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This is the McCullough Report and Focal Points Substack.

I'm Dr.

Peter McCullough, your host, and I want to welcome you to the program.

Uh and you know provide a warm welcome to our guest who's coming all the way from the Great North from the Toronto Metro area, John Mulanero, who has a master's in behavioral sciences, and he's one of the top experts in North America on autism.

John, welcome to the program.

Pleasure to be here with you, Dr.

McCullough.

Been a long time fan, love the work that you're doing, and happy to be on the battlefield with you.

And I have to ask you the first question because you know you look pretty tight.

When was the last time you had a tie on?

Oh, I wish you didn't ask me that.

Uh it was a long time.

It was a long time ago, but thankfully the not stayed intact.

So it's just a quick slip-on.

Oh, there we go.

I gotta tell you, well, you know, uh, yeah, I'm a medical doctor, so I'm wearing a sweater today, but I always have a tie on underneath because I just finished with my last uh patient.

But in the world of psychology, you guys have always led the way in terms of being comfortable and not being uptight and kind of having those those uh soft and furry sweaters and uh things like that.

So but uh anyhow, I when I go on TV, I always try to wear a shirt and tie and and be respectful and and and you're the same.

Now we have uh both talked uh in the past and you know, been out there in our observations about what we call an autism epidemic, and uh I certainly see autistic patients in my practice now, young people and older individuals and in everyday life.

When I uh do a public program, like I've done programs in the Toronto Metro area, thousands of people show up, and I ask them uh how many of you in the audience have been touched by autism, meaning you know somebody or a family member or you know, at work.

The answer is about 25% of people raise their hand.

That's not 25% with autism, but meaning it's it's they know about it, it's being influenced.

And um, you know, you know, you've been working in this field for quite some time.

So why don't you give us an update on what you see as uh you know this overall overarching problem of autism spectrum disorder?

Definitely, Dr.

McCullough.

So, yeah, as we mentioned, I'm a board certified behavior analyst, and when it comes to autism and autism intervention, all intervention should be led by a behavior analyst, which is exactly who and what I am.

And um, interestingly enough, Dr.

McCullough, as prevalent as autism is today, I don't think a lot of people really understand what it is.

So I'm excited to talk more about it, excited to let people know what it looks like and uh how how many people it affects today.

So why don't we start out just with the epidemiology statistics, and then we can get into the nuances of definitions and diagnosis, because I think that's where you know a lot of a lot of progress has been made.

But but what are the top line numbers in Canada and the US in terms of autism and you know, is it going up or down?

Yep, great question, Dr.

McCullough.

So, and I really hope I don't scare anyone with these numbers.

I think over the last couple of years, we've had more than enough fear, and the last thing I want to do is scare or discourage anyone.

But today the number and the frequency and the prevalence of autism is around one in 30.

I know it it varies between the US and Canada, but today we're at one in 30, maybe one in 40 on average.

And if we go back just 10 years, that ratio was one in 70, and then back in the year 2000, we're at around one and one fifty.

And then prior to that, the numbers do get pretty pretty drastic, and I don't know how accurate they are.

But going back to the 80s, we were at you know, one in 10,000.

So even you know, for error sake, let's cut that in half and say in the 80s and the 90s, we were at one and 5,000.

Mm-hmm.

Now, uh John, screening and detection.

People have said, well, all of that is accounted for by screening and detection.

What say you?

Yeah, so that's what the textbook will tell you that um the reason the prevalence has jumped so much, and we're talking several several fold is simply because we got better at identifying our our tools got sharper.

And I I would definitely concede and say yes, that maybe that's a factor, but to go from you know, back in the year 2000 from one in 50 to 1 in 30, I don't think our tools got that much sharper.

And again, that is just my opinion, my observation.

But um, I I think there might be more to kind of what's happening here.

Well, as you look around in in general life, do you think organically there are more people with autism than there were 20 years ago?

Uh I would say so.

I would say yes, in my personal opinion, and even when I look back to my my high school um student body, I I can't remember a whole lot of um students that had this diagnosis, and when you look at it today, uh a few years later, it's it's much more prevalent.

So I think organically, I'm seeing a natural increase.

I didn't tell you this uh before, but you know, my wife is from Toronto, and she went to Parkdale Collegiate.

If you remember Parkdale Collegiate in Toronto, and you know, when she was going to school there, she can't remember anyone with autism at all.

Right.

She can't even she can't even remember anybody with uh attention deficit hyperactivity disorder.

Yes.

And again, I I think there's a lot of people that might be watching this that are very science and and evidence-based.

So obviously this is observational, but uh I think nevertheless it still holds a holds a lot of weight.

Sure, it sure does.

Now, explain to us this uh diagnostic statistical manual DSM and just the working definitions of autism spectrum disorder.

Help us out there.

For sure.

So what I'll do, well, I'll do Dr.

McCullough is I'll give you the DSM definition, and then I'll give you the layman's John definition.

Okay.

So in the DSM, autism spectrum disorder is characterized by persistent deficits in social communication and social interaction across multiple contexts, along with restricted repetitive patterns of behavior, interests, or activities.

Okay, so that's the very clinical term.

And now in my term, I would qualify it as a neural developmental condition that impacts how someone communicates, how they interact, and how they experience the world around them today.

And if I can even go a step further, it's uh a difference in how someone inputs and outputs information.

Okay, that's very good.

So uh, you know, I've heard that well there has to be uh four criteria or two out of four.

In your view, I mean, is it a matter of like checking the box or or is it if you take an expert like you is it your clinical impression that you make the call?

Great question, Dr.

McCullough.

And I do want to preface that as a behavior analyst, um, we are not able to diagnose.

So I'm not the one delivering diagnoses by any means.

Okay.

Um, but I have worked with professionals in the past, and I have sat in and observed some of these more gold standard um assessment tools.

And so it's it's a matter of looking at a whole at these different developmental milestones, and it's not just like, okay, well, this individual um is impacted socially, so they're labeled autistic.

No, the gold standard and ADOS assessment, which is the gold standard tool, it's a very in-depth, very um sterile assessment where it looks at all sorts of different developmental milestones, and as a whole, it determines whether or not you meet criteria, and if you do, what level of severity do you meet that criteria?

So, what does that stand for?

ADOS.

Um, autism diagnostic observation schedule, I believe.

Schedule.

Okay.

And then how is it graded in terms of severity?

So there's three levels that often follow a diagnosis: level one, um, level two, level three.

And essentially what those levels mean, Dr.

McCullough, is it's the level of support that uh a learner or an individual might need throughout development or or throughout their life.

Okay.

Higher means more support or correct.

So a level one would mean um some support might be required.

Level two would be more substantial support and level three, very substantial support.

Again, I don't create the naming convention, so right, but but it's level three, the max.

Yes.

Okay, so uh just uh why why don't you describe to us the the characteristics uh of a level one, two, and three?

Absolutely.

So a level one learner, which and I I do I qualify them as learners because in my clinic, we work with young kiddos between the ages of one and a half up until six, and I do have experience with adults as well and teens.

But for the majority of it, we work with young kiddos.

And so uh a level one learner might have might have developed some communication where they have words, they're they're able to uh engage back and forth with language.

They might be very fluid with language, but where they might require some support is that social piece where um more deeper, meaningful a reciprocal social experiences, they might require some support.

Um, or also with transitions, so they might have some rigidity when it comes to daily routines, and again, it's just an indicator that a level one learner is going to require some support.

Um also just want to be careful that I'm not trying to overgeneralize.

The phrase goes, if you know one individual with autism, you know one individual with autism.

So again, this is a general overview.

So that would be a level one learner that would require some support.

But if we go to the level three, which is on the other end of the spectrum.

Well, actually, do level two if you don't mind.

Do level two for next.

Okay.

So level two, um, it kind of just blends level one and level three.

So if I if I can go to level three, it'll just help the conversation.

So level three learner, oftentimes is there's no communication that's developed, no language, no words.

No, people say non-verbal.

Correct, correct.

Um, and also what what often follows that is a high level of sensory behavior.

So these particular individuals might engage in uh uh self-stimulatory or stereotypy, um, a very significant amount of their day.

Okay, and often what follows a level three learner is aggressive behaviors, uh, inability to regulate when they are you know emotionally triggered, and lastly, um, self-interest behaviors, and again, this is not all level three learners.

This could, you know, some of these might apply to you.

That's why it's it's indicated of of a spectrum disorder, right?

So and then a level two, Dr.

McCullough will be somewhere in the middle, right?

Okay.

So so level three, sometimes I in the airport I'll see because I presume they're autistic, but they're wearing noise canceling headphones.

But why is that?

Yep.

So again, that often could indicate a level three learner, but that might also apply to level one learner.

And it could just mean that in terms of their sensory regulation, or again, how the input information might be on such a high sensity level that a lot of sounds or too many sounds at once is just overwhelming.

And and to be honest, you don't have to have an autism diagnosis for that to apply to you.

I know when I go into a mall, I can't wait to get the heck out of it.

So okay.

Um now um so this autism spectrum uh disorder.

So on this on this uh uh this autism side, this what Leo Canner described this level one, two, and three.

Yeah, isn't there um uh isn't there another axis of of int intellect?

So intellectual function.

Um that's a great question, Dr.

McCullough.

And it it's funny.

Uh I'm glad we're talking about autism and we're educating a lot of people because again, I don't think a lot of people know what autism is.

And it I don't think it's ever described as an intellectual disability.

Okay, so you can have again a very severe level three uh individual with autism whose IQ is at par, right?

Or or if not higher.

But again, I I don't know, and I don't want to be quoted for this, but I don't think um there's research out there that an autistic individual naturally has higher levels of IQ or lower levels of IQ.

But but didn't Asperger originally describe I thought was actually higher IQ or very high functioning.

Some people consider uh you know, children with Asperger's as part of this syndrome of having kind of super functions.

Is that not right?

Or yeah, so uh again, like today Asperger is obviously no longer a term that we use.

Um, but yeah, that would be defined, like that would define more of like the level one learners who are able to function, and again, high that would be called high functioning autism, but again, we no longer use those terms.

Um, but uh in my research, Dr.

McCullough, I I haven't come across like articles that say if you have Asperger's you're you're much higher intellectually.

Okay, maybe that's just something that I just got into the popular uh and I could be wrong, happy to be wrong if I have no but linguistics, but you know, this is good to correct this.

Now another feature that I notice with uh autism, uh particularly in like younger adults, is the inability to hold a gaze, that is to look somebody in the eye and and and communicate.

Is there anything to that?

Uh again, another great question, Dr.

McCullough.

So um there's some some individuals on the spectrum who very much have issues with eye contact.

Why that is, I'm not I'm not entirely sure.

I like to venture a guess and say it's more of a of a sensory uh challenge.

So, you know, for a lot of people, again, diagnosis are not gazing into someone's eyes can be very intimidating, right?

So I think it's more a matter of it's uncomfortable, it's too much for me.

And uh I know people without who are not on the spectrum who also have that challenge.

And and furthermore, Dr.

McCullough, like I mentioned, you could have an autism diagnosis and have absolutely no problem with eye contact.

Okay.

Now let me ask you another question.

Um children with autism, are they born normal?

And then they develop it during early early childhood, or how does this onset happen?

Uh, another very powerful question, Dr.

McCullough.

And I I feel like this might be getting out of my expertise as a behavior analyst.

Uh, I'm not in I'm not entirely sure.

So all I know is when children come seeking support.

Um sorry, there's a car alarm going off.

But when children come to me to receive services, again, they they're around two years old, maybe they have a diagnosis, and they've been uh exhibiting some symptoms for a little while.

So it's a great question.

I'd be very curious to see between the ages of of zero to eight months, zero to nine months, what does that look like?

But John, do the parents tell you that their perceptions were that the child was normal and now at age two, they they're clearly not normal.

Is that what they tell you?

There have been times where I've had that conversation, and you know, generally speaking, when I do an initial consultation, I will try to get some medical background, right?

Do they have any other comorbidities, any other diagnoses?

Are they generally healthy?

What does that look like?

Family history of mental health, things like this.

And there have been times where parents kind of willingly let me know.

Um, hey, listen, I actually noticed um uh a decrease or regression after one year, the one year shots or something like that.

So now um do some of these children with autism, do they also have um do they also have ADHD?

When we get old enough, you can figure that out.

Is there do they overlap?

Yeah, so again, that's a great question.

So because the kiddos that we support are you know between ages of two and five, and because I'm very familiar with hyperactivity and what that looks like, I'm able to see some of those symptoms.

Now, do they have a formal diagnosis?

More often than not, they don't, and it's because a lot of family doctors don't want to be giving out that diagnoses at such a young age, and rightfully so.

But I have had at least three or four formally diagnosed uh children that also did have ADHD, and a whole bunch of them that weren't yet diagnosed, but again, difficulty regulating their body, keeping still, um, focusing on tasks, even if the tasks were motivating.

So I would I would definitely say that I do see uh a connection between both of these diagnoses as well as anxiety as well.

And at what age do you think legitimately uh a child could be diagnosed with ADHD?

That's a great question, Dr.

McCullough.

And I think maybe I'll I'll return that question back to you.

Um I think I think clearly by the time they get an organized school, maybe K through 12, I I would say.

Yeah.

Um but I think that's I think that's fair.

And then I want to throw back to you in a sense of like, why do we want to diagnose a child with ADHD?

And for me, the only the only reason it's not to medicate, it's not to you know, start exploring pharmacological interventions, it's more so let's identify this child as learning differently than other people and is going to need support, right?

No, no, that's that's that's very fair.

And it's important.

Um it's important to have the understanding.

You know, I had a um an adult with autism in my office about two weeks ago.

And um he he sat down and his his mother needed some attention, and and he literally uh sat in the chair for like 30 seconds, and he was up.

He just walked into every room of the office, he just couldn't, he just you know, back in the olden days, we say it's somebody who couldn't sit still, right?

Someone who had ants in his pants, and he just he just couldn't sit still, and I was like, oh my lord, I got so uncomfortable.

Isa he's gonna get into something, you know.

So I think maybe somebody's computer is gonna get erased or something.

But no, he just it was just a feature uh of it, and um Well, what I know from the published data for what whatever it's worth, it's about of those with um with uh autism, it's roughly about a third also would meet some criteria of ADHD as they get older.

Now, of those with ADHD, we're talking about attention deficit hyperactivity disorder.

About 8% would meet a diagnosis of autism.

So it's it's not it's not an equal kind of part of the Venn uh diagram.

And that uh I imagine another comorbidity must be epilepsy or seizure.

So do some of your clients have seizures.

So uh again, Dr.

McCullough, my my practice is fairly small.

Um, but in the years I've been doing this, I haven't seen a vast majority of my my autistic individuals having epilepsy.

I have heard from other colleagues that um some of their students might have absence seizures, so a form of seizure disorder.

But in my in my personal experience, I haven't seen that all that much.

Okay, good.

Again, the published literature says that's about a 10%.

10%.

And then the last one to ask about is um on the neurologic side about ticks, that involuntary facial or motions or or gutterances, kind of half the side clicking like this, or or sometimes a uh a guttural tick would be like this.

Have you seen that?

So I have actually in uh again, my five years of being a behavior analyst, I've run into two kiddos that that did have some ticks.

Okay.

Okay.

Um I would say, Dr.

Mcala, more prevalently um the ADHD is a big big factor, anxiety for sure, and also GI issues, right?

Yeah, that's what I was gonna ask.

Is GI.

Now uh one of my observations about autistic people, maybe I'm wrong on this, but uh you know, I I think if anything, they tend to be on the leaner side of body mass index.

I mean, I know obesity is possible, but it almost seems like the kids seem they seem skinny, some of them.

And um uh and GI disturbance.

So abdominal cramping, diarrhea, constipation, um, being pale, sometimes they can become anemic.

Does that does that fit your observations?

It it does.

And I again I want to stay in the practice, uh, the scope of my practice.

I'm not a nutritionist, I can't speak to it.

Um, but I'm very much of the idea that diagnosis or not, uh, a healthy gut um exercise, getting sunlight on your body.

Uh, like these are all indicators of a behavior, right?

Whether you have a diagnosis or not, if your gut is all disturbed and your biome is is unhappy, your behavior is going to reflect that.

Right.

Right.

And I right, Jonathan.

We're gonna we're gonna get to therapy in a minute.

Because I know people always want to get to like, what do I do about this?

But I'm just trying to paint the picture so we can understand the illness without yet getting to um therapy.

So uh help us understand this diagnostic journey that um let's say a child born normal.

The parents start to notice something that's not right um around you know, 18 months or two or two years or I mean, isn't it true?

Most most, if they're gonna develop autism, it'll happen before age four.

Isn't that true?

Yes, that's from from my understanding that that's very true.

And uh so I'll speak on behalf of Ontario because that's obviously where I'm from.

Um but yeah, the typical journey for a family who um undergoes a diagnosis is like you mentioned, it kind of starts with identifying those red flags.

And that could come from parents or loved ones.

Um I also see a lot, a lot of times it actually comes from daycare staff or early education staff that start to notice, hey, listen, um, the milestones are not quite there, or we're noticing these atypical behaviors that most of our other students are not doing.

Um, so then from there, these red flags are noted, and the parents will take these concerns to their GP to their family doctor, where the first uh often the first level of screening is done.

And then from there, if the GP indicates that, yep, you know what, there is some cause for concern.

I'm gonna go ahead and send you over to for a more in-depth um assessment at a specialist.

And then right then and there, that specialist has the ability to give you a diagnosis, or there's also a level further, which is that ADOS assessment we spoke about.

So that's kind of the gold standard indicating do you meet criteria, um, what level you are, what areas of need are there?

But the specialist is also able to do that as well.

Now, is the specialist like a PhD in psychology or an MD?

Yeah, that's correct.

Yes.

Is it mainly PhD in psychology?

Um I think there is a variety, but um, like definitely a special speciality in uh like child development.

Okay.

Well, well, can somebody at the master's level, let's say somebody who has a master's no.

No, definitely PhD required.

So it's a PhD, like a child psychologist in in general.

So I imagine the child psychologists are are pretty busy, right?

They probably I mean, is there in Ontario is there a waiting list to see one?

Or uh absolutely.

So again, I don't think it's it's exclusively psychologists that can offer diagnoses.

Um I think other PhDs have that specialization.

Um, but yeah, wait lists is um uh a monster that uh I'm excited to get into with you and let you know what that looks like.

Yeah.

Wow.

Well, listen, you know, we're um uh nearly at the midpoint.

Let's take a break uh uh for our commercial sponsors.

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Um, we are talking to John Molinero.

He's uh he's a behavior expert, someone who every day is working with autism.

And autism is something that's really come up on our radar screen as the childhood epidemic, essentially of our uh of our generation and generations that we're observing.

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Let's get loud on America Out Loud Talk News is the McCullough report and focal point substack here listening to Dr.

Peter McCullough, your host and John Mulanero from Toronto Metro area.

Listen, I was pulling for the Blue Jays hard.

And you know, it was extra innings and a broken bet and a lot of sorrow uh as uh you know the the Dodgers were um were uh the heavy favorites, but I'm sure in the crowd were some young people with autism, maybe wearing noise canceling headphones and and try to uh enjoy what's going on.

But we're talking about this diagnostic journey that they go on, the waiting list.

So why don't you pick up with, you know, what is the family going through as they're trying to figure out what's going on?

Absolutely, Dr.

McCullough, great to be back.

Um, yeah, so wait lists are uh a term that a lot of families recently diagnosed or very familiar with.

And the first the first wait list that a family is kind of posed with, unfortunately, is that gold standard assessment.

So as I mentioned, there's kind of two avenues a family can receive a diagnosis.

One is just from um a specialist that's able to do their assessment and let you know yes, they meet criteria or not.

And then there's that gold standard assessment, which is much more detailed, longer, more clinical.

And there is a wait list for families to get to that gold standard assessment, and that could look upwards of of a year since the last time checked.

So many, many ways, maybe they're a year behind in therapeutic.

Right, right?

Because it well, let me ask you this.

Like with any illness, is it better to start interventions early for this problem?

Or does it matter?

Absolutely.

I can't think of a single diagnosis where it's not better to start early, right?

Okay.

Yeah.

Okay, that's a strong answer.

Good.

Yeah.

So absolutely.

So that year of a wait for families, um, is a is a lot of lost time.

Or again, they can go the private route and and pay for it themselves.

And I think that looks at a cost of north of $3,000.

And again, don't quote me on that.

It could be could be more.

In the Canadian system, if you go private as a is it a little shorter weight, or is there still a weight to see a private um great question?

I imagine there might be still some weight, but definitely not a year.

Okay.

So the clinical psychologist in Canada, that would be kind of on OHIP, the uh provincial health plan.

Is that right?

Or that's another great question, Dr.

McCullough.

I'm not I'm not entirely sure.

So to go the private route, I don't think, or I'm not sure if OHIP does cover that.

Yeah, but I'm sure the other ones, the the public one, yes, yes, my and that's why, and that's why there's such a wait list, right?

Is because it is it is funded, families don't have to pay for it.

And so that's why there's there's such a lengthy weight list just to get this.

But it is the weight partly due to the fact that it's it's literally just a supply and demand situation.

So if there were more child psychologists in Ontario who accepted OHIP, uh what have you, then the kids would be more they move through more quickly.

Definitely right.

So a good point for all of you young people out there looking for careers in healthcare.

Uh, you know, child psychologist and having some expertise in autism looks like pretty good career.

Looks like you'd have a lot of job security right now.

You said it.

Yeah.

It comes with a lot of burnout.

I'll tell you that.

It has to.

Oh, it has to.

It has to.

And it's not, I'm not saying it's an easy uh pathway.

Uh you know, people at the PhD psychology level.

That that's a really long haul to get there, but it sounds like you know, it's a serious diagnosis.

People take it, uh, take it seriously.

So uh so they get a diagnosis and you know, start to explain to us what this therapeutic journey is that the parents and the the child can expect.

Yeah, definitely.

So once a diagnosis is received, um, the next is they'll be directed towards the only real evidence-based therapy that there is, which is ABA, applied behavior analysis or otherwise known as behavior therapy.

So that's kind of where the journey of treatment really begins.

And so if you want Dr.

McCullough, we can talk before I kind of describe what it is, um, or maybe I describe it first, and then we could talk about like the costs associated with it, the time.

Let's let's talk about what it is.

Um, people can and you said it's the gold standard and it's evidence based.

Now, when I talk to a lot of parents with autistic children, they want to talk about lots of wild things, but they rarely bring this up, to be honest.

Now maybe it's always there and it's in the background, but why don't you tell us you know what are the gold standards here for this behavioral therapy?

Yep, absolutely, Dr.

McCullough.

So, as I mentioned, ABA therapy is pretty well the only evidence-based therapy for autism intervention that's withstood the test of time.

And so founded back in the 60s by three different psychologists, but I want to make note of one particular psychologist that's called the father of ABA, if you will, um, Ivar Lovas.

And so it'll come up later on why I want us to make note of his name.

But essentially, what ABA is, Dr.

McCullough, it's the science of learning and behavior.

So clinicians like myself, we use behavioral principles to assess behavior, measure behavior, and then collect data on triggers and and consequences and functions of behaviors, and then we use that information, we use reinforcement and motivation to either increase desired behaviors or decrease um not so desired behaviors.

So that's kind of a nutshell of what behavior therapy is.

So it sounds like it's very structured and organized.

So yeah, you keep going.

Yep, that's correct.

And it is, and it it um nowadays it's it's very heavily dependent again on reinforcement and motivation.

And um with ABA, there are different avenues, which I think are wonderful.

The um the discipline, the practice itself continues to get better and grows year after year, and there's different avenues where uh the more traditional ABA is more intensive, it's designed to be more intensive, uh, more tabletop clinician-led.

Um, but there are different avenues of ABA where they're much more naturalistic, much more play-based and child led.

So the discipline keeps growing, keeps learning, and the whole intention of it, Dr.

McCullough, is we want to target socially meaningful behaviors for each learner.

We want to give them independence, um to be who they are and function in their in their everyday life without the need of any support.

That's the ultimate goal uh of ABA.

Wow.

Well, sounds terrific.

So uh give us an example of a behavior that in your experiences is pretty modifiable that it's responsive to what you do.

Great question.

So it's interesting.

Behavior really applies to anything, right?

And it's funny, ABA and behavior analysts um are also working in the field of animals because animals also have behavior, right?

So the overall science is not just exclusive to autism intervention, right?

And it was actually Ivar Lovass that brought it to autism intervention years and years ago.

And how do you spell his last name?

L-O-V-A-S-S.

Low VAS.

Okay, so he's kind of the father of this.

Okay, yeah.

So get give us an idea, just pick one common behavior that's that you would consider to be uh barrent that you get on track with your approach.

Sure.

I think I'll the first thing that comes to mind is language.

So again, a lot of the learners that that come to us for support, um, they either have very early language or they have no language whatsoever yet, but they do have the um telling signs that language might be on the horizon for them.

So what would be the typical age that you'd kind of get get involved here?

How old would the child be?

Um, like how early can we do ABA?

Just a child is where language you think is gonna be modifiable.

What just give us idea of an age, like four-year-old or three-year-old, or I would say earlier than that.

Like we've worked with families um where even around two or three, we were able to start getting some language from them.

Really?

Yeah, absolutely.

And and again, it's not really indicative of the ABA or of the learner itself.

I think it does depend on the severity of your diagnosis, like I mentioned.

Yeah, sure.

Uh, but going back to your question, Dr.

McCullough, a lot of the behaviors that we kind of start with uh with ABA is language, is requesting.

So that's one of the first things that we will use ABA for to increase that behavior.

Okay, but but but you think it's responsive that that you can, you know, in medicine, I would I'm always looking for things that are quote, fixable or or responsive.

So you think language is something that you can clearly modify, you can actually start to bring it out in a child who's nonverbal.

Is that right?

So I think uh I'll phrase this very very particularly.

So I think ABA gives you that platform that if language can will develop, ABA will help bring that out.

But there's also on the flip side of that, Dr.

McCullough, there's uh unfortunately a lot of like level three um children, level three learners that even after years of ABA, uh after years of you know parental involvement, everyone's on board, and we're all trying really hard.

That language doesn't develop.

Really?

You mean so they could be 10 years old and and not say anything?

Unfortunately, yes.

And I don't think that's indicative of successful ABA or unsuccessful ABA.

I think there's a lot of factors there, and to be honest, it's maybe out of my um understanding, but that's just something I've I've experienced in my uh in my professional journey.

And so um uh so the the types of uh give us an idea of something you could do as an exercise where you start to bring out language in a non-verbal autistic child.

Absolutely.

How is it done?

Great question.

So uh if you recall earlier, Dr.

McCullough, I mentioned there's different avenues of ABA, some more intensive, some more clinician led, and others more um naturalistic, more child led.

And one of those avenues is actually called PRT, which was developed by um Lynn Cagle and I'm uh so rough.

I I I'm blanking on the name.

Um anyways, lovely people, excellent people, but they've established a form of ABA that's uh called PRT, pillow response training that's much more naturalistic, uh, much more again, child led and motivational.

So, for example, if I'm trying to teach a kiddo how to request for uh, let's say the term is car, I'm going to use And hopefully they're they're motivated by cars.

Hopefully they it's a young little guy who loves wheels and cars.

So what I would do is I would play with the car, I would engage with the car and very just gently and easily label car.

And just exposing them to the label and making sure I'm not over labeling things or overcommunicating, just making it very clear that this item that you like a lot is called car.

Okay.

And then perhaps once I build trust and build a great connection with them, I might put that car out of reach, or I might put that car somewhere else and see what they give me.

Let's see if they if they reach for it or what their initial reactions are to requesting.

Because I it's very unlikely that the first thing, if they're non-verbal or if they haven't developed language yet, that they're gonna be like car.

But the first the first level of um intent might be grabbing, or might be joint attention where they look at me and they look at the item, and and that's where we would start.

We would start reinforcing the intent and slowly shaping it to see, hey, um, will you eventually give me a sound instead of a look?

So does that if they let's say you do that, and they kind of kind of going for it.

Do you tell them this is a car or a car?

Do you keep working on that until uh once you've identified the intent they want to go for it?

Yep, exactly.

So that's when we have to be very clinical with the reward and the reinforcement.

And in this circumstance, the reinforcement would be the actual car, right?

Okay.

Um, so it's all about applying reinforcement and clearly specifying what behavior do I want to reward at this point in time.

And shaping is a is a big behavioral principle that all B CBAs practice, and sometimes it's required.

And first we need to walk and reinforce walking before we can reinforce running.

Wow.

And so are the parents uh kind of involved in this training the whole time too?

Great question.

So uh I think different agencies have different levels of involvement for parents, but I know that with uh pillar response training, and I think just globally ABA is a field, it's definitely involving parents a heck of a lot more, and rightfully so.

Um the whole idea is we want to generalize these skills, right?

We want we don't want the child to only perform in the clinical setting or in the school setting.

We want to generalize these these skills, not to mention that the parents often spend a lot of time more time with this with the students than we do, right?

So parental and parental involvement is something we very much strive for.

And and what did you say it's called pillow response testing?

Uh pivotal response training.

Pivotal pivotal, yeah, pivotal response testing.

Okay.

So it I mean, what you're describing to me, uh John, it's very effort-dependent, it's very structured, and you know, you're working through these principles.

And it sounds like like an average parent wouldn't necessarily intuitively know these steps, right?

I mean, they they have an autistic child, they're they're waiting to try to see uh trying to get a diagnosis, trying to see an expert like you.

Uh it may be um more expedient for just general life if the child is plumped in in front of a a TV or or given a video game or a cell phone.

Uh do you see that in your day-to-day life where where the kids, the autistic kids maybe just because of the parents are busy and other things, they literally just have some electronic source of stimulation.

Uh absolutely, Dr.

McCullough.

And that actually, for in my observation, that goes for both autistic children and non-autistic children.

And the only difference is oftentimes the autistic child, of course, much more high demands.

They have much more high sensory needs, or again, unable to communicate.

So they demand a lot more attention and effort from parents.

And uh, I I mean, parenting is already hard enough.

So I definitely see a lot of parents kind of resorting to these quick fixes, and it's not it's not to place blame, it's not judgment at all.

Um, I think life is hard, and I get it, and but this is very much something that I am seeing, especially with children who are on the spectrum.

Yeah, for sure.

I remember I I kind of grew up in a lower uh lower middle income uh household, and you know, three boys were close in age, and you know, back in the olden days, you know, we we would literally just create a lot of frustrations for my mom.

She would say, go outside, go in the backyard and play, just just kind of get out of my hair uh for expediency.

And um, you know, I think parents throughout uh you know, the millennia have done that, but it sounds like with an autistic child to just kind of get the child out of their hair, whether it be sit in front of a TV, play a video game, what have you, or it it sounds like it's not it's not helping them overcome these essentially disabilities.

I couldn't agree more, Dr.

McCullough, and nor do I think families are intending to do that.

No, right?

They're not, it's just it's just part of a busy life, right?

You said it, and again, my my compassion in my heart goes out to all the families.

I've had the blessing and the pleasure of working with you know 60 to 80, 60 to 80 different families in my time, and each and every single one of them are doing their absolute best.

And again, I my heart goes out to you guys.

I understand the frustrations and difficulties, I get it.

And oftentimes when I'm more than burnt out as a parent, and I have a child that I know is very high demands, who's very rigid, who I know can um enter into a tantrum at any given moment.

Yes, the iPad is is my um is my savior, and you know, I'm and a lot of these parents are aware that hey, I don't want to be doing it, but it's how she goes.

Yeah, it's it's uh uh it's clearly this kind of reality we have to confront.

Yeah, I wanted to comment and see what your reaction was.

You know, Leo Canner in the 1940s, who was credits him for describing autism uh initially, he made an observation in his initial monograph, which I read, uh that he thought the parents of autistic children were exceptional.

They're just exceptional people, and you know, I've had a chance to uh I spoke at a big autism event last year, and I've I've I've interacted with people now, maybe those who are just coming out to various seminars, what have you, but it's it's my conclusion as well that parents of autistic children, they seem to be exceptional people, uh meaning uh you know, successful and perceptive, and it is have you generally garnered that type of conclusion as well.

Absolutely, Dr.

McCullough.

Uh all the parents I've had the pleasure of working with in each in their own individual way are are remarkable.

And and I think life and having a child with special needs, it demands that of them.

Yes, okay.

So that's a good that's what I wanted to get to.

So having a child with autism, in a sense, makes that parent become more exceptional, or do you think there's really something to it?

Canner thought that there was some type of unique segregation that the autistic kids just naturally have more exceptional.

I mean exceptional, I mean more intelligent, more assiduous, more uh diligent.

Um than the average.

That it's not just it's not just uh you know, born out of necessity thing, right?

What do you think?

It could very well be.

Uh, I know genetics obviously play a huge role in life, so you know, incredible parents.

It doesn't strike me as as odd that they breed incredible children, right?

Well, there's also too a statistical, and this is in uh McCullough Foundation report on autism spectrum disorder.

There's also statistically, older parents have a higher risk of autistic children.

So you know, older parents you know, you can be a lot more exceptional as a man when you're 40 than when you were when you were 20, right?

So I mean, are the parents of your clients you know, are they on the older side as parents?

I would say the vast majority are in the average age group.

I haven't seen um any outliers where you know either the mother or the father are you know older in age, not in not in my small practice.

Okay, but but how about young?

Had you have any parents who are you know not you know younger than um 25 with autistic kids?

I think maybe in the in the few years I've been doing this, I came across one family with uh a pretty young mother in the early 20s.

Uh again, my sample.

But John, how much how about any teenage parents?

Have you had any teenage parents with autistic kids?

I have not.

Yeah, it's just interesting.

I mean, people have said um for instance the Amish or the Mennonites or certain uh uh you know, certain uh groups have lower rates of autism, but you know, of interest, they also have.

Children at a very young age.

So I had a patient today, and she's already a grandmother.

And you know, she has it's not related to autism at all, but but she's 48 and she's a grandmother.

I mean, I'm I'm 63, and I'm not a grandfather.

I mean, I mean that goes to show you.

I mean, that's the the difference.

Um so those are very interesting.

You know, in this last part we have, I I want you to um kind of lay out this therapeutic journey journey, and and and what do you see on the horizon?

That's one of the reasons why you reached out to me is your kind of vision for the horizon here as there's more and more children with autism spectrum disorder.

It sounds like the um autism behavioral therapy uh approach uh has grown and matured over time.

It sounds like it's it's it's a bedrock, it's had substantial improvements, but what do you see you know on the horizon?

Uh absolutely, Dr.

McCullough.

Thank you for for paving the way for me there.

And so uh I think my overall thesis, Dr.

McCullough, and why I reached out is you know, I've I've been in the field of ABA now for uh almost around 10 years, and I've worked with a lot of children who are those level three learners who I can see that they're gonna require support.

Um, you know, I'm not even sure how long or what that end goal looks like, but they are gonna require support uh indefinitely.

Um, not everyone, and ABA is wonderful, and ABA definitely even those children will help.

It's got a very high success rate in in progression.

And and there's there's a reason why that is.

Essentially, ABA, Dr.

McCullough is uh a highly trained professional doing almost one-on-one teaching uh at a very individualized level.

So there's not many learners in the world who are not going to benefit from that.

But again, I wanted to focus on those learners that are level three that are gonna be you know in the system getting ABA therapy for many years, not to mention the cost that's associated with it.

Oh, yeah.

Yeah, tell us about that.

I don't even want to know.

Sure.

Very expensive.

Yes.

So um, yeah, so just real quick, Dr.

McCullough.

So ABA therapy can be, I guess, prescribed to a patient or to a kiddo, anywhere between 15 to 30 hours a week of of ABA.

Oh my lord.

That's a ton of time.

Is that at like almost every day?

Uh yeah, it has to be.

Yeah.

So it's almost it's a full-time program.

And again, rightfully so, because these particular individuals in uh in a mainstream classroom are not going to get the same benefit.

They're not going to get individualized teaching, right?

And like one-to-one learning.

So, rightfully so, but it often takes place of school.

Um, and again, the cost, it can range a family anywhere between 40 to 80,000 annually.

And here in Ontario, Dr.

McCullough, um, the wait list to get funding is at least five years.

So my gosh, that's from uh the uh the OHIP, the the government funding?

The Ontario Autism Program.

Uh, yes, there's like families have to apply after they get a diagnosis, and five years um is is kind of a minimum.

Five year wait, so they actually have a government program.

So autism is that common in Ontario.

Correct.

You have a whole government funding program.

And this is in addition to school.

So the parents, so the parents get their kids from school and then they go to their specialist.

Yep.

And so again, it would definitely be.

Oh my lord.

Yeah, so it would it would rely heavily on again the functionality of the child, right?

Some children are able to go to school and do great and only require um a few hours a week of ABA fair.

But I would say on average, 15 to 20 hours for a lot of um autistic work.

It's most days of the week.

I would say so, yes.

And that's why it often replaces school, like school becomes the adjunct, the secondary.

Oh my lord.

But what about a child who's in let's say second grade?

Um how do they so they must go to elementary school, and the parents pick them up and then they take them to you?

Yep.

And so and so again, Dr.

McCullough, it would recommend on the needs of the child, right?

So some children being in school, being a school program is actually more beneficial, and ADA can be secondary, and it's because the child is thriving well in school, again, might not need that much support, and ABA can be the supplementary intervention.

But I think more often than not, it's it's the reversal.

And so, yeah, and so um it was after realizing this, Dr.

McCullough, that I started to think, okay, how else what other forms of intervention can support ABA?

How else is there any compounds or anything we can do to maybe help stimulate the brain in a different way?

And ABA is wonderful.

Um, and it definitely uh also impacts neurology and it does change the brain, but not the same as like a pharmaceutical uh stimulant would, right?

Um, not to mention, Dr.

McCullough, that a lot of these level three learners um who let's say are very aggressive, who do have self-interest behaviors, when they turn 15 years old, um, you know, options for them become more and more limited.

And if you're you know, six foot two, 15-year-old child with uh or young adult with autism, and you're very aggressive, more often than not, you you're put on pharmaceuticals, you're put on antipsychotics to you know mellow you.

Sorry?

Oh my lord.

So you mean uh somebody would just bang their head again, they'd be some big large person, they bang their head on the wall or start punching somebody or yeah, and again, I I don't want to say that all autistic people are like this, but those are definitely some instances, those are definitely some cases, or even outside of the aggression, Dr.

McCullough, the self-stimulatory behavior.

A lot of these level three learners or you know, it also applies to level two, level one.

They might have a very intense self-stimulatory um inclination where most of their day they just want to stim.

They want to either verbally stim or or visually stim.

And for an ABA specialist like myself, it's very hard to compete.

We're gonna have to leave it here, uh John.

Thank you so much for joining us.

It's been a great interview.

It's been a pleasure, Dr.

McCullough.

God bless everyone.

Thank you guys.

Wow, great interview.

Let's get real.

Let's get loud on America Loud Talk Radio.

This is the McCullough Report and Focal Points Substack.

I'm Dr.

Peter McCullough, your host.

Thanks for watching and listening.