How AI Could Transform Autism Treatment Forever

[0:00]  one of the things that has always really bugged me um was when people see a kid who doesn't have those great social uh empathetic behaviors that they they kind of view them as almost a sociopath because they sometimes laugh when a kid falls down like but if you in the context of the game someone falls down and UPC comes a a text cue that tells you are you okay are you hurt do you need help and you say that and the voice recognition picks up on that and you earn if you say the right things you earn more crystals and you practice that in the context of the game and then you do some out of game practice and reinforcement that all of a sudden you take a kid who um doesn't really demonstrate empathy and all of a sudden they they learn to do it in the con of the game and you generalize it outside the game you've got a kid who looks and sounds

[0:48]  empathetic now do you really want to be empathetic no you engage in empathetic responding contextually and games have the ability to give these kids those same skills to be able to have the context the appropriate social behavior to come across as someone's sad and like hey you okay what's the matter are they happy like hey you look really happy what's going on I'd love to see you smile like those behaviors are social behaviors that change the relationships between humans and games can build those skills a heck of a lot easier than any curriculum out there that exists there is no good social skills curriculum and for kids with autism that builds that level of complex social behavior all right guys I've got an incredibly

[1:47]  special guest with us here today now my guest is a world-renowned leader in the an innovator in the space of Applied behavioral analysis now he is one of the founders and a two-time president of the ma ABA the Massachusetts Association for Applied behavioral analysis the VP of clinical curriculum and research at Beacon Services Dr Ross received his Doctorate in Education um leadership from Nova Southeastern University is a co-director of the bcba certification program at Cambridge College in Cambridge Massachusetts the University of Massachusetts at Dartmouth he has presented over a hundred times in research poster presentations workshops symposiums at the ab aai conferences and continues to innovate in the space with

[2:34]  one simple idea that technology is going to be the answer that will help us face the challenges that we face in our community Dr Robert Ross welcome to the show man thank you very much Ken appreciate the invitation absolutely and some of those things are passed I'm no longer the director I've actually moved down from my my role moved from curriculum throughout development at Beacon I became actually the um senior vice president and then the chief clinical officer at Beacon I was there for about 30 years and I still am a consultant to Beacon um clinically and actually on these issues of Technology Innovation development and access to Services which is really right now the the real challenge for people who work in this space um we don't have enough people to provide these services and this is exactly where I want to kind of dive in you know with all of your

[3:21]  experience that we have in our space specifically in meeting the demand of our communities I want to kind of level set for the audience here now one of the things that we recognize in the ABA Services space is that more and more children per year are being diagnosed with autism just a few years ago one in 56 children were being diagnosed with autism today the number is about 1 in 36 children are being diagnosed with autism so we're seeing extreme ramp ups and increased numbers of individuals who are being diagnosed but the level in which we're able to meet the needs from a diagnosis from a treatment perspective seems to be really lagging behind that need in our community so why don't you kind of under give the audience a better understanding of the challenge I guess you would say that we're facing in our communities Dr Ross well so you you you um hit the nail on the head with the

[4:09]  increasing diagnosis right we've got more and more kids who meet the criteria which frankly have changed over the last decades I mean I remember it was one in 10,000 I remember when it moved to one in 5,000 I I've watched it tick down and I watch um what are the criteria for diagnosing someone with autism shift and change over time and some categories literally disappear um there are more kids who meet the criteria to have learning and behavioral challenges than ever did before there's a range of reasons for that we're probably not going to delve into that today but the bottom line of that is there's a lot of kids out there that have challenges in learning in communication and in challenging behavior and there aren't enough qualified trained people to serve them uh before they can get Services

[4:56]  though particularly in in an insurance world and we live in Insurance funded Services World they to be eligible you've got to get a diagnosis access to diagnostic services are in and of itself a separate challenge the number of clinicians and think when when you only have to identify one in 5,000 or one in a thousand the number of diagnosticians you need is fewer the number you need when it's one in 57 or less you need a lot more people identifying those kids and we see just tremendous disparity in the identification of kids I you know I live here and work in Massachusetts but I also work all over the world and across the US and there are places where there just simply aren't the clinicians to do the diagnostic work so the waiting lists become uh just unmanageable you have people who are waiting literally 6

[5:44]  months 9 months a year year and a half to get access to a a person who can say you meet the criteria and now you're eligible for services in the meantime if Insurance funds the services and you don't have a diagnosis you don't have access to ear early intensive treatment which is what is going to produce the best outcomes so you've got literally a generation of kids waiting to get access to services that they can't get and even if they get the diagnosis then there aren't enough qualified professionals to provide the services it's really if you're a parent and you know your kid is language delayed and has these challenges and you want to get him help it's a frustrating World um because you've got to negotiate getting a diagnosis and then finding a provider and most of those things are depending

[6:31]  on where you live um are just nearly impossible or take forever one of the things that I experienced with an organization that I work with here in southern Nevada is called the grant to gift autism Foundation now we have a 6,000 family weight list for services here in southern Nevada so not only are we a geographical desert but we're also a desert for the individuals who need to provide these services to the individuals in our community and I didn't understand the complexity of the problems until we really sat down and you started describing what were some of the unique challenges that we're seeing in our space Not only from a I would say top of funnel perspective for individuals who are getting certified to be these individuals and these Health Care Professionals but also some of the challenges in adoption of pieces of technology and Innovation I guess you

[7:19]  would say that help us kind of accelerate that road map before we kind of dive into that can you give everybody a better understanding of why did you choose this space with all the other things that you could be doing with your excellence Dr Ross why did we choose to go down this path so you know I've worked for for Beacon ABA Services pretty much most of my career early on I worked with adults with sever behavior problems um and and really interesting World working um but what happened is you know there was this gentleman actually fairly famous in in our world iar lovas who started taking some of the technology of teaching pated by people like Skinner and others around learning and just great early research that showed you can take a person and teach skills in ways uh for for some really challenging Learners and the early applications of ABA weren't with typically developing kids weren't with

[8:07]  even young kids with autism they were with um people with severe behavior problems and and what ABA demonstrated was that you can teach a range of really difficult skills to to people who were thought at that time to be uneducable who couldn't learn and and the the technology and the science is so powerful that it could um and loas demonstrated you could take that and and take a package of those things and do it intensively with very young kids and the trajectory of those kids future from being quote uneducable to have to IQ changes to typical functioning to half of those kids um losing the diagnosis in three to four or five years um so all of a sudden the future of kids with autism went from institutionalization to potential

[8:55]  typical development going to school having a life and the the you know the world changed at that was like one of those great Paradigm shifts where all of a sudden we realized oh my God we've got a poor effort and resources into early intervention because instead of having and Most states don't really have them anymore these institutions that were warehousing adults with you know cognitive and developmental disorders um those places don't exist anym they were all shut down um and and a part of that is there's no pipeline to those places anymore because early in ens of intervention changes someone who's even pretty limited cognitively able to dress and bathe themselves able to live more functionally in the community the future if you were a kid with a disability and I have a a parent who has this you know Wonderful awful story I worked with her

[9:44]  son who's now in his 20s he graduated from Pratt University of New York he was diagnosed with autism at under age three and the clinician who diagnosed this child who was unaware of early intensive treatment told the mom go home kiss your son goodbye while he's still sort of with you um and make plans to institutionalize him he's never going to speak he's never you need to say goodbye because your son's gone and she refused to let that happen she got a second opinion soone said oh you need to get early intensive ABA and you need to get it now and again this kid's a college graduate a great pianist fantastic artist you know lives a you know has his own life he has a f friends family you know people that was he was non-verbal and you know was at that

[10:33]  point that clinician believed he was never going to you know function That's The Power of ABA done early in intensive and if you're a parent and you have this oh that's a possibility for my kid but I can't get access imagine how frustrating that's got to be and so you know at that point shifting my career to oh my God we have got a and I had a pleasure of meeting a gentleman by the name of Dr Robert Littleton he ran early intervention programs in a school for adolescence with behavioral and learning challenges and he wanted to set up an really intensive program called Beacon and that's sort of how we got in there we went from this like six of us at the start of it to you know over 400 people and setting up those masters

[11:20]  programs to train more people Beacon also runs a diagnostic clinic um because we had to figure way to get better access to diagnosis for um so that became my all consuming career for the last 30 years of how do we train more people how do we get access for children and families to these to high quality excellent Services um when we're in Massachusetts it's a it's an education friendly State it's a it's a place that supports that um and GE geographically it's relatively small and we struggled to get people into homes because of geographic challenges Arizona big States like Texas you know AR I look at other parts of the country and say oh my God like we have a concentrated small place and and in a

[12:07]  decent amount of a population and we struggle to meet the need um the rest of the world is even in wor shape it's just hard but it's critically important because we have the ability to change the trajectory of of of lives for Children and Families my my line was always this is somebody's kid this is somebody's life it has to matter to you and if it doesn't matter to you go do something else work at McDonald's work like just pick another field but like you have the chance here to to change the trajectory of of a child in a family's life how can you not be like care about that and this is the biggest thing that I think we should call attention to which is this is an impact of not only a child or a patient but also their family as well I speak to so many different leaders today that talk about the need for us to be able to support the whole

[12:55]  family through this process I mean imagine how frustrating it would be I'm just going to Echo what you just said my child is non-verbal it takes me a year and a half to get a diagnosis then I have to wait another year and a half to be able to access services in my community or maybe I have to move to go somewhere else that demand and that stress that happens on the overall family as a nucleus in itself is incredibly devastating and if we don't have access in these different places and these different channels of access it seems like unless we focus intensive effort into increasing our ability to meet the top of the funnel in our community we're going to be in trouble for a long time yeah and and the thing is we can make long-term plans to train more people clinicians diagnosticians and people that do the treatment but today they're not here so today we need

[13:44]  solutions that increase access increase Diagnostic and that's where you know my path led to technology right because we we can you know the number of training programs for ABA professionals they were when I got my Masters in applied Behavior Analysis there were 13 in the world there are now over 400 okay and there aren't enough I mean so can you give the audience a little bit of an understanding of how long it takes for you to become a credential certified ABA individual in the space an ABA professional um so depending on which credential we're talking about sort of there's there's a you know sort of entry level you know non-degreed or high school diploma or even bachelor's degree credential and

[14:32]  you can get training in that and over the course of 30 60 days get the basic ability to work under somebody implementing stuff um but the somebody who's who's supervising you right they need a master's degree in in either education psychology applied Behavior Analysis and they have to complete certification coursework which takes on average about two to three years depending on the program and the and the amount of supervision um so it it isn't going to happen overnight and and even then um you always say that those are the people who have you know a minimum amount of training they have a basic knowledge they don't have 15 years experience implementing you know programs you know knowing how to apply and and modify

[15:20]  stuff they have a basic knowledge of the science and and minimal knowledge of working with children with autism so you know while they're credentialed they really AR you know the person who can be a lead clinician they they can on paper but they really need supervision training support mentor and to work under you know skilled competent people so the quality of outcomes and that quote certified trained person is still going to be very different than the person who's been working in the field for 10 15 20 years and really because you know the the breadth of literature what you have to know to to work with a kid with autism you talking about challenging behavior problems so how do you treat self- inurance Behavior repetitive Behavior how do you treat aggressive behavior how do you teach a

[16:07]  kid um who's not totet trained to go to the bathroom how do you teach how to read write um do you do you have any knowledge of teaching kids the the skills necessary to become a fluent reader well that's not Behavior Analysis right that's a degree in education um the you know toileting feeding sleeping all of these issues come up in autism so so the breadth and depth of skills you need to have to be able to treat all of the issues as well as be comp enough to work with a family siblings the in a family's home and the Dynamics of that right these are all a lot of things we expect clinicians to be able to do um and two years three years of training is simply not adequate to have someone who's at the level of skill necessary to do those things

[16:55]  fluently so we've got a a backlog and a training problem and you know people will say after 10 or 15 years I really know what I'm doing you know I had minimal competency and there's there's always a running joke it's like people get their credential they assume like I'm a master's I have a master's degree I I know everything and like that's and it takes you five to 10 years to realize oh my God I knew nothing then I mean the the experience that you gain through interacting like you said in all these Dynamic environments is truly your master's degree right your certification does not prepare you for all the complexities that you just named I think about ABA therapy I'm like okay think about this in a clinical environment at a location at a facility but we talk about the Dynamics of having to help en engage with family members

[17:42]  who are at home all the other things that you mentioned those are a incredibly complex Suite of skills to be able to meet your patient and your client where they are with the needs that they need y you know I was talking about that that um child I worked with years ago siblings he had a sister we involved her in therapy uh because if we didn't she was not going to uh sort of tolerate all these people coming into their home and not paying attention to her and so we we took great pains to engage her in that and this you know the literature is replete with stories of siblings who resented all these people coming into their family's home and spending time with their sibling and not with them and so that's something that a clinician has to be aware of like you're going in there if you're not paying

[18:29]  attention and engaging and involving that child that brother or sister in that in a way that makes them feel valued as part of the family and that it's not just these people coming in to spend time with my brother or my sister and not me um kids can come to resent that there's a lot of stress on parents raising a kid with autism and the you know the rates of divorce are just through the roof for parents of a kid with autism so how do you support a family to be able to work together and and and stay cohesive and and hopefully you know make it and those are all different challenges than applied Behavior Analysis I mean you're right I mean one of the buzzwords that we've seen in healthc care over the last I'm going to call it 5 10 years is whole person Health right the recognition that everything is connected when I hear you talking here I think about whole family health in this

[19:16]  instance and so we have to be able to address those needs ABA is often accused of not looking at the whole child and I always think that you know and I've seen cases where certain clinicians are just focused on you know the behavior and not not the person not the family not the context but you know good behavior and analysts have always been about the the whole context and the whole child and all of those issues uh because you can't be successful going into a stranger's home and working with a kid without understanding all the Dynamics of that home and how Grandma and Grandpa are are not involved you know issues they have with their neighbors um times of the day that the family um value being together and doing stuff or um or that people need to be alone and and there there's

[20:03]  just if you don't understand that context you're you're not going to be a successful as you need to be uh for that child and family so how are we supposed to meet the needs of our communities how can we look at this problem differently with a lens of curiosity what are some of the ways in which you're kind of helping to innovate in this space to help us meet the demand of everything that we're talking about here today well I've had the pleasure of um over the course of my career I go to these conferences and people are there you know presenting research and learn and you learn a lot there but also there are people there who have historically come in and like we have this data collection system or we have this product around teaching communication and I always you know take the time to see what's what's going on here and I had the pleasure a few years ago of um meeting a gentleman who was showing this um computer

[20:51]  game and it was was it was designed to be a game that um in the context of of the game if the character was talking if you looked at the character it kind of lit up and you're in crystals if you didn't it stopped talking and it just using behavioral technology shaping and fading and reinforcement to essentially shape looking at faces while they were talking you know one of the Hallmark deficits of kids with autism is they don't attend necessarily to faces I'm not I'm not a big eye contact eye gaze guy but I don't know whether you're ignoring me happy about what I'm saying or frustrated with me if I don't look at your face if I don't attend to those social cues um I could be annoying you or you you could also not be paying

[21:38]  attention to me at all and I can't adjust my behavior I can't have friendships and relationships if I don't attend to that so those social cues so building that skill which is a core deficit of kids with autism they don't do that like that's an Innovative way to do that it intrigue me so um well at that time I wasn't ready be to to sort of hey let's purchase this because I wanted evidence that it actually works outside the game like I I kind of said to the guy like do you have any evidence that the skills learning I can see that kids would look at this in the game I love it makes perfect sense to me any evidence that you know it affects them outside of the game he said we don't have that yet and I said hey how about you partner with me we'll do some research on it and we'll demonstrate that it does or doesn't and if it doesn't I'm happy to

[22:25]  work with you on developing curriculum to get it to do because we need Solutions like that so we developed this sort of partnership where I didn't work for them but I I liked the idea of it and over the course of Co I continued to communicate with them because our our research project got shut down thanks to covid um and as soon as it sort of ended he he come me and we're like let's let's go forward with this and so I've been working with them I'm helping develop a range of products one as a measurement tool to be able to see whether it does do this um and in the course of doing that we figured something out this using the computer game and it it was it's fundamentally predicated on I um what it call it um ey tracking software something called the Toby it's an ey tracking device and so it watches where you're looking I

[23:14]  said well what if we actually created a video where we could see where the kids looked at faces we could have other stuff in there and we could get a baseline measurement of did they look at faces look at other things and as we started to sort of develop this we realize oh my God if you get typical kids we get a we get a pattern I typical kids look at the faces of the speaker our kids with autism and I put some stuff in the background like you can see stuff in my background um that might be attractive to kids with autism and we started getting these really clear differential patterns where like the objects would hold the attention and when you start looking at the data and duration of where they looked I mean I don't you're familiar with fmis it's a technology that's brain scanned it and it shows brain activity um um and the classic presentation of an F is

[24:01]  something called a heat map so if you spend more if there's more activity going in this part of the brain it lights up doesn't light up because there's not much going on there um so you can see in teaching activities or even effects of medication um that certain areas light up more than others well in our heat map of where the eyes were looking you can see characteristically different things and I wait a minute you mean in one minute video you you can tell that kid's has autism and this kid does not and so like this actually might function as a diagnostic tool now there are actually probably right now seven to 10 different companies maybe even more than that because I'm not aware of probably all of them um that are essentially going down this road and developing diagnostic

[24:48]  tools based on ey gaze patterns and heat map technology and we literally will probably see within the next I would bet anywhere from you know one to five years one U company already has a FDA cleared diagnostic device to diagnose kids with autism using eye case patterns the market is probably going to become flooded shortly um and actually since we last spoken that that happened between the time you and I initially met for this and and today I was like two weeks ago or a week and a half ago that the FDA clearance was announced of this other device simple computer screen now think about access to diagnosis now you can go to a a clinic your kid sits in front of a computer a video plays and couple of

[25:39]  minutes later you have a definitive diagnosis yes autism not autism maybe ad8 maybe differential diagnosis of other issues or some combination and probably even severity levels that one of the Holy Grails of autism diagnosis that geneticists have been looking for forever something we call phenotypes different says we know that autism is a spectrum right there's a range of presentations from non-verbal and severely impacted to you know actually fairly smart cognitively really good skills but socially not and yet somehow those are the same diagnosis um so we know there's some differences and and we haven't been able to identify them genetically we may be able to differentiate them through Visual behavior and so that differential diagnosis and thus more sort of

[26:26]  specialized treatment as a function of that becomes possible so you know to go from you have to wait a year and a half to tomorrow you can go to a clinic and someone with a computer screen and and the and that video uh setup can give you an answer and get you access now to treatment services like that that world where the delay or the even inability I I used to you know tell the story of how in Massachusetts there were no kids labeled or diagnosed with autism in what's called Dukes County Martha's Vineyard in ucket in the 80s and early 90s until there were services available in Massachusetts for those children and families no parents took the ferry over to mass you know to Mass General or to the diagnostic clinics in in you know

[27:14]  Boston to get a diagnosis because there were no Services all right now there services and now they got to take the bat over they get the diagnosis so there are now you know children getting diagnosed but they wouldn't have to do that they wouldn't have to travel like this it just all of a sudden you want to talk about Equity availability changes for everybody regardless of socio economic status uh ethnicity anything now that that can become available across the world changing speed of access what it doesn't change is access to treatment right that doesn't change so there still so we got you know all of these wonderful potentials and and right now really you becoming true not just potential anymore

[28:03]  but in the pipeline realistic change in diagnostic access now treatment well what got me involved in BIOS scream in the first place um and is actually another company that does This Thing Called talko communication device at a conference and a guy was doing a research project about this simple handheld device that wasn't a a tablet wasn't breakable but easy for kids to be able to learn to communicate no difficulty in programming simple access like there are Technology Solutions out there and that's what I I found over the picl the last five or 10 years but last five and it's been accelerating there are really smart people out there coming up with answers to quality of treatment access to treatment and the only P right now is adoption because the the systems and the

[28:51]  and the the the smart people have figured out ways that we can teach communication that we can teach um I gay so we can teach we can actually build improvements in in behavior um we can teach skills social language communication core deficits of autism um social interaction we can teach these things in the context of computers and do it more efficiently we can do it at a greater frequency we can do it more you know the thing that I like is the accuracy when when a kid is not looking at the at the character the iase picks that up right away stops talking if you're talking to me and I'm looking at whatever I may not realize you're not looking at me if I'm trying to teach you look at me I have to contrive a lot of opportunities it takes a long time and I have to be really

[29:38]  skilled and I might miss whether you're looking at me or you know you might be looking at my glasses or the thing behind me the the computer doesn't miss the i gaze technology isn't inaccurate the devices that function to teach you language give you an accurate model every time when when I was working in Saudi Arabia with a a child who had significant language problems I had a British bcba who who speaks British so she says free instead of three um I had a Jordanian occupational therapist who has troubles of J's and P's and B's they're trying to teach language and they're giving different models and the child had like a nanny who was from the Philippines everybody said the sounds differently and he was

[30:26]  struggling we got to hold this talko device and things like that that consistent you know technology can give you a consistent model you modeled that a few times he he imitates that his imitation skills were good the the thing he was imitating was humans inconsistently giving you know wrong and and also judging that what he said was correct when it might not be technology and particularly artificial intelligence has the ability to fix all those things but we have to get it broadly disseminated and that to me is like the mission now it's like we as a field phally Behavior Analysis has an obligation if we truly care about these children and families who don't have access we've got to find ways to disseminate we've got to you know identify those effective Technologies

[31:13]  and get them in the hands of the 6,000 people on a waiting list you know those those people could get access to computer-based technology and get practice guided through a distance person and and have some support and get moving before they can get maybe more intensive Services down the road when we have more clinicians but is it nothing until they have something or is it something that can augment and maybe even help them get more and get good stuff while they're waiting for the world to catch up and we can't sacrifice these generations of kids we don't need to um we got to figure out how we get technology from these really smart people who developed cool stuff to the people who actually need to use it and that's I think our our next sort of phase here which is

[32:03]  adoption right there are so many barriers to adopting technology Dr Ross I want to I want to reverse a little bit and kind of give the audience a better understanding of why does the video game gamification makes so much sense for this demographic of a client or patient specifically I really want to hit on that I'm glad you did that because it it it really I I probably gave it short shrift and and matters because first of all kids with autism um I you say are often uniquely designed you know people look at autism a lot of different ways and I don't look at autism as a as a disorder I look at if you got a brain that processes visual information really well and you learn from visual animation but the rest of the world wants to teach you is if you're a great language learner you will do poorly not because

[32:51]  of anything other than the world wants to teach you in a way you don't learn visual information I I know that I can walk into almost any house with any kid with autism at whatever age and if if that kid has a favorite thing it's the favorite thing's a a doll a toy an object and I can like take their hand take that object walk with them in this house that I just walked into go down a hallway up a set of stairs another hallway into a room open a closet door put that item down I'm with the kid go back downstairs never said a word that kid in one teaching trial will go right back they'll go they'll have learned that route remember a multi-step task do it independently correct the first time one trial learner complex cognitive task and yet people are having trouble getting them to do and not do simple

[33:39]  things and and what I did was take language out of the instruction and use the poent reinforcer games work that way they're visual they don't sit there and go blah blah blah blah blah they you press this button this happens you press another button it doesn't happen like if you watch a kid with autism use aone they don't make 16 mistakes trying to turn it on they know it works and they don't do the wrong thing the the speed the efficiency the clarity of their learning is a function of how games and video games and computers work they are ideally designed as an instructional format for kids on the autism spectrum in my view so now you take that video game and it it shapes and use behavioral technology to shape so you know one of the things that early on the studies of

[34:28]  of the biostream look Weare games was that these kids as soon as they realized if I looked faster I got more crystals and if I didn't look I didn't you know you you literally kids are commenting I got all the crystals like they knew how many they could get and they wanted to get the maximum out they didn't want to be doo poorly in the context of the game they wanted to win and tyly you know a lot of the kidss that I work with who are you have language skills a little bit older they want to win don't like losing they they think of themselves as smart so doing wrong things in the context of game not interested doing wrong things socially perfect and what that happens people don't make me social if I don't look at you you'll stop looking at me and stop talking to me and go away I win that game the video game doesn't operate that way winning is

[35:19]  looking paying attention in fact one of the really neep things about the emotion recognition thing is character starts talking faces completely blurred and you have to discriminate what emotion they're feeling if you keep looking at the face the eyes unblur and you can see the eyebrow position and if you keep looking the mouth unblurs and you can see whether they're smiling or they're frowning right so you can discriminate emotion and to win the game to get be correct you have to attend to faces like it's just so efficient so fast so easy so consistent with the learning um sort of modalities and strengths of our kids that you know we move from kids who are avoiding eye contact in sort of typical social situations because if mom looks at me and I look at her and she's talking and

[36:06]  I keep looking at her she's going to ask me more questions and drag out this social interaction I don't prefer it it's not my strength um I said if I look away she'll leave me alone and so we don't realize that often kids who are um who don't prefer that get punished if they keep looking and get rewarded if they look away and we're surprised that they look away we're frustrated rather than say look how how do we set up so that there's value for them and we don't make this an aversive activity for kids because you'll hear many adults with autism say that looking face is aversive and you know there's no physiological reason that it would hurt but there's a really good you know environmental reason why it would be punished if you continue to do so um so if it's not your strength not your interest you you you

[36:55]  you learn the behavior that ends for you we got to make it so that it isn't so aversive and the skills to end it that aren't just looking away looking but looking at saying all right I'm all done talking now teaching games can teach you that they can teach those social skills and that's why the game format is to me is one of the most promising things for us to understand that we can set it up so kids win on their terms for the behavior that is really in their long-term social skills interest so many kids and you know this one thing you'll hear over and over again for with a lot of adults like they don't have friendships they don't have those relationships and they want them um but they don't want them on our terms they want them on their terms and we have to be better about understanding how we you

[37:44]  know change our sort of frame of reference about what is you know appropriate social skills right you don't need to be stared at somebody's eyes that's weird but but you do need to know if you're talking about the same topic over over again and it bores that kid and so they don't that they are not interested so you stop doing that and shift to something else so that you don't take someone who otherwise might want to be your friend and annoy the heck out of them so they don't want to be around you and you picking up with those social cues is a hard thing to teach in our previous conversation together you had mentioned another use case for this you said think about a gamified system that in an example of this game setting somebody's on on the ground asking a question are you okay will release crystals and

[38:32]  gamify and or positively reinforce that behavior so it's so much farther and so much larger than just eye contact in making I would say social recognition right exact it's one thing to recognize that someone's happy s or angry but what we really want is emotion responding like you know one of the things that has always really bugged me um was when people see a kid who doesn't have those great social empathetic behaviors that they they kind of view them as almost a sociopath because they sometimes laugh when a kid falls down right but if you in the context of the game someone falls down and up comes a a text cue that tells you are you okay are you hurt do you need help and you say that and the voice recognition picks up on that and you earn if you say the right things you earn more crystals and you practice that in the context of the

[39:20]  game and then you do some out of game practice and reinforcement that all of a sudden you take a kid who um doesn't really demonstrate empathy and all of a sudden they they learn to do it in the con of game and you generalize it outside the game you've got a kid who looks and sounds empathetic and I I always like to use that example of you know when you're with someone who you don't like and they fall down you you might think they're a jerk but you say hey you okay because you have good social skills now do you really want to be empathetic no you engage in empathetic responding contextually and games have the ability to give these kids those same skills to be able to have the contextually appropriate social behavior to come across as someone sad and like hey you okay what's the matter they happy like hey you look really happy what's going

[40:08]  on I'd love to see you smile like those behaviors are social behaviors that change the relationships between humans and games can build those skills a heck of a lot easier than any curriculum out there that exist there is no good social skills curriculum and for kids with autism that builds that level of complex social behavior um because it it seems too hard for people to conceptualize but in the context of a game you can come up with a hundred examples in a video game where someone gets hurt and you say the right things and you earn more where someone is happy and you comment on that and you earn more right that someone literally is injured and you you know offer help I want to use a little bit of contextualization here for the audience to recognize how powerful gamification elements are at influen your behavior so

[40:58]  a couple years ago there was a uh a documentary that came out called the social dilemma and it talked about how powerful things like social media are because they have gamified elements built into them to increase engagement and keep you coming back to the platform everybody who has a social or a mo a mobile device today and has social media on their phone will consistently go back to their device time and time again and open up Instagram or Facebook or one other platform that they have because of the gamified elements that are inside random release of rewards AKA likes notifications the dopamine release that you get from those tiny interactions over a consistent time period is a gamified element that keeps you coming back to this Behavior time and time again and so we're talking about the exact same thing here in using gamified elements to in to I would say increase

[41:47]  and improve social elements and behavior through G gamified Elements which is incredibly powerful and I wanted to make that connection so people could understand that you are playing games every those right that winning that getting something that I want and like it matters and the thing is computers and games do that better than any than any other format in the world that's why everyone is tied to their screens like people spend more time in those worlds and what you know we want a kid to want to get those skills you know to me there's nothing more inappropriate than coercively trying to make a kid like something they don't um but you can very subtly shape a a an interest that already exists and

[42:35]  into the service of skills that we know kids if they have and want can change the quality of their lives and their ability to interact and that matters because there are a lot of kids on the Spectrum as adults who are pretty solitary and their only interactions are in the computer World they don't have in friends in real life I I literally got a text message this weekend from a friend you know in another state has can for help cuz his 25-year-old doesn't leave the house MH has no friends no social skills no and you know he knows the kid want but doesn't know how to get it to him and so his his whole life revolves around being on the computer alone in his room and he expresses dissatisfaction with that but doesn't have a path out but do also doesn't recognize how powerful the consistent

[43:24]  reinforced behavior is being impacted did by those computer games and everything else giving them the satisfaction of reward and engagement and consistent I would say community because he's often probably probably playing with other people on those platforms right correct and so there Community exists 100% that's there and there's there's actually a few now even some of the video games and using AI that are creating virtual communities for kids on the Spectrum and older adults on the Spectrum to try to shape more you know both in the in the context of their game social behavior um to practice it that would serve outside the these are things that technology can do and games can do that bringing someone to a clinic in a you

[44:14]  know University you know autism you know research site will never be able to do I want to talk a little bit about you used a word consistency in this conversation a couple times in our previous conversation we had talked about some of the subjective nature of diagnosis that comes when we're not using a standardized consistent system let's kind of dive into that a little bit yeah one of the things that I think people don't always recognize that autism is not based diagnosed based on some sort of what we call a biomarker there's not a blood test right so what happens is you go to a clinician that clinician was trained by somebody and maybe they're their previous background was working with kids with ADHD and so they that's the population they know but there's a need for more diagnosis so they often will see that kid through the lens of

[45:01]  ADHD and they may or may not get a diagnosis of autism from that particular condition who would say oh no that's not autism it's ADHD um then they go to see somebody else who primarily works with kids with autism say oh no no that's autism and who's right you know the responses to the test and the behavior were the same that both clinicians saw the kid isn't different the diagnosing clinician is different now the thing about biomarkers like blood tests and this is where the FDA has declared i gaze a biomarker that we can get definitive like you every time when you see someone who's spending their entire time looking at objects and not at the faces that's different than typical kids um and so

[45:50]  you know with pick with AI you're going to be able to say here's the line this this is the gray area anything on either side is or isn't and so you know there are already studies talking about 90% 95% accuracy in diagnosis using iase technology um it takes away the subjectivity of a clinician's training background experience in making that diagnosis I think I was telling you I used to do something called the um when I was working in Connecticut they use it as a educational classification for autism but it's the do the autism diagnostic observation scale and it's a couple bit of Ra of it but um it's considered to be the gold standard if you're going to do NIH funded research on kids with autism then you're going to have to have everyone have an to demonstrate that they in fact have

[46:38]  autism um and it's a pretty subjective tool I my sort of story was I'd see a kid at 12 months you know 16 months even 18 months and on some aspects of the the the test they would make eye contact with me I could see them not making eye contact with Mom and dad when they called but when I was using certain activities and doing activities they would look at me and so their eye gaze and and their response even to what we call joint attention wasn't bad but I could also see it wasn't great and you know there were kids and I would see six months a year later and they wouldn't make eye contact with me and they wouldn't engage in joint attention that you could see it devolve and you know I got to the point where I was actually did pretty good at being able to say if

[47:25]  I see this kid again in six mon probably they don't meet the criteria today they don't today but I'm pretty certain they will in a little while they will learn to get better at not looking at people as they continue to get Social demands and not respond to them and get reinforced by not having to do stuff um and being able to discriminate the yelling is when I have to attend talking I can disregard that it doesn't mean come here come here you need to come here oh okay that's and they learn to discriminate um and you know the the ability of kids on the Spectrum to discriminate how adults will behave in their environment is one of those great skills that that people sometimes miss you see differential responding from different people if I consistently say it one time and make you do it to me you might respond pretty

[48:14]  reliably to the first instruction if I repeat the instruction 17 times and then give up on you you learn to disregard my language and that's not autism that's just good learning right I was you see that by the way you see that in typical kids as well um so it's you know it's an interesting thing but it speaks to the problem which is that isn't a great measure because it may be measuring learned behavior and not some medical diagnostic intrinsic you know condition of the individual where I G you know that's more likely to be an intrinsic characteristic of the individual blood you know you know you either have the virus you don't have the virus like there there are tests that just that's

[49:02]  why we you know we do diagnostic test we're trying to do you're pregnant you're not pregnant we know that if these things are present you are and or if they're not you're not um autism has suffered from the absence of that the subjectivity um it's actually resulted in a lot of kids not getting access to Services because there are clinicians whose job it is to minimize for instance if you work for you know insurance company doesn't want to fund Services your clinician can say they don't meet the criteria where someone else says they do and now it's just a different of op difference of opinion because there isn't an objective standard and that's a real problem and that combined with the despair if you will of the family who is looking for a specific diagnosis if they don't have access to multiple perspectives of that diagnosing healthc care professional then they're going to

[49:50]  take the first one that they get and so we talk about like ADHD as an example versus autism I would be really interested to kind of think about the impact on the family of like we've waited forever for this diagnosis we're not going to go through the cycle again so let's just go down this path of the first diagnosis that's given to us but it is subjective like you talked about which creates a little bit of a scary future yeah the the interesting sort of Converse of that is there are clinicians who recognize ADHD doesn't get your kid and your family any help so I don't care what your presentation is I'm saying autism because getting someone in your house who can teach your kid who can help shape you know new skills and new Behavior whether it's ADD ADHD or any other condition just a a behavior problem if I give you the diagnosis of autism then people can come in and help you and so one of the other problems is

[50:39]  you know all of a sudden we have all these kids meeting the diagnostic criteria that may or may not um because that's the only way the clinician has for getting help to the family and if you're a clinician and you know this label that family gets help this label they don't you know yeah it seems like they have that like you can see the pressure uh that some clinicians would be under to say it's close but I'm going to air on the side of it maybe down the road you get re-evaluated and maybe don't but you got the help you needed early on I want to throw out two statistics so earlier in our conversation you mentioned with this new gamified ey tracking biomarker way of diagnosis we're seeing upwards of 90% accuracy with our diagnosis as of 2023 90% plus of children over the age of two

[51:30]  play video games so we've got high 90s in both of these statistics why are we dealing with some of the challenges of adoption when we have so many people engaging with this modality of gamification we see great diagnosis data that's coming out as well why would we see any type of diag or any type of adoption I would say challenges as we move forward in this space with this new tech so you you hit on the interesting thing which is who why would he challengeing adoption well who has to adopt it so you could look at it two ways if I'm a old school psychiatrist neurodevelopmental pediatrician um and I'm getting insurance reimbursement for doing that why do I need to change right and by the way um you know I'm of a certain age uh people in my

[52:20]  generation may not always readily adopt new technology right yeah two kids Age 2 90% of using Compu using computers ask how many um you know people in in their 50s 60s um are really comfortable just adopting brand new technology to change how they do their job fundamentally like that's that's a barrier right um so in terms of you can have lovely great technology out there but if the people who have to use it are are I don't want to say leites but are just not comfortable adopting they're not early adopters right that's probably a gentle way of saying that they're they're they're not early adopters and you know I work in a field that is overwhelmingly um probably female i' would say that like a beacon

[53:09]  probably 80% of our staff maybe 75 now was female and younger um most of them were not video game people in their early youth I'm doing a research project now with a with a company in New Jersey and um the two people who who are using the software have never played video games the the gamification part of it the the game controller is the Xbox controller they don't know how it works we have to teach them and get them comfortable with a device with which they are literally unfamiliar where we showed it to the the sort of sibling the son of the director he's a you know 20-some year old guy he was on that thing cranking on I love it he was having a great time because he's

[53:57]  comfortable in that so the in the sort of target audience of adopting technology has to be people who are comfortable adopting new technology if you want to speed technology you know one of the things that the bi stream that the sort of challenges like we're looking for like early adopters people who we know are interested in technology or comfortable changing you know what they do who've adopted some of the computer-based data collection systems some things that suggest that they are comfortable making moves in that direction because not everybody is you know one of the things that I constantly say to the the sort of development team and the leadership at at B stream and the other place that I work with is that you have to identify these barriers and you have to find a way to overcome each and every one of

[54:44]  these like if they don't know how they're going to fit it to their Center and you have to and they have to figure it out they're not going to use it one of the most depressing things that my wife's a speech and language pathologist and commonly used in in kids with speech um production issues who kids who are non-verbal or really significantly challenged there's a lot of computer based devices out there some great augmentative alternative communication AAC um devices Now problem is you have to program them program them and so somewhere about I don't know maybe five 10 years ago someone did a study on the devices and in the first six months of implementation and a year after start of implementation and it was utterly depressing and I foret the exact number but basically they were being used about

[55:31]  90% less than in the first month or two some cases not being used at all not because it didn't work not because it didn't help the kid communicate or because having to reprogram them all the time because the child's communication changed and the needs changed and the structure of language like it's just hard and it became a a difficulty and a barrier like you know if you got a even an iPad device where you have to have all of these Pages set up for communication and you have to organize it all the time and new words come in and it's work so unless it intuitively does that it does it automatically if AI can fix it so you know you could say here are the ones that need to be in there and it just broke you know Repro you might get people to use it but if they have to jump in and spend an hour of time they don't have on their case

[56:18]  load that's too big um and too many kids who need services and insurance doesn't fund that then it isn't going to happen so the thing we have to really recognize as a field and in general is technology is hard for a lot of people that the kid may love it but if the adult who has to turn it on make sure uh the calibrations been done and you know that you're in the right kid so you don't have the data isn't being confused we don't have a hipo violation and there's like process that they have to walk through or they can just keep doing whatever they're doing in they don't have to worry about that well that's that that you can see how that can happen this is why the product in today's consumer behavior of society matters more than anything if I

[57:08]  had to go through 25 different steps to order an Uber instead of just calling a taxi Uber never would have got off the ground but three clicks I Dro my location it comes to me the elimination of friction is so important in every area of product development and consumer Behavior because like you're talking about this is a two-prong problem the writing is on the wall 2023 90% of children over the age of two are playing video games I cannot say the same thing for the clinicians that we have in the space who are delivering the services at this point in time and so it's like stuck between a rock and a hard place it's a really is true 90% of the staff who are providing the services probably don't play video games it may be closer to 80 but I mean it's a big number I mean so how are we

[57:55]  supposed to how we supposed to attack this problem right I mean like you said in the beginning when I gave the intro technology is the answer for us meeting the demand of the challenges we're facing in our community but we have slow adopters who are on the front line delivering our services and so is this a a longer term play that we think with the longer time Horizon of introducing this technology in the Education certification process or do we just wait and plant our flag in the ground and say this is the answer everybody's going to catch up but that seems at the dire need of our community and the families of people we're trying to meet so there's to me one of those things of um I like competition um being a driver right now the autism space is a crazy competitive environment you've got venture

[58:42]  capitalist coming in and and buying up companies and trying to hire all of the bcbas everybody's looking for the edge the advantage to try to keep themselves viable and so what you really need is a few early adopters in in those areas showing that that's that's a marketing Advantage we have this measurement and diagnostic tool and we have this game that gets increases the amount of basically therapy your kid gets that that makes the outcomes better if if your kids getting served by us so you want your kid being served by us because we have access to this and the other ones say we fall behind if we don't adopt this and so we're going to have to overcome our fear our barriers our concerns and and get onard to doing the thing that you know again ultimately the answer is anything that

[59:31]  actually produces better outcomes for kids is going to attract parents and that's what the you know if you're a provider right now Massachusetts a kid gets a you know under three gets a diagnose of autism they can hand a piece of paper of the 12 or 15 or 20 different providers in their region who can provide now that isn't true everywhere in the world but that is here um so they got to pick who are they picking they go online they do they do their you know level of research um but if you've got clear data showing better outcomes than all the other providers for the parents who want their kid to get the best possible outcome it's a no-brainer so we've got to make sure that the evidence of Effectiveness is what drives it and this is an really

[1:00:18]  interesting space to be in because your ability to tell your story share data and evidence of why this is less of a challenge easier access quicker responses better treatment plans better outcomes is becoming the Competitive Edge and this is why love the fact of technology in this instance doesn't need to be looked at as a replacement which a lot of our later adopters might think about but an accelerator on how you're going to help to be able to do more if that makes sense we like to use the word adjunctive therapy right it's an addition to what you get you know I say you know I have a military pass a force multiplier right you you've got X number of hours of treatment but now you've got a kid who likes to play video games who is motivated to do it um there's a the phrase We also use called happy relaxed

[1:01:05]  and engaged sometimes kids in in ABA sessions are um unhappy not that engaged distracted um and and and frankly unhappy U when it's a bad session or a bad therapist um one of the keys for us is we want kids to be happy rela we want a kid who who wants who's asking hey can I play that game and is playing the game with a smile on their face and do and they're getting therapy that supports the skills that are critical that are really core deficits of autism you know I would say autism is not a disorder of academic delay and a lot of people want to work on discriminating colors letters and numbers because it's the format is easy and you can train even less skilled people to do it it doesn't address social skills and social behavior which are core deficits of of kids with autism

[1:01:52]  and where they struggle the most and the reason is because people are not good at it it's hard to do now we got a solution that actually addresses the real issues in a way that is actually consistent with the strengths and interest of our Learners it should be a no-brainer why not adoption well because it involves technology that is you know perceived as difficult and we got to make sure the perception is like you know people buy an iPhone they pull it out of the box and turn it on and it works like one of the things that you know Apple has done well is make it easy for the user we've got to do the same with any technology solution you know anything that involves multiple steps and difficulty decreases adoption decreases use I want to uh I want to spend a

[1:02:40]  couple minutes here um as we start Landing the plane if you will and talking about the difference if you will between the technological world that we live in so I'm going to reference back to the story that you talked about you received a text message a 25-year-old is more engaged in the digital world than than in the outside world and their parents Andor whoever was looking after them was a little bit concerned what if I told you that the average 18-year-old today spends about nine hours of their time awake on their device behind the screen if we extrapolate that out through their life it equals 24 years of their life will be spent on screen time for the rest of their life okay the one thing that I recognize today is that the digital world is becoming more and more engaging and optimized for our attention than the regular world that we live in over the recent years we've also seen an

[1:03:28]  incredible increase in the amount of people who have either been diagnosed or identify as being ADHD what do you think is going on in the world is it we're seeing more people who are having these disabilities or is it more so that the world that we're living in isn't as optimized for garnering attention and keeping us engaged through the gamified elements that we've talked about today which kind of leads to that over Reliance or that over self diagnosis of ADHD like we see on Tik Tok and Instagram and everywhere else yeah again ADD and ADHD are those subjective right if you can spend five hours on a video playing um a video game sitting in that chair staring the screen paying attention to all of these things do you have an intentional problem doesn't seem like it to me if

[1:04:16]  you're out of the game and you're in a world that frankly doesn't have as many immediate reinforcers and and and and things that attract your attention and pay you off in the same way okay so you're not interested in that environment in my world that's not a disorder you don't have a you have competing environments and when I'm in a place that has that is boring I want to do something that's not boring like do I have a disorder now because the the current environment is is deficit of things that interest me like now the the the reality is most people grew up in a world where those interesting and immediate reinforcers weren't present so we're Lear to tolerate boring environments in some cases come to enjoy sitting back on the beach and doing nothing now my wife will say I'm not good at that I need to read

[1:05:04]  a book I need to be I want to dig a sand castle with the I need to be doing something now is that a disorder or that I have learned to find engaging in other things produces more reinforcement for me so I engage in those things um you know it's true that the world has changed and aspects of the World deliver short births of of dopamine and and and you know four little behaviors lots of them frequently and so you you become accustomed to that and when you're in an environment that doesn't do that you kind of want to get out of that environment and get to an environment that does now whether we as a society think that's a good idea or not is a different issue but it is simply true of the world that our kids are growing up

[1:05:51]  in and live in now I don't think pathy oling differences in the world is a good idea um now in the same way that I can get a kid to learn a skill that they didn't we can take kids who didn't read and teach them to read we can get kids who that didn't speak a language to learn a new language we can we can do lots of things in teaching if I'm crappy at golf you can work with me and I can get better at at swinging a golf club or playing basketball right and if we stop pathologizing these conditions and and thinking them simply as you know we we we probably need this kid to practice being able to sit still and do nothing and as a skill if they practice that they could probably get better at it and if we think of it that way we can

[1:06:39]  we don't need medication for ADHD we need some different skill set um and practice and and like in my world that's emmin doable um I no one considers to me to be well maybe a couple friends but I don't have golf disorder as a formal diagnosis now my my golf game might suggest that maybe I should but there isn't a medication I'm going to be put on for that you know I want to get better at that I got to play I got to practice and if I do that I can swing more controlled and carefully I can hit the ball better I can do things differently um you know one of the things I was talking with the biam people about I want to get a USB mat that plugs into your the computer game and it sits on the chair and the kid if they're sitting still without fidgeting for a longer periods of time they earn

[1:07:26]  more crystals or you know more points they access to other games like could you get them better at sitting still right could you increase the duration of the language information provided while sitting still to build those skills and are you curing ADD and ADHD or you're simply building skills and to me this is what games could do that no teacher classroom or medication can never do as efficiently as effectively as consistently you can literally have that algorithm that knows where you set you know finished last time starts you off just a little less than that to get you back into reinforcement and then systematically increases the duration of both the language and the sitting still requirement to earn the crystals or points or the next game that you want to play it seems like the answer is right

[1:08:13]  in front of us and you've done an amazing job of laying it out and saying this is how we can use gamification positive reinforcement to reinforce the behaviors and the skill sets that we're looking to develop that help us all be better human in our previous conversation I talked about a book called indistractable and the author of that book was talking about the prevailance of ADHD diagnosis today and how we don't have the skill set of regulating our own emotions because whenever we get into a uncomfortable situation what does everybody do we pull out our device which has a gamified element behind it which means as soon as I log on to Instagram I could have some likes or some hearts or some comments and those things reinforce or just a video that amuses me leading to another video like like that that amuses me that the algorithm has is feeding me I mean it's it's it's a really

[1:09:01]  interesting time I want to I want to use our last couple minutes here uh so let's talk about kind of the future from your perspective as we recognize technology is developing incredibly quickly and changing the landscape earlier in our conversation you had mentioned that the FDA just made um a recent I would say Improvement in using these biomarkers as a to or ey tracking as a biomarker for the specific that we talked about what are we thinking device to do diagnostics incredible yeah huge so that happened in the last two weeks what are we thinking about let's say the next two years if you had to rub your crystal ball Dr Ross and say this is where I think we're going what do we thinking that we're going to see um I think we're going to see probably there's at least 15 to 150 companies out there using Ai

[1:09:52]  and using Game technology to teach skills and the the question of how they get them into places is really the the next twoyear question every time I go now to an ABA conference the number of vendors selling Technology based Solutions as augmentative supports for social skills communication uh problem Behavior identifying data collection anything to make the clinician's job easier it used to be the only technology I saw at an ABA conference was companies selling software for for um billing and data collection and now educational related um software and computer stuff is now expanding dramatically the biggest question is what's it going to take to

[1:10:40]  get companies to bite because the model if you've got a buy it and you're an ABA provider do I buy this technology now and will will I've invested all this money in it it'll be Obsolete and a year and a half and there'll be new better version so do I hold off and wait for that do I spend money right do I you know get the parents to buy it for us right do we wait till it's insurance reimbursable and insurance pay like the funding models for these devices is probably going to be the The Tipping Point which way because I've already seen one set of devices that went with a FDA approval for some educational related stuff trying to get insurance reimbursement and and it takes too long they haven't got it and now they're

[1:11:27]  rethinking their whole business model technology is cool but they haven't figured out how to get people to buy it and that to me is the challenge for every device you know when I talk to the the communication people in their device talko love it but somebody's got to Fork out some money and then manage it and run it what if it's Insurance reimbursable well okay so you got a piece of that but insurance based for who's who's managing it and so same thing with the the game so is a parent buying it is the center buying it is the school system buying it um who's responsible and what what about upgrades all of those are technology questions and problems and you got your phone are you worried about an

[1:12:17]  upgrade probably not because you're going to get upgrade automatically right and at some point you're going to be deep in it and it's getting old and a little slow and you're ready to upgrade and you're going to get some deal from your provider right that that problem is solved for phones computers people keep an old computer for a really long time as long as it's not not working but educational uh software doesn't and and computer you know that kind of stuff is a big outline of expense and people need a reason to say yeah I'm willing to spend that money so who who does it's not the clinician who has to use it who might not want to use it it's some administrator who has to say is that a cost effective way to spend our dollars I wonder if there's an

[1:13:05]  opportunity to kind of think about how this technology can improve itself a great model that has really kind of taken an industry by storm that we haven't seen before is Tesla cars right I have a model Y and the one thing that I've Loved about having that piece of technology is they have something called over theair updates so every single year at Christmas time time they release a big update and your car has new features and capabilities that it didn't have before because of the power of software updates combined with the hardware that is pretty much commoditized today and so if we build it one time really well and we futurecast with software updates the improved capabilities of this technology that could be a good answer where we can kind of meet in the middle if that makes sense to be able to deploy this piece of technology to into the hands of the people who truly need it because I don't

[1:13:53]  think we have the ability to drag our feet and wait for I would say insurance reimbursement to solve this problem for us yeah that that can't be the path because basically it means it's not available now and frankly relying on insurance to pay for things um right now if you're diagnosed with autism in in Massachusetts um insurance will pay for an iPad now what's it used for video games and music and YouTube for young kids you're exactly right okay it's really it has the potential to be used for other things but it's really not used in that way cuz those are easy and highly reinforcing we've got we've got to find a way to to to same same model because the the Tesla Model is is

[1:14:40]  my phone I got it I got an update last night like I think my computer got updated the other day as well like it it just happens right and you know people might have issues with elon's politics but everyone I know who has a Tesla has been raving about it ever since they got it and still do yeah right because it works that's right inexpensive works and you don't have to do a lot to keep it working and that's the technology problem the early experiences with most Technologies for most particularly Educational Systems and provide you know at some point when the computers first came out schools got these grants to get um Macs and every school had a Mac a lot of them sat there unused for years so just getting them isn't always

[1:15:30]  enough like if you can overcome that barrier you still have the who's using them and for what maybe we need to come up with a gamified reimbursement bonus if you will for all of our ABA professionals who can start getting you know increased reimbursement rates if they're using technology that helps them be more you know effective and creating access and diagnosis opportunities for the communities that they serve maybe there's ways in which we can carve it up that way I I like that thing because I would actually say that one of the innovations that has been discussed a lot in certain ABA circles is differential reimbursement for better outcomes kids who make progress faster programs and agencies that adopt models that result in better faster outcomes for kids should get differential pay and because there's a lot of crappy

[1:16:18]  providers out there whose kids are have the same goals and objectives forever and they you know that should be diminished like unless you reinforce and and pay off quality and better outcomes you don't necessarily get them you'll get them from the small boutique providers who who just simply won't do anything but high quality but as as the market um sort of becomes sat with the venture capitalist and and it becomes about you know growing and not outcome I think we've run that risk but hey if you find out tomorrow you could get a 20% or a 25% bump and your rates of reimbursement if if kids meet these following markers in in six months instead of nine months if they do it in 3 months and you it bumps up to even more because all that does is better

[1:17:10]  access and and better outcomes so why wouldn't they I completely agree I think the once again Dr Ross has laid out the game plan here now it's our job to be able to figure out how we execute on this plan you know one of the things I've Loved about our conversation today is all the elements of your expertise your willingness to be curious when you came across the gamified system in the very beginning when you went to the conference and said hey do you have data that shows the outcomes that we're getting here and your willingness to partner to create opportunities for us to have a bigger impact in our space is something that is incredibly um re refreshing but the other element of it as well is you're not a 20-some or a 30s something coming into this space you have the Tre record and the proof and the experience to show why these Technologies are necessary for us to be

[1:17:56]  able to get out of the rock in a hard place problem that we're in in our communities right now so Dr Ross I just want to say for everybody who's been watching and listening today thank you so much for coming on the podcast the last thing that we do here on the show is we ask a question that came from our previous guest and I think I know how you're going to answer this one their question was what is one thing that you're doing that others in your space aren't and how do you differentiate yourself from those other people so um I'm an older guy um but throughout my entire career and to this day I carried direct case I work directly with kids have since I started working the field and I have had two two clients that I work literally I I do direct service with them I I have always kept

[1:18:44]  my hand in teaching it because I want to be able to show you how to do it and I don't want to do it from an ivory Tower I've read the research in literature and i' you know we published some papers on this and blah blah like like let me show you how to do it and cuz you can't tell me the kid can't learn it or the kid can't do it if I can show you they can and I can show you how um and so I've always been one of those I want to put my money with my mouth is because that kid learning matters to me I mean I got this job out in um Saudi Arabia years ago that I got asked to go see a kid who was had some services and they they've been trying to teach the kid to put an object into a container um for about 3 months and they'd give the instruction he would would do it they'd take his hand and they prompt him to do it and tell him to do it over again and U i' Been watched a little bit and I said I

[1:19:31]  think you're missing the fact that he finds your physical contact reinforcing like no no he's trying to escape from the task so you know let if you don't mind if I jump in so I literally jump and I I say you know put in I take his hand I take the object put it in as soon as he lets go into the thing I grab his hand I start shaking it rubbing it he's looking and smiling I do this like two or three times and then I say put in he picks it up puts it in and puts his hands out to me to get the physical contact I said you're missing this kid sliding under the table you're pushing him back up the kid's looking away you're turning him back he's making you give him physical contact like literally every 15 20 30 seconds and you think he's distracted and trying to escape because you're evaluating what you think about him not what his behavior causes

[1:20:20]  you to do and the he's learned the effect of his behavior is to produce physical contact but if he puts the object in you say good job and you don't touch him so you from his point of you punish him for doing the right thing and reward him for doing these other things you don't value putting it in you value slouching under the table and looking away and you don't see it so the thing that I think you have to always be is first of all don't accept um anybody's explanation for something that's not working if it's not working it's because whatever doing doesn't work it's not the kids's fault you never blame the learner you always blame instruction something about what we're doing isn't working and accounts for the whatever we're getting if we change our Behavior Behavior will change and so um I had early mentors who

[1:21:10]  drilled that into me and you don't you never blame the learner you blame the instruction not necessar the instructor but something the instruction the instructor is doing is not helping because that kid again in one teaching trial could an object but for 3 months he couldn't pick it up and put it in that makes no sense and you know the thing that we have always got to be willing to be curious about why are we seeing this and not that look for the disconfirming data you have a hypothesis there's always some data that either supports it or doesn't if you can find data that doesn't your hypothesis is wrong and it's time for you to change what you think and what you do that's a wrap that was beautiful um you know Robert this has been amazing I can't believe that

[1:21:58]  we've been able to R through this time so quickly this has been so valuable for us to be able to understand what are the challenges that we're facing how can we innovate in this space although we're innovating in this space there are still challenges that come along with the technology so once again I just want to say thank you for doing everything that you're doing and leading the way but also being willing to slow down look back and see where we came from and think about a different path and how we can get to where we're going so once again everybody for the heart and hustle podcast Dr Robert Ross thank you so much for coming on the show a pleasure yeah take care thank you so much for having me