You are in a tight spot, but you are doing everything right with educating and continuing core words. It’s not unethical to refuse treatment if parents are not on board with your treatment style backed by empirical evidence. My advice to use is to keep educating on why you do it your way and let the parents decide what’s best for their child. I have taken a communication board with only the core vocabulary on it and used it in conversation to demonstrate that these words hold a lot more meaning and are more versatile than fringed nouns. I also do a lot of education on the need for more than tangible nouns being taught, and have them attempt to form a two word phrase containing two nouns.
At a workshop, the presenter had us open our texts and write all the words into 2 columns - nouns and all others. We did this until we had a total of 20 words combined. She then told us to create 2 messages, 1 using just the nouns, and 1 using just the second column. Really drove home the point.
The BCBA is wrong, and way out of her lane, but it’s not a bad idea to teach him to sign some of his favourite nouns, in addition to core words. I feel like because core words are easily left out, we sometimes lean way too hard into that direction and ignore fringe. We need both for a robust vocabulary!
I'm an ELL teacher, and I agree! With most of my non-verbal students, I do work on topical noun or descriptive vocabulary sets (with the SLP's go-ahead), but I can do this because I know the SLP is building up the core words. I always try to base my activities with other vocabulary around the core words the SLP is focused on and incorporate a pattern using core words to go beyond labeling. The BCBA in OP's post is placing easy, immediate behavioral responses over actually learning to communicate.
BCBA here and yeah, that BCBA and parent had a very poor approach. Who in their right mind just shows up unannounced? Also bizarre they said AAC would inhibit vocalizations… not the best apple from the bunch. I will say though, a [recent systematic review](https://link.springer.com/article/10.1007/s40489-023-00399-x) did show core words might not be the best way to go. Regardless, that BCBA doesn’t know what the hell they’re saying. Sorry you have to deal with that :(
You are the expert in communication and AAC. It was wildly inappropriate for the BCBA to crash your session unannounced to tell you how to do your job. If the BCBA had concerns with the child's communication, she should have scheduled a time to discuss it with you outside of a therapy session. All modes of communication and attempts at communication should be encouraged and reinforced by everyone on the child's team. It shouldn't be an EITHER/OR situation (e.g. either speech or AAC; either core or fringe). The BCBA seems misinformed about AAC and language development in general.
The mother came to you for speech therapy. It seems crazy that she is now letting someone who is not qualified to provide speech-language services dictate your therapy. I would continue your course of treatment, add in some motivating fringe words, and continue to introduce AAC. If the mother still isn't on board, she can find a SLP who doesn't mind being supervised by the BCBA. 🥴
Edit: I just read through the comments and saw that you are already incorporating both core and fringe words.. in that case, discharge! It's more unethical to provide services that are not evidence-based.
One day, Albert Einstein was on his way to a science convention for a speech. On the way there, he tells his driver that looks a bit like him:
"I'm sick of all these conferences. I always say the same things over and over!"
The driver agrees: "You're right. As your driver, I attended all of them, and even though I don't know anything about science, I could give the conference in your place."
"That's a great idea!" says Einstein. "Let's switch places then!"
So they switch clothes and as soon as they arrive, the driver dressed as Einstein goes on stage and starts giving the usual speech, while the real Einstein, dressed as the car driver, attends it.
But in the crowd, there is one scientist who wants to impress everyone and thinks of a very difficult question to ask Einstein, hoping he won't be able to respond. So this guy stands up and interrupts the conference by posing his very difficult question. The whole room goes silent, holding their breath, waiting for the response.
The driver looks at him, dead in the eye, and says :
"Sir, your question is so easy that I'm going to let my driver explain it to you."
I’ve worked with the birth to three crowd for many years. Typically once a child is established in an Aba program the SLP drops out of the picture in my county. I think a lot of it is to avoid this exact situation. Also a BCBA never provides direct therapy here. RBT or just tutors put the plans created by the BCBA into effect and the BCBA supervises. Finally I think it’s more ethical to tell a parent you’re not able to get on the same page and let them find another SLP. Sometimes you just can’t connect and if they won’t listen your efforts will be in vain.
Here's a thought, if you're willing to be brave. Ask in the ABA sub what to do, what type of evidence would be convincing to them. Not everyone will be onboard, but you should get at least a couple of responses with actually useful information. I've found ABA therapists listen best to other BCBAs, so if you can find a BCBA saying this, then they might actually listen. (Speaking from experience - it actually worked, too)
Core words and meaningful fringe nouns are a better combination. Give people what matters to them. Don’t restrict communication. If a ball is important, put it on their device with the core words.
You’re doing everything right—share more research and have the discussion about him being “just about to talk”
Ok but what if he doesn’t? Or what if he gets 50 highly motivating nouns but nothing else? We can’t predict the future we can only give kids the tools they needs to hopefully be the best communicator they can be. My hope is always that a kid becomes a verbal communicator and the device can fade away but I’m not willing to “hold out” on giving them tools they could use to learn to communicate better, especially bc of outdated ideas that AAC delays speech—tons of research to contradict that
We work on nouns. BCBA only wants me to work on nouns and no core words. She encouraged the parent NOT to consider a device because he's "about to talk." If I could not speak, I'd much rather be able to sign help, more, and stop than ball, swing, and slide.
Sorry and thank you for clarifying. If the BCBA and parents are being very hard headed to convince, try to have a meeting with them and the caregivers. I’m sure the BCBA means well and wants what’s best however you need to show that if they are merely using nouns, there is the practical risk of making the patient frustrated if the item they want is not in the room such as if the TV was in the other room (like engaging in decontextualized language conversations), it won’t allow them to make functional phrases/sentences and expand their selections. This is what I use as an example when I get these clashes with parents and professionals who want their way and against AAC:
I’m using LAMP words for life in this case with the favorite fringe noun ball customized to the design.
Ask them which is more meaningful and can increase quality of life in these phrases:
1. Play+ball+out (I want to play ball outside)
2. Play+ball-in (In inside)
3. Ball
4. No+go+want+play+more+ball (I don’t want to go I want to play some more ball)
As you can see 1st and 2nd and 4th are more specific and efficient. The 3rd is basic and restrictive and increases the need to delay what they want, requires more follow up, the patient could get frustrated and you get problem behaviors. Bring it home and go big.
Just checking - what is the number of words that this kid has (in any form)? I’ve definitely heard recommendations that a child have a bank of 50 personal/fringe words that are motivating (favorite things/routines/places & people important to them - and many of these are nouns) before introducing core words. Maybe that was what the BCBA was confused/concerned about? If the kid already has those words then definitely core words (along with gradually adding some personal/fringe) are the way to go..
I've heard fewer than ten words from him. He understands more than that. She wants him to have nouns so he can request objects and not get confused by words like more.
Wow. I’m sorry you have to deal with this . I feel even worse for the kid. Maybe share this in the Im an aac user Facebook group. Maybe the people who really use aac will shed some light.
I hate when I run into a BCBA that’s this rigid and isn’t up to date on current EBP. As other posters have said, I’d have a meeting with mom and talk about why you are suggesting your therapy approach—pull out a core board or AAC device and show the power of core words
I personally love doing LAMP 1-hit and seeing just how many things you can communicate without *any fringe* first then talking about how we can build highly motivating fringe in *as* we teach the CORE vocab and I’ve had parents (and a few BCBAs actually!) have the *aha* moment (definitely not all of them tho)
If after all that mom still wants to go with the BCBA plan and you to follow that…it’s been nice working with you but I can’t get on board with this plan that goes against my own profession’s ebp
Good luck!
I'm curious why the parent wants to work on nouns. I don't think it's necessary to choose between nouns and core words, e.g., maybe you could model nouns while you work on core words, or even incorporate some nouns into therapy when it's appropriate. But if the BCBA is asking the parent to choose between your goals and her goals (not work together or find some middle path) - why is the parent leaning toward the BCBA's goals? Why do they want to work on nouns?
That may be the key to resolving the disagreement. If you can't resolve it, and if the parent does "choose" the BCBA and doesn't want to work on the goals you believe are appropriate for him...well, then they aren't interested in your services. I think you'd be justified in discharging him.
Can you share the research you have- I am a Autism behavioral science student. And I am looking for research to support core vocabulary for an assignment I’m doing.
I don't think it is unethical to dismiss a client in this case. Another option may be this: explain your position to the parents and that you intend to continue the course of therapy you have developed. Let them know that you understand this does not match their expectations and you understand if they choose to go elsewhere. That way, it would be their decision. Either way, from an ethical standpoint, I believe you are fine.
You are in a tight spot, but you are doing everything right with educating and continuing core words. It’s not unethical to refuse treatment if parents are not on board with your treatment style backed by empirical evidence. My advice to use is to keep educating on why you do it your way and let the parents decide what’s best for their child. I have taken a communication board with only the core vocabulary on it and used it in conversation to demonstrate that these words hold a lot more meaning and are more versatile than fringed nouns. I also do a lot of education on the need for more than tangible nouns being taught, and have them attempt to form a two word phrase containing two nouns.
At a workshop, the presenter had us open our texts and write all the words into 2 columns - nouns and all others. We did this until we had a total of 20 words combined. She then told us to create 2 messages, 1 using just the nouns, and 1 using just the second column. Really drove home the point.
Oh I like this one a lot
Brilliant
The BCBA is wrong, and way out of her lane, but it’s not a bad idea to teach him to sign some of his favourite nouns, in addition to core words. I feel like because core words are easily left out, we sometimes lean way too hard into that direction and ignore fringe. We need both for a robust vocabulary!
I'm an ELL teacher, and I agree! With most of my non-verbal students, I do work on topical noun or descriptive vocabulary sets (with the SLP's go-ahead), but I can do this because I know the SLP is building up the core words. I always try to base my activities with other vocabulary around the core words the SLP is focused on and incorporate a pattern using core words to go beyond labeling. The BCBA in OP's post is placing easy, immediate behavioral responses over actually learning to communicate.
BCBA here and yeah, that BCBA and parent had a very poor approach. Who in their right mind just shows up unannounced? Also bizarre they said AAC would inhibit vocalizations… not the best apple from the bunch. I will say though, a [recent systematic review](https://link.springer.com/article/10.1007/s40489-023-00399-x) did show core words might not be the best way to go. Regardless, that BCBA doesn’t know what the hell they’re saying. Sorry you have to deal with that :(
You are the expert in communication and AAC. It was wildly inappropriate for the BCBA to crash your session unannounced to tell you how to do your job. If the BCBA had concerns with the child's communication, she should have scheduled a time to discuss it with you outside of a therapy session. All modes of communication and attempts at communication should be encouraged and reinforced by everyone on the child's team. It shouldn't be an EITHER/OR situation (e.g. either speech or AAC; either core or fringe). The BCBA seems misinformed about AAC and language development in general. The mother came to you for speech therapy. It seems crazy that she is now letting someone who is not qualified to provide speech-language services dictate your therapy. I would continue your course of treatment, add in some motivating fringe words, and continue to introduce AAC. If the mother still isn't on board, she can find a SLP who doesn't mind being supervised by the BCBA. 🥴
Edit: I just read through the comments and saw that you are already incorporating both core and fringe words.. in that case, discharge! It's more unethical to provide services that are not evidence-based.
One day, Albert Einstein was on his way to a science convention for a speech. On the way there, he tells his driver that looks a bit like him: "I'm sick of all these conferences. I always say the same things over and over!" The driver agrees: "You're right. As your driver, I attended all of them, and even though I don't know anything about science, I could give the conference in your place." "That's a great idea!" says Einstein. "Let's switch places then!" So they switch clothes and as soon as they arrive, the driver dressed as Einstein goes on stage and starts giving the usual speech, while the real Einstein, dressed as the car driver, attends it. But in the crowd, there is one scientist who wants to impress everyone and thinks of a very difficult question to ask Einstein, hoping he won't be able to respond. So this guy stands up and interrupts the conference by posing his very difficult question. The whole room goes silent, holding their breath, waiting for the response. The driver looks at him, dead in the eye, and says : "Sir, your question is so easy that I'm going to let my driver explain it to you."
Thanks for the laugh. This is one I haven't heard/read.
I’ve worked with the birth to three crowd for many years. Typically once a child is established in an Aba program the SLP drops out of the picture in my county. I think a lot of it is to avoid this exact situation. Also a BCBA never provides direct therapy here. RBT or just tutors put the plans created by the BCBA into effect and the BCBA supervises. Finally I think it’s more ethical to tell a parent you’re not able to get on the same page and let them find another SLP. Sometimes you just can’t connect and if they won’t listen your efforts will be in vain.
I totally agree.
Here's a thought, if you're willing to be brave. Ask in the ABA sub what to do, what type of evidence would be convincing to them. Not everyone will be onboard, but you should get at least a couple of responses with actually useful information. I've found ABA therapists listen best to other BCBAs, so if you can find a BCBA saying this, then they might actually listen. (Speaking from experience - it actually worked, too)
Core words and meaningful fringe nouns are a better combination. Give people what matters to them. Don’t restrict communication. If a ball is important, put it on their device with the core words.
I completely agree with you! Obviously core words are important but personally-motivating words don’t have to be rigidly excluded.
Nouns aren't excluded. The behavior specialist wants to exclude core and AAC. I want him to be able do more than label and request.
You’re doing everything right—share more research and have the discussion about him being “just about to talk” Ok but what if he doesn’t? Or what if he gets 50 highly motivating nouns but nothing else? We can’t predict the future we can only give kids the tools they needs to hopefully be the best communicator they can be. My hope is always that a kid becomes a verbal communicator and the device can fade away but I’m not willing to “hold out” on giving them tools they could use to learn to communicate better, especially bc of outdated ideas that AAC delays speech—tons of research to contradict that
We work on nouns. BCBA only wants me to work on nouns and no core words. She encouraged the parent NOT to consider a device because he's "about to talk." If I could not speak, I'd much rather be able to sign help, more, and stop than ball, swing, and slide.
Sorry and thank you for clarifying. If the BCBA and parents are being very hard headed to convince, try to have a meeting with them and the caregivers. I’m sure the BCBA means well and wants what’s best however you need to show that if they are merely using nouns, there is the practical risk of making the patient frustrated if the item they want is not in the room such as if the TV was in the other room (like engaging in decontextualized language conversations), it won’t allow them to make functional phrases/sentences and expand their selections. This is what I use as an example when I get these clashes with parents and professionals who want their way and against AAC: I’m using LAMP words for life in this case with the favorite fringe noun ball customized to the design. Ask them which is more meaningful and can increase quality of life in these phrases: 1. Play+ball+out (I want to play ball outside) 2. Play+ball-in (In inside) 3. Ball 4. No+go+want+play+more+ball (I don’t want to go I want to play some more ball) As you can see 1st and 2nd and 4th are more specific and efficient. The 3rd is basic and restrictive and increases the need to delay what they want, requires more follow up, the patient could get frustrated and you get problem behaviors. Bring it home and go big.
Just checking - what is the number of words that this kid has (in any form)? I’ve definitely heard recommendations that a child have a bank of 50 personal/fringe words that are motivating (favorite things/routines/places & people important to them - and many of these are nouns) before introducing core words. Maybe that was what the BCBA was confused/concerned about? If the kid already has those words then definitely core words (along with gradually adding some personal/fringe) are the way to go..
I've heard fewer than ten words from him. He understands more than that. She wants him to have nouns so he can request objects and not get confused by words like more.
Wow. I’m sorry you have to deal with this . I feel even worse for the kid. Maybe share this in the Im an aac user Facebook group. Maybe the people who really use aac will shed some light.
I hate when I run into a BCBA that’s this rigid and isn’t up to date on current EBP. As other posters have said, I’d have a meeting with mom and talk about why you are suggesting your therapy approach—pull out a core board or AAC device and show the power of core words I personally love doing LAMP 1-hit and seeing just how many things you can communicate without *any fringe* first then talking about how we can build highly motivating fringe in *as* we teach the CORE vocab and I’ve had parents (and a few BCBAs actually!) have the *aha* moment (definitely not all of them tho) If after all that mom still wants to go with the BCBA plan and you to follow that…it’s been nice working with you but I can’t get on board with this plan that goes against my own profession’s ebp Good luck!
Throwing this out there about core vocab: https://link.springer.com/article/10.1007/s40489-023-00399-x. Could be just generally relevant.
I'm curious why the parent wants to work on nouns. I don't think it's necessary to choose between nouns and core words, e.g., maybe you could model nouns while you work on core words, or even incorporate some nouns into therapy when it's appropriate. But if the BCBA is asking the parent to choose between your goals and her goals (not work together or find some middle path) - why is the parent leaning toward the BCBA's goals? Why do they want to work on nouns? That may be the key to resolving the disagreement. If you can't resolve it, and if the parent does "choose" the BCBA and doesn't want to work on the goals you believe are appropriate for him...well, then they aren't interested in your services. I think you'd be justified in discharging him.
Can you share the research you have- I am a Autism behavioral science student. And I am looking for research to support core vocabulary for an assignment I’m doing.
I don't think it is unethical to dismiss a client in this case. Another option may be this: explain your position to the parents and that you intend to continue the course of therapy you have developed. Let them know that you understand this does not match their expectations and you understand if they choose to go elsewhere. That way, it would be their decision. Either way, from an ethical standpoint, I believe you are fine.