[00:00:00] 

Intro

Kate Grandbois: [00:00:00] Welcome to SLP Nerd Cast. I'm Kate. And 

Amy Wonkka: I'm Amy. And we appreciate you tuning in. In our podcast, we will review and provide commentary on resources, literature, and discussed issues related to the field of 

Kate Grandbois: speech language pathology. You can use this podcast for ASHA Professional Development. For more information about us and certification maintenance hours, go to our website, www.slpnerdcast.com.

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Amy Wonkka: the contents of this episode are not meant to replace clinical advice.

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Kate Grandbois: would love to hear from you. Before we get started in today's episode's, financial and Non-Financial Disclosures, um, I am the owner and founder of Grand Wa Therapy and Consulting, LLC and co-founder of SLP Nerd Cast.

Amy Wonka is an employee of a public school system and co-founder of [00:02:00] SLP Nerd Cast. Uh, we are both members of ASHA's six 12 and both serve on the a a C advisory group from Massachusetts Advocates for Children. I am a member of the Berkshire Association for Behavior Analysis and Therapy, mass, a BA, the Association for Behavior Analysis International and the corresponding Speech Language Pathology and Applied Behavior Analysis special Interest Group.

So here we are for part two, behavior Management, part two. Woohoo. Woohoo. So, um, this is this. I have been reflecting on this and realizing how relevant this is being stuck in quarantine with my, my children who have behavior management issues like all children. Um, and I'm really excited to get through the content that we have, that we have today.

Amy Wonkka: Yes, I'm as well. 

Kate Grandbois: So why did we choose this topic? We're not gonna go into that into too much detail 'cause we're assuming that most people have listened to our first [00:03:00] episode. But in case you are just joining us. We chose this topic because there's a high comorbidity between communication disorders and behavioral deficits.

And it's not just in pediatrics. It's not just the naughty little toddler, um, who has a language delay. There is evidence that, um, the comorbidity between communication disorders and behavioral deficits extends through much older clients, much older students, much older participants who have language impairment.

Um, also, I would be willing to bet that every pediatric SLP at least, has run into behavioral challenges and therapy at least once because of this high, high rate of comorbidity. 

Amy Wonkka: Because anybody who's spent quality time with a toddler knows that they can be a sassy bunch. 

Kate Grandbois: They a sassy bunch. That's a, that's, yeah.

Yeah, that's a nice way to put it. Yeah, I think, um, have you ever seen, um, will Ferrell impersonate his daughter? He did all these, these videos a long [00:04:00] time ago where he would impersonate his toddler child. And it's so funny, in case anyone else hasn't seen it, there's a plug. Maybe we should tag him. Yeah, that's right.

Tag him in a post. Anyway. Um, so every clinician has their bag of tricks for how to better manage behavior in your clinic or your classroom or your therapy room, but knowing the science behind behavior management can make your bag of tricks even more effective and more powerful. Um, and we couldn't fit all of this glorious information into one episode, so we broke it up into two.

So here we are. Here 

Amy Wonkka: we 

Kate Grandbois: are part two. 

Amy Wonkka: So we've covered some things already. In the first episode, we covered the difference between reinforcement and punishment. We talked about how what we focus on is reinforcement, and we talked a bit about the different types of reinforcement, how to choose reinforcers, and how to think about schedules of reinforcement.

Kate Grandbois: Right. Um, we also talked about how to identify punishment in case you are punishing things by accident. Mm-hmm. And how to make sure that you [00:05:00] are, um, you know, providing reinforcement at the right rate, um, and at the right times for your client. Today we are going, so all of those things, all of those things, reinforcement, punishment, how to choose reinforcers, those are all related to the changes you make after a behavior, or as we had talked about, the a, b, C antecedent behavior consequence, what, how you can manipulate the different consequences for a behavior.

Today we are going to talk about antecedent based interventions, so that is what you can do prior to a behavior to make the behavior more or less likely to happen. Um, so learning objective number three. Which is a carry over from one and two. We're in the first episode. So today we're starting with learning objective number three, understand how both antecedent based interventions and consequence based interventions can help improve client behavior during a session.

And at learning. Objective number four, we're going to review [00:06:00] commonly used behavior management strategies and the science behind them. So we're gonna talk about things that you probably already use in your practice or things you've seen around your school environment, but looking at them through the lens of the beha of behavior management as a science and talk about why they work.

So before we get into that, we're gonna do a real quick overview, um, of reinforcement and punishment. So if you listen to episode one, and this is the total snooze fest, I promise it's gonna take less than five minutes. We'll try and get there. So reinforcement in general are things you do after a behavior that increase the future likelihood of a behavior.

Punishment are things that you do after a behavior that decrease the future likelihood of that behavior. Positive reinforcement is when you add something after a behavior that increases the future frequency of a behavior. And negative reinforcement is when you remove something after a behavior [00:07:00] that increases the future frequency.

So we have these words, reinforcement and punishment, increasing and decreasing, and then we have these words, positive and negative. Positive means you add something. Negative means you remove something. We talked a lot in the first episode about how positive has this connotation of being like happy. It's not always the case.

Negative has this connotation of being sad and you know, grumpy and unpleasant. That's not the case either. Positive reinforcement. You're adding something after a behavior that increases the future frequency. Negative reinforcement. You are removing something after a behavior that increases the future frequency, similarly to reinforcement, positive punishment is when you're adding something after a behavior that decreases the future.

Frequency and negative punishment is when you are removing something after a behavior that decreases the future frequency. We're going to have an infographic, a little chart on our [00:08:00] website that helps explain all of this because it can get confusing. Even while we were writing these episodes, I kept coming up with examples that were the wrong examples of things and I'm, I am literally a board certified behavior analyst so it can get confusing.

Um, and we will put some visuals up on our website for you to download if you find that helpful. 

Amy Wonkka: And I think the big take. Takeaways as a clinician, I think for me, are thinking about the negatives, because that seems to be when you're inadvertently doing something right, you're inadvertently taking away the work and making it more likely that your client, you know, might give you a hard time in the future.

Um, not realizing you're actually making it more likely that that will happen, right? So it's a helpful, it's a helpful construct to have a bit of a handle on. 

Kate Grandbois: Um, the irony here is that I believe my son is having a massive tantrum at this exact moment of stairs. So he can be the backdrop to our episode on [00:09:00] behavior management as we go through this.

Um, so the other, so we've gone through positive and negative reinforcement, positive and negative punishment. There's one other variable we wanted to quickly review, which is extinction and extinction is not quite punishment, not quite reinforcement. It's when a some, when a behavior that has been previously reinforced.

So, uh, some behavior had been reinforced for, you know, however long there was a previously established reinforcer that is removed or discontinued in order to decrease or eliminate that behavior. Um, an example that we had given was, you have a long history of putting money in a coke in a vending machine.

You put the money in, you press the button, that's your response, and you expect to get a bag of chips to come out. But if that bag of chips doesn't come out, you might keep pushing the button. You might, you know, your reinforcer has been more money in Exactly. And [00:10:00] when that happens, you get something called an extinction burst.

So when you use extinction, the reinforcer has been removed and the behavior increases temporarily before it decreases. Um. And I think it's something really important to keep in mind because if you identify extinction or if you're using an extinction procedure, you need to be aware that the behavior will temporarily increase.

Amy Wonkka: Well, and it's not even that the, that the reinforcer has been removed. It's like you just don't have access to it when you used to all the time, right? You used to be able to go get your chips, go get your chips, and it's not like your chips were taken away from you. 

Kate Grandbois: Right? Your chips 

Amy Wonkka: weren't delivered. You just can't get your chips.

Kate Grandbois: Right. I'm pretty sure my, my son's having an extinction burst at this moment because someone took his iPad away, somebody took the screen away and, you know, it's, it behavior will increase, but it, it will go down. It will go down eventually. Um, and we're gonna, the extinction is related to some of the common behavior [00:11:00] management, um, strategies that you see in a classroom or in a clinic.

So it's, it's good to have a handle on, on what those things are. Okay. So we have done our quick review. A recap. Yep. Um, so our first learning objective of the day, antecedent interventions and how they can be used to improve client behavior during a session. 

Amy Wonkka: So we've talked, you know, we've talked a lot about things that you can do afterwards.

So in that antecedent behavior consequence paradigm, we've talked about reinforcement and punishment and how, you know, if you deliver those within two seconds of the behavior, it, it can be increased or decreased in the future in a similar situation. But, you know, what about before that behavior even happens?

Like, are there things that you can do as a clinician to make it less likely that, that your client is going to throw the game piece or yell in the first place? 

Kate Grandbois: Yeah. Yeah. Right. Yes, there [00:12:00] are 

Amy Wonkka: yes. To tell you about them. Yes. Um, those are antecedent interventions. So these are things you do before the behavior.

Um, and similar to consequences, this is a big, deep topic in a BA, um, it's, there's a whole section of the field that looks at these antecedent interventions. We are similarly to the first part of this podcast. We're scratching the surface. There's a lot more to learn. Um, I read this summer, this summer I read a really great book titled How to Reach and Teach All Children in the Inclusive Classroom.

I'm gonna mess up these people's names. Sandra Reef and Julie Berg. Uh, I'm sorry, I probably said both of your names. We, we 

Kate Grandbois: will put the reference on the website for you to read the names yourself. 

Amy Wonkka: Yeah. And they had a great quote in the book, uh, that I'm just gonna read to you where they said there will be far fewer discipline problems and behaviors requiring correction and intervention if students' basic needs are being met within the classroom.

And I think that that just [00:13:00] encapsulates the idea of antecedent interventions, right? So I love 

Kate Grandbois: that. 

Amy Wonkka: Yeah. It's so good. This is a really good book If, and it's like very accessible. They have a whole chapter on, he's 

Kate Grandbois: bringing me, he's bringing this on me again. Last minute. 

Amy Wonkka: I know. 

Kate Grandbois: Read this one. 

Amy Wonkka: Sorry. No, it's, it's really good.

So me kicking in there. It's also not a particularly expensive book. So that's something else. Not 

Kate Grandbois: that bonus check out. 

Amy Wonkka: Um, but I think that that's true if you're in a classroom setting, but also if you're in a clinic setting. Um, so the antecedent interventions are really powerful and they're awesome because when you're thinking about behaviors that you don't want to happen, kind of those problem behaviors, the best scenario for everybody is for them not to happen at all.

Kate Grandbois: Right. And I think that you make a good point in that I think these antecedent interventions are. Sort of an unsung hero because, you know, there is a lot of science behind this. There is a whole field of study around this. Um, and there are things that we do a [00:14:00] lot of, we do them naturally sometimes, but we don't really, we don't realize the specific variables that we're manipulating.

And I think awa a little bit more awareness of those can really make a big impact in terms of, um, how they're used. 

Amy Wonkka: Well, and I feel like anybody who is or has worked in a school-based setting, these are also things that when you think about that teacher, you know, you're like, oh, that kindergarten teacher is just an amazing, phenomenal teacher.

And if you step back and you do some observations of that amazing, phenomenal teacher through the lens of antecedent interventions, what you'll find mm-hmm. Is they're, they're just fantastic at, at creating a space that's such a positive learning space for the students. Uh, and, and, and those are the antecedent variables.

Kate Grandbois: And as we talked about, the other reason I think that these antecedent variables are so important is [00:15:00] because they do have a relationship with the consequences. Mm-hmm. So there is this dance between how you set up an environment to set up a set a student or a client up for success, but they have a, it also has a really, it, it has an impact on what you do after the behavior also.

So there is this, you know, there's this interplay there. Um, and they can't really, it makes sense to talk about the consequences first, which is a little backwards. Um, which is why we did that in part one. Um, but, but yeah, there is, there's like a, a, there's a good dance going there. So antecedent interventions, for the sake of what we're trying to, the content that we're trying to cover today, we're gonna bucket them into two categories.

Mm-hmm. So we have motivation. Which the a BA world will call motivating operations or establishing operations if you feel like going down a nerd hole and Googling those terms or doing a little bit more reading. Those are the actual sciencey words. But for the purposes of today, we're gonna just call it motivation.

How motivated someone is [00:16:00] to engage in a behavior. Um, and the other bucket is something called a discriminative stimulus, um, in the a BA world, you may have heard that, you may have heard this term, um, shortened as sd. And the the letters are backwards. We're not gonna go into YI dunno why. It's just we just have to accept it face value.

So sd, you've heard anybody throw the term SD around, um, it stands for discriminative stimulus. And I always think I'm saying that word wrong. 

Amy Wonkka: Well, and I think, you know, when I first heard that term thrown around, I, I thought it was the same thing as a direction. 

Kate Grandbois: Mm. 

Amy Wonkka: And so I thought, you know, the SD is when they give the direction, but actually that's not, that's not it.

Right? Can you tell us a little more? 

Kate Grandbois: So it is, it has a definition, um, or I think for the sake of our listeners in the speech world, we're gonna say that it is a stimulus in the environment. So [00:17:00] something in the environment that signals that reinforcement is available. That could be a lot of things. It's just a, it's anything that you interact with, with your senses.

It's a stimulus. It's a, it's a something in the environment that signals that if you engage in a behavior reinforcement is available. And sds, or the concept of the discriminative stimulus is powerful if you can understand it. But, you know, when we were studying for the, well, when I was studying for the exam, I got real lost in this.

This is another very complex thing that we are not gonna go into. Too deep or how discriminative stimuli and motivation interact with each other. That's a whole other thing. We're just gonna scratch the surface surface. So for the purposes of today, a discriminative stimulus is something in the environment that makes, that is reinforcement, that the signals, that reinforcement is available contingent on a behavior occurring.[00:18:00] 

So, um, let's talk about motivation first. 

Amy Wonkka: Yes. 

Kate Grandbois: I think that makes a great idea. That makes more sense. So again, they are in the, in the literature for a, BA, they're referred, this is referred to as motivating operations or establishing operations. But it, those are any environmental variable that alters the effectiveness of some stimulus, object or event as a reinforcer.

This is a direct quote, if you can't tell. Um, and alters the current frequency of all behavior that has been reinforced by that stimulus object or event. That's a quote from the Cooper Book, page 375 in case anybody is curious. So this is full of really heavy words, 

Amy Wonkka: but like for us, we're just like clinical application boots on the ground.

SLP, we're just thinking like motivation, 

Kate Grandbois: right? 

Amy Wonkka: This is somebody's motivation, 

Kate Grandbois: right? And how motivated they are alters how powerful [00:19:00] the reinforcer is. 

Amy Wonkka: Can you give us an example? 

Kate Grandbois: I can give you an example. So the water fountain at my job, the, like, bubbler or whatever you wanna call it, the, the thing that spews water into my giant water bottle is on the other side of the building and it's like a, a whole five minute walk, which doesn't seem like much, but when you're like between consults or between appointments or you've got, you know, meetings to go to and you're like parched like a camel, you do not want to walk, huff it all the way to the other side of the building, right?

And let's say on a typical day, you visit the water fountain like two times. You fill up your water bottle twice, or you're just visiting a water con. There's no water bottle. You're just going to drink water two times throughout the day. But let's say on one particular day, you may or may not have stayed up late consuming a delicious bread beverage.

A delicious red adult beverage. So you're hydrate. And let's say [00:20:00] because of those activities, you are tired and you may or may not have eaten a whole salty bag of Cheetos as a snack at 10 30 in the morning. I don't do these things. I'm, I'm mature. But let's just say that you did. Your mouth is a desert.

You are so thirsty. You're at work. Water is usually pretty valuable 'cause it keeps you alive. But on this day, water is the most valuable thing to your entire existence. So as a result, your behavior for huffing it all the way across the building to get to the water cooler has increased. The value of the water has increased, therefore, and so your behavior has increased to get to the water.

And that is because of your motivation, because of these environmental variables. 

Amy Wonkka: And that doesn't mean that forever and always in the future, you're gonna be Mrs. Water cooler. It just means like [00:21:00] in this one moment, on this one day, you are much more likely to go to the bubbler. 

Kate Grandbois: I am extra motivated to go to that bubbler because of my Cheeto bag Breakfast and bad choices.

I'm such a healthy person. I'm using the most trash examples, right? High like, but, but for this, this is relatable, right? I mean, everybody gets extra thirsty because they eat a bag of chips or they're dehydrated for some reason. Yeah. Another example, food deprivation. So if you're super, super high, let's say you have like your favorite sub shop, you moved and it's like a half hour drive.

But you love it so much. If you are super hungry and you, you just want that sandwich so bad that the value of that sandwich goes up or pizza or whatever it is, and you may be more likely. To drive all the way across town to get that reinforcer. So in that example, food deprivation is the motivation, is the motivating operation that makes food a more potent and [00:22:00] and effective reinforcer.

Amy Wonkka: Well, and there are potentially a couple of added layers there too, right? You moved, so you're probably eating your favorite subs less often than you were before because they're I 

Kate Grandbois: like that. Yes. That's even, it's additional deprivation. 

Amy Wonkka: Mm-hmm. And we're all kind of in a funny state of deprivation right now when we're living in remote, physically, socially distant times.

You know, I'd imagine when, when life becomes more normal, it'll be interesting to see, you know, how much we've missed our regular 

Kate Grandbois: right. 

Amy Wonkka: Things. Right. We're all in a fund state of 

Kate Grandbois: deprivation for a lot of things right now. A lot of, for a lot of things, I mean. Toilet paper I can't find anywhere. You know, so there it's, it's way more valuable.

Mm-hmm. Um, I, we had sort of alluded to this as just as a clinical application. We had alluded to this a little bit in the last episode about, we had this example about a student or a client who was super motivated by Power Ranger videos and making the [00:23:00] suggestion, well, if we want those Power Ranger videos to be incredibly potent and really reinforcing, maybe consider asking the mom could you, you know, see if you can get him to, you know, withhold the Power Ranger videos for a day or two days or whatever, to create a step, a state of deprivation to make those videos more reinforcing.

So again, you see motivation is the antecedent, but the video is the consequence. So when you're in a state of deprivation, that's that relationship between the antecedent and the consequence when the, you're in a state of deprivation that. Reinforcer becomes more powerful. 

Amy Wonkka: Well, and I think also clinically it's helpful even if you're not going to that level of kind of restricting access to something, but just knowing, you know, maybe, maybe the last like three sessions, you found this cool Mr.

Potato Head app on the iPad, you're having fun with it, your client loves it. Um, [00:24:00] but you didn't know, like the family just downloaded it and, and they live 45 minutes away from your clinic. And so the whole drive to the clinic after school, he played with the potato head app. So by the time he gets there, you know, it's just, it's not as much fun.

It's not as motivating and engaging. So just being aware of how people's motivation is fluctuating, you know, within a day. And some of it are those physiological things, right? Like, did, did, did your client have a horrible night's sleep and they're coming down with a cold and they're just super grouchy.

You know, maybe their tolerance and ability to engage in an activity like art tick drills, right? Maybe. You can, you can usually do some art drills for like 10 minutes, no problems. And then like around like 12 minutes, it's like too much articulation and you switch to something else. But maybe on this like bad night's sleep, grouchy, getting a cold day, that, that amount that they're able to work for that same level of like reinforcement or taking a break is, is shorter.

It's five minutes, you know? Um, [00:25:00] so just being aware, kind of, of the motivating operations or the motivation that might be at play for your clients coming in, coming in the door to your, to your clinic or your session. 

Kate Grandbois: Yeah, I think that's a, that's such a great point. And I think this is another area where just being involved, you know, if you are in pediatrics, talking with the parents, talking with the teacher, getting a feel for what kind of stimuli they're interacting with and how often when they're not in your therapy room or when they're not in the speech room can give you some.

Additional information about how you can manipulate those variables in preparation for your session, or what kind of collaboration you can get with other professionals to create those states of, of deprivation. 

Amy Wonkka: And later on we'll talk to a little bit more about just some of the environmental variables that could be serving as motivating on variables for your client.

Um, and that could be sensory input and all of these other components too that can help you set the stage for a bit more success. 

Kate Grandbois: [00:26:00] Totally. So now that we have an, a good understanding of what motivation is, how can we use it to our advantage? So we've gone through a lot of examples. What are some specific things that you can do, um, to use mos or use motivation in a, in preparing for a therapy session?

So we've already reviewed a couple of suggestions. I think the are, and we know 

Amy Wonkka: it's right. We know, we know motivation is an important thing for us to consider. Because it's going to affect how, how successful our interventions are in that moment, but also just like how successful our relationship building is with our clients.

Kate Grandbois: Definitely. Um, and I think that these are things that we do naturally. Mm-hmm. Sometimes, um, you know, it doesn't, these are, again, this is like the unsung component of antecedent management. I think we do a lot of these things already. Um, so one of the examples that I have put down here was moving [00:27:00] preferred toys or preferred snack items out of reach.

Right. You have free access to the bubbles, or you have free access to chocolate or, you know, whatever it is, you're gonna be less motivated to ask for it. Why would you ask for it if it's, if it's right there and I can walk over and, and play with it anytime. 

Amy Wonkka: Right? Right. 

Kate Grandbois: Um, so I. By manipulating the environment and we're creating those opportunities for communication.

I think that's sort of like speech 1 0 1, but I think it's also important to acknowledge that that's an antecedent management strategy that you're using to create, to create opportunities for communication, 

Amy Wonkka: right? You are changing the environment a little bit to set the stage for those communication opportunities.

Um, you know, I think those are chances to make requests, but they're also opportunities to work with your client on, you know, directing somebody else to do something or get something. And all of those [00:28:00] skills are important, are so important for later in life to be able to direct people and make choices and be assertive.

Kate Grandbois: And I think you make such a good point about directing the behavior of others. And this is an area where, um, I think. I, this is one of my favorite areas, and we're not gonna go into what conditioned motivating operations are CMOs. Um, but if anybody feels like having a nerd moment, there's a lot of literature out there about this, the examples that we've given about, you know, moving the bubbles out of the way, keeping the snack out of, out of reach, other, you know, sensory experiences, you know, manipulating other pieces of the environment.

Those are all great ways to, for creation, for creating communication opportunities to get the students' needs met. But I also love using these for, like Amy said, directing the behavior of others. Um, so for example, giving someone a bowl of macaroni and cheese and no spoon, or giving them a bowl of soup and no spoon.

So [00:29:00] they have to ask for something that's completely out of sight because it's semantically related to the item in front of them. And this is a great thing to work on for self-advocacy, for life skills, for ADLs, um, using those. Linguistic, you know, creating motivating opportunities for linguistically related items and directing other individuals to retrieve those items or, or what, what have you.

Amy Wonkka: And you can extend that even further. You know, if you're running a social skills group or a language group in a school and you establish a routine that, you know, when you start off, you always read a short story together or something like that, you're playing a game and then you disrupt the routine a little bit.

Uh, that, that's just opening the door for an opportunity for the students to work on whatever skills that are might be. It might be group problem solving, it might be, you know, making a new plan or changing their plan. Uh, but just thinking about ways that you can set the stage in advance so that [00:30:00] you are providing opportunities for your client to work on the target skills, whether those are really early communication skills or more complex problem solving skills.

Kate Grandbois: To me, this is very relatable to our more emergent communicators or students on the autism spectrum. When you are trying to figure out a way to teach vocabulary, so you've, you know, gone through teaching them all of their reinforcing items, but you wanna teach where it's like shoe and spoon and all of these things.

How can you reinforce use of that word well and 

Amy Wonkka: make it meaningful? Make it, make it not a flashcard drill. Like make it meaningful. Exactly. 

Kate Grandbois: So like, yeah, you label I have one student in particular. I'm sorry, I just interrupted you. I'm going to get better at that. But I have one student in particular who we taught him to say this was a huge eye-opening experience for me at the desk in the context of, you know, a super, I thought it was fun and motivating play activity.[00:31:00] 

He could, with his device label. A handful of everyday items. When you gave him a bowl of macaroni and cheese and no spoon, he ate it with his hands. He, you know, he didn't ha he had that, he had that word in a different context under different conditions of reinforcement, but we, he didn't have it in the context of, of something that was functional.

And for me, working on motivation and making, increasing the motivation to ask for items in the presence of other items can be a really powerful tool for self-advocacy and life skills and all those kinds of things. Um. But anyway, so that's motivation. That is arranging the environment to create opportunities for, or that's, that's how you can arrange the environment for motivation.

Um, but there are other ways you can use motivation and we've talked about some of these already, so considering deprivation, so making something, um, a little bit more rare prior to using it as a reinforcer. I had done this in my household [00:32:00] recently with my, with my children. I wanted to have, um, a handful of people over after work for, I mean no surprise, wine and food and cheese.

And I wanted my kids to sit and watch a movie and sort of let the adults be in the kitchen. And so I told them for that week that they couldn't watch TV any day after school. There was no screens in my house for four days. And then on this day I was like, you guys wanna watch a movie? They were like, oh my God, that's amazing.

They were so excited and they sat still for like two hours and, and because they had been in a state of deprivation and that potency of that. Um, of, of the, of the screen was just that much higher. Um, so deprivation can be really, really powerful. So can isolating a reinforcer for a difficult task. So if you have something that you want your student or client to do that you find is really challenging or really aversive and that student, you know, gets a certain reinforcer throughout the [00:33:00] day at school or gets a certain, you know, amount of reinforcement, a certain reinforcer at home, trying to isolate it just for that one task.

Um, so it's not just a state of deprivation, but it's specifically related to this one difficult task that you want them to do. 

Amy Wonkka: And that's gonna be different, you know, based on every individual too. I mean, I think I, I really like chocolate and so I, I could consume a fair amount of chocolate before I am, I'm feeling satiated or, you know, like chocolate is no longer doing it for me in that moment.

Um, so I think there's the piece of thinking, of thinking about how deprived or satiated your person might be. So how much could they potentially want this thing or not want this thing? Also, just like matching the levels. So, you know, when we're talking about really challenging or frustrating or effortful tasks, you wanna make sure that you are cognizant of that [00:34:00] and kind of providing reinforcement that is a bit more powerful in that situation.

Um, tell us your example of, of the, the consideration of the tipping point. I like that. Of the tipping 

Kate Grandbois: point. So if Amy asked me to eat a bug and told me that she would give me $5, no, Nope. Not gonna do it. I wouldn't even hold a bug for $5, much less. Eat a bug. If Amy told me that she was going to pay me $10 million.

I mean, you know, I would consider eating that book. Right? So you could you, when you say things like, you couldn't pay me. Well, you could, you just gotta name your price. So what's the tipping point? I won't do it for five, but dollars, I would do it for $10 million. What, you know, where is that? There is some dollar amount, there's some amount of reinforcement that tips into this is something that's like a, you know, fairly paired with the amount of work or the how aversive this stimulus is.

And [00:35:00] that is related to motivation. So if I really want a new kitchen or I really want a new bathroom, or I really want something that has a, you know. That I find very valuable. Maybe I would do it for $10,000. Um, maybe I would do it for even less than that. If I was in a, you know, COVID-19, cut my pay by 75% and now I would eat lots of bugs for, you know, a certain amount of money.

I think. So the, the amount of reinforcement that you're getting is related to that level of motivation, um, and, and naming your price. A, a similar example with, with, um, candy, just since you bring up chocolate, is one m and m might not do it for me unless maybe I had been eating like a bird for five days.

And then on Friday I treat myself with some sweets and that I will, you know, work really hard for one m&m. For one & or a bag. 

Amy Wonkka: But yeah, it's not 

Kate Grandbois: the m ms. [00:36:00] You know what it is for me, it's those mini Cadbury eggs. Oh. People have, I would do anything for those mini Cadbury eggs. 

Amy Wonkka: Yeah. Peanut butter, a lot of types of candy.

This, that could be the whole rest of the podcast. But 

Kate Grandbois: if you, if you told me you were gonna give me a peep. No thanks. Yeah, no thanks. They're gross. It makes my teeth hurt. They're too sweet. But do you see what I mean? Like, so this is like where I think you get into like preferences interacting with what is a reinforcer and how motivated you are based on your levels of deprivation or satiation and all of those kinds of things.

Um, and the last thing to consider when related to motivation is response effort. 

Amy Wonkka: Yeah. So when we think about the difficulty associated with a task, the more difficult it is as a, as a consequence intervention. Right? So thinking about the A, B, C, you wanna make sure that your, your reinforcement matches the level, [00:37:00] but antecedent interventions, you can do some things too, right?

Kate Grandbois: Right. So you can make a task. Less difficult. And by that I don't, I don't necessarily mean, um, changing the goal. So if you have a student who, you know, the, the biggest example that we could come up with for this response effort was related to programming a, a c devices. So you have a word that you would really like the student or client to start using, and it's really important, it's really powerful.

It's related to, you know, them getting access to something that you feel is very valuable to them. Are you gonna program that word to be seven hits away from the home screen? Or are you gonna program that word to be on the home screen itself? You're gonna take up real estate right on that home screen.

So it's one, one hit one selection, or maybe it's one, you know, maybe it's just two heads hits away. So what is the response effort that you are going [00:38:00] to ask that student? You don't want the response effort to be big if they have to sit there and hit the screen seven times to get to the word play, or get to the word go, or get to whatever target vocabulary word you have.

You wanna make that response effort low so that they're more likely to engage in that response to get access to the reinforcement. 

Amy Wonkka: And I think similarly, just thinking about this, you know, if you have language objectives for a student, and what you really want them to be able to do is identify, you know, members of a category or members of a group, uh, and perhaps find motor skills are hard for them.

And, and written communication is hard for them. So don't, if your real goal is for them to work on. That concept of knowing members within a category, don't make it a written list. Don't ask them to write because writing is hard and that's not really what you're after. You're after that understanding of members of a group.

So maybe use a, a cut and paste activity where you've already cut the, that's a great 

Kate Grandbois: suggestion. 

Amy Wonkka: Um, so just [00:39:00] really thinking about what your actual goal is for your client, and then removing any barriers that you can to make it not harder than it needs to be. 

Kate Grandbois: I, I think that that's such a, I think that that's such a, another really great example.

Um, and in the interest of time, I wanna keep moving on. So let's move on to talking quickly about what discriminative stimulus is, and then truck along to our third learning objective to discuss some of these regularly seen, uh, behavior management principles. So we talked a little bit before about, um, SDS discriminative stimuli, um, and a discriminative stimulus is a signal in the environment.

Our stimulus in the environment that signals that reinforcement for our response is available. And I'm gonna go with an example related to a previous example of the water cooler. So let's say you have a water cooler in your work environment and you walk by it a million times a day and there's this random light above it, and you notice over time that when you approach the water cooler to use it and the light is [00:40:00] green, the water cooler works and the water comes out.

When the water cooler light is red, the water cooler is broken and it gives you no water over time. If you are thirsty and you are walking past this water cooler and you notice that the light is green, you're more likely to approach the water cooler for water. If the light is red, you are less likely to approach the water cooler for water.

So in this example, the light is the discriminative stimulus that signals that reinforcement is available and makes it more or less likely that you will walk towards the water cooler when thirsty. 

Amy Wonkka: And I think that that's such an important distinction, the interplay between your motivation and the discriminative stimulus.

So even if you had your dehydrated evening, you ate all your Cheetos, you're super, super thirsty. If the SD doesn't tell you that water's available, you're not gonna go get the water, right, because it's not available. 

Kate Grandbois: So let's go [00:41:00] through maybe one clinical example of how an SD can be. 'cause you're right, I mean, I think as speech pathologist we hear SD and we think, oh, it's the direction or it's the, it's the verbal verbally presented question or, or whatever it is.

But what is an, what is another, um, what is a clinically relevant component of manipulating sds? 

Amy Wonkka: So, I mean, I think if we think back to our like tired and grouchy child, right? So if our tired and grouchy child is gonna crawl under the table because he doesn't wanna participate in the articulation drills.

If we never present those drills, which in this case are the sd, then he doesn't need to scream and cry to get away from them. Right. Like meaning you 

Kate Grandbois: present the, you presented the drills, the child's like, well, forget this, I'm not doing it. Mm-hmm. The, the stim, the cards or the materials that you place on the desk are the stimulus in the environment that indicate that what 

Amy Wonkka: work is coming.

Kate Grandbois: That work is coming. [00:42:00] Right. Work is, so they engage in, or it indicates that, well, if I crawl onto the table, she's just gonna take the materials away. So that's the negative reinforcement is available, which makes it more likely that the kid's just gonna crawl right under the table. 

Amy Wonkka: Mm-hmm. Yeah. I think that that's where.

Having flexibility in your sessions, in your planning and being a bit more, and it, these antecedent pieces are not always going to prevent somebody from getting grouchy and crawling under the table. And you do wanna strike a balance. You can't have, you know, people coming in for their outpatient session and then you never work on articulation.

Uh, but I think that it's helpful to be cognizant of all these different factors that are at play and be a bit flexible with the way that you present it. Because if you are tired and grouchy and getting sick and you're not super available for learning, chances are, even if you get a small number, smaller number of opportunities, lower frequency of opportunities [00:43:00] to practice those sounds than you might in a, in a session where you're not tired and ging coming down with a cold, those, those opportunities are still going to be able to, you're gonna follow through with 'em as opposed to if you come in hard with flashcards and the rest of the session is a sad time for everybody, 

Kate Grandbois: a very sad time for everybody.

Mm-hmm. Um. I've used this one other clinical example that I can think of, which I'm, I, I think is a good example, is training loosely. So you're trying, you know, you're teaching your student to, you know, you wanna teach them what shoes are. You don't want to use just the same pair of shoes every time you talk about shoes or put shoes on the doll.

The SD for the word shoes has to be varied. So the stimulus that you're using to indicate to, to signal that, oh, we're doing this activity now. Reinforcement is available if you say shoe and I show you the shoe. Or if we talk about the shoe, you wanna have different shoes so that you don't get [00:44:00] this, you know, rigid response where I say shoe only when I see this one shoe that is blue with a red swoosh stripe on it or whatever.

Amy Wonkka: I think there are some other considerations too, you know, that you just might a apply more broadly in general to your sessions if you're not already doing them. You know, if you notice that your client is getting upset when you're using mostly adult directed tasks, make a point to offer more choices.

You know, do, do you wanna do flashcards or bingo first? I think in general, providing choices and teaching clients to direct other people take ownership over the planning and engaging in the session to an increasing degree, depending on their age, is a really valuable strategy. I mean, I think in my head for a lot of this talk, it's that it's that toddler client.

This is equally applicable. You know, you have a high school student talk about what their goals are. What are your goals? How are we gonna achieve those goals together? What is the most important for you? Let's make a plan. Um, we are all more invested in things when they're meaningful to us, and we feel like we have some shared ownership of [00:45:00] where we're going.

Absolutely. 

Kate Grandbois: And that's a human condition, right? I mean, 

Amy Wonkka: yeah, 

Kate Grandbois: definitely. 

Amy Wonkka: We like control. Everybody likes control. 

Kate Grandbois: It's true. So learning objective number four, we're gonna sort of scoot right along here. What are some commonly used behavior management strategies and the science behind them? The first one we have listed is visual schedules, which is, I think something that is used very commonly in, in our field.

Amy Wonkka: Yes. And I, I mean, I think this connects back up to that other idea of giving choices and autonomy. You know, it's, it's helpful. We, like most people, like to know what the expectations are, you know. It helps us to be more independent and visual schedules can be as simple as like a first. Then first we're gonna do this, then we're gonna do this.

Just reminding everybody that, you know, there is an end to this work. And then it will be followed by something fun and enjoyable. Um, it could be linear, you could have pictures, you could just have a, a written [00:46:00] out list that's text. Um, but I think that visual schedules are helpful for, it's, it's like having an agenda for a meeting if you, if you go to a right 

Kate Grandbois: there.

I mean, we use self-management strategies. We use, I mean, I have a calendar. I, I use it every, I use it every day. Yeah. Um, you know, knowing, knowing what is an, you know, what, knowing what to anticipate and knowing when reinforcement is coming. Okay. So I have to be working all day, but it's Friday night, so I'm gonna make greasy cheese steaks and open an expensive bottle of wine because that's what I do on Fridays and I know that that is coming.

So, you know, I think that it's important to see. Visual schedules less as something that you do in therapy just because you do it. And more acknowledgement that this, this can be an antecedent strategy to prevent unwanted behavior if the unwanted behavior is related to avoidance or, you know, related to trying to get access to something beforehand.

So visual schedules can be really important. Um, and I think it's important to acknowledge that it's not something [00:47:00] that you do in therapy just because you're supposed to do it or just because you think that the, the student, you know, gravitates towards it. Or it's something that hap just, you know, 'cause it's something happens in the classroom and it is actually an AnSed management strategy that you can use to reduce, um, the likelihood of unwanted behavior if that unwanted behavior is related to not knowing when reinforcement is coming or avoiding avoiding something.

Um, because the student feels like it's hard. So that's, um, visual schedules. Another really popular one is a token economy. Um, token economies, I think is a fancy word for things that we use all the time. So token economies are star charts, sticker charts, points in a classroom, putting compounds in a jar.

Um, it's any system where there are a list of target behaviors that you're reinforcing and there are tokens that are small objects or whatever, um, that people can earn for emitting a target [00:48:00] behavior. And then in exchange for those tokens, there is a menu of backup reinforcers. So preferred items, privileges in the classroom, access to things, breaks from things, more minutes doing things.

And the client or the student. Exchange the earned tokens. And these are really powerful because they can be ex, the tokens can be exchanged for a variety of different for reinforcers. You can use your star chart or your token economy, or your sticker chart across all of your students and just change the menu based on what you know Donny likes versus what Sally likes.

Um, I think one thing that's really important to note when using a token economy, and we covered this a little bit in the first episode, is that you have to make sure before you just jump right in with using five stars or five stickers or whatever, you have to make sure that the student or client.

Understands that the token is reinforcing. So in our last episode, I had [00:49:00] described a situation, a big mistake I made where I expected Johnny to sit for five whole stars before he got his video. And he did one task, earned one star and was like, forget this, I'm outta here. I'm not sitting here for five more stars.

I want now. So in that example, I had to go back and teach Johnny that I had to pair the star with a reinforcer and then slowly over time build up to two stars and three stars. 

Amy Wonkka: And in the inclusive classroom book pages one 10 to one 12, they do a great job giving some really practical ideas for group behavior management systems.

Kate Grandbois: Oh yes. That's very important. 

Amy Wonkka: Yeah. And, and when you have group behavior management systems or other systems like that, they are kind of functioning as antecedent end consequences simultaneously because you know, like it's helping set the stage for, oh, everybody in the group we're all working for the classroom pizza party.

Um, and that's sort of an overlying motivation to earn this classroom pizza party. Um, so they give some great examples of, you know, marbles in a jar, [00:50:00] probability reinforcers to like earning a coupon to like a raffle. It's really, it sounds 

Kate Grandbois: like a great book. I can't believe you, you were holding out on me.

I 

Amy Wonkka: know. I just thought of it the last minute. It is a really good book and they have a lot of really nice practical suggestions. Um, so I would, I would say check that out, especially if you're running a lot of groups and you're trying to figure out how to incorporate some of this into your group behavior management.

Kate Grandbois: Yes, we will definitely have this resource up on the website. Um, so that's token economies super popular, super easy. You just have to make sure that you're using the right reinforcers on the menu and also making sure that your stars or stickers are actually conditioned reinforcers and they have been paired over time and slowly at the, at the threshold or schedule that the student or client can handle.

Um, second to last, ignore and redirect. This is something I hear parents using a lot. Um, I've heard it in, you know, preschools and, and kindergartens. Maybe not so much kindergartens, but I guess everywhere. [00:51:00] Um, so ignoring and redirecting is something that I see in preschools and I guess kindergarten, and I guess it's in a lot of places.

I, I hear, I hear it a lot, um, in very casual conversation with parents. Um, it's basically extinction using under the assumption, operating under the assumption that attention was the reinforcement. So remember in extinction, extinction is when you remove a previously established reinforcer, the expectation that the behavior will reduce or go away, and it's always associated with an extinction burst.

So when the, so the initially the response responding rate will go up and before it, before it reduces. So an ignore and redirect, you're ignoring a behavior. That you want to reduce operating under the assumption that attention was maintaining it and you are redirecting them to a more, I would assume, pro-social or replacement behavior and providing reinforcement [00:52:00] for that pro, pro-social behavior.

Um, I see it a lot with, um, avoidance behaviors. So you're ignoring Johnny in the back of the classroom while he's burping and getting up out of his seat, but then the second he doesn't something, you know, that's compliant, you're, you know, redirecting him to do something that's more compliant and then showering him with attention for the compliant behavior.

Is that how you see it also? 

Amy Wonkka: Yeah, I think so. I think it's also just being aware that if you were inadvertently reinforcing something, you stop doing that. 

Kate Grandbois: Mm-hmm. 

Amy Wonkka: Right. So the example of, you know, if, if you're, if you've historically been discontinuing your task, you are, you're stopping doing that.

Kate Grandbois: Definitely. Yes. Yes. Agreed. Um, so that's ignore and redirect. Um, and the last one is planned ignoring or inclusionary. Timeout. And as Amy and I were discussing this, we had to look it up to make sure that we, we delivered the right [00:53:00] information. Um, planned ignoring and inclusionary timeout are technically punishment procedures and it was, you know, it's not a hundred percent clear, but they are technically punishment procedures and not something that you typically see in a school environment.

Amy Wonkka: Yeah. And it's not probably something that you're going to be using in your clinical environment either because you're focusing on reinforcement, um, and if necessary adding in some extinction in there. But really the focus is on reinforcement. 

Kate Grandbois: So I'm sort of putting you in the hop seat with an unexpected question, but in the schools.

You really, we don't use punishment in schools anymore. There's no more corporal punishment. There is no, well, 

Amy Wonkka: it's not even missing recess like we talked about in the last Right. Podcast. Like back and forth when we were young. Um, right. Yeah. Because, because I think that what people have found is that reinforcement and these antecedent strategies are really powerful.

Kate Grandbois: Right. So, 

Amy Wonkka: you know, thinking [00:54:00] about all of these antecedent strategies that we've talked about today, I think helps set the stage for reinforcement to be available. 

Kate Grandbois: Yes. But what I was gonna ask you was planned ignoring and inclusionary timeout is technically allowed, right? It's, I think it 

Amy Wonkka: varies state by state.

Kate Grandbois: That's, that was gonna be my next question is, you know, there are some of our listeners, you know, we've got listeners all, all across the country. There are some listeners who may be listening to this. Oh, well we do this regularly in my classroom. 

Amy Wonkka: Well, and you can, I mean, I think that there's also a difference between, you know, the teacher not calling on somebody who's, who's shouting out and like doing something that's not part of the classroom norms.

Um, that's, that's different. 

Kate Grandbois: Right. And 

Amy Wonkka: I think that those things do happen. And then choosing to call on them when they're in their seat and following the classroom norms. So that actually the inclusive classroom book does talk a lot about behavior management in a classroom context. And I think it makes it pretty clear, [00:55:00] you know, that a lot of these strategies are things that are happening as part of classroom management.

Um, so it depends. It depends on how deep you're, you're getting into it and what specific procedures you're talking about, I think. Right. 

Kate Grandbois: But those are our, that's our list. So that's the list of commonly used behavioral management strategies, visual schedules, token economies, ignore, redirect, and planned ignoring.

Um, are there any other manage antecedent management strategies that you feel like are important? 

Amy Wonkka: Yeah. So just to recap, we did talk a lot about antecedent management. We talked about being aware of the person's motivation and how that might change the value of the reinforcement. Uh, we talked about a lot of things that the clinician can do in their sessions to sort of set the stage for those communication temptations, which can range from promoting really early communication behaviors or later communication behaviors and kind of more sophisticated social groups.

Um, [00:56:00] we talked about modifying the tasks themselves and being flexible in our session planning and within sessions to not stick rigidly to our agenda or lesson plan. Um, if it turns out that the client comes in, in a space where they're not as ready to learn as they normally are. We talked a little bit about building rapport.

I think that that's super important. Your first few sessions, you may hear A, B, C, B, A call, this pairing with reinforcement and it really just means. You are associating yourself with good things and good times and good activities. Uh, which A, which A B, C, BA, I guess would say, you know, you've, you've paired yourself with all of these different reinforcements so that you just, like a token becomes reinforcing over time through all this repeated pairing, you kind of do too.

We all want to be such 

Kate Grandbois: a good point. 

Amy Wonkka: We wanna be where our clients want to come. We want them to want to come and work with us. And so I've always felt like I might spend my first few sessions with somebody, and this is, this is [00:57:00] true for toddlers, this is true for adolescents who I've worked with, or young adults.

You know, I, I want us to build a relationship before I start asking you to do hard work. I want us to build a relationship so we're working together on shared goals. And so those sessions aren't wasted. And I think sometimes it can be helpful with pediatric clients to have an explicit conversation with families about that.

It might look like we're not doing much in these first few sessions. We're doing this really important work. That's laying the foundation for us to be able to do later hard work. It's so important. I think that's 

Kate Grandbois: such a good point. 

Amy Wonkka: And then I think the last piece is just modifying the environment last plug for that inclusive classroom book.

Um, but page 106 has a really nice list of potential environmental triggers of misbehavior is what they call their chart. Um, so this is just thinking about, and, and I think this comes into play a lot in the school and the interaction and the interplay between outpatient and school-based clinicians. [00:58:00] So the clinical outpatient environment is very different.

It's quiet. There's not a lot of noise, there's not a lot of distractions. Maybe there's nobody else there between besides the two of you. When you layer in all of these environmental variables that could set the stage and change the motivation and the bandwidth that your client has to participate and engage in these tasks.

In a very different way from how they would look in your session. It doesn't mean that they can't do those things quietly with you in outpatient, but it also doesn't necessarily mean they can just automatically go do those things in a noisy hallway or the cafeteria. Um, and for some, for some clients, it's not an issue at all.

But I think just being mindful of things like, you know, the actual, the actual internal state of the person, the sounds, the lights, the movement, all of those things can be really important variables for people. And then there are also modifications just around challenging behaviors you [00:59:00] might see in your session, right?

So if your client sometimes swipes materials from the table onto the floor. Make sure there aren't extra materials sitting out on your desk or your workspace if they tend to climb up on extra chairs. Like, that was 

Kate Grandbois: the first lesson I learned as a graduate student. Yeah. I was like, oh, 

Amy Wonkka: set the stage. So, so now that problem behavior can't happen 'cause you don't have a stack of stuff up on your table.

Um, if they climb up on your extra chairs, move the chairs in the hallway for that session. 'cause now you can't even climb on the chairs and we don't have to worry about the, the consequence because the behavior never happened in the first place. Um, you know, if they flap out of their chair, think about playing on the floor instead of sitting at a table.

You know, when you've got the little guys sitting at a table. And this is 

Kate Grandbois: where, just to loop it back to what you said, this is where when you watch an amazing teacher, these are the things that they're doing. Yes, yes. They're setting this, they're changing the environment to set the student up for success from the get go.

And it's so important. 

Amy Wonkka: Yeah, antecedent interventions are the best. 

Kate Grandbois: High five. 

Amy Wonkka: High five. 

Kate Grandbois: [01:00:00] Well, I think that wraps us up. 

Amy Wonkka: Yeah, we, 

Kate Grandbois: we covered a whole lot of material in these two episodes and I, I hope that our listeners don't have glossy eyes, um, and have stuck with us through the, through the very end, through the bitter end.

Um, so thank you for listening. Check us out, um, on our website. If you have any questions, send us an email. Um, if you feel so inclined, leave us a review. That would be awesome. And, um, we hope to listen. See you guys back here again soon, 

Amy Wonkka: or at www.slpnerdcast.com. Woohoo.