What Is Neuro-Affirming Care, Anyway?

Brittany: 00:00:00

So when we talk about neuroaffirming care, we're not just talking about being kind or progressive. We're actually talking about ethical practice. Like, this isn't opinion feel good stuff.

This is actually in our codes of contact for both SLP and bcba. Hey everyone, I'm Brittany, speech language pathologist.

Shawna: 00:00:17

And I'm Shauna, behavior analyst.

Brittany: 00:00:19

And we're your hosts at Neurodiversally Speaking.

Shawna: 00:00:21

This is a podcast where we bridge the gap between research and practice, exploring autism and neurodiversity through the lens of speech and behavior.

Brittany: 00:00:28

Whether you're a parent or a professional, we'll give you practical tips to bring bring into your home or your next therapy session.

Shawna: 00:00:34

Let's get started.

Narrator: 00:00:35

Welcome to the Neurodiversity Speaking Podcast with Brittany Clark and Shauna Fleming from lmno, brought to you by the Sensory Supply.

While we aim to make neurodiversity speaking suitable for all audiences, mature subject matter can sometimes be discussed suitable only for those over the age of 18.

If you're under the age of 18, please talk to your parent or guardian before listening to our show or listen together with him to stay up to date date on new episode releases and show updates. Connect with us on Instagram @NeurodiversitySpeaking.

You can also send us listener questions to address on the show at helloeurodiversityspeaking.com neurodiversely speaking starts now.

Brittany: 00:01:23

Hey everyone and thanks so much for joining us. We're at episode four of the Neurodiversity Speaking podcast. It's Brittani here and Shauna, so glad that you're here with us.

Thank you so much for listening and being on this journey with us today. We're really excited to talk about what is Neuro Affirming care.

Anyway, but before we launch into the topic, we wanted to just share with you our new podcast tradition that we started today.

Shawna: 00:01:49

The first weekly elemental run. I'm calling it Brittany and I ran 700 meters.

Brittany: 00:02:00

I've read a lot in my past and enjoy that much before children, but truthfully, it's hard to find time to run and jog and do those things while doing everything else that we do. How about you?

Shawna: 00:02:09

Yes, I've never been a runner and I should say Brittany could have run for much longer than me. I ran for 700 meters proudly, which is a Turns out only four minutes long. That's okay. Torture it felt like, but we did it.

It was nice to get out moving our bodies and in the nice weather.

Brittany: 00:02:27

So anyone who knows me as a speech pathologist, anytime there's a major shift in the seasons. Well, I would say we're very fortunate.

We have four seasons here where Shawn and I are in Ontario, Canada, and we've recently had this shift in seasons. And so, again, it doesn't matter whether it's spring or fall or winter. The vocabulary really changes, and I absolutely love that.

I think it's this cool exposure that we can give to our kids to teach them new words that maybe didn't exist a month or two ago. So think of things like tulips or buds on the trees if it's springtime, or if it's winter, maybe sled or boots.

And so even just a simple walk outside for five minutes, you can really expose your kids in a natural way, in a negating, changing way to all this new vocabulary. Yeah, so true.

Shawna: 00:03:11

So true.

Brittany: 00:03:12

Anyways, all right, so welcome again to neurodiversely speaking. Here we're talking about communication, connection, and care that actually respects neurodivergent individuals.

So we're, like I said, we're really excited today.

We're going to dive into what it really means to offer neuroaffirming care, because, let's face it, there's a lot of noise out there about what autistic people can and cannot do.

Shawna: 00:03:36

There really is a lot going on in our world talking about that. Right. And we had recently a certain someone.

Brittany: 00:03:45

Who shall remain unnamed because hopefully the podcast will outlive this news story.

Shawna: 00:03:50

But yes, and he was really perpetuating this rhetoric that's not just wrong, but also harmful and hurtful. And hurtful, yeah. If. Certainly. And we saw that response from society. Right. Like, this is hurtful to us.

And so he was saying things like, autistic individuals may never write poetry or use a bathroom unassisted, and it, like, diminish the lives of neurodivergent individuals. And then truthfully, those next steps are also a little bit scary for us as a society as well, that he was proposing.

Brittany: 00:04:27

Right. And I just. What I really loved from that is the backlash and the parents sharing, my child is not a tragedy and my life is not a tragedy.

And actually, like, makes me very emotional. Emotional thinking about that.

And all of these families sharing on their Instagram or sharing to neighbors or wherever, saying, I love my child with autism more than anything, and you'll never take that away from me, no matter what hurtful words you say.

Shawna: 00:04:52

Exactly. And like, some autistic individuals might not write poetry, and some neurotypical individuals might not Write poetry either. Right.

And so why were we trying to define people based on certain abilities or skills? Really? You know, it just was like, not the right way to approach this at all.

Brittany: 00:05:10

Exactly. And so we're not here for that. We're here for.

For real conversations about supporting neurodivergent individuals in ways that honor who they really are. So not what so and so or what anyone else thinks they should be.

So let's talk about where the system still falls short, how neuro affirming practice is really changing the game and what we can all do better. Me, you, us as a clinic, and then us as a society. Everyone again, whether you're a parent, a clinician, or just a curious human.

I think we can all do better in this topic.

Shawna: 00:05:41

Yes, exactly. And so today's episode is all about neuro affirming care. It's so much more than just a buzzword.

It's a really timely conversation considering some of the criticisms of aba, some of the evolutions that are occurring in both of our fields.

Brittany: 00:05:57

Yeah.

Shawna: 00:05:58

And listening to those voices who are helping us change the narrative here. So, really excited to dive in. So what is neuro affirming care?

Brittany: 00:06:07

Yeah, I know we briefly touched on this on our, on one of our previous episodes, but today we're going to define it.

And neurodiversity is the idea that brain differences like autism or ADHD and other things are natural variations in the human brain, not deficits that need to be cured or normalized or fixed.

So whether someone is speaking or non speaking, highly verbal or profoundly impacted, neuroaffirming care prioritizes their rights to communication, their rights for dignity and for agency.

Shawna: 00:06:37

Exactly. And so instead of trying to make people appear neurotypical or normal, our neuroaffirming approach focuses on helping that individual to thrive.

And so we're taking in their unique aspects of themselves. And how can we help that shine and help you live your most joyful life? So we want to use those supports that are respectful, functional, meaningful.

Those words that we always use at the clinic.

Brittany: 00:06:59

Yeah, exactly.

And I, I sort of think back to, you know, we had a discussion in our family too, about like treating others, that sort of golden rule like that, treating others the way that you want to be treated. And I think this circles back to that too. Like, none of us want to be looked at. Like, I have a, I am a problem.

And that's sort of the dialogue that was shared by this person this week in the news. And that's what we're trying to talk about. And what we're trying to fix, like treat someone whether they're neurodivergent or not, with respect.

And that's what we're talking about here.

Shawna: 00:07:29

Exactly. And that's where it's like, I.

I think important that we do take a step back and look at the history, sort of why the neurodiversity movement even needed to start.

Brittany: 00:07:38

Right.

Shawna: 00:07:38

I think it gives us a really good understanding of why neuroaffirming care is so important.

d so if we look back into the: 1990

Brittany: 00:08:03

Cool.

Shawna: 00:08:05

And so it grew out of this broader disability rights movement that existed at the time, championed mostly by people with physical disabilities, rejecting the idea that disabled people need to be fixed or hidden away from society. And so these autistic self advocates were quite vocal to make this a movement that was heard by society.

And so one of their things was nothing about us without us. And I think that's such an empowering statement. So I'll just. Nothing about us without us.

And so what they mean by that is that they want to seat at the table when we're talking about policies for autistic individuals, when you're doing research or therapy or education, and so pushing back around this idea of decisions being made about them instead of with them. And so I love that. Nothing about us without us.

And so looking at this, reframing conditions like autism, ADHD as neurological differences rather than disorders in need of correction.

And then really, it's not that they're rejecting this idea of therapy or support, it's that the therapy or support should respect their identity and who they are as a person. So keeping in mind their autonomy and dignity.

Brittany: 00:09:23

So when we talk about neuro affirming care, we're not just talking about being kind or progressive. We're actually talking about ethical practice. Like, this isn't opinion feel good stuff.

This is actually in our codes of contact for both SLP and bcba.

Shawna: 00:09:36

Exactly. So for behavior analysts, the BACB mode spells it out. We got to be culturally responsive. Culturally responsive.

We got to prioritize our client values and adjust our practices when the environment isn't supportive of those things. And that includes recognizing neurodivergence as part of the human diversity.

Brittany: 00:09:54

Yeah, exactly. Same goes for us in the SLP world. Castle PO which is the Ontario based organization.

So our Cath Castle PO Code of ethics highlights respect for dignity, autonomy and values of our clients. And we're extremely expected as SLPs to provide services that are person centered and responsive to their individual needs.

Not a one size fits all model.

Shawna: 00:10:17

Exactly.

And I think that's probably one of my favorite things about being a clinician really is being able to take that whole picture of you of a problem or area of need and developing that truly individualized plan.

Brittany: 00:10:29

Yeah.

Shawna: 00:10:30

So let's look at a little bit more the ethics code. A little bit dry, but worth a reminder. And so in behavior analysis, our code 1.07. So we need to be culturally responsive and to continue learning.

And I know you guys have something similar, right?

Brittany: 00:10:45

Yeah. We have to respect our clients dignity and understand their cultural and personal values in everything that we do.

Shawna: 00:10:51

And so neuro affirming care, of course helps us do that really well and keeping that in mind. So by seeing that neurodivergent communication styles our sensory needs, the behaviors are valid and meaningful, not something to fix.

Brittany: 00:11:04

Yeah, exactly.

So if we see someone who's flapping their hands when they're excited or rocking back and forth or uses an AAC device to tell us what they want, we're not not stopping that. We get curious and not corrective.

Shawna: 00:11:16

Exactly, exactly. And so in a similar lane, we're looking at centering the client's values and goals.

And for behavior analysts, looking at code 2.09 where we select goals based on the client's needs and preferences, not just what's convenient for us or what we think normal looks like.

Brittany: 00:11:36

And in as part of Castle poll regulations, very similar to ASHA regulations, if any American listeners on here were expected to deliver client centered care, which means goals that actually matter to the person receiving the support and that means involving them right from the start and their families and having a conversation about it, not just us imposing our impressions based on what we think they need.

Shawna: 00:11:58

Exactly.

And throughout the rest of the podcast, we'll drop some tips and tricks around how we do that in practice with a learner as young as what, like a year old or even younger probably. You're able to inform a scent based practice from the beginning. And so we'll drop some tips throughout here.

And so neurofirming care means that we're not just teaching eye contact or sit still behavior because someone thinks that's what good should look like. You know, we're asking what matters to you and how do you want to communicate or connect with others?

Brittany: 00:12:30

Yeah, and if someone can't tell us with words or with spoken communication, we collaborate with their family and care team. We're always looking for ways to bring the person into that conversation.

Shawna: 00:12:40

Right, exactly. And so we're not abandoning our ethics. We're actually leaning into them. And that's not just ethical, it's powerful.

It's how we build trust, connection, and real change with our clients. Okay, so if we take a step back again, go way, way, way back.

Because to understand where we are today, I think it's, again, like, really prudent to take a look back at the history of how things have gone. And so if we look at disabilities and how they have historically been treated in society and the history is not great.

Brittany: 00:13:11

Yes, exactly. And now we're not just talking about behavior therapy or speech therapy.

We're talking about the world we all grew up in and our parents and our grandparents.

And so for most of the 20th century, disability, especially if it was visible, developmental or an intellectual disability, was seen as something to be hidden or managed or even institutionalized. And that goes for mental health, too, Right?

Shawna: 00:13:34

Exactly. And picture some horrible images that I came across in my undergrad and graduate studies. Right. When I was learning the history of behavior analysis.

so looking back in the early: 1900

And so these people were sort of hidden away from society.

Brittany: 00:14:09

Right. And then for many families, especially in the 50s and 60s, there really wasn't support available.

So parents of children with a disability were told, you know, sort of very sad and no hope sort of messages, like, your kids are never going to lead a meaningful life. They were told like, yeah, like, put them in a home and just move on. And so how heartbreaking is that? But also dehumanizing.

And then if that was the norm, as a parent, you're sort of thinking you're caught between, like, this is the advice. Maybe they know best.

Shawna: 00:14:40

Right. And what other option do I have? Either. Right.

And I was on social media last night reading some discussion around this topic and looking at this woman had commented, oftentimes you'll see in the comment section people saying, like, autism didn't exist 40 years ago. It didn't exist when I was in school. The rates weren't this high.

When I was in school and I saw a couple comments where it's like, because my brother wasn't in school, my parents hid him at home, you know, and so my brother has always existed and he actually was a part of the world, you know, and the world didn't see him.

And so I think things like that are, like, really insightful about when we're talking about rates of autism and where things are today, the importance of continuing to advocate for neuroaffirming care and this idea of neurodiversity and neurodivergence.

Brittany: 00:15:32

Absolutely.

And then when I think of our personal experience, like growing up, for me in the 80s and 90s in Ontario, I imagine kind of looking back that there were definitely some kids with autism in our classrooms, weren't labeled as such. And then again, there wasn't that support available or the knowledge or communication. In my mind, I sort of remember the.

There was this label of like, just being bad, like so and so is just acting out or crying or like having a hard time, not because of any other understanding about who they are or what they need. It was just like, oh, so and so is bad and I better stay away from them.

Shawna: 00:16:06

Yeah.

Brittany: 00:16:07

Just like, so now they're not hidden, but they're just bad. And that's. That wasn't. Wasn't really changing things in a forward moving way, you know?

Shawna: 00:16:14

Yeah. Or like, I think of like those kids that always had those messy desks.

Like, those are probably undiagnosed children that need more support without making their desk more organized. Right. And they weren't always losing their homework or their sheets.

They just like, really didn't have the skills to know how to organize things in a way that the teacher expected, you know.

And so when we look at the history, it really wasn't until those disability activists came in, it was again, the physical disability community, I would say, that was like starting the movement. And they were saying, like, wait a minute, like, maybe we're not the problem. Maybe the stairs are the problem. Maybe your attitudes are the problem.

And that really encouraged new discussion.

Brittany: 00:16:55

Yeah. And that's where the social model of disability came in.

So the idea that people aren't disabled by their bodies or minds, they're disabled by barriers in the environment. And I love that. And then we were just talking about visible disability versus an invisible disability. And we're. There's.

There's still so much that we could improve as a society on these. Like, you know, there's more ramps now for a physical disability. But what about communication ramps?

What about supporting someone who knows what they want to say but can't get their words out or has a. Needs a little bit more time or has different needs.

Shawna: 00:17:31

Yeah, exactly.

And we're seeing, like you said, that shift, right, in society, that shift in thinking to away from this medical model of disability into more of a social model where it isn't a deficit. It's. We're looking at it more about the environment being a mismatch to the person's needs.

And I love that as a behavior analyst, we're always kind of considering what are the environmental factors and what are the supports maybe that are missing in the environment to support the individual. And so I love this model.

Brittany: 00:17:59

And when I. Whenever I hear you say that, I know, because I know you, and we've had lengthy discussions that it's so much broader.

But when I hear you say, like, the environment is the problem, that's what I think of things like ramps.

Shawna: 00:18:09

Right.

Brittany: 00:18:09

And I know I just mentioned that, but, like. And so, for example, you can't walk. Well, the problem isn't you. It's the lack of a ramp.

And so those physical disabilities come to mind a little bit more, like, easier in my mind, again, when you're saying, like, the environment is the problem. Oh, well, we need these, like, things like ramps.

But again, coming back to those invisible disabilities, like, if you communicate differently, the problem actually isn't your language. It's the lack of people willing to learn, give you time or learn how you are going to express yourself.

Shawna: 00:18:39

Exactly. And I think a lot of that ties in, again, to the way society functions and the rules that govern society. Right.

If we think about physical, Physical things like ramps, they're mandated. They have to be at buildings. Right. We have parking spots that are closer for people that have mobility concerns. And. But we don't.

When I go to a restaurant or something, it's not like there's communication supports readily available or the staff are trained on how to support someone with complex communication needs. Right. The education just, like, isn't necessarily there.

I think for some of these, like, hidden or invisible disabilities that come with neurodivergent individuals.

Brittany: 00:19:17

Sometimes you're right. Actually reminds me of when we were recently just at the CSUN Technology conference. That's the California State University Northridge.

CSUN is what that stands for. But it was all about accessibility. And you.

And I remember walking around and learning in the exhibition booth about all these different ways that, hey, this is like, accessibility options are really cool and they're out there, but it's still so innovative and not mandated.

And remember, remember, I can remember that one was like, put on these glasses and the way you moved your head could control the light across the room. And we were thinking about how someone with a physical disability, how cool is that if their mobility was limited? But again, it's like those.

This is all still new.

Shawna: 00:20:02

Yeah, exactly.

And even there, we saw a lot of accommodations for physical disabilities, and again, sort of lacking in some of these solutions for, say, a communication delay or something like that.

Brittany: 00:20:16

Yeah, you're right.

Shawna: 00:20:18

And so with this social model, what we see and what we hear from the neurodivergent advocacy is we're not broken.

Brittany: 00:20:27

Right.

Shawna: 00:20:27

We exist in a world that wasn't built for our brains.

Brittany: 00:20:30

Right, Right.

Shawna: 00:20:31

And I think the more that we can consider those things as parents, as educators, as professionals, the more inclusive we can make the world and help these individuals live and thrive. Drive.

Brittany: 00:20:42

Yeah. All right. So at this point, we need to talk about aba. But, you know, I. This is Britney speaking.

I am such a passionate advocate for what ABA can do, and we truly, truly believe that and see the amazing things that happen every day in the clinic. But we have to sometimes unpack some of this negative history, for sure.

Shawna: 00:21:05

And there is a. A long negative history here. So applied behavior analysis.

ABA came out of psychology in the 60s and 70s deeply influenced by that medical model of disability.

Brittany: 00:21:17

Right.

Shawna: 00:21:18

And so in the early literature, certainly Lovas is a common name in the autism world, is sort of the.

Or is often coined as the founder of aba, and autism behavior analysts would like to stop that association because the work that he did, while certainly it did advance the field. Let's unpack some of the sort of negative things that came from the research there. And so it wouldn't. Lovas's case.

He openly talked about making autistic children indistinguishable from their peers, and that that would be what success looked like.

Brittany: 00:21:54

Right.

Shawna: 00:21:55

And again, if we go back to sort of that, the societal shifts and, like, what was going on in society, that's sort of what everyone was saying, right. Is here's an institution for them, here's keep them at home. We don't have any supports in the classroom and that sort of thing.

And so that is where a lot of the psychology research, unfortunately, in the 60s and 70s was rooted.

Brittany: 00:22:17

It makes me think of stuttering, which is also a form of neurodivergence. And that's something that I treat as in a speech pathologist. And again, up until, sadly, fairly recently, again, it was like, fix it not help it.

We're not supporting you.

And then they call it like this iceberg in stuttering that everything is just pushed down below the water, and you end up having all of these negative attitudes and emotions about your speaking. Because that's sort of what you were taught.

Shawna: 00:22:44

Yeah.

Brittany: 00:22:44

To be ashamed. Like, to be ashamed of who you are.

Shawna: 00:22:47

Yeah, yeah. And I. The first time I ever heard about the new stuttering treatment, I was so excited.

And what we do at the clinic, I love the approach that we take, really. Taking the individual's values and what's important to them and supporting them with their stuttering.

Brittany: 00:23:04

Yeah, yeah, exactly. But coming back to ABA that we were just talking about in the 60s and 70s. Sorry for my tangent there.

But looking back to that, some of these early practices were absolutely harmful, and we got to be honest about that.

So things like punishment, reinforcing eye contact, even if it hurt people, doing procedures that were really, like, aversive to someone targeting stimming as a problem to be eliminated. So like we talked about earlier, that hand flapping or rucking, like, for.

We know now that that calms certain individuals, or maybe that's their way of expressing joy, is by hand flapping. But then autistic. Autistic adults were looking at the history and sort of saying, like, we were trained and we were not supported.

And so no wonder there's this, like, bad impression of aba if people were trained that way.

Shawna: 00:23:54

Yeah, exactly.

Brittany: 00:23:55

Or treated that way.

Shawna: 00:23:55

Yeah. And, like, not to excuse it or diminish that feedback. Right. Or that criticism. I think ABA certainly has to own that.

And I think it's an incredible thing that we can use to learn from as well. Right. We learn from history and we do better. And so aba, I think the research was sort of reflecting the values of the time.

And the thing about behavior analysis is it really is studying why we do what we do. And so it's a very powerful tool.

And under the wrong hands or in the wrong hands, we see misuse of that tool where compliance is king and difference is seen as a disorder.

Brittany: 00:24:37

Right.

Shawna: 00:24:37

And that's where I think we do need to unpack a lot of the. And learn from the history and criticisms coming from the neurodivergent and autistic community.

Brittany: 00:24:47

Yeah. We need to recognize this was a systemic issue, not specific to aba. So we're not saying that to excuse it.

We're just saying we need to recognize that it was a part of a bigger picture. So families were desperate. Professionals were trying to help with the tools that they had. And society was asking for normal, not support.

Shawna: 00:25:07

Exactly.

And so like, we don't want to stay in defense, and I don't want to sound defensive of the history of ABA either, or denying it it, but we want to use it as a way to grow and to understand why certain things are not right. Right. And make sure we're aligning those with our ethical duties as well.

And so if we dig into the literature here, because these critiques of ABA aren't just coming from social media, there's real scholarship behind them and researchers looking into this subject in both of our fields. Right. And also from other fields.

And some of it's hard to hear, but like I said, it's like something that we can use to empower ourselves and do better.

Brittany: 00:25:52

You're right.

And so a central theme across research, self advocacy, and even with behavior analysts itself, is that early ABA was deeply problematic, especially when it came to the goal of making autistic people indistinguishable from their peers.

Shawna: 00:26:05

Yeah, that term indistinguishable just makes me shudder.

Brittany: 00:26:08

I know.

Shawna: 00:26:09

, what is it,: 1987

And so the research is quite old at this point. And so the, in those studies they were looking to try and make them indistinguishable. And so that's where this term has sort of carried forward.

And honest, if we're honest, like we still see this sometimes at intake. Right.

Like we're meeting with a family, the parents just gotten a diagnosis and I think is probably scared and unsure what the future looks like for their child. And they know or have a picture of what a neurotypical child's childhood would look like. And so we do see that at intake still.

Brittany: 00:27:04

Yeah, yeah, you're right.

Shawna: 00:27:06

And so that's one thing again that Brittany and I are super passionate about when we're chatting with families, is helping them to see the light and helping them to work through this change from what they thought and how we can help support them through that. And so I think if we're looking at this indistinguishable as a term, it's so problematic in so many ways, not just in research, but in society. Right.

It causes society to have these preconceived ideas of what autism is.

Brittany: 00:27:35

Right. And autism, but other things too, right?

Shawna: 00:27:37

Yeah, exactly, exactly. Beyond autism, we've got ADHD. We're just talking about stuttering approaches, etc.

And then with Lovas, in his case, he also did this study that you might have heard of with the sissy boy experiment. Are you familiar with it?

Brittany: 00:27:52

I remember you mentioned that one time. Tell me more.

Shawna: 00:27:54

Yeah, it's very hard to chat about, but they had this. It was a gender study. And so this boy was doing things that they were referring to as feminine.

And his dad would beat him if he engaged in feminine behavior. And when he did masculine things, he received attention from the mom, I'm pretty sure.

Brittany: 00:28:17

Oh.

Shawna: 00:28:18

And so Lovas and the other guy, whatever his name was, celebrated this success.

Brittany: 00:28:25

Yeah.

Shawna: 00:28:27

Because he stopped doing the feminine behaviors.

Brittany: 00:28:30

Right.

Shawna: 00:28:31

guy said it was a success. In: 2010

Brittany: 00:28:40

Yeah.

Shawna: 00:28:40

Ended up dying by suicide at 39 years old.

Brittany: 00:28:43

Oh my gosh.

Shawna: 00:28:44

And. And so this had already happened and this guy's still saying, hey, I did a really great job. This was successful.

Brittany: 00:28:49

Right.

Shawna: 00:28:49

Even though in the end the boy, like, obviously just like, could never feel comfortable Right. In who he was. And so we see this term sort of all over, like throughout neurodivergence or anything sort of atypical.

I'm putting that in your quotes for those of us that can't see me.

Brittany: 00:29:07

Right. Oh, that just gives me like my whole body reacted to what you just said there in such a bad way. And it makes me think it depends.

Like he was saying, it's successful.

And so looking at what's that success criteria is what's so important too, because what's successful to you as the BCBA or me as the slp, if it's not functional and meaningful, that for that person, and in this case it's like horrifying for that person. And so wasn't successful in. But we need to look at again, it brings us right back around to that person centered care.

If it's not successful or meaningful for them or making an impact in their life, then it's actually not successful.

Shawna: 00:29:43

Right, Exactly, Exactly. And that's true story is just so tragic and such a missed opportunity here of education to the family, education to the individual.

And so yeah, I hate that story. But. And it is again part of our history and I think an important thing that we learn. Right.

Like I said, behavior analysis, understanding why people do what they do is a really powerful tool Right, right. And so by the dad beating him, of course he stopped doing it. That is very punishing.

Brittany: 00:30:11

Yeah.

Shawna: 00:30:12

And so something I. I like to keep in mind is like, we can change almost any behavior, but should we?

Brittany: 00:30:17

Love that.

Shawna: 00:30:17

Sort of. My grounding question to myself.

Brittany: 00:30:19

Exactly. This is such a hard discussion. I actually had to pause us there for a moment because I was reacting to that story that you said.

And so the history is so painful and we just want to say it out loud, that we truly and wholeheartedly believe in our values and that autistic people appearing indistinguishable from their peers is never the same. The goal.

Shawna: 00:30:42

No. And it's dehumanizing to even say it. Right. Like you're then saying that their way of being is less than. And like one is even like, Right.

Normal, you know, especially with children. I have a four year old at home and he does some really off the wall stuff. Exactly.

Brittany: 00:30:58

So what is the.

Shawna: 00:30:59

Yeah, exactly. But as a small anecdote, last week I did tell my older son that he could not touch his brother's bum.

Brittany: 00:31:07

Oh.

Shawna: 00:31:07

And I was like, I didn't know that this would be something I would have to keep saying on a Saturday, you know? And so anyways, think the whole sentiment of it is incorrect because what is normal? What is indistinguishable?

Like, what do those terms even mean other than to say that autistics are less than right or bad? Yes.

Brittany: 00:31:26

And you know, we said this before, like, we truly believe there are no bad kids. We say that to our own kids. And we have that mindset in the clinic too. If someone's having a hard time, they're not just giving us a hard time.

It's because there's something in their environment that their needs aren't getting. Getting met.

Shawna: 00:31:42

Exactly. Always.

Brittany: 00:31:43

Always, always, always. So coming back to that, and we're talking about this very painful history.

Let's also mention, like you mentioned, really aversive things like beating and punishment, but also electric shock was used. Right. There's like a controversy with abai, which is Applied Behavior Analysis International.

Shawna: 00:32:03

Yeah. Recently. Which is crazy. I couldn't believe it. Truthfully, in my time as a behavior analyst, I've never heard of or seen any like, electric sh.

And like, I truthfully thought it died in the 60s when the asylum sort of were on their way out. But the abi, which is like our big. What do you call that? Like a board?

I don't know, a group that you can be a part of, they have a conference every year and so behavior analysts and other professionals can come and talk and share their research.

Brittany: 00:32:33

Right.

Shawna: 00:32:33

controversy just in, I think,: 2021

Literally shocking people as part of their behavior program.

Brittany: 00:32:52

Oh, my God. Yeah.

Shawna: 00:32:53

And this is, like I said, not back in the day, like, this is now.

Brittany: 00:32:56

Wow.

Shawna: 00:32:57

Electric shock has been condemned by the United nations, of course, as torture. Yes, of course. So they use this device called a graduated electronic decelerator.

Brittany: 00:33:07

Okay.

Shawna: 00:33:08

It's obviously hugely controversial.

Brittany: 00:33:10

Yeah.

Shawna: 00:33:12

But despite all that, they've been allowed and actually were sponsors of abai, even though they knew that they were using the. This shock treatment, ABAI allowed them to.

Brittany: 00:33:25

Hold on, hold on. What year is this?

Shawna: 00:33:27

This One was in: 2019

Brittany: 00:33:29

We presented at: 2020

Shawna: 00:33:32

Yes.

Brittany: 00:33:33

Oh, my God, yes.

Shawna: 00:33:34

Yeah.

Brittany: 00:33:34

Like just a couple hot second later.

Shawna: 00:33:36

Exactly. Yay. And so in: 2019

Brittany: 00:33:44

Wow.

Shawna: 00:33:44

And so, as you can imagine, everyone there was like, sorry, what I want to say.

Brittany: 00:33:49

Shocking.

Shawna: 00:33:49

Yeah, I know, a bad pun. Yes. And so the backlash was fierce.

And I'm like, proud to say, like, behavior analysts were like, yeah, no, this isn't the field that I signed up to be a part of. You know, and of course, the autistic self advocates, parents, parents, etc, like, they called out abai, which.

Thanks, thank you to everyone that spoke up. Yeah. Saying that ABAI was like, complicit in the torturing of these individuals.

And so there are petitions, project protests, so much pushback inside the field. And eventually ABAI responded. Wow. But, like, the fact that any of that was even required is still mind blowing.

Brittany: 00:34:29

Yeah. I'm actually in. In just like in dismay. I don't want to say shock. Yeah, I'm sorry, That's the only word that's coming to my mind.

at is. Like, you and I met in: 2019

Shawna: 00:34:42

f the top of my head, I know.: 2018

Brittany: 00:34:44

2018 for sure.

Shawna: 00:34:46

2018. So again, feels like yesterday.

Brittany: 00:34:49

And so. Wow.

Shawna: 00:34:51

Yeah.

Brittany: 00:34:51

Okay, so when ABII finally responded, what happened?

Shawna: 00:34:54

into it. But then finally in: 2022

And so it did signal a shift, which. Great. I guess.

Brittany: 00:35:14

Yeah, yeah.

Shawna: 00:35:15

Not just in policy, but in our ethics culture of the field, it was like a wake up call. Like, how did this, why were they even at the conference? Yeah, for the last 20 years or longer than that.

But like, yeah, you know, like, why were they even allowed to present?

Brittany: 00:35:28

Right.

Shawna: 00:35:29

And so just because something works doesn't mean it's okay. And like I said before, you know, like, we can change anyone's behavior, but should you?

Brittany: 00:35:35

Right. And what's successful to these individuals who was doing, who were doing the treatment? You and I would not fine.

Like, oh, no, we're not going to say that's successful. That's how you got there.

Shawna: 00:35:43

I can't even imagine, like administer, like I, I would be crying, just administering the treatment. Like, I just can't.

And like the fact that these people that were administrating got so desensitized to this idea of torturing others, like the whole, the psychology of it is fascinating.

Brittany: 00:35:58

Yeah. It takes us back to those prison studies and you know, back in the early psychology days, same thing where people just get desensitized.

And we're here to say that's not right and that's not okay.

Shawna: 00:36:09

No, no. And like, this is why we need to have con like this and why diversity matters. And conversations about diversity in the human existence matters.

Brittany: 00:36:23

Wow. Yeah, this is heavy.

Shawna: 00:36:26

Yes.

Brittany: 00:36:27

But again, we got to keep listening to advocates, to our clients, parents of our learners, their communities, to our own sense of humanity.

Shawna: 00:36:36

Yes, exactly. And if we look at their research, really we're tying it into social validity. Just behavior analysts. This is like one of our founding.

Well, I'm sure for speech pathologists we.

Brittany: 00:36:47

Just call it something different. Right.

Shawna: 00:36:48

Always say interesting. And so we want to ask those questions, like, are the goals meaningful? Are the methods acceptable?

So acceptable to us as clinicians, acceptable to the outside world, but most importantly acceptable and preferred by that individual. And then do the outcomes matter to the person receiving the support? You know, like, do they care about this goal?

Brittany: 00:37:07

Yeah, yeah, exactly. So those critiques go beyond physical aversives. There's a bigger concern around compliance culture.

So training to children to say yes, for example, or to stop stimming or to mask their distress.

Shawna: 00:37:21

Yeah, exactly. And again, I think we do see this a lot.

And if I go back to like my early days implementing ABA in home with kids, like we were sort of focused on compliance. And if the kid was non compliant, the answer was to somehow switch things around and make them compliant.

It wasn't sort of to dive into why the non compliance exists, you know, and so clinically I'll still use the word non compliant or compliance because that my training, I'm trying to shift my vocabulary, but it does come out every once in a while. But when I'm looking at compliance now, it would never be simply to make them compliant.

Be like, okay, I see this is an indicating behavior for me that you don't like this condition and you've now removed ascent.

Brittany: 00:38:07

Okay, love that. And again, I know you, so I know all those words that you just used, but let's just unpack that a little bit for our parents who are listening.

You're talking about compliance, you're talking about indicating behaviors and you're talking about ascent. Before I met you, I didn't know any of those terms from being honest.

Shawna: 00:38:23

And so if we look at like non compliance typically looks like a tantrum. Right. Or some sort of like they're running away from you, they're hiding under a desk. Right.

So my old world, I'd pick that kid up and sit him back in the chair and we'd be back on that token board and he'd be back to touching his nose or whatever I was getting him to do.

Brittany: 00:38:41

Right, right.

Shawna: 00:38:41

That's my old school training.

Brittany: 00:38:43

Right.

Shawna: 00:38:44

And then now when I see that kid hiding under the desk, I'm definitely not going to go and pick them up.

Brittany: 00:38:48

Yeah.

Shawna: 00:38:48

I'm going to get curious. Curious and say, okay, you've now shown me with your body. You didn't tell me I hate this or I don't want to do this. Right.

You're telling me you're indicating behavior is you hiding under the desk is telling me that you don't like this and you don't want to continue this activity. Right, Right. And so I want to stop there. Right. And again, get curious here. What don't. I wonder what they don't like about this?

You know, of course, at the clinic we never or we hoped that all their time there is joyful and fun and. But every once in a while, in a while, yeah, this comes up. Right.

Brittany: 00:39:20

It's going to be a hard time. Yeah.

Shawna: 00:39:21

And so our job then is to really think about why don't you like this, what's going on here?

And then how can I get you some communication to tell me that so that you don't feel that you have to run and hide under a table in order to get a break. You know what I mean?

Brittany: 00:39:35

And I'm not going to dismiss that by picking you up, as you said. And so then, so we talked about compliance, old term. We talked about Indicating behaviors.

And what I love is it is actually, actually in the name of that title, like, indicating behaviors. It's behaviors indicating a like or a dislike. Right, exactly. So it could be as subtle as like a looking away shows.

Maybe I'm not interested right now, or it could be like my body is shifting away, so maybe I'm not interested in that toy anymore.

Shawna: 00:40:01

Right, yeah. And I think those are even some more obvious ways.

Like if you think about the people that you love, like, I can sort of quickly, like Tim, my husband, doesn't even have to probably come in the door and say something. Like, I can tell from his face or just from the way he's like holding his shoulders, you know, if he's had a bad day at work.

And so with our kids, certainly if you're a parent of a neurodivergent individual, we often know sort of some of those really small changes in their body that can start giving us signals that things are going downhill for them or uphill, you know, and then start helping them kind of right away.

And that's almost one of my number one tips for appearance, really, is to be so aware of those really subtle changes and try and get in with that communication if you can. And then.

Brittany: 00:40:47

And so functional communication, like you said, if someone's under the desk, we might want to tell them, like, need a break? Yes, need a break. And then we're giving them those words to say when. What, like any of us, for emotional, the words are, Are harder.

Shawna: 00:41:00

Yes. Yeah, exactly. Exactly.

Brittany: 00:41:02

The last term that you used was ascent. Again, is that an ABA based term or is that something I just never.

Shawna: 00:41:08

I don't. I think maybe from psychology.

Brittany: 00:41:10

Okay, maybe.

Shawna: 00:41:11

And then separating out content consent, which has more of a legal implication. Right. Ascent, we can apply to anyone. So even our little, our little learners. With ascent, they can give it to us in so many ways. Right.

Like, we can see the young learners, they'll point to things or guide us, or they might push something away. Like those are some ways that they can give and remove. Ascent. Right. They're giving me a scent.

If they're coming close to me and reaching out, then that's a scent to pick them up. Right. But I'm going to wait for some of those behavior behaviors to show that it's okay to pick you up, you know? Yeah.

And so ascent just being, I would say, like a less formal way of talking about consent, which has usually a legal framework.

Brittany: 00:41:53

Okay, perfect. Thank you. I thought that those, that that sentence that you said was so meaningful, but I Just wanted to.

Shawna: 00:41:58

Yeah.

Brittany: 00:42:01

All right. So again, back to our discussion. There's a bigger concern around compliance culture that we were saying.

's a quote, I think it's from: 2019

To me, it was abusive stopping those children stimming when they're trying to calm themselves down or cope with a situation.

Shawna: 00:42:31

Yeah, exactly.

Brittany: 00:42:32

Right, Totally.

Shawna: 00:42:33

And that's how I kind of feel too. Like Brittany and I've shared before, we have the same shared mentor.

Prior to meeting her, I was doing in home therapy with children and I just knew what we were doing wasn't right. But I wasn't in a master or I think I just started maybe a master's program and I didn't know what else we could do, you know.

And then the mentor came in and was showing us some stuff and I was like, oh, I see. This is a big, subtle change, but a big difference to the way we're providing support to these individuals.

Brittany: 00:43:04

Right.

Shawna: 00:43:05

And we know now like, like quotes like that one. Right? Like stopping kids from stimming. And again, like certainly had times where we were implementing procedures to stop, like a vocal hum.

Brittany: 00:43:18

Right.

Shawna: 00:43:19

Or hand slapping here and there. And now what we know is that the stimming is meaningful. Right.

It can give us some insight into times that the individual might need some support with regulation. And the stimming really could be serving a regulatory function for the individual. And so by.

By simply getting rid of the behavior, you're providing them with no tools to regulate their nervous system.

Brittany: 00:43:44

Right.

Shawna: 00:43:45

And maybe sometimes we need to come up with another tools. Like a vocal hum, for example, sometimes can be disruptive or sometimes as teenagers, they don't want to do it in certain situations.

And so helping to come up with some different options for that individual is a way that we can provide neuroaffirming care while still supporting the unique kind of preferences and goals of that individual. Individual.

Brittany: 00:44:09

I think that framed it really nicely. But then it raises this ethical question, like how much compliance is too much.

So there's a risk that some forms of long term ABA can cross into control or even abuse if the client's voice isn't at the center. Is that what you think?

Shawna: 00:44:24

Yeah, exactly. And I think again, this like, idea of ascent informed care is interesting and something that you and I, I think are constantly sort of Juggling.

Right. We have parents coming in and they have all these goals for their child. Some of them were like, yeah, that' really great goal. I love that idea.

And then other goals, like we kind of said earlier, like, sometimes parents do want us to make their children indistinguishable. Right. They want to work on that eye contact.

Brittany: 00:44:49

Right.

Shawna: 00:44:50

They want to work on them sitting and having a conversation for five minutes or something like that.

Brittany: 00:44:55

Right, Right.

Shawna: 00:44:56

And so our job now is to really have a discussion with the parent about why that goal is important.

And I say sometimes it comes down to a little bit of like, as a parent thinking your child has to behave in society a certain way and feeling that pressure kind of thing. Like, my kid needs to look at someone and say hello or else they're rude. Right, Right. And so it's our job to then help them understand.

Even, like, typical kids aren't doing those things either. Right. They're not always polite or some of those things.

And so I think our job comes into educating people about the social validity or social significance of the goals that they are suggesting. And then with our little, little ones who can't give us input on their goals, they don't know how to communicate something complex like that.

And so with them, we're using those indicating behaviors in their body to tell us, like, okay, I really like that, or I don't like that, or even things like responding to name or looking at us. We track those things. So we'll collect data on if they look at us or if they're responding to their name.

Every once in a while, we have treatment goals related to one or two of those. Those goals. But a lot of the time we're just tracking if it's occurring and if it's increasing or not.

And then we can tell from the learner as well if it's increasing. Then eye contact is something that they feel comfortable with, we think. Right. We're not putting any specific procedures in to train it.

Brittany: 00:46:18

Right.

Shawna: 00:46:18

But just through the interactions with us, they're looking up to us more. And then, same with responding to names. Sometimes, again, we'll put in a specific program to teach a child that.

But oftentimes we find as they just become more aware of the voices in their environment, they'll kind of naturally will start responding to their name. And so the data sort of can help us decide if the goal is worth sort of pushing forward or not.

Brittany: 00:46:41

Right. And again, it makes me think of that building that trusting relationship.

And so maybe our learners are looking even in our Direction a little bit more when we have that trusting relationship built.

Shawna: 00:46:51

Exactly.

Brittany: 00:46:52

So like, that data sometimes will show that, hey, this relationship is getting stronger.

Shawna: 00:46:57

Yes.

Brittany: 00:46:57

And that's important.

Shawna: 00:46:58

Exactly. And like, we, as you know, are so passionate about joyful learning. And so the time at the clinic really is like very fun.

Usually all their favorite stuff. And then I think our final value at the clinic is really like communication trumps everything. Yeah.

So if your body's telling me or your voice is telling me or your speech generating vices devices telling me, all those are appropriate modes of communication. And I hear you and I, I'll respond to that.

Brittany: 00:47:21

Yeah. And you can trust me.

Shawna: 00:47:22

Yes.

Brittany: 00:47:22

Yeah.

Shawna: 00:47:22

Thankfully, there's so much change happening in the field, in both of our fields.

And so in the ABA world, we've got people like Hanley and Leaf who are coming out talking about neuroaffirming practices and not, I was going to say dispelling and maybe that's the wrong word, but sort of suggestions for behavior analysts about how we can embed neuro affirming care into our practices and what are some of the things that we should be thinking about. So with Hanley, we're looking at ascent based and trauma assumed protocols like the My Way approach, which we use at the clinic often.

And one of my favorite things from the Myway approaches, he calls it Happy, relaxed and engaged. So HRE is our or his acronym for it. And so really it's like, what does the learner look like?

So again, when we were looking at those indicating behaviors, what does the learner look like when they're happy, relaxed and engaged in something that they find joyful? And we use that description to decide when they're ready for us to sort of try something new.

And so we're not just bombarding them with a whole bunch of drills and stuff like that. Right.

We're really trying to make their time with us, joining us joyful and keep them at that HRE level by embedding their dignity choices joy into our sessions. So the data matters, but that lived experience and the individual's experience of the support trumps the data.

Brittany: 00:48:49

You know, we unpacked a lot of the trauma and past history within the ABA field. But I also wanted to comment that I think as SLPs we need to shift that narrative as well.

So I'm as, again, I was trained about 12 years, but I was trained and we all are to conduct standardized assessments. And in those standardized assessments, we're comparing people like our learners to a normalized population.

And that's Even how, you know, it's described in the testing process. And then we're judging or comparing them to that sample.

And so that word, even pathologist is in my title, speech language pathologist, and it literally means, like, the study of disease in some cases, or in our case, it's meant to be diagnostic. So I'm taught to look for disorders and then label them.

So I wanted to say that it's part of our training that we're, like, looking at someone and then comparing them to that normal population. And certainly sometimes it can be.

We obviously believe in what I do, and I think it's helpful for me to learn what are these areas that you're so strong in. And so that's somewhere where standardized assessment can certainly be helpful. And then where are these areas where you can use that support?

And so I'm not saying that standardized assessment is bad at all. I. I think that really has a time and a place.

But what you and I do often is this thing called dynamic assessment where we're sort of putting a pause within the assessment and saying, okay, now if I give you a little bit more support in this way or that way, how do you do? Or if I talk to you about it, like, how does this impact your life?

Or, you know, with some of our older clients, I can say to them, like, is writing something that you do often and is this really meaningful to you? And then how do you feel like you did with that? Writing assessment or having those discussions is a bit more dynamic.

And so, again, I wanted to highlight that in the slp. We've got to shift this narrative too, that, again, it's not fixing someone. So just because a standardized score shows them.

And actually, again, the terms are like, not nice. It's like deficient is a term then that I am often will have to put on a report. Like, that's not nice for a parent reading that.

And so, again, I think it's so important that we shift and really look at what are the strengths and then what are. What's important to the client and how can we support. Support them. And so sometimes, again, I'm not saying, like, labeling isn't important either.

I think sometimes there's a case for a label. Like, again, some, you know, some individuals are really proud of their autism diagnosis.

And I think that label certainly can be very helpful to identify areas of support, areas of strength, areas of need, or sometimes even find funding sources. Labels can be really important, but we need to shift from that fixing mentality to supporting and then just helping our Learners thrive.

And I think that as SLP is, if you're listening, we have to really live and breathe that difference.

And remember that when we're talking to a parent that even if the standard score says this, you know, we're embracing the uniqueness of that child and not saying here's what's wrong with them or they're bad or they need to be more normal.

Shawna: 00:51:49

Right, Right. And the one thing I also love that I know you often do when you're administering those standardized assessments is explaining sort of why first.

Right. Like we're talking about why are we even doing this? And does that feel good to you? Do you want that information? Right.

And if you don't want it, then fine, you know.

Brittany: 00:52:06

Right.

Shawna: 00:52:06

And then I think each of the exercises that are within the standardized assessment as well, you're sort of talking about like this is sort of what this one either is going to or did look at.

Brittany: 00:52:16

Right.

Shawna: 00:52:17

And what do you think about that? Right.

And that way they sort of understand too, like they're involved in the decision making along the way and you're using that client sense centered approach to embed their preferences within the assessment, which sometimes means you veer from a standard assessment model.

Brittany: 00:52:34

Yeah. And. And in the clinic we teach our students this.

Like I'm always sending my students a blurb or an article about dynamic testing and the importance of it, because I know I certainly wasn't taught that in grad school. And so I was thinking again, coming back around, I was assessing a 17 year old today in the clinic.

Such a bright learner, such a unique guy, he was really fun.

And instead of throwing a standardized assessment in front of him, I knew that wasn't going to be again, like I could maybe learn something from that, but I don't think it was going to help me get a big picture of his skills and capability. And so the bcba, one of our colleagues had just said like, hey, can I get another perspective on this learner of ours?

I want to make sure our goals are really functional and meaningful. And so I said, sure.

So I went in with a dynamic assessment of reading and I put six different words in front of him and I gave him like a three field of three. And it was things that he loves, like video, mom, iPad, his name, and like some other really functional words like go or eat. He nailed it.

He actually got all of them, which is really cool. And the therapist that was working with him was like, wow, I didn't know he could read all these really functional words.

Now again, I'M kind of going on a tangent, but again I want to think about like shifting that focus where sometimes a different kind of assessment can really help us learn a little bit more about this learner in a different way.

Shawna: 00:53:53

Exactly, exactly. And I think that ties into like really what we're seeing in the research. Right. Like in the research world.

When we read about neuro affirming care, there's a ton of recommendations in the show notes, you can check out some of our favorite articles. But really calling for that collaboration and consent every step of the way. Right.

And collaboration with the individual, with their family, if that's appropriate. Appropriate to select goals, teaching methods, as well as the various supports that you might add in.

Brittany: 00:54:26

Yeah, exactly. So the shift isn't just for the kids.

This dignity of risk framework reminds us that people of all ages, like if I'm working with my 8 month old or a 12 month old or a 17 year old, that people of all ages have the right to make choices.

Shawna: 00:54:42

Yeah, exactly.

We have a field with a painful past, you know, and, but also we have the potential to make changes that are for the better, allowing us to do more ethical, more compassionate care.

Brittany: 00:54:55

Exactly. And in both fields, I would say, I would argue so that change isn't going to happen because we get defensive.

It happens because we get curious, we listen and we evolve.

Shawna: 00:55:05

Yes. And I love that that is so who we are at our values. Right. We know better and we do better.

And neuroaffirming care doesn't reject ABA outright, but it certainly demands that we do it better. And I think that like what an appropriate. Yeah, exactly. Sorry, what an appropriate demand.

Brittany: 00:55:20

Yeah, exactly.

Shawna: 00:55:22

That we step away from that indistinguishability idea and towards authenticity. And that we stop prioritizing that compliance focus and start prioritizing connection and communication.

Brittany: 00:55:32

Totally. Because when we align our science with our values, that's when we really become better clinicians.

Shawna: 00:55:38

Yes.

Brittany: 00:55:39

And parents and humans.

Shawna: 00:55:41

Yes, exactly. And when we look at the research through a neuroaffirming lens, then our questions change. Right.

And you can certainly see this if you go back even 10 years in the research. Right. We stop asking how do we reduce this behavior? And instead start asking what is this behavior? Telling me, is it adaptive?

Is it necessary for regulation or for them to express themselves? And then from there I can make more informed, client centered neuroaffirming treatment decisions.

Brittany: 00:56:09

And this is why it's so important that we continue learning, like as you and me and everyone. Because like you said, a lot of this is in the last 10 years. That's when you and I were trained 10, 12 years ago.

And so if we weren't constantly learning more, we'd be stuck in not as compassionate, evolving science.

Shawna: 00:56:27

Exactly.

Brittany: 00:56:27

Not a science. I don't know. Yeah, we'd be, we'd be stuck. I should say we'd be stuck in maybe bad therapy.

Shawna: 00:56:33

Yes, certainly stuck in bad therapy for sure. And I think you and I both would say like we lived and breathed bad therapy for sure.

Brittany: 00:56:39

Yeah, for sure. So where does this leave us? We got some hard truths, but I do think we've had a. We have a lot of hope.

Shawna: 00:56:45

Yes, I agree, I agree. I think the future is bright for sure.

We've got some really great, amazing researchers and advocates sort of coming together as a guide for parents, clinicians, professionals. And so neuro affirming care is asking us to acknowledge that past. Don't get stuck in it, but we do need to do better.

Because now that we know better, you know, so we're trying to build something new all together as a kind of a whole society. Right. Appreciating. There's so many people in that circle of care that that person is interacting with that have valuable insight.

Brittany: 00:57:21

Yeah, exactly. And that includes listening to those neurodivergent voices. So we're still offering therapy, but now it's with curiosity, consent and ascent.

Shawna: 00:57:31

Yes.

Brittany: 00:57:33

And compassion. And like that's one of our core values. Humans.

Shawna: 00:57:37

Right.

Brittany: 00:57:37

To just be compassionate.

Shawna: 00:57:38

Yes, yes. Because disability isn't the problem. It's that inex and inaccessibility or stigma. And when we change those things and everyone benefits.

Brittany: 00:57:47

Yes.

Shawna: 00:57:48

And so if we look at what can we do, what does neuro affirming practices look like? Right. I think the first thing that comes to mind is support. Supporting autonomy and consent or assent.

And so seeking permission, offering choices, explaining what we're doing.

Brittany: 00:58:05

And this is just kind again, acting as a kind, compassionate human. So we start this very early with our young learners during their diaper changes. But I did this with my girls and you probably did too with your boys.

Like when I'm giving a diaper change, I'm talking them through it and saying, okay, I'm going to touch your bum now or I'm going to lift you here and I'll do the same with my girls now that they're older. Like, hey, is that okay if I rub your back?

Shawna: 00:58:26

Right.

Brittany: 00:58:26

Because we're always thinking about like they might not like want that. And so it's in sort of ingrained in all of our discussions in our daily Lives, but like to seek that permission and get, give them choices, for sure.

Shawna: 00:58:37

And like, I think even with my own kids, think about the rubbing your back example. If I'm rubbing my kids back and he starts to move away from me, then I want to give him the language. Right.

And come in and be like, you can say, I don't really like that and that's okay. Like mom can hear that, you know?

And so I think really like the things that we embed in our neuro affirming practices are things that we can embed just in how we treat people. Because it's respectful.

Brittany: 00:58:58

Exactly. And so we're letting the child lead, whether it's at home or at the clinic. Um, we're following their interests. Again, not just because it's nice.

That's where the language lives. And so if they're joyful or happy, relaxed and engaged, they're learning better.

And then they're not in the state of anxiety because someone's punishing you or, you know, forcing procedures on you.

Shawna: 00:59:21

Exactly. And then we know we're teaching them things or suspect that we're teaching them things that are valuable. Right. We're following their lead.

They're showing us. I like playing with Hot Wheels tracks.

Brittany: 00:59:32

Yeah.

Shawna: 00:59:32

Amazing, right? There's tons of language I can embed in this, you know, and how much more fun to embed it in this and sit with you with some flashcards.

This is a car. These are wheels. That is not fun.

Brittany: 00:59:41

Yeah, I agree. I agree.

Shawna: 00:59:43

And so in aba, what we're looking at is that shift from compliance to autonomy and self advocacy. And sometimes that means stopping. And I think as my, as behavior analyst, that can be hard for us. We want productive, efficient sessions.

We need all their data of points. And I think it's important to take a step back and remember your big picture goals. And something I do often at home too. Right.

Is like, it's not about this little tantrum that I'm dealing with right now. It's about that big picture view of where this client is going.

And if I teach this individual that people can pick them up and manipulate their body and move them places, then they would tolerate that elsewhere.

And so even though I might have a trusting relationship with them, where they might allow me to pick them up and move them somewhere, I'm just not going to do that because it's not serving my greater goal, which is that this child is able to live a joyful life out in the community.

Brittany: 01:00:34

Yeah.

Shawna: 01:00:35

So we're shifting away from that compliance, really focused on that autonomy, self advocacy, emphasizing the social validity of our goals. So the goals matter to the client, their family. Moving beyond that don't stim idea to Morted.

This is part of their interest or something they like to do. Maybe it feels good, maybe it's calming. Maybe I'll never understand while they're doing why they're doing it and does that matter?

And then finally kind of getting or moving away from any sort of disciplinary approaches or this idea that ABA knows all. You know, we can collaborate with others and we should collaborate across fields and be humble as behavior analysts.

Brittany: 01:01:18

Yeah, we had a good collaboration this week on some speech shaping stuff and that was not always easy. And then we came back around and I really excited about this collaboration.

Shawna: 01:01:26

Yeah, that one was fun.

Brittany: 01:01:27

So. Yeah. And then in slp, coming back around in our field, I think we need to move from correcting to connecting.

You know, we can do standardized assessments. We can look at these things and look at their language or their play skills or whatever it might be.

But again, we're how does this apply to their real life? And what kind of functional, meaningful goals? And. And why am I doing this assessment?

And is it going to lead me to something that's functional and meaningful? I was reading a paper preparing for this about conversation analysis for autistic individuals.

And this conversation analysis was looking at seeing real life skills like initiation, repair, even echolalia as communication, which is really cool. Yeah.

And so it was like, instead of putting a standardized language assessment in front of the child, what about a conversation analysis and what kind of interaction response we can get from something like that, which is really cool. Again, like something I was trying to do with my teenage learner today in an. In an assessment.

And I ended up just observing him and his instructor or yeah, instructor today. And the relationship they had was so lovely. And I got a real sense of like their interactions, how often he's initiating. And so it's really cool.

Anyway, so we want to shift and think about, sure, maybe we're doing something standardized, but then also what are we doing? What are we doing? Any dynamic assessment or any conversation analysis.

Shawna: 01:02:51

Cool. That sounds very interesting. I'll be interested to see the results for sure.

Brittany: 01:02:54

Yeah.

Shawna: 01:02:55

Okay, so some practical takeaways for the listeners.

If you are a parent of a child or an individual receiving support, whether it's from aba, SLP or another field, we can think about like, whose goal is this?

Brittany: 01:03:09

Yes. Yes.

Shawna: 01:03:11

And whose voice might be missing from this conversation and think about some ways to include the individual in the decision making. If You're a clinician. You can also ask those similar questions. Whose goal is this? Why are we working on it?

Think those social validity certifications, is this.

Brittany: 01:03:27

Helping me or the learner?

Shawna: 01:03:29

Yeah, exactly.

Brittany: 01:03:30

And then again, don't treat difference as a disorder. And then you were just talking about it, but creating those goals with the client, not just for them.

Shawna: 01:03:38

Right, exactly.

And I think responding like the, as a behavior analyst, the data often tells you too, you know, where are they enjoy, what types of tasks are they enjoying doing? Where are we seeing that increase?

Or like I was saying with that respond to name example, you know, if we're probing it and it's kind of just sitting the scene, we're not really seeing an increase. And maybe now's not the time to work on that skill, you know, you can come back and visit it again.

And I think understanding there's not like a linear path of child development for sure. And then certainly when we factor in our neurodivergent individuals, it's not linear.

And so while you might have a curriculum or something, you're using our jobs as clinicians really are to be able to interpret those curriculums and figure out what's going to work best for the individual with their point of view. And so then we're looking at those ascent based, trauma informed, flexible practices.

And so ascent based, meaning I'm looking at those indicating behaviors. I want you to be in on this learning.

And if you're not in on this learning, I hope you have the skill or the skills to tell me you don't want to do it. And if you don't, then I want to teach you that. And then if you, if you don't, you don't like this, then I need to take that as feedback.

What am I changing as a person that's supposed to support you? You know, these are your goals. I'm supposed to be like your coach getting you there.

Brittany: 01:04:57

Right.

Shawna: 01:04:57

And if I'm not, if that's not serving as a mo, if I'm not motivating you, then my, I'm not doing my job very well.

Brittany: 01:05:03

Right. And we're sometimes trying to teach our learners to be flexible, but we gotta be flexible. Good point.

Shawna: 01:05:08

Exactly.

With trauma informed care, really looking at how often you're physically prompting is certainly something that we keep in mind at the clinic because some individuals who have a history with old school ABA that we are talking about, and also just people in general, like, I don't really like being touched that much, like, just don't touch me. I'm Good. You can show me another way, like point to something, model it for me, etc.

And so I think some of our prompting or supportive strategies we can get a little bit more flexible with. And then flexible practices. Practices meaning like I'm not teaching responding to names at the same protocol every single time.

You know, it's like I know sort of what the research says, I know what behavior analysis says, I know what behavior science says right around how to support this goal. But I got to take in all of these different factors. And that is my favorite thing about being a clinician.

Brittany: 01:06:02

Yeah, exactly. And then learning and growing, like we always say, like there are.

We're helping our learners to learn and grow, but we are learning and growing right alongside them. And that's my.

I would say like one of my favorite things is we're always challenging, changing ourselves to be better and to know just like expand and be flexible and expand our own look at everything.

Shawna: 01:06:22

Yeah, exactly. And like we're not perfect either. Right.

Like we're trying to stay educated and like I'm trying to change some of my vocabulary and the way that I speak about treatment and goals and that sort of thing, but I'm not perfect for sure. And we are just like trying to learn and grow as clinicians. And like we said like 10 years ago, this wasn't even something that was talked about.

Brittany: 01:06:41

Right.

Shawna: 01:06:41

Um, and so now that we've been in our careers for a while, we're trying to adapt to and like kind of follow the advocacy efforts of the neurodiverse. Neurodiversity movement.

Brittany: 01:06:54

Yeah. So as we wrap up today, thanks so much for listening, everyone. Sean and I have shared a lot of our personal stories today, a lot of research.

So again, thanks so much for listening. We'd love to hear your comments about this.

And what do you think about neuro affirming care and what does that mean to you in your practice and how do you. You collaborate? If you're a clinician, I should say, how do you bring together neuro affirming care while being evidence based?

And how does that come together? Because sometimes we see a little bit of a clash there. Yes.

And so, you know, being both of those things, what kinds of things are you doing to be compassionate in following ascent and using those values in your clinical practice? So I'm going to challenge you with a call to action for those clinicians. What's one neuroaffirmation shift that you can commit to this month?

And I want you to think about that. This might even in your next therapy session. What's your plan to embody those values of compassionate care?

Scent based looking for those indicating behaviors and if you have questions, we love to chat about this so give us a call or send us a message.

Shawna: 01:07:53

Yeah exactly. And I'm excited to keep learning and growing in the comments section I hope. Thanks everyone.

Brittany: 01:07:58

Yeah and if you're a parent also we'd love to hear your feedback because because like we said we're always learning and growing and wanting to do better. So thanks so much.

Before we go, we want to remind our listeners that topics we discuss in the podcast are not a replacement for professional medical advice. Please contact a professional if you have questions.

Shawna: 01:08:17

And just a heads up, we'll use both identity first and person first language to respect different preferences. We'll also see treatment and therapy since we come from a clinical space but always with respect and a focus on what works for each person.

Brittany: 01:08:29

See you next time.

Shawna: 01:08:30

Bye.