highly sensitive child, if they're overly stubborn. Lucas actually didn't have excessive tantrums. He was mild mannered since birth. If you told him, you know, time to get your shoes, we're going, you know, I remember somebody asking me like, how does he do with transitions? I'm like, he's great. He always wants to go to the next place. They're like, what if he's doing something

he really likes? I'm like, he thinks the next place might be better. Like, you never, you know what I mean? but my other son, Spencer, we would have had our hands full if he would have had autism because he was much more persistent and highly sensitive, you know, would argue back about transitioning or whatever. So, you know, all of these things don't have to be in place, but these are some of the red flags. So excessive tantrums happens in a lot of kids that can't communicate well, at some mild matter kids. And you're highlighting also the tantrums sometimes. occur around transitions, changes in schedules, stuff like that. Not getting their way.

And it also can be, you know, as a parent, you're reinforcing tantrums unknowingly. And, you know, maybe, you know, some of my clients, they had older kids and they're like, the stuff I was using for my older kids, the parenting techniques don't work now. How do people commonly reinforce their own kid's tantrums? Well, you think of the classic example of like the kid wants candy at the grocery aisle and they're whining or crying and even whining and crying and the parents might be like saying, no, well, I'll give you something at home and, you know, I got you something last time. And then if the crying pipes up, okay, all right, just I'll get the candy.

100%. We don't just have problems at the grocery store aisle. Now we have problems when you get home and they want the iPad. Now they just learned that they cry and they get. Yep. And so it's just, and I didn't know any of this when my kids were little. So it just happens. But we do have easy techniques to put structure in place.

All of these techniques work for typically developing children. perfectly, you know, for speech to lay kids, for kids that might go on to get some other kind of diagnosis and for kids with autism, because these are all just basic scientific procedures. I mean, I have four steps in the turn autism around approach, and it's basically the scientific method. Of course, it's going to work because we're not going to reinforce behaviors or we don't want. Okay, so excessive tantrums. One thing I would add is me and my wife have a rule in our household. If I say no candy or my wife, then we're both supporting each other. So there's no splitting that happens, right? There's no like, well, I'm going to go to the weaker parent because

they always give me the candy. And then if you reward them, like, it's something like one out of eight times if they get their way. It actually reinforces it. So yeah, go ahead. Intermittent reinforcement is the most powerful form of reinforcement. That is not every time. and you think of slot machines, you know, it's not every time you don't know when it's coming. So intermittent reinforcement is actually reinforcement system that strengthens behavior the most. And the key to fixing problem behaviors, no matter what age or ability level diagnosis, is to prevent problem behaviors by putting structure in place, by putting expectations in place, and by teaching children to,

request things and to accept no. Yep. And learning how to alluse with grace and accept a no is so important as they venture out into the real world, right? Yeah. Yeah. Okay. So let's talk about number four, not responding to his or her name. How do we know if that's a hearing issue or if that's autism? You know, what are your thoughts on that? Yeah, that is a common sign that can happen. and we thought maybe Lucas was hard of hearing or deaf. We had his hearing ruled out, his hearing, you know, he could hear. But we did also think that he could probably hear because even though he wouldn't respond to his name,

like Lucas, Lucas, Lucas, he would hear like a theme song from Barney or the Pennsylvania lottery song and he'd run in. So, you know, one of the things that if kids don't respond to their name, think about your own behavior, are you overusing the child's name? So, especially when placing a demand. Like, it's our natural tendency, I think, as parents to be like, Lucas, no, no, stop, you know, or Lucas, touch your nose when we started ABA therapy and the therapist was like, okay, can everybody stop using his name? Because that's just pairing his name with a demand. Okay. So to get children to respond to their name, wait and have something good like bubbles, call their name and blow bubbles if they like that,

or only use their name when you're doing something fun. Interesting. Okay. Let's say number five is playing behaviors. So, like, what are you noticing about how they play with other children, how they play with themselves? Yeah. And this can really vary because we're talking, I think the M-Chat is valid for 16 months

to 30 months. And if you think about a 16-month playing versus a 30-month-old playing, those are different kind of skills, right? But as the children age, they should be getting more language within their play, sharing better, you know, eventually. But early on, and then the M-chat, I think it's like some of the yes, no answers are like, well, your child, like, how does he react great to, you know, playing little, sing-songy games like Paddy Cake, Paddy Cake, or bouncing on your knee and singing a song, like kids with early signs of autism might not like that. Are you noticing how they play with other kids?

And then, like, what is, like, is there less sort of reciprocal play early on? Yes. And I forget the exact age when, you know, kids usually transition from parallel play to more interactive, play, but kids with autism don't tend to transition to interactive play. They'll stay with parallel play. The other thing is watch their play. Are they playing with the same blocks over and over again? Are they, you know, one child I worked with like to put straws in a bottle, but he'd do that for like an hour or two. And you think about that example with Ami Klin with the with the wagging going open and closed, you know, like putting straws in a bottle, what's that doing?

doing for your brain in terms of expanding. So watching their play too, even if they can independently or parallel play, if they're doing the same thing over and over again, not using a variety of toys, that is a red flag. Okay. How about repetitive behaviors? I just guess we were just kind of talking about that. Number six is repetitive behaviors. Are there other repetitive behaviors that sort of pop into your mind that you commonly hear about? Lining up toys is a big one. repetitive could be just rocking. That's like a low level self-stimulatory behavior, rocking.

I had a client who would rock and bang his head on hard and soft surfaces to the point where he was two. And he had an open lesion on his head when I started with. And when I asked the babysitter, like, how much is he banging? When's he banging? And it was at the nine hours a day that he was at the, the babysitters, he was banging about three hours a day.

So we were able to like put in place procedures like the high, high chair, you know, okay, no more high chair like the back. You know what I mean? Like yeah, yeah, yeah. Not letting bang in a pack and play. Thinking outside of the box there, yeah. Before nap, after nap, like those sorts of things. So but repetitive behaviors can be lining up,

saying the same thing over and over again can also be a repetitive language scripting behavior. Wow. Yeah, we, I have this little like, it's like a deer camera. So it takes pictures of deer as they walk by. And so I set this out whenever we have a new babysitter to just kind of see how they interact with our kids. And like the babysitters that we don't invite back are on their phone sitting on the chair,

doing whatever they're doing. And the babysitters that we invite back are the ones that, like, interact and play and are on their level and there's, like, reciprocity. So just a little clinical pearl to throw out to my audience as well there. Okay, so repetitive behaviors, playing behaviors. Number seven is sameness. So tell me about sameness. Yeah, they want to, some kids, and Lucas was in this, he wants to go the same way in the mall. he wants to look at the same things, you know, when he was little.

Some kids really want to go the same direction on walks the same way in the car, where are the same things over and over again, have the same bowl for certain foods, have the same cup. And then if you don't provide that, then... Tantrums. Yep. And there are some typical kids that, you know, they like routine. and, you know, we all like routine.

I usually go to the same, park the same spot at the mall and go kind of the same way. You know what I mean? But kids on the spectrum might be more temperamental about stages and routine. Yeah, I have an adult patient. And if it's like if the mom will write out what's happening for the week on a calendar and if something happens and there's, you know, going to, swimming three times a week. He's an amazing swimmer. If there's something that like it's canceled, it's just like, it's a huge deal, right? And before we got him to a more functional place with,

you know, therapy and medications, he would, he would attack, right? And he would like get physically, physically assault his poor mother. So, yeah, it's, um, that's, um, that's, sameness and the sort of the, it's like the intensity around it, right, is what we're looking at. And if you think about all the changes that suddenly happened with COVID, it just really crushed a lot of families who, you know, the kids don't understand. I mean, the adults don't, we don't understand what's happening. We don't have a date for reopening. We don't have any information. and has a lot of issues with families. Yeah, we could spend some time lamenting that.

Okay, number eight, sensory issues. Tell me, what are the kind of sensory issues that you're noticing? Yeah, like hypersensitive or hyposensitive, covering the ears. My son wears a lot of headphones. A lot of times it's too. overwhelming autistic adults who are, you know, conversational will tell you that lights in the grocery store and sounds and smells and touch, you know, certain food textures the way things feel and, you know, tags in clothing. Again, this is a spectrum of sensory, you know,

sensitivities. I think, you know, my husband and my typically developing son are more sensitive to sights and smells than Lucas. You know what I mean? So it's not a definite, but Lucas has major sensitivity to noise that is unusual. So those are, that sign is there in some kids. And it's confusing because they might like want to crash into walls or jump on the trampoline excessively, but then at the same time, tags bother them and they, and noise bothers them. So it could be some of both. Yep. Yep.

I have some couples where one partner is possibly on the spectrum, right? And so the intensity around certain smells, how the lights are set up, how, you know, certain types of food, the intensity of the affect around those things is it's not understandable to their partner. And so sometimes it's like educating on the, like, for you, it might not be completely overwhelming, but it's like, how can we put our mind inside this person, right? And I'm thinking about kids, the parents may give the message over and over again, like, don't feel that way or don't respond that way. And it's like, well, but your kid is like, they're literally, their sensorium is totally off. They're overwhelmed by this.

So how can we have more compassion for our kids? as well, I would say, in the midst of that. And I think that probably will lead into the way that you treat and recommend treatment. Okay, let's get through this up. Number eight is sensory issues. Okay, that's what we just covered. Number nine is motor delays and toe walking. Yeah, and this doesn't happen all the time.

And back when Lucas was diagnosed, it wasn't really known that kids had motor delays, like were late walkers on average. Lucas did walk at 14 months, which isn't technically late, but it is kind of late. And toe walking happens, you know, for some kids. So, you know, some kids that I've gone and worked in early intervention, they have, you know, physical therapists with them and occupational therapists that see them and speech therapists and early intervention teachers. And a lot of times it's everybody, but the motor delays and toe walking early on. tends to, you know, sometimes trigger a PT or OT evaluation, which I always am a fan of. Yeah.

Yeah. Okay. And number 10 is imitation. So how does imitation show up? Yeah. So imitation is usually delayed with kids that are on the spectrum because of that reciprocal stuff. And then after, you know, you get the eye contact and the babbling back and forth and the smiles back and forth. Then you start playing things like peekaboo or blowing kisses or waving high. And without

direct instruction, kids on the spectrum tend to not pick those things up naturally. Okay. So I kind of want to get into your approach now and how you turn things around. And maybe contrast it or, you know, like we know what the, we know this idea of applied behavioral approach. Like, where do you differentiate, so maybe educate us both on what is applied behavioral approach, and then how does your approach different, how is it differentiated from that? Yeah. So applied behavior analysis is the science of changing behavior. It was not created for kids with autism. It is a science, and it was created in the mid to later 1990s. And, well, I guess it started more in the 30s, of the 50s, you know, it's been evolving. So apply behavior analysis is based on all the behavior,

experimental behavior of animals, you know, rats through mazes and, and pigeons pecking and training pigeons to fly overseas or training dolphins. And a lot of people are like, well, I don't want my child treated like an animal. That's what ABA is. Well, ABA is based on that science. and it's a science of changing behavior. And so if you, it's kind of like saying, if you say, well, I don't believe in ABA. I don't like ABA. It's kind of like, to me, if you reinforce a behavior, it's going to go up. If you are maintained or go up.

If you don't, it's likely to go down. Now, there's also medical issues and all kinds of things that are also operating. So ABA is the science of changing behavior. but ABA is also coined in terms of treatment packages for kids with autism. And we use all the science to increase good behaviors we want, like pro-social behaviors like talking and math and imitation and all kinds of skills. And then we also use the science to reduce any problem behaviors or things that are challenging or getting in the way.

Now, again, I. I wrote my first book to incorporate the BF Skinner's verbal behavior analysis in with that. Because if children are motivated to participate in therapy, to learn, to run to the table, to want to imitate, to want to sing the songs, to want to pull their pants up and down for potty training, if they want to do things, we're going to have a much better chance of getting it as quickly as possible without. a lot of effort. So we incorporate pairing and manding, making it child-friendly and family-focused. So there are four steps to the turn autism around approach, and they are basically the scientific method. Assess, plan, teach, and evaluate using easy data. So I've taken all of that where, you know, 40 hours a week, you need a professional that totally knows what they're doing, step by step, when to bring in object imitation, when to do this, and broke it down very simply where it's a one-page

assessment. Okay. So I like that. So you're bringing it. So you're trying to make this simplistic enough so that parents can do it with their kids. They don't need that sort of that pro with that Ph.D. That, you know, and do you think it's possible for the parent to learn this stuff? I know it's possible because I,

I've been doing online courses where parents have been learning since 2015. Okay. So teach us some like just pearls. I know there's going to be a lot that like you're not going to be able to teach us today. But like give me a couple pearls that maybe someone can take away. They can apply it immediately. Okay, nonverbal children. You said repeat things three times.

That's one of the things you mentioned. The one word times three strategy. So we want to do that throughout the day, but we only want to do it if the child wants something. So say they want a banana and you're in the kitchen. So instead of just, okay, you know, they're kind of reaching for a banana or you know they want a banana. Instead of just handing them a banana, you could cut it up. You could, you know, just say the word three times if you're going to give them a whole banana. Banana, hold it to your face the first time.

Banana, get at their level. Banana, banana. that as you move the item towards that. If they want to go outside on the swing, stand by the door, get at their level, again, open, open, open. So I'm blowing it down. I'm slightly exaggerating,

making it fun and pleasant, you know? And then if they say open or say, oh, the first time, I'm going to open the door. I'm not going to say it three times. If they say, no, nah, I'm going to give them a banana right away. We want to shape up any approximations. We also do that at table time where we get a shoebox with a cut a slit into it and get pictures of grandma, mommy, spot the dog, iPad, juice, whatever the reinforcers are and people,

we get pictures of them. So we can get a shoebox, have the child sit. mommy, mommy, mommy, okay, they get to put the picture in the shoebox. You might need to help them a little bit. We're just blowing things down. If you think about like learning a foreign language, like if I went to a country and I know, no language, if somebody said, oohie, owie, ubi, as they were handing me a drink, and they were saying, do you want to drink or here's a drink or here's a cold drink.

I wouldn't know what out of that sentence was meant drink, right? But if they held it up and just said, Ubi, Ubi, Ubi, Ubi, as they handed it to me, I'm like, hey, I'm going to need water again. Ubi must mean this. I'm going to tuck that in my head. So the one word times three strategy can be used throughout the day, going up the steps, instead of saying, Johnny, let's go up the steps.

Time to take a bath. Up. Up. And a lot of people can get language just going like that. Yeah, that's good. What do you think about like one approach I've heard is you have like two objects, right? Like a banana or an apple. You say banana, apple, banana, apple, you're moving the one that you're talking about.

And then normally they'll point, right, to which one they want. but instead you give it to them when they like try to mouth it or say it close. Is that kind of, would that be another sort of step in that? Yeah, you can offer choices. And, you know, with kids with autism, they might not point whether they might just reach or maybe just have eye contact. So if you are going to offer choices and they are visual where you have them, I would say separate them out. farther so you can kind of see their general body direction. Okay.

Contact. You know, that's a mistake I see sometimes is people will offer, you know, kind of snacks all together and then you don't really know what their intention is, so you can't really pair the word. Got it. Okay. Yeah, I like that. Let me give you another good technique that is kind of, you know, I think your listeners

might remember this is the shush and give procedure. So if the child can have something, but you don't want to give it to them when they're screaming, right, or crying or whining. So say they're reaching for bubbles, but they're like, Bubbles, you know, bubble. You can just get some time, even if it's only three seconds, shush them. You can't have anything when you're screaming. But we don't want to use all that language because remember my foreign language example. Like if you were in a foreign language, just sh, hold it down, the shush. And then as soon as there's quiet for three seconds, bubbles, bubbles, we're going to do bubbles and start blowing.

Okay. So the one word times three strategy and the shush and give procedure are two really easy things that you can use for any child, you know, or even adult, but obviously, you know, even these are just basic, basic principles that will, I think, help you increase language and decrease problem behaviors right away. One of the other interventions you talk about to ease transitions is to offer choices. Can you talk about that a little bit? Yeah, I saw a presenter once who said, you know, choices really are what make us happen. And if we think about all the choices that we made already today, you know, we chose what to wear

and and all, you know, what time to show up, whether to have breakfast or not, you know, we have made a lot of choices. And so for kids with autism, they are not given enough choices. And sometimes they have difficulty making choices. So providing the actual items with choices, providing visuals of two choices. And for kids, like Lucas is 25 now, and he can make choices. He can talk. He's not conversational.

But for him, he can't really say, like, I like this job better than that job. I'm bored with this. This is too much. I'm overwhelmed. You know, when he volunteers at, say, the food bank. So we have a data sheet that we created that counts, it keeps track of his affect.

As affect is basically how happy is. Is it low, medium, or high? Also, we keep track of his speed. Is it slow, medium, or fast? And we keep track of the number of prompts and any agitation signs. So there are ways to monitor, you know, keeping track of smiles and laughs.

We want to first, you know, have our kids be happy, not just when they're older, but every step of the way. My three goals are as safe as possible, as independent as possible, and as happy as possible. So if your child can't make choices, well, help them, provide more visuals, measure affect, and look for those smiles and laughs. I think that's always a good approach. Very cool. Kaden, do you have any questions that you want to get out before? we kind of wrap things up.

Yeah, I wanted to talk to you or ask you rather about Lucas and the diagnostic. I was wondering mostly about, you know, he was diagnosed under DSM 3 or 4. I'm not sure which one you mentioned. And now with the DSM 5, there were a lot of changes there for the autism spectrum disorder and levels of severity. And I was kind of wondering, you know, is that helpful for the clients in your experience? kind of what do you think about that? Yeah.

So I believe the DSM-4 was valid until 2013. Is that correct? And then it moved on to the DSM-5. So back in the past when Lucas was diagnosed, there were under the autism spectrum umbrella, there was PDD-NOS, Asperger's syndrome, classic autism, childhood disintegrated disorder, and RET syndrome.

Now they found a genetic cause for RETs and childhood disorder came out. But when they moved to the SM5, Asperger's went away and PDDNOS went away. So it is a big deal because now it's level one, level two, and level three autism and level three being severe and level one being mild. I think for Lucas, he was diagnosed initially with PDD NOS. but then with the developmental pediatrician, he was diagnosed with moderate severe autism.

Even though he looked pretty good at the age of two, I mean, he went to typical preschool by himself at two. He didn't have a lot of tantrums. He was more to look like a quiet kid. But he did, like, not imitate, not have receptive language. And, you know, he was really pretty impaired when he was diagnosed. So he got diagnosed moderate severe. I think way back if the DSM-5 would be in place,

it would be level three. Then and now, he also now, Lucas is 25. He has intellectual disability on top of it. He's language disorder. And then he has this autonomic nervous system dysfunction. And he has pediatric autoimmune issues. So he's got some medical stuff, severe, like chronic allergy, he said he gets allergy shots for.

So it gets more complicated. but I do think that there has been some issues with the DSM-5 in terms of adult autistics who either haven't been diagnosed, diagnosed late, just think they're on the spectrum, or have been diagnosed early and gotten treatment. They tend to be like autism is a gift, the media, the way the media portrays autism with like the good doctor and atypical. These aren't kids like Lucas who are severely impaired who need lifelong care.

So I do think that there have been issues, you know, with just three levels, with the media and funding and everything, listening to higher language level abilities, much more so than the parents. And I do think that because the increase in autism from what, and 500 to 1 in 54, you know, kids are reaching adulthood. There is a crisis in terms of funding in terms of providing lifelong supports. It's very costly. So I don't know what the answer is.

I don't know if and when the DSM 6 is coming out anytime soon or what kind of changes should or could be made. Like that is a tough, tough question. Yeah, I did a pretty deep dive on the adult. the adult diagnostic stuff and it definitely seems like it's lacking lacking a little bit in that area so hopefully we can encourage that to move forward.

Very good. If this has been really excellent, I think there's been a lot of really good information. I've learned a lot in looking at this with you and I will, in the show notes, put all the links to your different channels, your website, your YouTube, your podcast. And so if you want to, I'm sure there'll be people that binge on your content that kind of get that big picture, the deep dive.

So we'll do that. And then we'll write up this in a blog so that people, if they want to look back and kind of remember something that was said, it'll be there. Anything else that you'd like to share with our audience as we sort of wrap this up? Just that I really appreciate you having me on the show, turning autism around. just involves helping each child reach his or her fault's potential, being as safe as independent and as happy as possible. We're not trying to change a child's personality. We're just trying to help them improve talking, reduce tantrums, work on, eating, sleeping, potty training, all the things that are going to lead to more independence and happy lives for not just the kids,

but their families and the professionals that work with them too. So thank you so much for having me today. Yeah, excellent. Thank you. All right. Thank you for joining us for this episode. I hope that you appreciated some of the practical discussion on autism. I hope you understand a little bit more about how to diagnose it and some little things you might do if you were parenting a child with autism. I took some time and wrote up with my co-author. Here some details on autism from her book. I'll be linking that in the show notes. So if you want to check out more, you can check that out. And then from there, you can find all of her website and resources.

So check out that if you're curious about more practical tips. Secondly, once again, if you are thinking about coming to the webinar, check out the link in the show notes. Or if you go to the website, psychiatrypodcast.com, you should see on the very top bar a link to that webinar. all right guys have a great day