ragebutt

Well it should only be a bit but I will try it without, sounds interesting

To be clear i am not the person who downvoted you

It’s not like I get paid extra to do ABA. I get paid to do therapy regardless of who shows up and thanks to the shitshow of the world there’s no shortage of people. Mental health isn’t really like physical health. We can’t really “pad” billing with a ton of codes in outpatient settings most of the time. We bill in units, not services. So you come in and I bill more like you would expect from a worker, essentially by the hour. This is not like a surgeon that tacks on a complexity billing code and an extra code because you took a $300 Tylenol. Of course not all mental health is like this (especially crisis, which has more modifier codes)

But clearly you think regardless of how the billing works it doesn’t matter. So anyone who charges for their services is invalidated from speaking on issues? Got it. That is a viewpoint entirely incompatible with modern society. How do you reconcile such a thing?

Do you distrust vaccination because the evidence is sponsored by companies with a vested financial interest? Do you distrust the providers who recommend your flu shot because they have a vested financial interest in being able to bill for the service in rendering it? Do you distrust the evidence based treatments for your TN-2? There is a vested financial interest behind every treatment if you are that cynical.

A financial interest is absolutely something to investigate. That’s why they’re required to be disclosed in research. But it’s not inherently an issue if there is valid evidence of efficacy

I am criticizing their bias because their bias allows them to present a one sided inflammatory and misleading argument that masks the true issue of what the problem is here.

When someone comes into my job I give them the associated risks and rewards with ABA or any other therapy. They are allowed to weigh that risk and either consent or leave. Obviously my bias is that I think it is good. Like all people I have bias. But my bias is supported by a base of evidence supporting the efficacy of treatment

Again I think the issue here is consent and I think the article obfuscates that. If a parent comes in and says “my autistic child flaps their hands and that is weird, make them stop” it is my responsibility to say no. That is where I take offense to your point. If I was purely working from financial interest why wouldn’t I be like “fuck that kid?”. Granted there are practitioners out there who do this. I am sure of it. I am sure some of them are malicious even, knowing this is bad but doing it because they can bill. But I am betting the majority of them are more naive. They believe they are being helpful. They believe they are making this child’s life easier because it will help avoid social stigma, rather than think of ways to address causal factors of social stigma.

And to their credit they at least have an argument. I have worked with clients who wished they could suppress their stereotypy early in life to avoid bullying. I would argue these clients need work on self esteem and self advocacy rather than finding themselves in a position where they feel the need to be subservient to an abusive system only to make the abuse stop, but on the other hand it is not my right to tell someone how to interpret the world and this is starting to get away from the point.

But there is a very difficult ethical debate here. Where is the line for clients that cannot actively consent? A moral gray area exists, obviously. It’s easy to say that using ABA to extinguish non harmful stereotypy is fucked up. It’s somewhat easy to make the argument that someone who is physically harming themselves to the point of hospitalization would likely consent to changing their behavior (though obviously some will steadfastly disagree no matter what the risk is and regardless of the lack of viable alternatives). But where is the middle? What about doing homework? Chores? Moderating access to games and such? Far more interpretable

But we can’t have these nuanced discussions because of misleading articles like this and hardline stances like yours that reject any nuanced discussion on the topic whatsoever.

Edit: and that blog absolutely has a financial interest, they literally have a fucking shop link in their top bar. I have no idea if they run Adsense because I have Adblock. Their financial interest is more nefarious if anything! At least mine is upfront! I will tell you my hourly rate beforehand!

I never claimed to not have bias. Everyone has bias. But I run my practice with a fairly extreme sliding scale, I take Medicaid, and I work with several clients for no money at all. I make a livable wage but I don’t make as much as you think. And the reason I do is because I do literally everything myself to cut as many middlemen and overheads as possible.

Additionally ABA is only a part of my practice. I do a lot of gender affirming care, CBT, etc. frankly if you removed ABA from my practice I would be fine, financially.

While it is valid and important to expose a vested financial interest I think it’s also important to look at the overall content of what is being displayed as well. Of course you have no obligation to do so and can always tell me to go fuck myself

I mean see the much more involved reply I gave to the to other person but in addition to that the difference here is that ABA does work. It’s evidenced based to do so. It is not kooky bullshit of people stealing your money with snake oil.

The issue surrounding it is one of consent, which is a very worthwhile discussion to have. This is another issue with the way the article is presented. It confounds the actual issue! Now you are conflating it with snake oil when there is an astoundingly large body of evidence in support of its efficacy. To be clear, this is not a flimsy “it works sometimes under some scenarios maybe” thing. This is decades of evidence

So when you come into my practice and say you want to change a behavior that bothers you and negatively impacts your quality of life I can present you with operant conditioning. You want to change something about yourself, which is sometimes a thing that people do. It will likely be effective if done correctly. If I present it to you clearly and you consent to it, what’s the problem? But the moment I call it ABA you are far more likely to simply reject it now. That’s your right of course, but it’s sad

Now we can discuss the ethics of treating those who cannot reliably consent, children, people who cannot reliably communicate, etc. but frankly is ABA the issue here? Again I argue your issue is with programming direction being forced upon someone who cannot advocate for themselves. This is not ABAs fault. But it is an easier thing to scapegoat

Well you’re obviously being sarcastic but to expound on the point

ABA is a difficult thing because of consent issues, obviously. But the article portrays it solely as torture, as do you. I have worked with children who literally bash their head into the wall until they give themselves concussions. One kid did it so hard he detached a fucking retina. I have worked with people that have done so much property damage to their homes their houses are condemnable. I have worked with people that become violent when presented with stimuli that they consider aversive, like a song comes on the radio they don’t like. And when I say violent I don’t mean they are “mean”, I mean they fuck people up, they send people to the hospital.

To further confound things research shows the absolute best thing that can be done to avoid the above scenarios is early intervention to work on issues like frustration tolerance and toleration of denied access.

What do we do in these cases? Contingent reinforcement is evidenced, effective, and when applied effectively can be balanced against the cost. These people have serious quality of life issues and ABA can alleviate that when not much else, if anything, can, aside from just giving them what they want all the time and creating a sterile environment free from any stressor, which is unrealistic and foolish.

The article is presenting it in terms of “ABA is bad because people implementing it have misused it”. This is why I say it’s one sided. I should have elaborated this in my first comment probably. But so many people, you included, seem to have no interest in having a more nuanced discussion on this. It’s demonized because of practitioner misuse. This is understandable. But I will continue to make the point that all ABA is is the science of operant conditioning, nothing more, nothing less. How it is implemented is up to the practitioner. It is up to the social norms surrounding to dictate that

To that point I would argue your real beef is with capitalistic systems. These practitioners are generally well intentioned but they are misguided. They are doing what they and the parents of the individual often think is “right”, to make you “work” within such frameworks. This is where the article starts to come into play and this is where bad application of ABA comes in.

Utilizing ABA to encourage a child to stay seated, to discourage stereotypy, etc. of note is that this application is generally discouraged although to your point there is nothing strictly disallowing it. Parents and education environments ultimately have the most power here although many practitioners, myself included, will refuse to “work” on behaviors that don’t need to be worked on when they can be accommodated instead or simply just ignored, eg hand flapping doesn’t bother anyone so who cares? And getting up from their seat during class may be disruptive but can we possibly accommodate somehow, like changing seating or directing to the back of classroom so they can pace freely?

Further the article completely glosses over things like functional communication training. So never mind that utilization of ABA has led to me giving communication skills to many clients who otherwise had either none at all or very limited skills. And never mind that it’s not just contingent reinforcement in a bubble, it’s generally operant conditioning paired with functional communication.

And never mind that operant conditioning is in many ways naturalized consequences of real world conditions made safer and more artificial so that they can be practiced and learned without more serious cost

The issue I ultimately take here is that yes, there are issues with ABA. I outlined them above but will explicitly say them again: it’s in the application. Contingent reinforcement is a powerful tool and misusing it means you can attempt to shape behavior in flawed ways that are harmful. Conversion therapy is not ABA but is based in somewhat similar principles of behavior conditioning (classical vs operant conditioning), and yet I still don’t think the gross misuse by those clinicians nullifies the applicability of classical conditioning based therapies for similar reasons.

But to respond in such an obviously biased way steers people away without providing a balanced view. It reeks of tactics that anti science zealots utilize. it puts families in a position that makes the susceptible to dangerous treatment options. Etc

It’s basically a protection thing that some mobile devices and laptops do. Essentially if it booted before that it would probably immediately shut off right after it booted if power were disconnected. It charges to a point where power can be disconnected for a few minutes and you’ll be okay, then it boots

Hopefully the switch 2 has fast charging

sick

If only I still had any optical drive and blank optical media

Tofu is just an ingredient, it doesn’t have to be in a vegan dish

The biggest thing with Japanese cooking is ultimately the heavy use of dashi, which is based on katsuobushi, dried and fermented tuna that has been shaved into flakes. It’s a stock that’s not necessarily in everything but it’s in a lot of stuff

Agedashi tofu is a good example. Delicious and would appear vegan. Tofu, drained, pressed, dusted with potato starch, and fried. Place in a bowl and pour a broth/sauce of dashi, shoyu, mirin, and sugar. Top with grated daikon, ginger, scallions, and shichimi togarashi. There are other ways to make it but that’s a general prep.

The dashi makes it not even vegetarian but at a glance it appears vegan. It’s easily made vegan because you can make a reasonable dashi with dried shiitake in place of katsuobushi. This will not taste the same of course but it will still be good. This is very much not traditional though and is extremely unlikely in Japan

There have been places to get vegan options in cities like Tokyo for awhile though. Despite that Japans definitely one of the more vegan and vegetarian unfriendly places you could travel to. Non vegan restaurants often simply won’t have an option for you and traveling outside of the cities often means no options at all unless you’re good with konbini stuff the whole time. That said Japan is super hospitable; if you explain your diet to wait staff they’ll almost always accommodate in my experience. This of course may require you to have a reasonable command of Japanese, especially if you’re not in a place like Tokyo, and you should be prepared to eat a lot of fairly simple (but still very good) dishes of mixed vegetables in soy sauce and mirin. Also don’t be surprised if they introduce you to natto haha

Clever!

I wonder if someone could figure out a way to write an app that would generate an iso that would “tattoo” a dvd based on what you’ve done here. Like ascii art, kind of

It does, and so do some vr headsets. I’ve never used a vision pro bc I don’t know anyone irl who is a total goober. I have used a playstation vr2 and the eye tracking is lackluster but in general the psvr2 seems like sony shit it out and just kind of gave up. Like when you configure the eye tracking it’s clearly fairly capable but in games it doesn’t do much of anything.

I do feel like apple would probably have given it a bit more polish although I also feel like it probably wouldn’t work as smoothly as they describe. Like you look at “s” and continually type “a” or “z” and the finger gesture keeps not gesturing. I did try a new apple watch that had the feature where you could tap your index finger and thumb to confirm dialogs and it worked like 60% of the time. When it worked it worked really well, like even with the gesture being small and covert, and when it didn’t it would be super dramatic and big and it would just not register

But either way the issue for glasses is getting the hardware for eye tracking, associated cpu power, and battery power to run it all within a somewhat reasonable glasses frame. A big goofy vr helmet has room to spare

For reference these weren’t what we used in the study (what we had were far more hacky looking, I don’t think they were a commercial product) but they were similar ish:

https://www.tobii.com/products/eye-trackers/wearables/tobii-pro-glasses-3

I wish you super well. I would love it if you could share more as I’m extremely interested in cog sci and ux research stuff but if you can’t or are uncomfortable sharing I totally understand

A shot in the dark guess based on an idea I had a while back thinking about this: eye tracking?? I did a study on autism where we used glasses that could do eye tracking a few years ago. I didn’t realize you could do it so unobtrusively and with the tech a bit more matured I could see it being a viable option, if you could software magic around just general eye movements and blinking and shit

Again though totally get it if you do not want to discuss!!