The ABA and PT Podcast

One of the most effective ways to teach kids with limited skills is with activity schedules. These can be checklists or simple visual stimuli that allow kids to match activities to tasks that need completing.

Recent studies reinforce its effectiveness and Mandy and Aditi's own personal experiences provide you with actionable tips that you can apply to your own clients. Activity schedules are flexible and you can program them based on the skill levels of your students with high rates of reinforcement.

HIGHLIGHTS

02:18 Shoutout to Bethan Mair Williams

04:40 Activity schedules promote independence at home

12:47 Instructional control allows effective application of activity schedules

22:11 Activity schedules: Examples that work

28:39 Reinforcement and difficulties in scheduling activities 

38:00 Programming activity schedules based on the student's skills

GLOSSARY

Instructional control - ABAs may also call this compliance, engagement, and history of pleasant experiences such that a person feels motivated to complete tasks for you.

Premack's principle - A theory of reinforcement that states that a less desired behavior can be reinforced by the opportunity to engage in a more desired behavior. 

RESOURCES

Join our The ABA and OT Podcast Facebook Group to get access to the following resources:

Facebook group link: https://www.facebook.com/groups/397478901376425

EXTERNAL RESOURCES

Aditi's Website

"Activity Schedules for Children with Autism: Teaching Independent Behavior" Book by Lynn E. McClannahan 

"A Review of McClannahan and Krantz's Activity Schedules for Children With Autism: Teaching Independent Behavior: Toward the Inclusion and Integration of Children with Disabilities" by Ruth Anne Rehfeldt

University of Kansas Princeton Child Development Institute - McClannahan and Krantz are faculty members at this institution 

QUOTES

07:03 "The activity schedule is a really good way of being directed independently, not so much by him, but for him, he was reading at this stage so a written schedule to complete activities. And he actually loved it."

10:36 "The actual skill of observing, looking at some stimuli, either a shape or picture of the item, it can be anything that matches an activity to something that has to be completed, and complete that activity and then move on."

31:30 "It doesn't stay in place very long if it's not working... that's probably the hardest part is to make sure you have enough crossover with parents or a method of them getting help if they need it."

36:54 "What often comes up is you have kids that really want to complete an activity and so you have to teach flexibility around leaving tasks not completed. For instance, do a jigsaw puzzle for 10 minutes where the puzzle's not completed."

37:39 "You can vary and build in flexibility time into it. You can get them to self-check some work that they previously did or complete a homework task or do their spell words. So yeah, you can really use them in a lot of different ways depending on the skill level."

Shoe tying is particularly tricky to teach to kids who are on the spectrum. This episode shares strategies to overcome obstacles in teaching this ADL, as well as adaptations you can use with students.   

Mandy and Aditi share the various component skills needed for shoe tying and the effectiveness of using precision teaching, tag teaching for instructing without distracting, and video modeling.   

HIGHLIGHTS

01:48 Shoutout to the Complete Anatomy App

03:33 Recap on Sam's fine motor, fluency, foundation skills

08:59 OT and ABA perspectives: Prerequisites and strategies for shoe tying

23:09 Teaching component skills of shoe tying

33:13 Tag teaching: Extremely useful for shoe tying and much more

37:53 Video modeling: A case-specific medium for tighter delivery controls

GLOSSARY

TAG (Teaching with Acoustical Guidance) - TAGteach is a teaching and training technology based on the application of the science of behavior that focuses on the structured application of positive reinforcement. 

RESOURCES

Join our The ABA and OT Podcast Facebook Group to get access to the following resources:

Facebook group link: https://www.facebook.com/groups/397478901376425

EXTERNAL RESOURCES

Complete Anatomy App Android Download

Complete Anatomy App Apple Download

Clicker Training by Karen Pryor

Association for Science in Autism Treatment (ASAT)

QUOTES

13:05 "This signal is a very distinct cue to say this is where you need to look right now. And then, when you are instructing them around the shoe, the pencil or signal goes down to the shoe and go this is where your eyes need to be right now."

21:14 "Incorporating that fluency piece made a world of difference because for that 10 minutes what we would do I would tell them, alright, Johnny, you've got 10 trials. I want you to get through 10 of step 1 and then you get to play with Playdoh, whatever, and he was so motivated."

29:41 "Actually, kids love it because you can set them a personal best, right? And say, last time you did this 10 times and if you do this 11 times this time, you get a token or clicks or a break. So that was step 1 and 2."

35:51 "You can use it for anything where you don't want to stop instruction and go, oh I love the way you said that. You just go tag and they know that they got it right. So there's a million uses for tag teaching but particularly with shoe tying it is awesome."

38:17 "Video modeling is effective because it allows more tighter control over the delivery of instruction. What did they call it, antecedent instructional prompting, and then videos can obviously be produced, edited, re-edited, based on what they need."

Teaching basic activities of daily living (ADL) to children with autism requires a more involved and understanding approach. This was the case with Sam whose progress in fluency was positively impacted by applying the Big 6 + 6. 

In the beginning, Sam exhibited many errors in component skills but instruction with the Big 6 quickly improved his ability to play and manipulate objects. Teaching these component skills enabled Sam to engage with his environment and practice higher-level skills used in ADL's. 

HIGHLIGHTS

02:09 Shoutout to Abigail B. Calkin

06:01 Sam's development: What didn't work and fluency targets

17:32 The Big 6 + 6: Improving fine and gross motor skills for ADL's 

28:05 Working with Johnny: Introducing awareness of his thumbs 

35:18 Training to fluency: Teaching component skills for higher-level skills 

GLOSSARY

Forward chaining - A data-driven technique that reaches a goal using the available data 

Backward chaining - A goal-driven technique that starts from the last component of the skill and reaches the initial state 

Bilateral integration - The ability to use both sides of the body at the same time which is important in performing ADL's 

The Big 6 + 6 - Six fine motor skills to assist in ADL's, (reach, touch, point, place, grasp, and release) with the plus six (push, pull, shape, squeeze, tap, and twist) which are gross motor skills to assist in manipulating larger objects.

Learning channels - Refers to what sensory input and output a skill is using   

RESOURCES

Join our The ABA and OT Podcast Facebook Group to get access to the following resources:

Facebook group link

EXTERNAL RESOURCES

Inner Behavior: Empirical Investigations of Private Events by Abigail B. Calkin

Abigail B. Calkin's website

The Effects of Fluent Levels of Big 6 + 6 Skill Elements on Functional Motor Skills with Children with Autism by Twarek, Cihon and Eshleman

Peak: Secrets from the New Science of Expertise Book by Anders Ericsson

QUOTES

09:19 "We took baseline data on many of the component skills that look at hand strength and your ability to successfully engage in things like buttoning and shoe-tying and feeding yourself, etc."

18:53 "We started by teaching him the Big 6 and, all of a sudden, it was so exciting, he started manipulating objects and we were able to teach him cause and effect, which then reinforced him playing with things like pushing money into a money box."

27:49 "Pointing is obviously culturally a very important skill to be able to say, even if you can't talk, I see something that's of interest to me that I want to draw your attention to. So pointing is such an important skill within our culture."

31:50 "In free operant instruction, fluency-based instruction, the instruction is given once so the expectation is raised once, and then the learner engages freely in that and gives them a lot of opportunity for a lot of practice without any prompts."

36:16 "If you have identified that this is a component skill of a higher-level skill, you can train the lower-level skill but check the higher-level skill to see if your teaching is showing up in higher-level skills."

Mandy and Aditi continue to examine Sam, a 9-year old client with autism with aggressive behavior. As OT's and ABA's have different assessment tools for fine motor development, this episode explores the goals and methodologies they use to improve Sam's fine motor skills.  

ABA tests range from handwriting and the grip and pinch strength test while OT assessments use examples like the Silly Bug, the Superman extension pose, and core strength. These assess behavioral fluency and aims which are reflected in competent performance and higher-level skills.  

HIGHLIGHTS

02:52 Shoutout to Elizabeth Haughton

07:09 Sam's case study: ABA assessment goals and tools

17:10 OT assessment goals and tools for fine motor development

31:58 Importance of Aims and fluency

GLOSSARY

Grip and pinch strength - A baseline assessment tool used for baseline data for intervention 

Dynamometer grip and pinch strengthening tools - Tools that measure how hard a child can squeeze and pinch

Behavioral fluency - The fluid combination of accuracy plus speed that characterizes competent performance 

Adduction - Showing up in novel skills that you have never trained before 

RESA - Retention, Endurance, Stability, and Application 

RESOURCES

Join our The ABA and OT Podcast Facebook Group to get access to the following resources:

Facebook group link: https://www.facebook.com/groups/397478901376425

EXTERNAL RESOURCES

Dr. Aditi the OT website

Handgrip Strength: A Population-Based Study of Norms and Age Trajectories for 3- to 17-Year-Olds

Behavioral fluency: Evolution of a new paradigm

QUOTES

12:35 "The first part of our assessment was putting a pencil down and picking it up because that is a component of fluent handwriting is being able to reach out for a pencil and pick it up very easily without having to think about adjusting."

17:55 "For fine motor, the Bart's really good, but also I would do strengthening. I would look at his strength and range of motion. And most OT's know about strengthening tools but a lot don't use the measurement tool because we typically don't take baseline data."

25:25 "First, I would assess flexion, and this is called, you probably did this with Sam, the Silly Bug. So the child lies on their back, cross their arms over their chest, legs are bent, head lifted off the floor, and they have to keep this sort of crunchy, silly bug position."

35:07 "A count per minute by skill that, over time, we have worked out that when the skill is taught to that rate like a count per minute, you have that skill and you never lose it, or you get it back with just a little bit of practice."

39:46 "We want kids being able to form between 80 and 100 letters per minute so that when they come spell word, they're not thinking about how to form their A or Z, whether they're doing their Z backwards or not. So that's why aims is so important."

43:39 "If you want a child to do something easy and effortlessly, look at what fluent performance is for that skill and measure it."

Aggressive behavior in children can be a real challenge for therapists and family members. This episode examines the case of Sam, an extremely aggressive child, and the OT and ABA behavior strategies that worked and didn't work for him.

Mandy explains how she began her collaboration with an OT to work out a behavior plan for Sam and the steps they took to produce improvements. Mandy and Aditi explore the points of collaboration between the two professionals and how their interaction can be used as a learning tool for others as well.

HIGHLIGHTS

02:48 Shoutout to the Ask for Evidence campaign

03:37 Case study: Sam's aggressive behavior 

14:28 Strategies with Sam: Where to begin

21:01 Strategies that needed fading out

25:45 Early teaching goals

29:58 Starting the OT and ABA collaboration

GLOSSARY

Light switch on and off protocol - A procedure of extinction on behaviors maintained by automatic reinforcement. This is commonly referred to as “sensory extinction.”

Red card, green card protocol - A procedure using two stimuli (red and green colored cards), conditioned via discrimination training, to reduce motor and vocal stereotypy in a youngster with autism.

Escape extinction - A procedure of extinction on behaviors maintained by negative reinforcement.

Variable ratio of reinforcement - In operant conditioning, a variable-ratio schedule is a schedule of reinforcement where a response is reinforced after an unpredictable number of responses. This schedule creates a steady, high rate of responding.

Signal - Directing eyes for instructional control 

Behavioral Skills Training (BST) - A training package that utilizes instructions, modeling, rehearsal, and feedback in order to teach a new skill. Typically training is implemented not for some fixed time, but rather to some predetermined criterion.

The Big 6+6 - In the Precision Teaching world, there is a set of 12 discreet fine motor movements which are the components of more complex skills. Being able to accurately and quickly complete these movements can lead to the successful performance of more advanced and functional tasks like dressing, eating, bathing, playing with toys, and writing.

RESOURCES

Join our The ABA and OT Podcast Facebook Group to get access to the following resources:

Facebook group link 

EXTERNAL RESOURCES

Ask for Evidence campaign website 

Sense about Science website 

The Effects of the Big 6 + 6 Skills Training on Daily Living Skills for an Adolescent With Intellectual Disability 

QUOTES

12:23 "We taught him, over time, how to use Minecraft and how to build things and that allowed us to engage with him. He just developed this amazing interaction and all of a sudden we had an ability to instruct him and compete with that aggression."

15:20 "Those items were always directed at a person, so straight away that tells you that it's not self-stimulatory behavior. His mother accounted to me, he'd never throw things when left to his own in his room."

19:03 "Once we had him waiting for about 20 to 30 seconds, we knew we would have the ability to 20 or 30 seconds of work. So we started to introduce some very very simple skills."

28:05 "Improving his eye ticks made the most dramatic improvement in his aggression because he wasn't being corrected so he wasn't getting negative attention from having to repeat tasks."

38:10 "We did a combination of her fine motor strengthening goals, we used her core strengthening goals, then we brought in the Big 6 as well."

Evidence-based practice can be a touchy subject for ABAs and OTs alike. Dr. Josh Pritchard of the Lodestone Academy shares his insights on collaboration and the strengths and weaknesses of single-case design versus group-case design.

Dr. Pritchard discusses the groundbreaking study that put standards in place for sensory integrations for children with ASD. He further provides ways that ABAs and OTs can improve their collaboration by using measurements to determine the effectiveness of their interventions.

HIGHLIGHTS

01:50 Introducing Dr. Josh Pritchard

08:54 Research and OT strategies: Challenges to collaboration 

17:19 Evidence-based practice: Single case design vs group design

29:57 The Bedtime Pass

33:51 Discussing the study "Effectiveness of Sensory Integration Interventions in Children With Autism Spectrum Disorders"

38:49 Insights for OTs and measuring the effectiveness of their interventions

GLOSSARY

Single case design - Takes a single unit, many times a single person, or a setting or small group of people but treated as a unit, and use that unit as its own control, and involves repeated measures, and manipulation of a single, independent variable in specific patterns.

Group case design - Uses the same kind of control but using averages of the measurement across each group and compares using statistical analysis. The goal is to find statistical significance. 

RESOURCES

Join our The ABA and OT Podcast Facebook Group to get access to the following resources:

Facebook group link: https://www.facebook.com/groups/397478901376425

EXTERNAL RESOURCES

Fit Learning Website 

Fit Learning Australia

Effectiveness of Sensory Integration Interventions in Children With Autism Spectrum Disorders: A Pilot Study 

QUOTES

20:36 "In single case, you control that by only changing one thing at a time and changing it in specific patterns to eliminate or minimize randomness or confound." 

20:47 "In a group design, you do the same kind of control but the way you control is you take averages of the measurement across each group, and then you compare those and you use statistical analysis."

22:20 "We are an inductive approach so that's sort of bottom-up. We want to gather lots of data and look at it and discover patterns versus a hypothetical deductive approach, which is sort of top-down, come up with a theory and then try to just prove it. And if you can't disprove it, then it's good."

27:24 "The single-case design is good for the development, refinement, make more efficient a technology and then you can extrapolate that. I think this'll work for many. The group-design actually is good for telling the effectiveness and does it, in fact, work for most people."

43:17 "The challenge to the behavior analyst and the value of the OT, there's some stuff we want to change in life that's got the je ne sais quoi of, I can't say what that is but I can say when it's happening or not. And we got to dive in and what is that?"

Bedtime resistance and frequent night wakings are a source of frustration for many parents. This episode talks about the biggest mistakes parents make in establishing sleep patterns, as well as the Bedtime Pass, an effective intervention designed to address bedtime resistance.

They also discuss the case of Liv and her mum and how they used the Bedtime Pass to modify sleep behaviors. This case was particularly difficult because of the deteriorated relationship between mother and daughter. However, the Bedtime Pass was an effective tool in creating a positive outcome for better sleep and more compliance.

HIGHLIGHTS

01:56 Shoutout to the Association for Science in Autism Treatment (ASAT)

06:21 Mistakes with establishing sleep habits with children  

12:47 Technology, blue light, and its impact on sleep

18:07 The ABC model of behavior 

28:04 The bedtime pass: Explaining the study that established it

32:30 Discussing the case study of Liv

GLOSSARY

Reinforcement - Anything that happens after a behavior that strengthens that behavior or makes it more likely to occur again

Extinction - Removing pleasant consequences that have occurred previously

Extinction burst - The reaction to a stimulus that once produced positive reinforcements, but now ceases to exist

Bedtime Pass - An intervention to address bedtime resistance using a card with the child's name on it that can be redeemed for one thing like a glass of water, hug, or toilet visit.

RESOURCES

Join our The ABA and OT Podcast Facebook Group to get access to the following resources:

Facebook group link: https://www.facebook.com/groups/397478901376425

EXTERNAL RESOURCES

Association for Science in Autism Treatment (ASAT)

QUOTES

11:11 "If we don't teach kids to fall asleep on their own, they become dependent on some crutch, either parents or something else to assist them to go to sleep. And breaking that habit is extremely difficult."

14:12 "Blue wavelengths, specifically, which are brilliantly beneficial for daylights hours because they keep us alert. They boost our attention, reaction times, mood, etc., they have an equal and opposite effect at night."

22:22 "What all of our hundred years of science reinforces is it's what happens after a behavior or the consequence that determines whether it occurs again."

30:59 "In general, we know that behavior that has been intermittently reinforced is more resistant to extinction."

38:21 "Behavior rehearsal of any intervention that I do is to make sure that the child is practiced and rehearsed and it can be done in a really fun way. And you can do it as a game."

Sleeping challenges in infants and toddlers, especially those with ASD, can prove debilitating to parents. Mandy and Aditi discuss sleep patterns and disorders and give two perspectives on this complex yet essential aspect of life.

They share their personal experiences with sleep issues and define what sleep is according to sensory and behavior perspectives. Mandy and Aditi also explore how both fields approach interventions, the importance of documentation for effective intervention, and the ways to analyze factors like environment and habituation that influence a child's sleep.

HIGHLIGHTS

01:22 Shoutout to Dr. Patrick Friman

04:12 Personal experiences with sleeping challenges and methods

12:37 Discussing sleep: Two perspectives affected by culture and habituation

41:59 Integrating ABA and OT for sleep disorders

52:44 Differences between ABA and OT sleep interventions

GLOSSARY

Graduated extinction - Using longer and longer periods of time to attend to the child. 

Faded Bedtime Procedure - Pushing back bedtime from baseline measurement and keep the child awake through any means possible for a longer period so they are more likely to go to sleep.

Escape extinction - The discontinuation of negative reinforcement of a behavior.

Sensory diet - The therapeutic use of sensory activity that is embedded in the daily routine.

RESOURCES

Join our The ABA and OT Podcast Facebook Group to get access to the following resources:

Facebook group link: https://www.facebook.com/groups/397478901376425

EXTERNAL RESOURCES

Behavior Analysts to the Front! A 15-Step Tutorial on Public Speaking by Dr. Patrick C. Friman 

Sleep Assessment and Treatment Tool (SATT) by Dr. Gregory P. Hanley

Brief Infant Sleep Questionnaire (BISQ) by Dr. Avi Sadeh

Applied behavior analysis measurement, assessment, and treatment of sleep and sleep-related problems by Dr. James Luiselli

Occupational Therapy Practice in Sleep Management: A Review of Conceptual Models and Research Evidence by Eris C. M. Ho and Andrew M. H. Siu 

QUOTES

12:56 "Babies sleep an average of 16 hours in 24 hour period and it's reported that between 20 and 30% of children experience sleep problems and 40 to 80% of children with developmental disabilities have sleep disorders."

18:57 "Perhaps the behavior of falling asleep is reinforced by sleep. In other words, what happens before sleep, from a behavior analyst, results in sleep and that component of sleeping is partly operant and the falling asleep is the end of a chain of behavior."

28:00 "As soon as you start reinforcing any behavior that might be either syncing or blocking sensory stimuli, you add a behavioral component as well." 

39:30 "When you add in a bedtime resistance, it can come about by sleep onset delay, and then potentially you have a complex combination of both biological, circadian, and neurodevelopmental factors as well that are influenced but not solely attributable to environment and behavioral variables."

46:32 "Sensory disorders impact sleep differently. Sometimes it might be the routine leading up to bedtime which is dysregulated or perhaps the child is so overstimulated from the day that they can't settle down to go to sleep."

ABAs and OTs look at early learning from two very different lenses. Mandy and Aditi define terms according to their sciences and give their insights on the case of Stella, a premature baby.

They take a closer look at the sensory and behavioral aspects of early motor development and the roles of classical and operant conditioning. Mandy and Aditi also explore tactile defensiveness, habituation, and desensitization which are all used to accelerate early learning and therapeutic outcomes.

HIGHLIGHTS

01:27 Shoutout to Dr. Kimberly Berens

08:38 Debunking myths: ABA's only deal with ASD clients

11:45 Two perspectives: What does early learning look like?

19:35 Reflexes: Learning through respondent and operant conditioning

27:55 Sensory processes in preemies

38:25 Case study: Interventions with Stella the premature baby

GLOSSARY

Primitive reflexes - Unlearned behaviors that are automatic responses that are essential for survival

Reflexes - Purpose of the reflex is to provide a baby with an internal alarm system to protect from danger 

Little Albert Experiment - A study that looked at fears or phobias in conditioning in infancy (Pavlovian conditioning) 

Tactile defensiveness - A pattern of observable behavioral and emotional responses which can be aversive and negative and out of proportion to certain types of tactile stimuli that most people would not find painful.

RESOURCES

Join our The ABA and OT Podcast Facebook Group to get access to the following resources:

Facebook group link: https://www.facebook.com/groups/397478901376425

EXTERNAL RESOURCES

"Blind Spots: Why Students Fail and the Science That Can Save Them" Book by Dr. Kimberly Berens - https://www.amazon.com/Blind-Spots-Students-Fail-Science-ebook/dp/B08HNJYW3T

QUOTES

15:54 "Behavior analysts believe that things unfold by exposure to the environment and by consequences delivered to those behaviors."

16:21 "For OTs, the developmental milestones serve as a general guideline or roadmap, if you will. They aren't necessarily a benchmark because we know that every child has their own timeline and trajectory."

30:40 "Learned behavior occurs through experiential learning while unlearned is more of a combination of biology and sensory experiences that occurs very early on."

35:47 "We know that there is a  biological basis for sensory processing differences which can lead to poor processing of sensory information and, in turn, results in atypical perceptions of pain and discomfort."

49:04 "I think we can empower parents if we make it very specific what we're asking them to do and teach them to take data to see if what we're prescribing is working or making it worse."

What is the impact of sensory and behavior on early survival skills? Mandy and Aditi begin with a case study on Aditi's son Tristan who was diagnosed with failure to thrive. 

Mandy and Aditi also refer to a behavioral feeding program where differential reinforcement was used alongside other interventions to build adaptive eating repertoires. They also talk how a collaborative sensory and behavior approach can develop a hypothesis and the need to exercise caution when using profession-specific terms to avoid miscommunication.

04:36 Shoutout to Margo B. Holm

05:45 Case study: Tristan's early feeding problems

12:57 Differentiating sensory and behavior: Interoception and Dead Man’s Test 

22:49 Early feeding behaviors and the sensory hypothesis behind it 

30:14 A behavioral feeding program for failure-to-thrive infants by Larson, Ayllon, and Barrett

42:12 Key takeaways

Interoception - The perception of sensations from inside the body and includes the perception of physical sensations related to internal organs like the heartbeat, respiration, and satiety.

Dead man test - If a dead person can do it, it's not behavior. If a dead person can't do it, it is behavior. Examples: laying still, falling down stairs, being noncompliant, sitting in a chair.

Unlearned (respondent) behavior - Behavior that a baby does not need prior learning to engage like survival mechanisms (feeding, suckling).

Differential reinforcement - Promotion and strengthening of behavior we want to see again and weakening what is reinforcing behavior that we want to reduce.

Punishment - Something that reduces a behavior.

Join our The ABA and OT Podcast Facebook Group to get access to the following resources:

- Early Feeding - Failure to Thrive Glossary of Terms for ABA & OT

Facebook group link: https://www.facebook.com/groups/397478901376425

https://www.researchgate.net/publication/270026479_Our_Mandate_for_the_New_Millennium_Evidence-Based_Practice - Our Mandate for the New Millenium by Margo B. Holm

https://nebula.wsimg.com/3783318e9b2543b7e5a133adb3b0bafb?AccessKeyId=1133D4CF8F18F0339400&disposition=0&alloworigin=1 - The Dead Man Test by Ogden Lindsley

https://www.sciencedirect.com/science/article/abs/pii/0005796787901136 - A Behavioral Feeding Program for Failure-to-Thrive Infants by Karen L. Larson, Teodoro Ayllon, Drue H. Barrett

08:38 "My OT brain started going okay, I have ruled out all medical issues, so what's next? Then I was like there's got to be a sensory facet to this. This is when I started thinking about interoception."

21:44 "Since receiving and reacting to sensory responses, whether it's intrinsic or extrinsic, a dead man cannot do, therefore all sensory responses would actually be considered a behavior."

34:41 "They cautioned that the use of music alone was not recommended and that the adaptive eating was consequated by food and social attention primarily and while music was to mask the beginning of the feeding cycle, that it wasn't the primary reinforcer."

41:04 "We use terms that are very specific and defined but they also often have a common meaning as well such as another term that behavioral analysts use is punishment which often has a really negative connotation."

42:14 "The key takeaway, it's really about coming up with a sensory behavioral approach to develop a hypothesis. In this case with the baby, an infant who is in failure to thrive."