The Critical Role of Respect and Person-Centered Planning in ABA Therapy
In this interview:
Dr. Hilya and Dr. Gwen talk about the practice of Applied Behavior Analysis (ABA) and deconstruct the
best and worst applications for ABA in the treatment of individuals on the autism and disability spectrum. Together,
they discuss the importance of person-centered treatment, the role of trust and respect in a therapeutic relationship,
paying attention to individual differences, and delivering treatment with intentionality.
*Linked to transcript with time stamp of video
Who is Dr. Hilya? 1:45
What is Dr. Hilya's ABA Background? 3:12
What is ABA? 6:45
What are the main goals of ABA as a framework? 12:38
What are the best applications of ABA? 18:48
What are situations in which ABA is not the best choice? 26:00
How can ABA be delivered while keeping it relational, respectful, person-centered, and collaborative? 37:38
Dr. Hilya's favorite ABA techniques and strategies. 45:09
Dr. Hilya's most important skill used to empower clients and their parents. 49:13
Full Transcript of Interview
Hi, I’m Dr. Gwen. I'm a clinical psychologist who's been empowering disabled individuals, their families, and their support systems for over 20 years.
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In this episode I interview Dr. Hilya Tehrani, a clinical psychologist and founder of Connected Strides, a psychological practice dedicated to the therapy and assessment of individuals with Autism, ADHD, anxiety and trauma.
Hilya and I talk about the practice of Applied Behavior Analysis or ABA and deconstruct the best and worst applications for ABA in the treatment of individuals on the autism and disability spectrum. As two clinical psychologists who have been in this field for a while, we can't help but explore the importance of person-centered treatment, the role of trust and respect in a therapeutic relationship, paying attention to individual differences, and delivering treatment with intentionality.
Having a conversation with Hilya is always a grounding experience for me. Her expertise and deep care for what she does always shines through.
I hope you enjoy this conversation with Hilya.
Dr. Gwen: Okay. Hi Hilya, welcome to the channel! How are you?
Dr. Hilya: I'm good thank you so much for having me.
Dr. Gwen: Of course, I mean you and I go way back. We've known each other for a very long time, lucky me, but our audience might not know you, so can you introduce yourself and tell us who you are?
Dr. Hilya: Sure, I'm a clinical psychologist. My focus has always been working with kids and teens and their families and predominantly working with the neurodivergent population for over 20 years and from the time I did my internship at that point my focus was on a lot of testing psychodiagnostic, neurosite testing. Once I completed that, my postdoctoral training was actually in your practice being able to really focus on working with the autistic community as well as other, neurodivergent, adhd, learning disability profile kids and teens and really just finding ways to empower them and know how best to work with them through therapy and assessment.
Dr. Gwen: Our topic of conversation is really going to be about ABA or Applied Behavioral Analysis. We go way back in regards to the application of ABA principles or ABA as it's applied in real time and how theoretically what it looks like and so I'm hoping for us to get into that today. You do have an extensive background in ABA, so tell us a little bit about that just so that people know your ABA background.
Dr. Hilya: It was sort of this dual path that I was on right, so simultaneously with going to my doctoral program and all through internship postdoc when I was licensed even for about 10 years after being licensed I actually worked as a clinical director at an ABA agency, overseeing them providing in-home and school-based ABA services for kids and teens with autism. I really got to be kind of on that side of it. I became a Board-Certified Behavior Analyst at the doctoral level, so I really kind of learned the ins and outs of doing ABA, overseeing ABA programming. I also had my foot on the clinical side and looking at things from a little bit of a different perspective as well.
Dr.Gwen: I think there's this misconception that ABA or behavioral types of therapies can't exist together with being clinical psychologists. And you and I have had this conversation about “How do you marry clinical psychology with ABA or behavioral principles?” They go hand in hand in many ways, but how do we focus on the relational parts of ABA, which is really not something that's discussed because in many ways many individuals and agencies that are grounded in ABA practice don't necessarily think about the relational aspects of therapy. This kind of marriage of your behavioral background and your clinical psych as a licensed psychologist really gives you a different perspective about how wonderful in many ways ABA can be and how it doesn't fit for some things.
Dr.Hilya: I really felt like having the clinical side was helpful in that the whole time I was at the agency my focus was “How can I bring that sense of understanding to all of these providers?” because it was such a great way to reach hundreds and hundreds of families whose kids need these services who wouldn't otherwise be able to access any other kind of form of therapy without what's offered to them through insurance or regional center. I really was very passionate about how to help the people who are in the homes and the schools understand ABA in a little bit of a different way of what we talked about as being more person-centered; really being about the child and understanding the child and their unique and individual differences and starting from that place.
Dr. Gwen: Even just saying “individual differences”, I mean there’s a lot of times that terminology is more aligned with the floor time DIR terminology, but it's just good practice. Especially as psychologists we think about lots of different factors that that help an individual in their planning of their treatment or their interventions that we have to be person-centered and individually focused.
Hilya, for those out there that are listening, can you define just very briefly what ABA is just so that we're kind of all clear and on the same page?
Dr. Hilya: Sure, so ABA goes way back to initially the work of Skinner and Pavlov and it was all respondent conditioning and operant conditioning. Basically, it was a way of teaching where you either can you learn by association or you can change behavior by strengthening it through reinforcing it or withholding reinforcement. Reinforcement weakens behavior. But then through the years, in the late 60s Dr. Ivar Lovsas, which has kind of become synonymous with the world of ABA and DTT, started to use this particular way of teaching with kids with autism. He started to do imitation training. Really at that time, the focus was on kids who had a really significant self-injurious behaviors, dangerous behaviors. That's where the history of ABA also becomes a little bit problematic. At that time, he was using things like punishment and electric shock. I need to work with some of these kids and that its history, that's where it started. Fortunately, we've come a long, long way from that over the years. He did a study where he basically compared kids who had 40 hours of DTT, this intensive form of intervention with a group who had less than 10 hours, and a control group who didn’t have any kind of ABA or DTT and found that he reported these findings – 47% of these kids who had the 40 hours a week intervention were no longer distinguishable from their peers and that became a really kind of groundbreaking study that started to be replicated clinics and different universities. Eventually, by the late 90’s ABA had really become established as the primary kind of evidence-based form of intervention that was sanctioned and approved to be provided for all kids with autism.
Dr. Gwen: For those of us that have been there in that ABA place - because that was my initial training as well, decades ago, and that's where really I started, I started as a one-on-one, that’s how I got introduced to the field - there was something really lovely about how formulaic it was. It was very organized, clean, if you will, in regards to you do this, you expect this, you
you reinforce it, negatively or positively, you're out. And ta-da! It’s done.
I think as I progressed and grew as a professional, and as the kids I was working with started to age, I started to realize how very simplistic way of reducing behavior felt too simplistic and reductionistic and it wasn’t capturing the wonderful pieces of emotionality and how emotions inevitably play with the nervous system. Then, it gets in the way of production. How do we then produce behavior for any human being when we’re overstimulated, distressed, upset, or really really happy? When there’s a big emotion happening, I felt like that was really hard to control. There’s just so many things, people are so complex and it was getting difficult for me to just reside in the ABA realm or just the purely behavioral realm. I was searching and needing other types, integrating other types of theoretical information in my practice. I look back and when I know I can use a pill cutter to make a skittle go eight ways, things are serious! I think the ability to reduce things down to that request-expectation-reinforcement in those three quick phrases in teaching in ABA more generally was easier to measure empirically. So, I know ABA – and maybe we can get into this – there are many areas in which ABA is really helpful and productive and positive and a great tool, it does have a lot of empirical and scientific support to back it up.
Hilya, what would you say the main goals of ABA are as a framework?
Dr. Hilya: ABA is really about being able to objectively measure and track the interventions that you’re doing and that’s a big part it – being able to take data and really see if what you’re doing is working or not. It’s really about changing behavior either directly or through manipulating the environment, setting up the environment in a way that’s going to lead to an increase or decrease in behavior. There is this fundamental assumption that all behavior has a purpose, so I think the difference is with ABA, maybe it looks at it at a more surface level. Behavior has a purpose, but from an ABA perspective the purpose is going to be getting attention, escaping, or avoiding a situation that’s unwanted or a task, getting access to thing that you want, whether it’s tangible or an activity, or they lump together this idea that it’s sensory-based behavior, and those are kind of understood as the functions that behavior serves. We have to understand the functions in order to know how to approach, what kind of interventions to use, and that’s the main focus of it
There’s lots of techniques within ABA that are just things good teachers do, that parents often do. If whenever a teacher gives lots of attention to the child who’s sitting well in their seat and raising their hand to ask a question, they’re like, “Oh I love the way you’re sitting!”, “I’m going to call on you because you raised a quiet hand.”, that’s reinforcement. We’re giving attention to behaviors that we want to see. Anytime, if you’re helping your child then you’re giving them just a little bit of help by pointing at what they are supposing to be doing or giving them a little hint, you’re prompting. If you realize you’ve been helping a lot and you’re trying to pull back and do less so they can do it more on their own, that’s fading prompts. These are all behavioral techniques. If you’ve ever said, “Eat your veggies and you’ll get your desserts”, that’s the Premack Principle. So on one-hand I think of ABA and it’s not really this other thing that only ABA technicians can do. We kind of have to just throw that out because it’s problematic. There’s so much about it that is useful and that we use in everyday that we actually see.
As you said, there’s a ton of research in part because it really lends itself to research because everything you’re doing, you’re gathering data. So there’s a ton of research in which it shows that you can help improve behaviors you want to see. By behaviors in ABA, we’re really looking at all kinds of things: self-help skills, adaptive living skills, communication, socialization. It’s not just behavior in the way we would consider, like tantrums or such, but it’s really anything that’s observable and measurable. That’s what the field is all about. Being able to strengthen and increase those kinds of things that we want to see more of but also reduce the more problematic behaviors that are interfering with learning. If a child is having tantrums anytime they’re sitting at a desk in a class trying to learn, they would say that’s interfering with them being able to learn. How do we reduce that and increase their time of just sit and attend?
Dr. Gwen: This is where I feel like ABA offers a framework which is so lovely in skill building. In doing what I do today where I’m specifically working with adolescents and adults. It really does come down to skills, skill execution. If you can’t execute a skill, then we just know we need to back and support. There’s no judgement there, it’s just making sure that adults and adolescents are healthy, safe, and happy. This is where I feel like ABA offers a very nice framework to understand how skills are built, how habits are built, what we pay attention to, and really focusing on the minutia of the interaction. I’m going to pay attention because I want to reinforce this particular behavior or I’m not. Or I’m going to ignore that, or I’m going to do something else so that behavior just kind of goes away. Or we shape something, for example, we make something start, we approximate something in the beginning, and then we bring it to some kind of mastery. I feel like ABA really does that in a very strong way and I love what you said because maybe we can think about ABA, behaviors, these kind of principles, techniques, and strategies as tools in a toolbox.
I think way back when there was a very, very serious disagreement between theoretical orientations for how we were going to provide intervention for children with autism. I don’t think we need to be exclusive; DIR Floortime doesn’t have to be mutually exclusive from ABA if we borrow and use tools that make sense for the client in that moment, then we’re really being very comprehensive in the way that we can address the support of somebody.
Hilya, maybe we can talk about some of the best applications of ABA. Where do you see ABA as being strong while respecting the individual? Because I think that’s another piece, we can maybe talk about down the road. But where does it nod to the individual differences, to the person, it is respectful, and collaborative? Where do you think ABA shines?
Dr. Hilya: I’ll start with my very favorite thing, which in behavioral terms is called getting a baseline, then shaping your chaining behavior. Essentially to me, that is meeting the child where they are at. Really honing in a very clear-specific way on what is their skills level at this point, whether it is communication or play or engagement. I’m going to stop and I’m going to really put the lend on, understanding where they are at and knowing that that’s our starting point. Being mindful of our starting point and the next step. If a child is using scripting language, the next step is not going to be let’s engage them in a back and forth conversation. Scripted language is what they have right now, so how do we make that a little bit more meaningful? What is just finding these small, little steps where we can gradually move forward. Being in that zone of proximal development, I’ll throw in my clinical understanding of it. Where you’re challenging them just enough so that you’re making this forward progress, but not the point where they’re frustrated or they’re going to give up. When they can meet that challenge, reinforcing it, letting them know that, giving them feedback of “This is great, you’re doing it this is what we want.” Because that feedback is powerful, we know that it changes behavior when what’s expected is really clear. When what is expected is within your range of things you can do, maybe with a little bit of extra effort, maybe with a little bit of prompting, with a little bit of environmental support, there is some internal satisfaction and it’s fine to also add this external reinforcement because we’re trying to build up momentum.
I hear that a lot too – how is this child going to internally have a sense of motivation if we’re constantly throwing reinforcers at them? Well, that’s one of the great things I learned from ABA. You do reinforcement very deliberately. When you’re first learning a task as for all of us – we’re learning something new, it takes a lot of building up momentum and getting through frustration. Persisting all those great growth mindset things that are challenging, you need a little extra reinforcement. We might do that for ourselves and say, “Hey, I spent the whole day skiing. I’m going to treat myself to some hot chocolate.” There’s nothing wrong with that. But over time, when you get really good at it, the activity in and of itself because reinforcing and you can fade reinforcement. Just having reinforcement in place does not in and of itself mean it always needs to be there. It’s not going to be something that kids rely on or individuals rely on, so I think ABA is good about recognizing when to deliver it, how much to deliver it, and when and how to pull back in that we have. A lot of tools for how to pull back. There’s different ways in which you can reinforce. Some of them are much more intrusive and can gradually shift towards being internally driven. So those are a couple of my favorite things about ABA.
Dr. Gwen: I love that. I would love to sit with this idea of intentionality and deliberation, how deliberate things are because when we talk about intervention and treatment we want to be intentional about what we’re doing. I think all theoretical models, all applications can suffer from getting into a rut or not being intentional about what you’re doing. Even if it’s intentionally doing nothing. Intentionally not saying anything. Because I have in my mind that not doing something is going to lead the person I’m working with do whatever they need to do and find that they can do it on their own, approximate it on their own, moto plan on their own, or whatever it is. When you’re deliberate and intentional your expectations are set reasonably. I think therapeutically as psychologists when we’re offering a therapeutic or a clinical press to our clients, we’re really intentional about how intrusive, hard, and easy that press is. This is where our ABA training gave us a framework to understand that. You can use prompting as a way to fade, you can use reinforcement in a different schedule to fade. There’s so many different ways you can work with that. ABA being really nice and providing that structure and framework for hitting your target or at least making your best guess about what target you should be hitting. Being observant, continuing to collect data and let that give you a guide about where to go. I like behavioral principles for skill building and what I would consider “tightening”. Whenever I need to tighten something, something a little bit awry; maybe my client is experiencing something and it’s taking over their life. I need to contain that and help the client contain that, behavioral aspects of not just ABA, but of psychology are really helpful.
Hilya, let’s go to the opposite end of this, which is where do you feel like ABA is maybe not the best choice or those kinds of behavioral principles are not the best choice for outcomes? What situations would be those be?
Dr. Hilya: I think it applies to ABA and any discipline – whenever you get very rigid about how something is applied, you come in with your idea. You mentioned earlier when we were both first getting trained, it was very satisfying to come in with a log book of this goal I’m working on and every time I get a correct response, I mark it and you have the nice little graphs that show progress. In that way, the structure of ABA can be very satisfying, very containing, and it can be wonderful in that way. But if we are very rigid with how we apply it, if we don’t allow for just the human tendency to have an off-day, to have been able to do something one day but not the next, to say well, we were here yesterday and if we can’t hit it today, we’re going to keep at it until we hit it, that’s all rigidity. That’s being really set on going with the data as opposed to going with “What does it feel like today?”, “How is it different?”, “How are you showing up today?” That’s going to guide what we do.
I work a lot with the autistic community and autistic adults. Unfortunately, there’s been a lot of negative experiences and we can’t discount that. Those who had years of ABA which, unfortunately, was very focused on and in some places, still is, on compliance. The adults comes in with their agenda and the entire goal of the session is getting the child to comply with whatever that preset agenda is. It’s problematic because how can individual develop their own inner voice when they’re spending 20-30 hours a week in this mode of doing what others are asking of them? As adults we hear a lot of about how its made them so vulnerable, to being taken advantage of, and even sexual trauma. There’s just problematic things that we have to acknowledge that have come from it. This whole idea of everything you do gets reinforced so that carrying guilt of “I can’t just do something that I enjoy if I haven’t worked for it”, “I have to do a task in order to earn what I want to enjoy”. None of us want to walk around feeling like that, so why would we impose that on autistic individuals? Respecting differences continues to be what I strive for as I work with others and others in the ABA field. Understanding everyone has differences, especially if you have autism; your sensory profile is going to look a little different, the way your process information, the ways in which you are impacted by your environment on a day-to-day basis is a visceral thing. It’s something that they have to work through on a daily basis. The sensory bombardment and difficulties living in a world that’s created for neurotypicals, in a world that has these expectations of good learning requires a “quiet body” or a “calm body”. So there’s all this stuff that they have to work against. So it doesn’t help for us to go in and just say “That’s our goal, we’re going to work on, you having a calm body in order to learn” as opposed to “What does your body look like when you’re learning?” That’s very different from what I expect learning to look like. Those are all problematic things.
When I hear parents talk about being told their child is scripting and a professional tells them we don’t want scripting, let’s just put it on extinction, we want to ignore it as opposed to that’s serving something. Maybe the that’s the only avenue through which the child is connecting. And for autistic individuals, their avenue of connections is not necessarily even going to be verbal. It might be in a lot of others ways. Self-stimulatory behavior, stimming, is something that I always cringe when I hear someone trying to do away with it, it’s not something that we want, let’s reduce it. I definitely acknowledge that those are problematic, but I think we can still use ABA techniques as long as we recognize that those are differences that’s it’s not our place to do away with. It’s not our place to do away special interests. Actually we should join in on special interests. We should use them as an avenue for engagement and connection.
I feel like in that way, we can be impactful and still use our behavioral tools when necessary to change the environment. I think that’s one of the great ways about ABA – it doesn’t just look at what you can do directly for the child, or what a teacher can do or a parent can do, but also how do we set up the environment proactively in a way that is predictable? Maybe there’s lot of visuals, just reminders in these ways that help to make it more structured and organized and predictable. Those are wonderful things, and there’s no reason why we wouldn’t want to use those as long as we’re taking the unique child who is in front of us into account.
Dr. Gwen: I love that. Not only, if we’re doing an environmental analysis, can we set that up in a way that can serve the person in their learning profile, but we can also evaluate environments in which going into that environment, we’re going to need to back in support or some skill building. I face this a lot as I’m helping my clients prepare for work or college or vocational programs or starting internships and coming into the world in a way that’s not so controlled or manageable where we can control it. The question is “What are they going to need to be as successful as they can be?” and maybe we look at the demands. In our work, we call this demand fade in, but the idea of how we look at everything that’s going to demand something from this person. How sensitive they are, how overwhelmed they get by external stimulus – all of this. The demand might not just be the job at hand but maybe how long they are there for. How do we bridge those gaps and connect those gaps? There’s a few things that just really resonate with me and I would completely agree anytime we become rigid about anything, it’s a problem. Whether it’s a mindset or an attitude or a thought or a behavior, anytime we become rigid we miss stuff.
The other thing too is this idea of compliance squashing the inner voice of a person or compliance really not helping someone build self-awareness. The most important skills in my mind when I’m supporting adolescence in transitioning to adulthood is the social emotional learning, competencies, executive functioning, and self-awareness. Competency is the foundation for where behavior and thoughts come from. So if we’re only focusing on compliance with ABA programs… In the old days, we used to call this “drill and kill”. I’m not trying to be offensive, that word just tells you what you’re doing at a table. You’re drilling things, you let the kid leave, you come back, you drill things. And while that might be a starting place for somethings, it’s definitely not the best place in which we learn skills that are applicable and usable in everyday life. Compliance, squashing self-awareness, I’m uncomfortable; I don’t like this. And then now, I’m trying to teach my adolescents advocacy when they don’t even know the language, or the fact that they are uncomfortable. So yeah, they’re set up for exploitation. And heaven forbid some of my clients are pleasers and they want to please you. They want to do a good job, they want to do these things and then they’re blowing past all the signals of “This is not right, this is not good, I don’t like this”. We never taught them the ability to collaborate and be problem solvers in their environments. I’m really looking for any kind of ABA provider these days that are working with adolescents, all the way down to 10, 11 and older is how person-centered are you and how much of a collaborator. Can this child/adolescent/teen/young adult be in their treatment? They should be setting their own goals, talking about what reinforcements they want, talking about the prompts that are comfortable for them. If you physically prompt clients, it’s aversive for them. Especially my adults, you don’t want to be touching adults. Compliance shouldn’t be our goal and if the child is not compliant, why? What is happening there?
Everything has a good and bad and I love that we’re unpacking that and deconstructing it. I think you’re right, there are parts of ABA that are lovely and can be applied. Even the lovely parts may not be applicable in a certain situation. Much like our clinical work, there are times when we shouldn’t be insight-oriented, we shouldn’t be opening up conversations about thing that we know our clients can’t then cope with or self-soothe about it.
What are your suggestions or your ideas on how to deliver ABA while keeping it relational, respectful, person-centered, collaborative?
Dr.Hilya: We always begin with relationship is paramount. Even with ABA, you have to begin by building rapport with a child. They have to get comfortable with you and they have to have fun with you. If they’re not invested and want to hang out with you, how are you going to be there to support them, co-regulate them, prompt them, through those difficult moments? You really have to establish a good relationship and that every good ABA therapist that I’ve ever worked with. That’s what made them shine, they knew hot to connect with a child and that’s just fundamental. The next level is really getting the child that you’re working with. That saying: “If you’ve met one person with autism, you’ve met one person with autism”. Every individual is different, we have to be really mindful of what they bring to the table from a sensory perspective. That’s where I love collaborating with OT’s. I think the best ABA providers are the ones who are actively working with OT’s and incorporating those great sensory strategies and helping the child learn how to incorporate them within the sessions. Like “Oh, you’re seeming like you’re needing a break. What’s a good break for your body right now?” That’s going to build in self-awareness within the structure of an ABA session. You can have a structured ABA session, but you can take breaks and bring in those strategies that has been recommended, so really understating what they need because our physical self is fundamental. If we can’t regulate, we can’t get to anything else. All the skill building and learning things and language and symbolic play, those are all icing on the cake once you have that well, regulated, calm body. You can’t come in and just drill and get to what needs to be done through reinforcement alone if you’re not mindful of the kid not sleeping well last night. Today we’re going to spend most of the day just playing outside and doing obstacle courses because it’s going through motor planning, and following a couple of directions, and what not. So you really have to see the child for where they’re at. What is their processing style? What’s their learning style? Developmentally, where are they at? Just because you have a 10-year-old, you’re not going to impose certain 10-year-old expectations because with ABA we look at all the different skill sets. There’s going to be all these peaks and valleys so where there’s valleys, we’re going to meet them closer to where that is and start building from there. The collaboration with other professionals is huge – none of us are good at everything and 20 something years into this, I know you and I are constantly still trying to learn. I call you up like, “What do I do? How do I get a good sense of what’s going on here?” So being collaborative and always understanding there’s intentionality behind behaviors. I think that’s key, that we never go into this mode of “This behavior is really disruptive” or “These tantrums are lasting 45 minutes and they are disruptive so we’ll just ignore them and put them on extinction” To me, it’s about understanding why they are happening. I know from an ABA perspective, they’re going to look at function of behaviors. As a clinician, we can dig a little bit deeper. But in general, I think if we’re only focused on reducing behaviors, that’s problematic. I’m always looking for providers who are really big on being proactive and skill building. Yes, there will be some of as I build these skills, I’m going to look at how the route behaviors are reducing and maybe tracking that. There’s a skills missing and we have to figure out what that is. We have to support the child to be able to get there. That’s why they’re exhibiting the difficulties that they’re exhibiting. One of my favorite sayings is “kids are doing the best that they can with the tools that they’ve got at the time”. That’s not something to be punished, it’s not something to be ignored. It’s okay. What other tools do we give them or what environmental supports do we give them? How do we structure things by working with the teacher and working with parents and have this collaborative team approach so that everyone’s on the same page with having appropriate expectations and giving the tools where they’re needed?
Dr. Gwen: Absolutely, I love that there’s some base assumptions that you have to make. Going back to doing the best you can with what you’ve got at the time, our assumptions about our work and people is best intentions. They’re working as hard as they can and when you come at it from that point, then the answer is skill building or support. And I’m not saying that there aren’t times when there is intention or malicious behavior, I’m not saying that never happens. It’s still communicating something to us, usually anger, frustration, irritability, something along those lines. We have to try to understand what that is, but the other piece here too, Hilya, is the idea of regulation. That idea of “my body, my mind, and my brain is ready for learning.” Learning is the last thing we do. We got to make sure all this other stuff is cared for and provided for. I do feel like as I was listening to you talking about how to deliver ABA in this way, it sounds a lot like the framework of DIR Floortime. How do we understand someone’s neurological profile, their sensory profile, their processing, their language, their developmental levels? DIR Floortime provides that framework for you to understand who you’re supporting and who you are working together with. There’s so much that’s unsaid – I didn’t sleep well last night, my medication’s off, I haven’t been eating well because I’m a really picky eater – whatever it is, how does that play a role? So Hilya, as we think about all the kinds of ABA techniques and strategies, what would you say is one of your favorites?
Dr. Hilya: Starting with a good baseline and just taking small steps from there. Really being intentional, just kind of recognizing where kids are at is important for parents, for us as we’re doing the work that we’re doing. And then just not jumping too quickly; being able to know that “we’ve met this goal” doesn’t mean we’d just quickly go to the next step. Being able to as you learn something, you can stay there and strengthen it. This whole idea of fading prompts too quickly, you might see skills falling apart. It’s very often if we’re not mindful of that. We get the gains and we’re like “great, that’s done, let’s keep going forward” whereas you have to let things settle. You have to allow for very slowly and deliberately say “Okay if I pull the support, let me just observe.” And again, this is from ABA being able to be very observant. I’m not necessarily taking data of how frequently a child is maybe getting dysregulated when I’m interacting with them, but I’m mindful of what I’m doing having an impact. Is it promoting more of what I want to see or is what I’m doing making us go the opposite direction? That’s how I know if it’s working or not. That’s a very fundamental ABA principle, which I think is wonderful.
We don’t always know what tools are going to work for a particular child again because of their unique differences. We can try things, we track them, and we’ll see over time: Is it leading to improvements? If not, that’s okay! We have to stop and take a moment to regroup and try something different and see how things pan out over the course of a couple weeks. That’s one of my favorite things that I do with parents. You don’t have to know exactly what’s going to work and use that. You can try it and just watch and see what happens. If in a couple of weeks things seem to be getting better, then you’re probably doing something that’s helpful. If they’re getting worse or you’re not seeing any difference, maybe it’s time to try something else. Let’s brainstorm and come up with other ideas. It’s not imperative that we get it right. We don’t just have this one chance to get it right. Our behavior is a response to things happening over the course of time. Things that maintain behavior happen very slowly over the course of time and just in the same way, will take time to reshape and change in different ways.
Dr. Gwen: I’m guilty of this therapeutically and even as a mother, where I call it “getting greedy”. It’s like “Oh my god, it’s working, let’s do it more!” And now I’ve completely flooded somebody, I’ve overshot it because I was greedy, I was hungry for the yummy goodness of what was going on and not just letting it digest. The neurological systems that we work with are sensitive and vulnerable, so they need some time. It’s like “Back off, lady!” I imagine that’s a lot of times I say that to my clients. Tell me to back off, tell me I’m going too fast. You have permission to tell me to hold up a second and to allow that to happen.
So Hilya, I love this question, if you could only choose one skill to empower your clients with that could be parents as well if you wanted, what would it be and why?
Dr. Hilya: It would be insight or self-awareness. I think it’s kind of across the board of whoever you are. I think that is the single most powerful thing. It is why I do what I do. It’s to give my clients and their families the insight. For clients, it’s: Who am I? What are my strengths and stretches? What are the ways where I shine? Where are the places in which I need additional support? What environments are going to overwhelm me? It really is just being really clear and part of insight is being able to tune into your body. What feels like too much? What doesn’t feel right? And being able to pause and listen to that and honor that. Because if we don’t have that, we don’t get to the next step which is empowerment. It’s absolutely what we work on with teens and really recognizing what is it that I need. Being mindful, being aware of it and then being able to believe in it strongly enough to be able to speak up and say, “This is what I need.” In session for a client to be able to say “Woah, we’re going too fast” or “I’ve had enough of this today, I want to do something easy now”, that’s great. That’s honoring what your body and mind are telling you and if you can do that across your life, you’re going to do better socially, in your workplace. Knowing when to take a break, knowing what you need to reset yourself and come back so you can put forth your best self; those are so crucial and they’re big goals. We spend years working on that, kind of chipping away and trying to make that happen in small ways because it’s something that’s a work in progress.
Dr. Gwen: Yeah, totally. You and I both know that there’s so many competencies or skills under self-awareness and we tend to have to get very specific, all the way down to how tall are you, what color are your eyes, how much do you weigh. You can’t ask me that question, but I’m going to you this question! It’s funny because self-awareness is limited so much that you’re having a difficult time describing your body, your physical characteristics. I can’t tell you how many times my adults can’t answer these questions and they’ll pull out their driver’s license and read it to me. I know you didn’t fill out that form, your mom did! It just shows me we need to empower you with this tool so that you can then advocate and communicate and self-manage and have relationships and solve your problems and set some goals. I wholeheartedly second that skill.
Hilya, if anyone’s listening to this interview and they’re interested in finding out more about you, what’s the best way for them to do that?
Dr. Hilya: My website is the best way, all my contact info is there. It’s ConnectedStrides.com. Feel free at any point through there you can reach out through email or phone, I’m happy to consult. I have a facebook page, but really my website is the main way to find me.
Dr. Gwen: Awesome, thank you so much Hilya for spending time with me today.
Dr. Hilya: Oh, you’re welcome it’s been a pleasure.