Applied Behavioral Analysis - Autism Explained

hey guys um i'm doing this video non-scripted as well but this happens to be a subject i know much more about and you know we're not talking about attention in general so i have an actual path that i have talked about this numerous times with different people it's practically routine by this point plus i'm going through some specific studies and some other examples so keep me on track anyways um i left yesterday off saying i didn't know what the video was going to be on and i obviously know earlier today a friend messaged me uh some [ __ ] about this psychologist that really shouldn't be a psychologist going around social media pushing the anti-vaxx thing and me and him when digging through her history even going to the extent of like reading her doctoral dissertation um unsurprisingly i somebody who's good at finding that stuff oh my god it is bad really bad but it became pretty clear this woman despite several degrees and a doctorate in psychology no medical training is one of the anti-vaxxers specifically the vaccines cause autism group which means the very large amount of autistic patients that she claims to take on and support probably not doing the best of jobs and i've had some similar experiences in my childhood but talk a bit about but i want to keep this mostly pretty general so we're going to be talking about unintended consequences of therapy and malpractice some of it is going to border into abuse some of it was even considered human rights violations because it was bad enough now to go beyond abuse into actual human rights violations getting recognized by the u.n uh much more difficult so you can imagine how badly somebody messed up the organization messed up uh reached that level numerous therapies were tried for autism over the decades i figured the formal recognition of the diagnosis has gone on for about a hundred years now um been documented in literature for the earliest one that i know of goes back to lutheranism uh martin luther described a child that would have been what we now consider a level three um but the earliest medical example i i can think of goes back to a civil war doctor from the united states civil war um who honestly i think had more or less the right attitude that civil life um city life great forum you can move out to the countryside less social interaction the better just focus on skill development not social development and they're gonna be mostly fine and they mostly were um it never really got felt like a need to formally uh describe the condition because it wasn't from any of the medical literature describing the symptoms not just the behavioral ones but the all of the symptoms that i've talked about already and some others that we will cover these kids matched that and it wasn't a problem for the longest time in fact you really only started to see oh we'll cover that in the middle hans asperger [ __ ] [ __ ] for many reasons but parts of his description asperger syndrome were pretty spot-on noticed that these kids were less sociable but there was a tremendous aptitude for the sciences part of the stereotype we all recognize today and it's not wrong the three havens for the autistic stem i'm including oh yeah tech is part of it that's trade work and acting i'll get into that in another video but yes acting the thing that you wouldn't think we'd be able to do well is one of the havens for employment when you're autistic severely over represented in acting you probably if you've watched the other videos probably thinking okay and maybe i can see that we'll get into more of my video where you started to see the stigma towards autism get a lot worse was when a particular school of psychology one that is very useful for the problems that it is meant to address got applied to autism applied behavioral analysis from the behaviorists i'm going to read a passage from one of these articles that i'm citing as always links down in the video description um but this is from uh eileen herlinda sandova norton and others how much compliance is too much compliance and there was [Music] applied behavioral analysis is a form of behavior modification that relies heavily on external reinforcement both positive and negative of the operant conditioning aba is intended to modify or diminish behaviors as well as increase language communication social skills attention etc children autism spectrum disorders and however this conditioning only applies to one skill and once they have mastered it the conditioning subsides conversely many children with asd are taught the same task or skill for years using the same conditioning techniques yet mastery has never met anybody who's done education that should be a red flag like either you're not going to get it at all but there's plenty of autistic people who do and from numerous things it seems to converge all of the same skill sets and perspectives and everything else that doesn't seem to fit or we're approaching it the wrong way which spoilers approaching their own way and there was one other part of this where was it okay in fact schools aba specialists and researchers are learning that such intensive and chronic conditioning has instead mounted to compliance low intrinsic motivation which is why the autistic who go through aba are often described as lazy whereas the ones who don't are actually out there leading the most productive lives that they are able to and often rather productive lives not necessarily in the workplace that's a huge problem but able to do a lot of things that they enjoy and just get satisfaction out of life rather than doing the bare minimum required to appease the apa therapist and a lack of independent functioning that one is a huge issue because we are talking about taking people who have a difference a condition if you are adamant and calling it that that's fine for the purposes of this discussion i'm not going to argue against that but a condition that you can go through life with and be fine be a productive member of society this therapy was actually recognized to turn it into the disability that is widely known as it's not autism that led to the disability it was the treatment for autism that led to the disability again sources down in the video description one of the common things aba proponents say is oh this really does help and it's just your personal opinion that you don't like but no the science behind it is that it is bad we'll get into a little bit on why and what we missed but it is not our opinion alone the latter of which is the presumed goal of aba therapy in the first place dependent functioning perhaps because aba therapy is considered effective in verbal children and in typical children for select tasks where it is legitimately useful the assumption is that an even more intensive approach would be suitable for nonverbal and or lower functioning children with asd trying to get away from that language i use it sometimes but the attention is regardless researchers have indicated numerous problems with the underlying theory of aba um not aba itself aba applied to treating autism because aba is useful for actual behavioral problems but we've gone over and we'll talk about more in this video a lot of these behaviors from autism actually have underlying internal things going on and are either adapting to them or results of them we'll touch up on that specifically unintended consequences such as prompt dependency among other issues so uh prompt dependency is a requirement for the individual will be prompted to do something else you see this in the workplace with individuals who have gone through aba therapy but it's essentially conditioning to the point that you need somebody else to tell you to do something because you essentially had your own sense of agency and self-directed uh destroyed which is a horrible thing to do to another person and there's there's a lot more in this i'm not going to read the whole article because that would potentially put me a copyright violation because then it's no longer transformative but also you you know how to read you you read aba why i'm saying it's defensible but not for autism aba originates from behavioral analysis the idea is we don't know how to test for internal things so we're only going to treat the external kinda see a problem they look at everything as behaviors and that's fine if it's a behavioral problem but ignoring any internal things i'm not going to repeat the things i've talked about in previous videos but one fantastic one i can bring up because behavioralists um especially the aba guys have a massive problem with it and you just you're going to understand why you shouldn't want to explain it rocking back and forth a behavior that you need to teach the kid not to do it's not socially appropriate it's not but what's going on that causes the need to rock back and forth i've described sensory differences anomalies whatever you want to call it some people describe it as sensory modulation some a synaesthesia as evidence there's a lot of different things going on and we don't know how to best characterize it but it's clear that there are sensory things going on one of those things that can happen is with your sense of balance since the balance gets thrown off you start feeling like you're falling or otherwise moving when you know you are not it creates a weird disconnect in the brain but it can't quite resolve it just on its own your ears or rather the part of your brain that processes the inner ear uh your sense of balance that's where that comes from something's whack at the moment the motor parts of your brain are going yeah i'm not moving i know i'm not moving how do you resolve that well we know from plenty of cognitive psychology experiments that if you have one messed up sensory stimulus and you can present several more that agree with each other but don't agree with the messed up one that your brain will just start ignoring the messed up signal you feel like you're moving when you're not so why don't we try moving this for whatever reason presents as rocking back and forth and it works fantastically well the feeling the literally nauseating feeling goes away you rock for a few minutes and you're fine clearly this is not something aba would help this is not actually a behavioral problem this is a behavior resulting from internal factors that behaviorism does not like to look into so does that mean you should go rocking in back and forth in a chair in the middle of a restaurant no we can help sort of i look i in an ideal world yes you'd be able to i would love a situation where all of these problems are so well understood that it's not stigmatized anymore but the simple reality is we live in a world where tons of things are stigmatized not understood and tons of other problems i mean look at how long mammary glands and breastfeeding have been a thing and yet this is still a debated issue in society so realistically speaking you're gonna be able to rock back and forth in the middle of a restaurant because you feel like you're falling when you're not now what i do and what a lot of people could easily do just take take a few minutes step outside in your car a bathroom movement alone is often enough to do it take a walk around the restaurant if it's not from that same sensory thing that i described talk about it see what options people can come up with see what you can do that is more presentable but still meets your needs as well if your child is doing this talk to them if they're non-verbal i've talked about that in another video you computers are literally everywhere talk to them even if you're not getting feedback i promise they understand you give a bunch of explanations different options for how that could be addressed in a way that isn't going to get people giving them the evil eye they can still meet their needs in a more appropriate way that's better for everybody another one of the problems with aba is it kind of implies that the reason well not kind of i've literally just described that for several minutes it does imply that you are wrong for being the way you are and that the reasons for why you do things don't matter this has de severely debilitating effects on somebody's mental health this has caused a very large amount of self-loathing and there's some research that even found it considerably increases the rates of ptsd in adulthood this is not helping it looks like it's helping and it does help for several years which is why for it it got accepted and so prevalent longitudinal studies matter and a lot of research is really bad in longitudinal studies but autism in particular is pretty bad when it comes to logical studies one of many complaints about autism research is that it often doesn't go beyond 18 years old one of the biggest problems aba causes or contributes to i got plenty to criticize about aba to be fair it does not cause this it contributes to it we could probably prevent this phenomenon aba is making it much worse autistic burnout this is similar similar to professional burnout or depression but it is a unique phenomenon i'll talk about this in another video maybe the next one the first burnout experience that an autist experiences is typically just after they turn 18 usually about 18 to 20 is when it happens now again if the effect efficacy of aba is being analyzed in childhood and typically going no longer than until they're 18 they are missing the major negative effect that it has so it looks like it helps for a while for many years but it doesn't i gotta check a stake i'll pick right back up after all right i got myself a full belly so the talking about aba sort of finishing that up um one of the other findings was that aba also instead of conditioning fixing the behaviors because again the behaviors have rather important internal causes they're addressing symptoms that maybe should be treated maybe just need to be learned to dealt with in a different way hannah the unintended effect of conditioning the conditioning what do i mean there that instead of fixing the behaviors the autists wind up learning about reward expectation similar to the need to be prompted to do things this can sort of be generalized as clients you're having your sense of agency an incredibly important concept in mental health beat out of you and you just sort of comply with the therapist which i'm going to actually make the pun here in another video we talked about the considerably higher rates of abuse towards the autistic and this is sort of similar to that see you don't just wind up more compliant with the therapist this is probably an additional confounding factor behind the compliance with the rapist one of the biggest strategies they have been shown to utilize when it comes to the um anything ddid so developmentally disabled or intellectually disabled is exploiting rewards and here you have a therapy literally setting them up for that conditioning them to be reward seeking to be compliant with authority figures where aba works is when you have things like oppositional defiant disorder where there is a behavioral problem that needs to be addressed where a higher degree of compliance is actually appropriate because their level of compliance is so bad that you're correcting it to a normal level but if what you have isn't a lack of compliance if it's not defiance what are you really doing getting them set up or really not okay things now in some cases these approaches get taken to a much more extreme level towards not applied behavioral analysis anymore it's abuse or human rights violations i'm going to link to a video to a creator who does a much better job describing this puts a lot more effort into her videos because that's how she makes her money i don't make my money through these so i don't put a crap ton of effort a lot of work ahead of the video researching things but my editing i don't edit most of these if i do it's like color grading um illuminati covers it uh autism's electric our autism speaks electrifying past uh we'll get into autism support agencies advocacy agencies uh in another video as well autism speaks is horrible uh they're much better ones like aane and asan the more interesting part of that video is with the judge rotenberg center i'll follow up with that video she described sort of the history behind that how it got named after a judge the [ __ ] up history there but the important takeaway and i don't think i watched this a while ago i don't think she touched up on this because this seems to be a more recent thing um this is what i mean by the un declaring somebody as guilty of human rights violations yeah there's some hefty implications there that the us has to deal with that make some changes at the government level because of that that's a whole messed up thing well the other thing i'm going to do is link to a video of when a media uh group i think it was cbs uh first broke story um sort of what bought the un interested um because they're essentially just tasing the [ __ ] out of autistic kids when they don't behave the way other people want them to which beating a child or a spouse ever got them to behave the way you want them to no that's no why is escalating that to the point of tasing them to the point where they get burns going to address that you know we reserve those kinds of things for criminals to stop them in one of the least damaging ways possible but they're criminals this is being done to children that are not engaging in criminal activity any decent psychologist is going to tell you that that kind of environment is going to cause behavioral problems not resolve them a cycle of abuse is pretty well known you abuse somebody they go on to abuse that's creating the problem it's meant to resolve also just ridiculously inhumane another less contentious than the jrc but more contentious than aba is on medications um i'm gonna get this out there immediately i'm not opposed to medications for the symptom level but i don't personally want to be cured of autism i find many people in my life find that the difference in perspective those particular skills are beneficial it's sort of easier and better for everybody to learn to meet each other in the middle note meet each other in the middle there are some of the more hostile younger certain political affiliation autists who are very hostile i think everybody needs to meet them on their level incredibly opposed to any kind of treatment at all i like the perspective i have them i like specific skills i learn to use them to my advantage having an incredible attention to detail having a fantastic ability to focus on things that you find highly interesting which there's a lot of work you can do with things you find very interesting these are good things there's even more beyond that but you get the point chronic constipation no you treat that you don't live with that you treat that but this is what i mean i'm okay with treating some of the sick some of the stuff that barely anybody talks about but some of the symptoms some of the associated things we'll cover legitimate medications first the atypical neuroleptics so atypical seizure medications as it turns out seizure medications are also useful treating psychosis there are some myself included who are pretty sure that all episodes of psychosis are actually seizures and this is because certain forms of temporal lobe epilepsy or even just seizures that cross into the temporal lobe will cause synaesthesia or hallucinations but that is a whole other thing and that's not even strictly dealing with autism but neuroleptics especially the atypical neuroleptics have shown efficacy in the aggregate for reducing the irritability in autism now neuroleptics have a rather major cost to them they're not the nicest of medications so i think i've said this before but i'm going to say it again 20.8 percent of the time behavioral problems in the autistic are due to the gastrointestinal issues the constipation decreased gastro motility treat that first rule that out because you can treat that without anything really um don't go high fiber diet uh you know you're gonna want to talk to a nutritionist if you're the parent do not do this go to a nutritionist who knows about this in particular but um guar gum has been shown considerably effective whereas fiber tends to worsen the blockages are worse than the constipation to the point where you get a blockage that's a huge problem then you have a medical issue instead of just constipation your child's going to the er don't do that but guar gargum inappropriate amounts that a nutritionist would know how to do um or a gastroenterologist of being better has been shown effective there are certain medications if it's more justified but they're not laxatives either long-term laxatives will cause really bad problems but if it's not that and you can rule out this will be another video and you can rule out abuse is going on which you probably should these atypical neuroleptics have shown like i said in the aggregate benefits they have been shown useful in alleviating irritability that is not constipation all that stuff i say you want to be careful with this because if the child was abused physically sexually whatever and you're not aware of it you're not actually addressing the problem in a healthy way that needs to be resolved in a very different way than medication especially the dealing with the abuser that's you don't want to let that go but i'm not saying these medications are never justified they are there's some who have found tremendous benefit some whom they're full-grown adults and they keep taking them because they do genuinely believe it helps them i'm not gonna tell them it doesn't help them i'm not them you need to be careful with this though because and i haven't talked too much about autism at the genetic level um so we're just gonna really quick cursory overview there are no genetic mutations associated with autism but it is genetic okay okay this makes sense i promise none of the genes are mutated what instead happens is called cnv copy number variations this is where the gene the correct gene is duplicated or deleted to where it's present more or less times than it would normally be so if you normally have say i'm just going to make this up two copies of the gene that produces cytochrome t452d6 the autist might have only one of them might have four of them cytochrome p450 2d6 still gets produced correctly it's just that there's more or less of it than there should be this is one of those weird areas where autism differs from how it normally is see as far as behavior and perspective and tons of other things it converges into a very narrow category to where you can group autism very well based on how it presents even though there's tons of internal things that you can't just see you know this this is why it can be diagnosed strictly through behaviors however this is not one of them i mentioned cytochrome p452d6 in particular or cyp cyp2d6 for sure i'm probably just going to say the full thing that's how my mind works it's a liver liver enzyme it's an enzyme i believe it's produced by the liver but it's responsible for metabolizing neuroleptics among numerous other things it's an incredibly important enzyme if the autist has more cyp2d6 this would actually mean that they need higher doses of the medication in order for it to be as effective as somebody who's not autistic a normal dose however if they under produce it this is going to cause the drug to build up and it's going to cause problems such as parkinsonism or serotonin syndrome or a bit of a contentious term a catheter may be better explained by already existing stuff maybe a unique phenomenon i'm not going to get into that but the point is you may get adverse drug reactions under a normal dose because you have to measure the enzyme anybody who studied pharmacology watching this probably recognizes that i'm specifically talking about pharmacodynamical kinetics taught as important stuff to learn but we often in medical practice and ignore it because in the aggregate it's fine for the audience but the problem is is the autists aren't following a nice bell curve as far as this goes it's widely varied much more so than it would normally be and so this throws a lot of medications if you are the parent of an autistic child who is on or considering to be on these medications push for measuring how much cytochrome p450 p452d6 is present push for doing some blood tests um in the months following up on their being on the medication just to make sure that the titrated levels are what they should be and that it's not building up or conversely that there's not enough of it because it's over metabolized in either case you want to help and not do harm so this is actually significant in that but the the under production and how that doesn't get looked at is enough of a problem that the normal rates the difference um of adverse drug reactions in the autism is about four and a half times more common than it is in uh the general population this winds up also causing problems uh i'll link to the article as well it's not research it's um more like media outlet kind of article um but it sort of talks about this how on a repurposable the second generation atypical neuroleptic used to be a really big thing for treating autism even that is being phased out because problems um but not as much as aba aba is merely being thrown out there's a lot of people that are like [ __ ] ebay i have purposely make bag for what exactly what i just described um one kid did fantastic another kid had a severely adverse reaction at nine years old was trying to stab himself in the head with a knife no history of aggressive behavior before that so yeah we need to be careful about this this video has gone on long enough i'll mention i i was planning on talking about my own experiences with the therapist as far as this kind of stuff goes and what effect it had on me i'll leave this to another video um because right now we're looking at about 40 minutes which is longer than any of them have been and i try to not do really long videos um because the viewership sucks but is what it is so yeah i don't know what the next video will be again um but hopefully you found this informative helpful all of that until then have a good one guys