#089: Autism in India & ABA Training in Multiple Languages | Interview with Dr. Smita Awasthi

Over 35 years ago, Dr. Smita Awasthi encountered a child who had a textbook case of autism in India, but she didn’t actually know how to help him. There were no resources in India to rely on, and Dr. Smita felt a great deal of guilt for not being able to help this child. That’s when she applied to the online ABA program through the University of North Texas. From this correspondence course, Dr. Awasthi was able to begin her journey learning how to help children and adults with autism in India.

There are some truly unique challenges working with the autism community in India, and one of them is choosing which language to teach a child. Some parts of the country can speak up to four languages, and many students have a dominant language at home but are then instructed in English in the schools. Dr. Awasthi finds that teaching a child to request in the dominant language and reinforcing the listener responding in English can be effective. Whatever route the parents or therapists might choose, bilingualism is an additional piece of the puzzle that the autism community in India must factor in to their programming.

Children with autism struggle with some skills like sleep, potty training, sibling relationships, and speech. There are so many factors that play into how to approach therapy such as the child’s age, family priorities, cultural differences, and whether the child has low or high cognition. Dr. Awasthi has just finished a seven-year study where she worked with 126 children with autism to improve their vocals, and 83% showed a marked improvement. She really believes it’s never too early or too late to help children with autism learn to speak.

Trying to help kids knows no boundaries. One of the most amazing things about online education is how it connects autism professionals around the world and helps them work together to better serve their own communities. I admire Dr. Awasthi’s initiative and I look forward to many more years of collaboration because we can do better to help children around the world reach their fullest potential.

TODAY’S GUEST

Smita Awasthi, Ph.D., BCBA-D holds a Doctorate in Behavior Analysis and has 36 years of clinical experience. During this period, Smita has worked on capacity building, skilling therapists, parent training, advocacy, education, and mentoring students in the latest technologies in autism intervention. She wears many hats and has many Firsts to her credit. In 2004, she became the first Board Certified behavior analyst from India and the region. She has provided leadership in the dissemination of behavior analysis by forming “ABA India”, a non-gov’t organization and an affiliated Chapter of ABA international of which she is Past President. In 2010, she founded the first organization “Behavior Momentum India” to provide 1:1 behavioral interventions to children and adults with autism. Today BMI is the largest interventional center outside the USA with a team of behavior analysts, RBT’s, and 200+ paraprofessionals. It has 9 centers serving nearly 300+ people with autism and IDD between ages 1.4 years to 30 years of age. She started the first BACB approved behavior analysis consequence in India in 2014 of which she is the Program Director. She formed Behavior Momentum Indian Foundation, a non-gov’t not for profit organization which is currently working towards building a large residential community for adults with autism.

Smita has two publications and one book chapter to her credit. In the last 15 years, she has presented research at international scientific conferences in behavior analysis in various countries and has been an invited speaker at various universities such as Queen’s University Belfast, Panteion University Athens, Greece, and prestigious conferences such as Penn State. Among other awards, she has also received the Governor’s award in 2005 for the dissemination of autism in the most populous State of U.P. in India and the Metro-city Rotary in 2013 and the SABA award from the Association of Behavior Analysis International, U.S.A. (2009) for the dissemination of behavior analysis. She is currently providing support and mentorship towards the development of behavior analysis in Bangladesh and Nepal.

YOU’LL LEARN

  • How to choose which language to teach in a bilingual household.
  • Why turning to communication devices too quickly can inhibit vocals developing.
  • Some ways to identify oral motor issues and how this can impact speech development.
  • How autism professionals in India are collaborating with each other.

Want to get started on the right path and start making a difference for your child or client with autism?
SIGN-UP FOR DR. MARY BARBERA’S FREE TRAINING

Transcript for Podcast Episode: 089
Autism in India & ABA Training in Multiple Languages | Interview with Dr. Smita Awasthi
Hosted by: Dr. Mary Barbera

Mary: You're listening to another episode of The Turn Autism Around podcast. I'm your host, Dr. Mary Barbera. Today, I'm joined by a special guest, Dr. Smita Awasthi from India. She is a doctoral level behavior analyst. She's spent over thirty-five years in the field, and she is in India really working on training and capacity building and working with therapists and other behavior analysts to bring better training to India. She also has done some fascinating research to show that it's never too early or too late to get non-verbal kids speaking. And we're going to talk about that and some of the issues in training people in multiple languages in this special episode. So please welcome Dr. Smita Awasthi.

Mary: I'm so excited to talk to you today, Smita. Thanks so much for spending some time with us.

Dr. Smita Awasthi: Thank you for inviting me.

Mary: Yes. So you are in India. What part of India are you are you living?

Dr. Smita Awasthi: I live in Bangalore, but I work across the country.

Mary: All around the country.

Dr. Smita Awasthi: All around the country. And a couple of neighboring countries, too.

Mary: OK, great. So I always like to start with getting interviewees to tell me about their fall into the autism world and, I know you've been in the autism world for so many years now, how did you get started in with your interest in autism?

Dr. Smita Awasthi: So my journey in the field of special needs started in 1983when I got a job in a UNICEF project where I was involved in community based habitation of people with special needs. And that's when I came across a 10-year-old boy who was a mystery. Nobody understood him and nobody could really diagnose him. And this was around 1983. It was a long time back. I was very young and I didn't have the courage to ask people that this looks like autism because I had this much of a paragraph. I had read in my book in psychology. That, in retrospect, that has left me with a huge sense of guilt for being not able to help that child.

Dr. Smita Awasthi: Then in 1993, I was referred or a two-year-old girl with autism, classical autism, who was having very limited skills. And this time I took it on as a challenge. And so with my master's in psychology, I knew how to use reinforcement principles. I knew a bit about chaping although I was not trained. So I used those and I could see a difference in the child. So this be good that. So I was working the door for almost seven years and then I decided that I'm scrambling too with this child. But I think I need to do more. I need to have better skills. So in 2000, in the year 2000, I enrolled myself in the ABA course.

Mary: So where was the ABA course?

Dr. Smita Awasthi: So this was in UNT. University of North Texas. It was their course. I was living in Dubai at that time and I enrolled for the course. This was the first edition of the course. So my mentor was in United States. I had to send her those old gussets with my work once a month. And there was, you know, hardly any rigorous mentoring at that time. But everybody was very supportive. And I ended up acquiring the skill sets that were necessary to go on. And this was also the time when autism was being diagnosed much more. So I would be referred cases. Dubai was a bit more advanced than India at that time. In India, the knowledge and awareness was not there in 2000. I started working in India in 2004. I started visiting. I started doing all kinds of things.

Dr. Smita Awasthi: So this time when I started having all these kids referred to me, I already had the skill set and I was seeing a difference during that time, Dr. Pat McGreevey traveled down here to do a workshop on global behavior, and that was an eye opener. Suddenly we could not just work on listener behavior, but also speaker behavior. And children started learning. We started learning with them. And that was the time I really fell in love with what I was doing. And every day there was a new learning from the child. And that's how I fell into autism. There hasn't been any turning around since then. It's just learning from one thing and moving ahead to another thing. It's been that journey.

Mary: So your time at University of North Texas, that was a distance learning program.

Dr. Smita Awasthi: It was.

Mary: And that was, you know, around the time, you were 2000. I was 2002 when I enrolled in the Penn State Distance Learning Program. And it's interesting because I know we have both parents and professionals here, so we don't make it too technical for the parents to understand. But for the professionals out there, especially the behavior analysts who have been trained in distance learning now and online courses. Like back in 2000, 2002, 2003, it was very primitive. Like I remember getting a box of VHS tapes and binders with PowerPoint slides in them. And then, like you said, you had mentors. They weren't supervisors. You had to go in and you had proctors for your exams because it was all in writing and you had to fax it back or whatever, it wasn't online.

Mary: But in your case, you were in Dubai and studying North Texas? I was in Pennsylvania, but two and a half hours away from Penn State main campus. And so if it wouldn't have been for those early online distance learning starts, we wouldn't be here. And so it's evolved into online training. And now that you are living and working in India, you have done not just the University of North Texas, but I mean, I've physically met you at the ABA-I conference, at the National Autism Conference.

Mary: People say, oh, the United States some areas are very backward and in the in a lot of ways in two decades have gone by, and not in my mind, not a ton has changed for kids with autism in some ways since my son was diagnosed. But you've had to come to the United States for pretty much all the training or had people from the United States come to you, because we really are in terms of the whole world really making the most headway here over the years.

Dr. Smita Awasthi: Absolutely. I got certified in 2004 and I had to do my exam. I had to travel for my exam to UK, for the BCABA and to Washington, USA for my BCBA exam. There were no exams being held over here. And by 2004, I realized that it's very lonely out here. There's nobody. So if I have to learn, I have to travel. If I need to know what's happening in the developed world where behavior analysis, as has been practiced for so many years, I need to travel. And so every year I would travel to ABA international conference. And later on it was the ABBA. Also, later on it was the EABA. Also, because that is the only way to listen to what's happening in the autism intervention world, actually.

Dr. Smita Awasthi: So the new techniques emerging. What are the big wigs saying? What are these expert behavior? Analysts are conceptually so sound. What are they saying? Because I was not only late, because by the time I started my behavior analysis in 2000, I was 40 years old. So I wasn't young. I couldn't leave my family and my son and go and live somewhere and, you know, go to the school or some other Morningside Academy and live there. No, I couldn't. So I had to depend on whatever source of knowledge was there and just traveled maybe once in a year and attend the conference and learn from that. It's just been a difficult journey. It's also been a lonely journey, actually, because there was nobody else there.

Mary: And that's why I've been so passionate over the years. You know, once I got my PhD and worked and developed my systems, it was like, I've got to get this information online because there's people all over the country and all over the world that need this information and is simply going door to door servicing one child at a time or and traveling around the world. Like, I've never been to India, but I've been to Australia three times. I've been to other countries. And it's just not very efficient. So I think now that we are a lot more online, especially during COVID, I think it's just magnified the need to be online.

Mary: But I've had online courses for over five years and proud to say that we've had customers from over 80 countries. And one of the barriers to people learning with my online courses is the main barrier is, is language. Not everybody speaks and understands English and the bright now. That's what we have. But let's talk a little bit about India and in terms of multiple languages and how that impacts things. And also, I am curious, like in India, do kids get an early diagnosis? Are there waiting lists? Do you have a rate of autism in India? Calculated those sorts of questions. Let's move into that quickly.

Dr. Smita Awasthi: I started looking in India in 2004 and at that time, the diagnosis of autism was very limited. A lot of the pediatric community that were not aware about autism. That awareness in the last 15 years has increased drastically. Children not being identified much earlier. And the good thing is that in these years, the parent community in India has played a very big role in advertising, marketing. Talking about autism. So there are campaigns which are being held every now and then. Autism is in the newspaper. Autism is on media. And so people are beginning to hear about autism. Parents also, you know, on their part are beginning to accept an approach rather than hide the child behind. And seek intervention.

Dr. Smita Awasthi: So they are going and saying that I need help for my child much before maybe they could be diagnosed. The pediatric community has become much more aware. And it's been very interesting because in the last two years, I have been invited by the pediatric community to write for the newsletter on applied behavior analysis and autism. So they have given me that platform. They have invited me for various conferences to talk about why ABA is a good intervention and evidence-based practice for autism. So that gave me a good opportunity to show videos and talk about things. And more than talking in India, I or maybe everywhere. People believe that they see something.

Dr. Smita Awasthi: So initially, even then, I used to be called they would be expecting to see the change. Now you can do a change. So in one day, however, during consultations, what they would do is they would have this ABA therapist come in or maybe ABA consultant come in to see a child and they would give their most difficult children the biters, the hitters, the floppers and present to you. And all you needed was the correct skill set. And knowing how to use reinforcers correctly so that they don't hit you and they don't behave the way they were expecting them to behave. And a two-hour presentation would be like miraculous because they would be watching on CCTV from another room and they would see that what happened.

Dr. Smita Awasthi: This child is like sitting. He is not scooting. He's not flopping. He's listening. He's responding. He's allowing the throngs. And that is where it all started. So when they started observing. And looking at the children and looking at the change that you could bring in in an hour's time without doing magic of schools, you're not doing magic, you're just manipulating the variable enough for the child to be with you and not run away from you. That itself was a good first step And that started having parents believe in what is ABA.

Mary: It's the power of reinforcement. I remember when you're saying this, they bring in the most difficult children. I remember being working within the Pennsylvania Verbal Behavior Project as a professional in and I go to this classroom a and they'd be like, oh, we want to bring down, you know, Johnny from the you know, from another class for you to look at him like, he hits, he bites, you know, and well first of all, like I can't work magic but do not bring any child to me like that without major reinforcement. I'm not going to be able to do anything without reinforcement.

Mary: And so time and time again, it's like this is what's needed. I know I did a podcast with the folks from ABA Inside Track. Yeah, ABA Inside Track, the podcast host from there. And we did it all about positive parenting. And behind the school house doors, Glenn Latham and positive reinforcement. So we may be able to link that in the show notes. And so in India, I know it's quite common, even if English isn't spoken by everybody, but it's very common to have people speak a couple of languages.

Mary: Is that is that a barrier? Like when you go to present in this part of India, you're asked to present in this language or that language. And, you know, is that a barrier?

Dr. Smita Awasthi: When we are presenting. As of now, at this stage, we are really not addressing the rural community. We are not addressing people who are still not aware about autism. We are addressing the educated community in India who are living in big cities. So then you are presenting in a big city to an educated community. English is fine, even if they can't speak in English or they're not fluent in English. They can understand. But when you go beyond that. And this is just the surface of what India is. So at the moment, you go to a middle class family where English may not be the first language, then you can reach out to them and just to have somebody talking in the local language.

Dr. Smita Awasthi: The good thing is that we have a lot of people now who are educating and doing workshops in regional languages. So we have. India, we have about twenty-six states, I think nine states, something like that, and every state has a different language. Wow. And that does make it so difficult because when you're communicating, you cannot speak in so many languages. India is also divided into the south where there are four major languages. So mostly people who are living in the south, most of them get to be called four languages. Then we have people who are living in the western part of the country and they have about two, three languages that they speak. So there's the Marathi and the Godhra. Then Hindi. And of course, English. And then we go to the eastern side, which is another set of languages.

Mary: If you go into a child's house and they speak four languages, the parents both speak four languages. And I know I I did a video blog on bilingual. I did a podcast episode with Magui. We which we can link in the show notes. I'm not sure what that was about her son's journey with bilingualism, but what do you do when somebody speaks four languages? How do you pick a language in terms of teaching the child?

Dr. Smita Awasthi: It is a challenge because a lot of families who may be living in a region where this a particular dominant language and they speak and all of the family members and the House help and everybody speaks in that dominant language. Most families send their children to schools where the education is provided in English. So there's a lot of pressure from the family for you to teach in English. And that next challenge that we have to face, sometimes we have to tell them that it is better we do the listener responding in English and you do the mans in your regional language. So that's a compromise you start with.

Dr. Smita Awasthi: And then gradually, as the child is learning or having difficulties in language, then then you meet again and then you discuss what to do, because sometimes we start in the dominant language at home and then move to English, which becomes very difficult because if the child is doing well and is going to school, then you need to translate everything and and teach the child everything into English in English language. Which becomes quite tough. And we do this all the time. So if you say dominant language, mother tongue at home, then after two years you're doing everything, all of the teaching in English. If you say mans in your dominant language and the rest of the listener responding in English, that kind of works much better. So bilingualism is a tough one most of us face. It's a challenge.

Mary: Yes. Most of the research has not been done with kids with severe language impairments. First of all, and then most of the language is like, oh, bilingualism is fine, just teach both languages at the same time. And I quite frankly, think that's confusing for a lot of kids with very limited, with no language or they have two words. And it's like I do think that at least for the first, you know, maybe 50 or 100 words, we should pick one language, almost like teaching sign language, like we should all be on the same page, because if they hear this word for that, especially if there's three or four languages at play, I do think that might hold kids back. But you did some research for your PhD, when you were getting your PhD, on taking nonverbal or non-vocal children and teaching them to request or man for things using sign language that then resulted in vocal language, too. So can you tell our listeners a little bit about that research?

Dr. Smita Awasthi: So this was a seven year research that I did from Queens University, Belfast, under my supervisor, Dr. Corona Dylanberger.

Mary: Yeah, I met her when I was presenting, I think in Australia. I met her somewhere. Yes, she's very nice. OK.

Dr. Smita Awasthi: So this research was actually done on the clients in India, but it was in University of Belfast. So, here in this research, we enrolled who were non-vocal and the assessment done was whether they had vocals. So whether they could echo when you asked them to say a word. Or could they label when you showed them something and asked them, what is this? Or if they could ask vocally for something they wanted? Any child who was able to do anything of these vocally they were not taken in the study. The study, the children who had no vocals at all.

Mary: Or nothing under any control. So, no echoic, no tacting, no manding. But they could have what I call pop out words, words that come out every now and again because they're not under the control of anything and or babbling. They could probably have that.

Dr. Smita Awasthi: Yes. Babbling was present in some of the children. But words which were not under control were not. Yeah. So we had children who we did not use speech at all.

Mary: You had told me a hundred. A hundred, over one hundred kids.

Dr. Smita Awasthi: 126 children.

Mary: And some of them were quite old. They were.

Dr. Smita Awasthi: Yes. I had two older children. One was twelve years six months, and one was thirteen years five months. And they were the oldest children on the study. And interestingly, of the older children, most these were the oldest. They emerged with speech.

Mary: Right. And what percentage of the kids in the study went from non-verbal, non-vocal to somewhat vocal or verbal?

Dr. Smita Awasthi: We got, a percentage of 83 percent.

Mary: Eighty three percent of the kids in the study went from non-vocal, nonverbal to speaking.

Dr. Smita Awasthi: Speaking and the mastery criteria for speaking was they need to have at least seven different sounds or words.

Mary: Different sounds or words under some kind of control?

Dr. Smita Awasthi: Under some control, yes.

Mary: Yeah, that's great. And you said this was seven years of study. But how long was this 13-year-old in the study?

Dr. Smita Awasthi: Good question there. So we had children who emerged with vocals and I know emerged is a word which is debated. But they started becoming vocal within a period of two weeks� time. Up to a period of almost a year, a year and a half.

Mary: So you kept them in the study all that time until they emerged with vocals.

Dr. Smita Awasthi: We continued the protocols because we were working on communication. So sign man training was going on. They were taught to sign and we paired the vocals while we delivered the reinforcer. So sign meant man training continued while they were also on the IBI program. And those who did not emerge with speech in a short period of time. We just continued on the study till the study completed. I think there were a couple of outliers in the study who actually took almost three years because they did emerge with vocals. 2 vocals or 3 vocals.

Dr. Smita Awasthi: But they did not have seven vocals to reach the mastery criteria. So they just continued with their protocols. We made modifications. There were a couple of different doll experiments there. One was the assignment protocol where the signs were bad. Goodwill goes. We also try Dr. Cardboards time dealing with three children and all three children emerge with vocals. We used the time deal and that really help them. Then we also added the integral component with some children and that a lot of children.

Mary: That sounds really interesting. So you told me before we started recording that you are hoping to get this published somewhere, that it's under review now, which is excellent. Because I think it's important to note that it's never too early and it's never too late to get vocal language.

Mary: I know several members of our courses and community, not just the toddler, preschooler course, but our verbal behavior bundle as well. I can think of example after example where Anna with her son, Nick, for instance, she joined the course years ago. And her son was eight at the time and he was essentially non-verbal. Everybody called him nonverbal. But he did have some very poorly articulated mans if you will, and poorly articulated. And everybody just pushed him into using a device to communicate. And when she started with my courses and everything, then she was able to see how we slowed things down.

Mary: We work on one syllable. We work on mans or within the mand frame. We pair words, single words, single syllable words. And within, I don't know, six months or a year, he was talking hundreds of words and she was very empowered to go. OK. You know, it's never too late. And she got a lot of training. We also have Michelle C, who is on podcast episode seventy-eight, which we'll link of the show notes, who during COVID shutdown got her daughter from two words to 500 words and phrases just in 60 days of the toddler preschool course. So it can happen quite quickly. Like you said, in two weeks we have people reporting, I joined the course two weeks ago, and now my son is talking.

Mary: And we use a lot of, I know your study involved a lot of signs with mans, so that would be like holding up a cookie, signing cookie, having the child sign for cookie. And also the adult that's pairing it would pair the word three times. And as they were delivering the cookie. I've taken for my courses, my early learner programs like the shoe box program, potato head puzzle, inset puzzles. Everything is based on that multiple control where each shoe box with a slit in it. You hold up a picture of mommy, you say, Mommy, Mommy, Mommy. If the child echoes even more, if the child says nothing, they get to take the picture and put it in the box, which is kind of a cause and effect activity.

Mary: But if the child says mom on the first go or the second or says, Mommy, that word is part mand because he wants the picture to put it in the box because we pair that up. It's part tact because he can see it as part echo because you're echoing it. And so everything in my courses and in my new book is all about multiple control using. Every activity, puzzles, matching, everything is a language enriched, multiple control activity to get some language.

Mary: And, you know, I'm a very big proponent of sign language as well, although I think we even had my toddler preschooler course, I don't really talk about sign language because I think it's more bang for your buck to bombard them and get vocal language going, if possible, before we get it.

Dr. Smita Awasthi: And that is exactly what most parents also see, that we would do anything for the vocals to emerge. And we are not very sure if behavior analysts and other people who are knowing the science of all of the contingencies around local language, whether they are putting in enough time and giving the child enough time to work on the vocals. And I think most people give up very quickly and move to other methods, which gives a way of being verbal and communication brings in communication but doesn't work on the vocals. I think that has been my big area. This research started much later, but I've been doing this since 2000, since I attended Dr. Carboran's workshops and learned from what he was saying. I have been doing this since then and it was just an extension of that work.

Dr. Smita Awasthi: So it's child after child after child. And we are still continuing the same and do see the emergence of vocals. So to see when we use the right protocols, those protocols, of course, have to be tweaked because you have to look at the child. Where is the faulty self-stimulus control coming? Where is the child becoming dependent on? Something else or where the child is not really, despite the feeling that you are doing the child. You know there's a blocking effect. So the child is not missing out on that word that you are pairing. So those things need to be studied and analyzed and modified so that the child can be helped and vocals have an opportunity to emerge. You can just provide that opportunity. You can't do anything else.

Mary: Yes. And I do think that even Rose Griffin, who's on the episode number 10 of the podcast, when I say episode number 10 or 78, you could just get there by MaryBarbera.com/10 or /78. But she's a speech language pathologist and a board-certified behavior analyst. And Rose said before she took my courses that she did rely. She sees that she jumped to communication devices maybe a little bit too quickly, too prematurely. That or maybe she didn't, but others did. And kind of left the vocal in the rearview mirror too quickly. And then now she realizes and she realized over the years that like your research showed that it is actually never too late. And I think a lot of kids get labeled as, quote unquote, nonverbal.

Mary: I can think of this one kid. He was 17. He was in a residential placement since he had been about eight. And I was going. And everybody saying he's nonverbal. His report said he's nonverbal. I talked to mom. She said he's nonverbal. And when I said, well, does he say anything? Does he ever have any pop out words? Does he say anything? Well, yeah. He'll say mom or he'll say hi. Or he'll say bees. It's like, well, that's not non-verbal to me. You say a child has been heard to say a word or even sounds. I'm excited, too. You sound like you're like me. Like let's roll up our sleeves and try to get vocal language.

Mary: And that's not to say that they're going to be fully conversational. That's a whole nother step up. But I think, you know, when I did evaluate that, that 17-year-old boy, he actually was doing some intervertebral felon's. He was doing like some humming to request a song. He was saying beads. Articulation wise, it was like B, but he was saying things as he was getting his device and doing that, too. The other thing I noticed with the 17-year-old is, and I don't know if this was part of your research, but like he took a bottle of water and he drank it like just a regular bottle of water and it spilled all over him. And I'm like can he drink, like with a straw? Can he drink from an open cup without spilling?

Mary: I mean, his oral motor, I mean, to a lay person, I mean, I'm not a lay person, but I'm not a speech pathologist. But if that child is drinking out of a water bottle and and water is spilling out at the sides of his mouth, he has very poor oral motor control. And so in my course, as we talk about straw drinking, we talk about drinking from an open cup and all of those. I did a podcast episode with Mags Kirk on talk tools like there is something about the oral muscular, too.

Dr. Smita Awasthi: Yes, absolutely. And I do refer the children to a speech pathologist. And I mean, all of us get them involved to look at my children if there are oral motor issues where they need to strengthen their muscles by various exercises. I do recommend them. I've done them to guide them so that they are you know, we are having interdisciplinary collaboration while at the same time the parent needs to understand that different people have different skill sets. So this is extremely important in a country like India, because many times you become a master of all and you're like, I knew this and I knew that. And you don't need to go to anybody else. And that's really not true. So everybody has a place there. Everybody has their own expertise.

Dr. Smita Awasthi: So I always send them and I'll recommend. Because identifying somebody whom you can recommend. You need to know that person's skill set also. So over a period of time, I would was interested. Who are the people who do what? What kind of assessment? Like, for example, in India there are very few people who will do a proper assessment for apraxia. I've been sending right, left, center. And this even though we don't do this kind of an assessment and there used to be one lady in the south of India in Bangalore where I stayed. And she shifted to United States. So we don't have anybody who does a proper, detailed assessment of apraxia. And that makes it very difficult because you don't know where to go. So we don't have enough skilled people there.

Dr. Smita Awasthi: Which makes it quite difficult, so that collaboration is something that we are trying to encourage. We do an Interdisciplinary Collaboration Conference. We've done three of them in the last three years. We have medical professionals who believe in ABA. Who understand ABA and they come and talk about evidence based practice. So they come from the platform , then there are speech therapist who talk from the platform, there are occupational therapists who talk and there are behavior analysts. So we've done three conferences on interdisciplinary collaboration where everybody comes together and talks about their field to help children with autism. Those are very new concepts of the country right now.

Mary: Well, they're new concepts everywhere, even in the United States. I mean, you know, it's not a new concept, but I think that we all have a lot of room for improvement in terms of multidisciplinary collaboration. And, you know, we're all in a hurry to help these kids reach your full potential. But we all need to grow. We all need to get better and better at diagnosis, treatment, working with parents, empowering parents to be the captain of the ship so that they areknowing how to navigate the waters, because it's not just about speech.

Mary: It's also about feeding and sleep and potty training and your spouse relationship, your sibling relationship. We just had a few episodes ago, my typically developing son, Spencer, was on the show on episode number eighty-five to talk about sibling relationship. I mean, there's just it's a complex disorder and a complex set of needs for each individual child. Across countries, across the whole world. I mean, it sounds like you're doing a phenomenal job of trying to train as many people as possible with really good techniques to help kids. And that knows no boundaries. Right.

Dr. Smita Awasthi: Thank you. I think I'd like to talk a little bit about the complexity of autism, because it's such a complex spectrum disorder with children who have vision issues along with autism issues. On one end of the spectrum to high cognition, but autism related issues on the other end of the spectrum. And there are children who have less of autism related issues and more of language related issues on the other end of the spectrum. So there are a variety of children, but different levels of disability. And that makes it so difficult for people to understand. And for us to communicate that every child is different. You cannot just take the same program anddo it for everybody because every child has different needs, because they are having different issues around themselves.

Dr. Smita Awasthi: I think that just makes everything so complex because. Do you talk about the intervention or do you explain then the complexity of the autism? Do you focus on because when a new parent comes to you, they are so confused and reading on the Internet, especially the educated people, the first thing they will do is they will go on the Internet and get all the information.So they are already coming with information, which may not be accurate. So you have to start talking to them about autism and its complexity if you talk too much. They just shut down. They don't want to listen because it's too complex for them.

Dr. Smita Awasthi: So they are just looking for answers as to where are you heading? How can my child go to school? And going to school will solve all the problems. So we have a lot of high functioning children who are going to school and they're not coming for services because parents don't want to talk about the problems. They feel that being in school is going to solve the problem. So I think that those are awareness issues and advocacy issues that we all need to take up from time to time educating one parent at a time. It's like that.

Mary: Well, hopefully we'll be educating lot of parents all at the same time. And then you talked about the low cognition, high cognition, low whatever. Then you have the age span. And then you have the cultural differences among families, even in the same country. Their priorities, family priorities. So it is it is very complex.

Mary: I mean, my work, my book, my new book that's coming out in the spring of 2021called Turn Autism Around is very much step by step. And so, like I believe you do my one-page assessment. And you make a one-page plan based on that assessment, which includes the strengths and needs. And you get going with multiple control, early learning materials. And I don't have a ton for very high functioning conversational kids at this point. I don't. I focus mostly on the chronologic age of one to five-year-old or the developmental age of a one to five-year-old. So kids that have, you know, that are 12 but language ability of a two or three or four year old.

Mary: In fact, Lucas, my son with autism, is twenty-four. And he just started with a new habilitation worker just this past week and I just completed it. I was curious and did the Marc Sundburg's intraverbal subtests with Lucas the other day and he scored, he actually scored better than I thought he would. But clearly still in that one to five-year-old level of language, even though he's twenty-four years old now. I didn't do that for really any reason, but just to show the new hard worker kind of what that look like, what questions he could answer, what questions he kind of could not answer. He still has problems with negation.

Mary: Like what is something you can't wear or what is something that's not a food. He still has problems with that he has problems with like what grows on your head vs. what? What helps flowers grow? You know, the whole growing process and heat, you know, and then other than that, he's pretty good on the inter verbal subtests.

Mary: And so we always have to think functional, not just for twenty four year olds, but for two year olds, we need to think functional self-care skills. Drinking out of straws and cups and washing their hands and all these things. And that's what makes it so complex. But I mean, it sounds like from your research, you've been so invested in the field for so many decades and really a pioneer, especially in India, for getting the training. I mean, was a lot of effort for a lot of expense, I'm sure, for you to come over to the United States and seek this training. And so my hat goes off to you for really taking the initiative to be like, you know what? We can do better. We can do better here. We can do better anywhere around the world. So that is awesome.

Mary: Thank you. So let's end this podcast. Part of my podcast goals are for parents and professionals to be less stressed and lead happier lives. So do you have any self-care tips, stress management tools that you use or you could recommend for parents or professionals?

Dr. Smita Awasthi: I would approach this question in two ways. One is what as behavior analysts, as professionals, what can we do to reduce the family stress? And the second is what the parents themselves can do to reduce stress. To answer the first one, despite being extremely busy. I find that one giving time to the parents. To listen to them, to listen to their problems, which may be immediate and may not be looking at long term consequences, I think listening to them and finding solutions and helping them find solutions to deal with those helps them to stay calm because they know that my problem, at least somebody is trying to help me to address those problems. The second thing that I use as a behavior analyst is shaping procedures.

Dr. Smita Awasthi: And instead of giving them long term goals, I keep them successful with short term goals. I keep them focused on weekly tasks and so that they are not worrying too much about the future. But they are rejoicing the small improvements that they see, the small changes and modifications that they see in the immediate terms. So that's what as a behavior analyst, I always would suggest anybody should do. The second part is the parents. Now parents, for parents, I do not like to tell them that, do meditation and do yoga and do all that, because giving advice is the easiest thing that one can do. Anybody can do that. I actually keep them positive. I keep them so busy and engaged and I tell them that we are here to help you schedule your day.

Dr. Smita Awasthi: So instead of worrying about the future, let's focus on what we can do. So keeping them task-focused, teaching them to do self-management, but short term goals. And showing them success is what my guidance to them is for the parents. If they sometimes get too ambitious because school pressure is there. School curriculum is there. Or family pressure is there. Then I tell them to back off and look at it from, you know, take a view and see how there are different ratios and what we can deal with and what we cannot. What is in our hands and what is not in our hands.

Dr. Smita Awasthi: So if there's a family pressure, which you can do nothing about, then how do you kind of just leave it and focus on something else that you can do? So that is generally what I've done the parents to do. But mostly I've seen that if you give them short term goals, keep them focused, have them access reinforcers in their daily lives weekly and on a weekly basis. They are very happy to be with you, to listen to you, to follow procedures with their children and book at home with you.

Mary: So I think just keeping everything as positive as possible, everybody needs eight positives for every negative. So if you go in there with demands and you didn't do this, then, oh, well.

Dr. Smita Awasthi: All right. Let's see how you can take the data without stressing yourself.

Mary: Yeah, so I think that's great advice. Great advice. OK. Well, thank you so much for your time. I look forward to future collaboration to help the parents and professionals in India and around the world learn better ways to help our kids reach their fullest potential. So that's my goal. And I know that's your goal as well. So I look forward to many years of collaborating.

Dr. Smita Awasthi: You are doing a wonderful job, Mary. Keep it up. Keep it going. And I'm sure you will help a lot of children, a lot of families. Your second book is coming. So best wishes for that. And congratulations, too.

Mary: Thank you. All right. Thanks a lot for your time. And have a good one. Thank you.