The Nation's Premier Autism and Disabilities Conference

November 16-18 | Columbus, OH

The Nation's Premier Autism and Disabilities Conference

November 16-18

Columbus, Ohio

Emily Rubin Keynote


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Video Transcript:

So without further ado, I want to introduce Emily Rubin, who will be our keynote speaker today.

[APPLAUSE]

I have a six-year-old. Thank you. Thank you. Wonderful. I do believe that he's just a little bit more mature than your average six-year-old.

It is absolutely an honor to be here on the day that the Autism Certification series is being launched, such a wonderful tool to get what we need in all of our hands, that Level 1 training, and understanding that our children need predictability, they need visuals, they need time. They need their interests to be honored. That's what is going to be conveyed in those video modules. It was such a pleasure to be a part of that Blue Ribbon Commission and to see it get launched today.

It is also just a pleasure to be here to share with you some of my favorite things to talk about, and that is social emotional development. I get to talk about social emotional engagement today. And if you're confused by that term, we often talk about social emotional learning, social emotional skills.

But the truth is that a child actually needs to be interested in people. A child actually needs to have some kind of a passion to connect with people, motivation to engage with people socially, before they can acquire a social skill and use it in everyday situation.

So I get to talk to you today about the importance of social emotional engagement as a fuel for a child's learning, that it is actually the basis of what allows a child to learn social skills and actually learn academics and learn life skills and to be successful in life. And that is what we call social emotional engagement.

But this is actually something that's not unique to autism. Social emotional engagement is important for every one of us in this room. It is what fueled our brains to develop. It's what's fueled us to be successful in school and in life.

My work has changed quite a bit in the last four or five years, or actually 10 years, if you think about it. We've been hearing a lot about ratios of children with autism. The statistics are being thrown off of you today already. One in 68, or one in 45 if you read the news this last weekend.

Why are these numbers increasing so much? And being in the field over the course of the last two decades, it's important to think about trends and what has changed. And one of the things that has changed that I think is really remarkable is when children were diagnosed 15 years ago with autism, there was a different characterization. Children at that time about, 80% of them, had significant intellectual disabilities. And we were dealing with not only a social learning difference, but also significant cognitive challenges as well.

But over the last 10 to 15 years, now when we have one in 45 or one in 68 children being diagnosed, the CDC is saying that half of those children have IQs that are in the average range or in the above average range. So we're talking about intellectual bell curve that could be as significant cognitive challenges to intellectual capacities that are higher than some of us in the room.

So we're talking about the full bell curve of children whose social learning differences that are being identified. And that's changing the way we're going to be educating and supporting our children with autism, because for the most part now, children with autism may very well be in general education settings. They're going to be in classrooms with a wide range of diverse learners. And the evidence based strategies that we've been perfecting over the last two decades sometimes aren't very relevant for a class of 20 or a class of 35 at a middle school or high school stage.

So my work has shifted a lot to thinking about how do we make education for children with autism relevant for every child in the classroom? How do we do this in a way that's more of a tier one? What do we do for all children? And what's universal about all of this is social and emotional engagement. Every child on the planet needs this as the fuel for their brain to grow and to develop social skills.

So this is what I'm going to talk to you about today. We will be talking a little bit about the differences in children with autism but, we're going to be talking more about commonality than not.

I must disclose to you some of the speaker disclosures because this is a CEO event, and I need to make sure I'm upfront with my various involvements. And I can't get my eyes off of my colleague Dr. Prizant, or Barry, because I never get to see him in person. So I keep looking at him right now, going, I want to talk to you.

We are the co-authors of the SCERTS model. And we are extremely proud about the growth that it has had nationally and internationally. And this is my life's work, my passion, of helping children and families understand the importance of social communication and emotional regulation as the highest priorities to help children with autism be successful. So that is definitely something that I receive royalties from the Brooks Publishing Company. I'm also receiving an honorarium to be here today.

And I'm also the director of the Educational Outreach Program at the Marcus Autism Center. I work alongside Dr. Ami Klin at Emory University, and we are an Autism Center for Excellence for the NIH. I'm going to share with you some of the neuroscience that we are so proud of, and how that is going to be moved into what we call transformative community models.

I couldn't help but move to Atlanta to be a part of that excitement. Last but not least, I'm also a member of the American Speech and Hearing Association's Ad Hoc Committee on Autism Spectrum Disorders, which is a team that was kind of charged with the idea of understanding the roles and responsibilities of speech and language pathologists. I'm also on the Executive Committee for the National Autism Leadership Collaborative, and as Sean says, I can't collaborate enough. This is going to take a big team. All of us in this room need to contribute to progress in the field.

So these are some of the disclosures that I just wanted to share with you.

Now I get to be a nerd and talk a little bit about social emotional development. This is what I really like to talk about, is brain development. I had learned a lot of different strategies, evidence based strategies, to help children with autism. But it wasn't until I was recruited by the Yale Child Study Center to do a fellowship in neuroscience, and I got to learn about how babies develop social emotional skills through eye-tracking research and MRI studies.

And while I was there learning a lot about autism, I was realizing, my goodness, this is what every child on the planet needs. When I look at the slide, it reminds me to share with you that when babies are born, all of our babies, regardless of whether or not they have autism, they are not socially and emotionally competent.

In fact, I often joke that infants, they're some of the most socially inappropriate children I know. They're completely egocentric. They dominate the conversation. They're attention-seeking. They use appropriate vocal volume. They don't know how to share. They definitely don't know how to share. And certainly delayed gratification, forget that.

So our babies have a lot to learn. They have a lot to learn in order to grow their brains to become socially and emotionally competent. And we often talk about how important is they get good nutrition, that they're in loving homes where it's safe, and so forth. But really, the strongest fuel that our children need is something called social emotional engagement. It's brain fuel. It's what actually grows the child's brain architecture to become successful.

And it's not just emotional connection, its chemical connection. And that's what I want to share with you today. As you watch the children climb up that particular ladder that you see there, one of the first things that our children need to do is develop their social brain. They need to fall in love with the social world. They need to feel that experience of what it's like to find people stimuli more interesting than anything else, that the love of the social world leads children to develop language. Got something to say, you're going to start talking.

So that language hemisphere starts to emerge and to develop. And once you have creative language, that's going to fuel up something called executive functioning, the ability to plan and prepare ahead for how to be successful on a wide range of social situations.

So I'm back that up, because I know I talk fast, and I'm going to share with you what we've learned about neurodevelopment in all children, and how that relates to children with differences, like children with autism. Very interestingly, most babies on the planet, with the exception of those that are visually impaired, have a reflex to look at the eyes in the first two months of age.

And that's kind of an interesting thing, because we've learned that kids with autism don't look at the eyes. But actually, for the first two months of life, most babies look at the eyes. And that's because the eyes are really beautiful. And there's a reflex in all of us for looking at black on white contrast.

And that's kind of an interesting thing, right? You're just learning your visual acuity, and if somebody's holding you, you're going to look at the face. Those eyes are going to pop out as the most interesting thing.

And it is kind of interesting to the nerdy Emory geneticists down at Atlanta. They're studying this. They realize that it's not just in human babies that they have a black on white contrast. It's in all species that have caregiver child bonding. Not all, but most of these species. If you look at primates, if you look at killer whales and canines and felines, they've got these black on white backgrounds.

Why is that interesting? Well, you can compare that animal species that don't require social bonding, like the snake I saw in the north Georgia woods just recently. He was a black rat snake with his eyes all dark. Or I don't know if it was a female or male. I don't even care. And I don't think its offspring was at all interested in looking at its eyes when it was born. In fact, the offspring of that particular species can take care of itself the first day it's hatched or born, or whatever it is.

And what we do is, the geneticists will look at the chromosomes of species like this and compare it to the species that have the black on white contrast. And we're starting to get closer to understanding, there's certain genetics that lead to social emotional competence. And we're coming down to about 130 different genes that play a role in whether or not we're going to be socially competent. And so that, to me, is fascinating stuff.

So you take these babies that are reflexively looking at the eyes in the first two months of life. What's going on some? Children are born with a genetic advantage plan. And that genetic advantage plan allows the child, when they look at the eyes, to get kind of high from it. A neuro-endorphin rush is signaled in the social regions of the brain. And those neuro-endorphins, you don't have to be an MD or PhD know what these endorphins are. They're called opioids and dopamine.

So when a baby with a genetic advantage plan looks at a caregiver's eyes, what's going to happen? They're going to get high. You've seen it, you know? When you're holding a baby and they're like, oh my gosh, you're the coolest thing on the planet, right? And they could be looking at all these things, but they're looking at you. And that's because their genetic advantage is saying, hey, people rock, people are amazing. And so that's key.

But genetics alone don't do the trick. That baby needs to be nurtured. That baby needs to be played with, interacted with, and talked with. And during that talking, more chemicals are exchanged. There's a hormone called oxytocin, and that hormone is a pheromone. It goes from me to you and you to me, and caregivers are boat-loading it on their babies and vice versa.

And what is oxytocin known as? The cuddle hormone. Some people are really crazy, and they take a little nasal spray of it before they go out to the bars at night, and it makes them very amorous. I don't recommend that. I'm just saying that there's a hormone out there that makes you really like people. So you take oxytocin, you put a little on your opioid and your dopamine, and you have a mixed cocktail from heaven, right? I call it the oxytocin mixed cocktail.

Genetics, nurture, equals addiction. This two-month-old baby is going to be not only looking at people, but they're going to be falling in love with people. And they're going to become so addicted.

Now if all of you don't believe that you're addicted to people, when you wake up in the morning, what do you do? Think about, do I look OK? Am I wearing a nice clothes? Am I going to be able to talk to this person or that person? It fuels us constantly thinking about people. And that is what we call attachment in developmental psychology. Our babies need to attach themselves to the social world. Genetic advantages and nurture advantages play a role.

Now what if-- I'm putting out the what if-- what if you're born with a genetic difference? And there are many different genetic differences. There isn't one genetic form of autism, for example. But what if you're born with a genetic difference in which you look toward people at the first two months of life, and it's just kind of, eh. It's just not there. You don't get the same opioids. You don't get the same dopamine. You may not receive the oxytocin. That's the current research going on at Emery right now, is looking at oxytocin reception. The caregivers are giving it. The babies are saying no, thank you.

So this is going to make the first milestone of social emotional development very challenging. It doesn't mean you can't accomplish it, but it's going to make it a little bit harder to fall in love with the social world, especially if you don't find out that your child has these challenges until two and a half, four and a half, five years of age. This is important information to know from the outset of development. So we need to know. All of our babies, every single one of them, needs really intense social emotional engagement in the first couple of months of life.

Now what if you were born with genetic advantages, but you didn't have the nurture? You're born into an environment where your caregivers are overstressed. Maybe there's mental health issues. You're just not getting interacted with. And of course, we all question right now what happens when a baby gets put in front of an iPad for six hours a day. Is that the same dose of oxytocin cocktail? Oh, no. Not at all. We need social engagement for our brains to grow and to flourish.

So we think about these things, and we need to be sharing the most important climate for a baby to succeed is going to be one filled with lots of social emotional engagement. And what that does is, as that child who falls in love with a social world, what's going to happen is, that baby's going to love people so much their rate of nonverbal communication skyrockets. And now they've got something to say. Language development is kicked off because the social regions of the brain have grown and that have been wired, and now they're saying, I want to talk. I want to use speech, I want to use pictures, sign language, voice output, whatever it is. They're going to start using messages to share to the world around them.

But language alone is not enough. You still need social engagement as your fuel, because I've met plenty of children in my life that have language, but they use it like this. I want yellow block, please. It's effective. It gets the point across. It's words. But it doesn't have the social engagement behind it. When you look at this image right here, you see this little boy, and I hope he's not saying, I want yellow block, please. I hope he's saying, Max do, Max play, Max build.

And what I hope he's doing is using a person's name and verbs, because there's nothing more important than people and actions. People and action, subject verb, which is something we've written right into the early parts of the SCERTS assessment process, are some of the most important priorities. And yet we spend a lot of time teaching children with social learning differences about objects. Oh, no, no, no. This is about people, not things.

So we get the subject verb. Why is that so important for every baby? Subject verb noun is the basis for creative language acquisition. If you can put a sentence together with subject, verb, and noun, you can create language. And what that does is get the language hemispheres of your brains growing, so now you have a full and rich area of the brain related to language acquisition.

What that does, as you go into late preschool, early elementary school and kindergarten and beyond, is it fuels something called executive functioning. If you've got creative language skills and you've got social emotional engagement as your fuel, you go into schools. Now you have the ability to plan ahead and talk about the past and the future with your language.

And if a teacher says to you, when you-- first day of kindergarten, you come and you sit down and you're talking to your peer because you're so high on oxytocin cocktails you can't stop talking-- and the teacher says, shh, be quiet. And you look at the teacher and say, I don't want to be quiet. But you say, wait a second. I want that teacher to like me, and I want her to like me tomorrow and the next day and the next day. And I have complex sentence structures, so I'm planning ahead to maintain the relationship with her over time. So I'm going to behave because I like her, and I like people.

Children behave because they want to maintain social relationships. Sure, you can get behavior a different way, but it doesn't tend to stick, and it certainly doesn't generalize.

The best way to get children to learn about social norms and expectations get them to fall in love with people. And that's the social emotional engagement that's fueling it up. This is the trajectory of social emotional development. All too often I see teams are teaching children social skills like appropriate vocal volume and turn taking and sharing. And yet I kind of say to them every now, does he even like people? Does he even have a relationship with the teacher? Does he even like the child that he's being asked to share that toy with? Do they have a relationship? Because that is the fuel the gets children thinking and learning.

And I share with you-- I've already kind of talked a little bit about the differences in autism-- that when we go into the classroom of 22 kids or 35 kids, I mentioned before, I'm going to talk a little bit about autism, but we'll be shifting back to every child.

There is a lot of unique neurodevelopment in those classes. There's barriers toward climbing up that ladder, toward falling in love with the social world, toward language acquisition and executive functioning. And the first of them is that we're learning that children with autism spectrum, the genetic form, don't have as much neural sensitivity. So they may not get the same dose of oxytocin cocktail, whether it be the opioids, the dopamine, the oxytocin reception, and so forth.

There are, of course, other developmental differences-- intellectual abilities, attention challenges-- that may play a role in this child's climb up this ladder. And of course, the care giving environment matters tremendously. If a child is born into an environment where there isn't a lot of social emotional engagement-- they aren't cared for, they aren't interacted with, they aren't talked with a lot when they're growing up-- that actually has lifelong implications for brain development, and I want to share a little bit of that for you.

I'm excited to be a part of the Marcus Autism Center because when I was at Yale 15 years ago, we came up with technology, the eye tracking equipment. We stole it from the Central Intelligence Agency. We really did. It with espionage equipment. And it was used to look at how people kind of gaze shift and look at each other. And Ami's like, I want to use that for understanding what kids with autism are looking at.

And we found out that you can pick up autism differences and risk factors for it as early as six months of age. We're not diagnosing children at that stage, but we're finding that there are risk factors. And how do we know this? That we've been tracking baby since their second week of life, and four weeks of life, six weeks, so forth. And we've done this with hundreds of children at this point.

And we've found that at two months of age, yes, the babies with autism are looking, because it's interesting to look at a black on white contrast. But by six months of age, their interest in the eyes has declined significantly. So they go from like the 50th percentile to the 5th percentile, and a pretty significant decline. That's hard to notice as a caregiver because your babies are so busy and active at that time, you're not noticing that decline. We need objective tools, like an eye tracking device, to do this.

Why did I move down to Atlanta? Because finally, as a whole group of people left Yale to go down to Emory, we were given a research budget of no less than $25 to $30 million. We were given $50 million of philanthropy to field test an eye tracking device in over 1,600 pediatricians' offices throughout the greater Atlanta and Georgia area. And we've just kicked off the Federal Drug Administration trial so that pediatricians all over the world can someday have a way to not only look at head circumference, height and weight percentiles, but your social emotional gaze and how that relates to your developmental trajectory.

We could possibly be picking up at risk factors by six months of age, two and 1/2 years of early intervention before preschool even starts. And I will tell you very, low cost interventions. Interventions based on some of what I've been talking about are about parent education and support, the SCERTS framework has been tested in a randomized control trial with very young children showing very positive outcomes if we start very young there.

And so it's exciting to be a part of that. We're not trying, by the way, to "cure" those genetic differences. We're trying to reduce the associated disabilities that come with not having the supports as you're growing up and maturing. Because something happens as you do that, and I'm going to share with that notion right now, is that children who are at risk, who are not getting oxytocin cocktails every time they engage with people, they just don't find it as pleasurable, what happens is they start to miss the gaze shifts. They start to stop looking at the eyes, and they miss the person looking at what they're looking at and back, the gaze shifting.

If you're not doing that, you're not able to predict what other people are doing very well, and you certainly aren't going to ask that person for engagement and for comfort. And so people go from being uninteresting to kind of being unpredictable, kind of being undesirable, possibly, by two or three or four years of age, kind of aversive. You go from not liking people to really kind of being scared of people and being threatened by people.

This is a secondary issue. Children with autism don't necessarily aren't born to be scared of people. They just don't understand people. They don't have that excitement. And so this is something that we can really prevent.

But it also is something concerning related to brain architecture, because our brains are forming at 100 miles an hour. And we're deciding at very young ages, are we going to be a social expert or an object expert? Are we going to be an expert in things or people?

So let me show you what an eye tracking study looks like. This is something that you would see in a pediatrician's office in children between 12 months of age and three years of age. In the long-term future you're going to have this right here in Ohio, I just know it. And there's a different video that you would show from babies that are just from birth to one year of age, and it's just caregivers' faces, very salient.

This is what I call the "desperate housewives" of early childhood. This is the video that you're about to see, because you have to entertain. I mean, you know, if a baby is going to sit and watch a video, it has to be interesting.

These babies here, they just had a special day at their child care program. One of them has an ice cream cone in his hand, and he's just looking for a place to sit. He thinks that sitting on the other side of the Little Tykes wagon is a perfectly viable option.

This little girl does not think so at all. She's not going to share. And so there's a drama that ensues between the two of them, and at the end they literally kiss and make up. And I don't know how they got them to do that, but there you go. So that's why I call it the desperate housewives.

What we're going to do is, we're going to put a baby in a car seat and let them watch this. We're going to put eye tracking devices on it, and we're going to figure out what they pay attention to in this environment, and compare that to what other children pay attention to see if we can pick up risk.

So I'm going to go ahead and play that video for you right now so that you kind of see the drama unfold.

[VIDEO PLAYBACK]

-Please. Please. Please.

[SCREAMING]

-It's hard to take turns.

[SCREAMING]

-Open. Open. Leave it open. OK.

-I'm angry. Me too. We are both angry.

EMILY RUBIN: The drama.

[SCREAMING]

EMILY RUBIN: Got to have a close-up here, you know.

-It's hard to share. When we share, kids are happy.

[MUSIC PLAYING]

EMILY RUBIN: OK. Sorry about that. OK.

[END PLAYBACK]

So how do we use that as a tool to identify risk? How do we use a video that's 60 seconds long? You take a really nerdy computer scientist named Warren Jones, who's now a research psychologist, director of research at Emory down in Marcus. And he's like, you know what, I'm going to take every second of that video, and I'm going to put hundreds of children's eye tracking data in there. And I'm going to find moments in which there is a convergence of energy. This is where most of the children are looking at this specific spot. And I'm going to call that, that's the data point, when you call it the funnel of attention. I think some of you who saw Dr. Klin present last year probably saw him show this a little bit.

So at this particular moment you're seeing them look at the door latch, because that's an interesting focal point. But what you're going to quickly see, majority of the children leave that door latch, and as I play this right here and I pause it here, wait a second. The majority of the children are no longer looking at the door latch. They're looking at that boy's face in complete worry that something's going to go awry here. Is this girl going to let him in, let him out, trap him, and so forth.

It's called the triangular of social attention. Children typically look at the door latch, the faces, back to the faces, and back to the door latch. And that's because they're socially connected. They're constantly thinking about people and what people are thinking and feeling. And so we like to see that gaze shifting.

What you're not able to see right now are the outliers, that there are some children that are not following that funnel, and we're going to talk about those in just a moment. If the data is really spread out like this, it's kind of thrown out, we're only looking at those moments in which the children are really converging.

And what this is important is, you're going to be able to find out at six months of age, is your baby following that funnel of attention 50% of the time, 70% of the time, 90% of the time? They're going to be, like, social experts. Or are they falling at 5% of the time? And it provides you with a little bit of a risk there, that wait a second, your baby's not looking at what other babies look at.

And why is that so critical, as I shift it to the next slide here, Warren has taken that data. And on the upper row, these are children who end up having social and emotional competence going into kindergarten two or three years later. And the children on the bottom row, these are children that ultimately are identified with social disabilities like autism.

And what he's done is light up what they see, and that's going to affect their brain development. So I'm going to push play right here. The upper row are the children who are typical. Children on the bottom are children and end up having autism. And again, the lights are the data points right there. They mostly start out with the door latch. But a flashlight beam starts to go to that boy's nose on the top row. And if you'll notice on the top frame right there, as it's paused, they're really worried about this boy's face.

On the bottom row, they're really worried about that Little Tykes door latch right there. That's what the attention is focused on, face versus door latch. They might be worried, why don't they just slide that little yellow thing, and it would close better? I mean, they're just like slamming it. Don't they know how to use a door latch?

But you know, truly, this is in 15-month-old babies, that we can see this difference. And what that does is it's going to affect their brain architecture. Children are wiring their brain to become experts in something. Babies that have the genetic advantage plan, the nurture advantage plan, what are they doing? They're wiring to become social experts. They're falling in love. They're developing language, executive functioning, and so forth.

Children that have differences are looking at that door latch. And what's happening is their brain is wiring, they're growing. They're going to be experts in things and not people. And that leads to a lot of challenges as you climb up that social emotional curve.

I've been biased, and I've been sharing with you a lot about the visual data, the eye tracking. But this social stimuli is not just one's face or one's eyes. Speech is an interesting one. When I talk to you right now, if I'm stimulating you-- there's some that may be hard to stimulate-- if I'm stimulating you right now, the opioids and dopamine are getting you excited. That speech is just as stimulating as looking at the eyes.

In fact, we have a research study going on at the Emory University where babies are coming into Marcus. And what are we doing? We're doing 4D ultrasound before they're born. They're in third trimester and we're spying on them. And the caregivers are talking to the babies, and not only is their auditory nerve firing, but their heart's going 100 miles an hour. That speech is stimulating and exciting and social.

For children with genetic differences, it's a little bit different. Speech is just another thing in the environment, another noise, another sound. Many of us who had children with social learning differences noticed it felt like they were deaf at times. We're trying to talk to them and they don't even react. I say to teachers out there, if you're a teacher of diverse learners out there, it's probably one of the least effective way to get someone to pay attention to you is to use speech because it is so social.

But if you pair it with visuals, oh yeah, now you got non-social and social. That's what you call the backup plan. Our children are often just hearing sounds, and that really significantly impacts their understanding.

So what I'm leading this all up to is brain architectures forming, is that when children with vulnerabilities in these areas grow and mature, their brain architecture forms. Neuro-imaging in older children, nine, ten, eleven years of age will show that children who don't have that oxytocin cocktail, that haven't been paying attention to social, they tend to process social information in the non-social parts of their brain.

That's going to be pretty hard. If you're processing where objects are typically processed, it makes understanding that we're animate, that we have thoughts and feelings and emotions, much more challenging. Doesn't mean that people with autism can't do that. Of course they can. It's just a lot harder. It doesn't come as naturally.

Here's a functional MRI of a child that I call has a genetic advantage plan. He had good nurturing and so forth. Very bright young boy. And he's using the limbic region of the brain, that's the social region of the brain, to figure out what you're thinking and feeling. This is the kind of region of the brain that gives you an advantage, because there's some special neurons in that brain. They're called mirror neurons. And I know that's kind of a technical term, but I find it really fascinating.

What is a mirror neuron? It's a special brain neuron, that when I look out on you right now, and I see the way that you're sitting, your body posture, the way you're holding your hands, kind of this, and your facial expressions, my mirror neurons imitate the way that you look in your face. And I quickly think, if I were sitting like that and I had a face like that, I might be thinking and feeling this. That's the definition of intuition. And it's the reason why we use the limbic system as an advantage to understand what people are thinking and feeling. We don't have to think that hard about it. It comes very naturally.

That's if you have a genetic advantage plan and you had that nurturing. This is a child with autism, a very bright boy with autism. High functioning. He's in general education, fifth grade classroom. He is able to do his math. He's able to read at grade level. He knows his science really well. He knows every Pokemon character on the planet. So he's good.

He doesn't get invited to birthday parties, though, and his mental health is significantly at risk. This is where he's processing people's faces and speech and social cues. This is the regions of the brain we would typically use to process things, like tables and chairs. So he could see a chair, he could see a person, he could see a piece of paper. I see a person object with a red shirt, a person object with a black coat.

And I have to stop and think, oh yeah, people think. Let me go back and look at your facial expression. I know this one. I saw it in a book one time. I think you're thinking about the birthday party you're having after the conference today, right? Because it looks like you're happy and content.

And during that, by the way, he was staring at you the whole time, and it was starting to get pretty uncomfortable to be stared at. So his compensatory strategy actually makes the social awkwardness even more challenging. He can do it. A child with autism, a girl with autism can do this as well. Some of them are very good at it, and I'm amazed by it.

But it's really hard work. This is the learning difference. The first time that I saw this image I was blown away. It was 2000 when Robert Schultz first published this. I was at Yale. I was one of the few clinicians. I was raising my hand going, what are you saying? What are you doing up there? And I don't think I was even allowed to raise my hand, but I was raising my hand.

And I'm saying, are you trying to say we're just another object in the environment? My heart is breaking here, thinking about all the children with autism in my life, and thinking about just being another object. And he's like, oh, no, no. I'm not trying to say that. This is just my data. I'm just presenting my data, you know, not even thinking about the ethical implications here.

And he says, no. People with autism and a wide range of neurology, of course they feel emotional attachment. They could be really excited and passionate about you. You could be the object of their affection. And I smiled and I said, I don't think I am.

But when they're trying to figure out what you're thinking and feeling in this part of their brain, that's the learning disability, or the learning difference. And that can be really challenging. So yes, you can be the object of their affection. And I saw it and I think, I don't think I was. I don't think I knew that that was the issue. And all the evidence based strategies that I was taught, yes, they were effective, they were working. But they weren't working the way that I had hoped they would. And I have to tell you a quick story about that.

I worked with a little boy named Kyle. He was a two-year-old. His mother was desperate for him to learn the academic skills he was going to need to go off to school. I learned an approach that was very repetitive, lots of degree of reinforcement and so forth.

And I saw the effectiveness. I could sit down with him and teach him, put with same, put with same, put these two objects together, match them. I taught him how to label objects, you know, this is the truck versus the car versus the ball. I taught him how to discriminate between his colors, red versus green, and the numbers, the letters, and so forth. I taught them all this stuff about categories of food versus clothing. 20 hours a week they paid me to do this over and over again, and I saw that it was effective. And when you look at the definition of evidence based practice, it worked. It was effective with the skill that it was trying to accomplish.

But I think to myself, 20 hours a week for an entire year, what did I do? I taught this child everything he needed to know about things and not people. I was feeding sugar to a diabetic. I mean, that's basically what I was doing. I was like, here, let's spend your entire day talking about things.

How do I know that I messed up in some way? I was hired to be an aide in his preschool classroom. He went into this beautiful, integrated preschool environment. And guess what? He sat there with the whole time with his back to all his classmates, lining up his alphabet letters from A to Z in perfect sequence, not wanting to interact with people at all.

He went from a baby at two months of age that was kind of uninterested in people, to three years of age, finding people to be completely uninteresting and completely aversive. And yet he had had a year of early intervention.

Sure, he learned skills. But did he learn that people rock, and that people are amazing?

And I kept thinking to myself, I think I missed something. And then guess what? We made matters worse. And I didn't do that because I was a bad person and I didn't have a good heart. But man, we made matters worse. The teacher said, it's time for morning circle. And Kyle comprehends language, and he has speech and so forth, so this teacher assumed he would understand the verbal language.

But remember speech, if processed in that party of your brain, is just an object making noise, like Charlie Brown's teacher going wah, wah, wah, wah. Kyle doesn't even flinch. The teacher, though, takes it personally, gets a little bit annoyed, raises his tone of voice, comes closer. Kyle, it's time for morning circle right now. Now there's a scarier object approaching me. I better plug my years and rock.

And then the teacher turns to me, the aide, who by the way has less education, less training, less support. And he tells me, you help him along. And I was like, and you don't know how to do it. How am I supposed to do it, right?

And so what do I do? I pick up this boy and I carry him to circle time so he can learn to follow directions. If something in that part of your brain picked you up right now and carried you across the room, and it was being processed in the non-social part of your brain, it kind of would be like a crane coming out of the ceiling, picking you up and carrying you across the room.

What would you do as a human being in that situation? Kyle had never done this to me before. He kicked, he screamed, he pinched, he cried. I think sometimes he cried so much I swear he almost threw up, he was so upset.

And what did I do? I went to the team and I said, we have a problem behavior. He's scratching me and pinching me. What should we do? Well, isn't it obvious, they said. You should learn not to respond to it, because if you respond to scratching, he will learn that scratching is an OK way to communicate. I'm like, well, isn't that logical?

So I did it really well because my heart was so big. He drew blood and I didn't respond because I thought it would help. And then we get to circle time and guess what he's doing? If you're happy and you know it, clap your hands. He's not happy and he knows that, right? So if you're happy and you know it, clap your hands, right? And he's not clapping. I've got to prompt his happiness. I'm going to sit behind him and prompt his happiness for him. And if something in that part of your brain just started clapping your hands for you, what would that feel like? Scary. And that nervous reaction of scratching and pinching and all that, once again, I ignored it, and I just clapped his hands.

And I think the sad part of this whole story is the misconception, because two or three weeks later, I'm taking data, I'm being methodical. And I find out that two or three weeks later, if you say it's time for morning circle now, Kyle will look up for the crane and be like, all right, if I go to the carpet area I'm safe.

So he'll go. He went begrudgingly over there and he was safe on the carpet. And then I can say, four out of five times he follows directions. Then when he gets to circle time and he hears if you're happy and you know it, he looks behind him for the claws, and he's like, I don't know why I'm doing this but I'm clapping my hands.

And he's a smart kid. He's an adaptive kid and, I get to say, four out of five times, imitates actions on command. I get to pat myself on the back on the back. I taught him his objects, his numbers, his letters, his colors, how to categorize. I taught him how to follow directions and how to imitate actions on command.

And how do I know I messed up is that when I left after working with this boy for two years, 20 hours a week, and I say goodbye, I'm going off to speech and language school to learn from the best, and I gave him a hug, he didn't trust me. He thought I was restraining him. He thought I'd done something wrong. He head butted me. And I couldn't feel that attachment in that relationship. And I questioned and questioned, what was I doing incorrectly when I was using those strategies that everyone says are effective?

And then I saw that MRI and I said, oh my goodness, this is an invisible difference. It can trick even the most intelligent teacher, the most caring teacher, the most nurturing teacher. This is one of the most challenging challenges to have, because you don't see the disability, you don't see the difference, and you presume certain things that are just not there. And we need to change a lot, as teachers and so forth.

And the two things that I take away from this-- I'm going to quickly shift to what is universal to all children-- I look at that image and I think to myself, we need to be predictable. If there are children in our classrooms that don't know what we're thinking because they're using different parts of their brain-- which there very well be undiagnosed children out there, you know, this is a bell curve-- that might not know what you're thinking.

What do we need to do as teachers? Make ourselves predictable. Take your thoughts out of your head and put them out here on a visual support. Write down your daily schedule, and please refer to it at every transition. If there are steps within a task, write those down. Use pictures, objects, use visuals, visuals, visuals. Predictability.

Then the next thing is, if they're going to have to work really hard to understand us, desirability. Desirability, predictability. They have to want to be with us. We have to earn that relationship. We have to build it. We have to get the joy and get the connection going.

So people will say, how would I get Kyle to circle time now? I would say to the teacher, I'm not thinking that "If you're happy and you know it" is the best song for the moment. Maybe in the spring, when he actually like school. But right now he's not so fond of it. He loves the alphabet. How about we sing him the alphabet song? Let's embed his interest in the group lesson. Everybody likes the alphabet. We use the letters and so forth. And so we start singing the song even before we invite him to transition. That will help him predict what we're doing. He'll hear the song and he may join us. That's predictability.

What if he doesn't join us? How about if I bring over a visual support, either a picture or the letter A, the letter B, have a little magnetic board waiting for him at circle time. We entice him and we're predictable. And people will say, is it really that easy? And I shake my head and say, no, it took 10 years and about a half million dollars of MRI data to suggest that the problem behavior in him scratching me as I carried him across the room was in me, was that I wasn't equipped to know, what do I do to help this child engage? And desirability and predictability are things that I go off now.

And I realized, what about every child on the planet? Every child on the planet needs to be surrounded by people who are desirable and predictable. And that is how we can support this growth in all of our babies, all of our students, all the way through high school. How do we help them move from falling in love with the people around them to connecting with people and building up confidence to ultimately learning social skills? We do that by creating a school climate in which desirability and predictability is evident in every child and every classroom and every setting.

And we're going to shift now to talk a little bit about universal design for learning, because I want to make sure that you leave here with that notion, and talk about school climate. I constantly hear-- and I apologize for my rate of speech, because I'm taking you through this whole journey here. We're going to get there, though. We're going to create an equitable learning environment.

I hear about this all the time. We have to do equity. We need positive behavioral supports. We need to have environments where all children have access to the academic curriculum. I hear people talking about equity. But if you're going to need to understand what equity is, you need to know the successful outcomes for every student relies on something called active engagement. A child needs to be actively engaged in their environment around them.

And research and neuroscience is going to help us. Why is it that some children actively engage with people? They're like oxytocin junkies. They're out constantly talking with their peers and with their teachers. Even if the most boring lesson was put in front of them, they would do it just to get your phrase. You know, happens in children who have had a lot of genetic advantages and a lot of nurturing. It wears thin, by the way, over time, but if it does work.

Now but for children who are less likely to engage, it may be that there's genetic differences, that maybe there was nurturing differences, and they're not so fond of people. We've got to think about this from a whole standpoint.

What do we need to measure? I'm going to show you a tool that is in your handout. And yes, you can download all of these slides in today's handout packet on the OCALI website, including this form that you're welcome to use. It's a form that was adapted from a tool in the United Kingdom called the Student Engagement Ladder. And this is about a whole class engagement. We talk about that a lot at Tier One. How do we make sure that this lesson is engaging?

As you climb up the ladder, the top of the ladder represents something called full engagement. This is the data we needed to have taken on Kyle, not whether or not he can comply to requests or imitate my actions, but whether or not he looked toward the teacher and smiled, that he was showing emotional investment, that he was initiating, that he was independently making that transition to circle time. That's engagement. If we take data on that and Kyle, and also on all of our students, we've got it.

So what we do is we measure student engagement in the classroom to make sure that children are fully engaged in what they're learning, that they're emotionally invested in that curriculum. This is important for every child to be successful in an academic setting.

Programs that are designed to support social emotional learning are getting a lot of attention. The research is showing that the return on investment for teaching children about social emotional skills equals huge payoff in the long haul, because the child who's connecting socially is likely to be successful. The social emotional programs need to be considerate of helping you understand the scope and sequence. We can't be teaching vocal volume to a child who doesn't even like people, who doesn't even have a rate of communication high enough to sustain language acquisition.

We need to make sure that we're hitting the right social skills at the right time. And I firmly believe that we need to embed the social emotional programs that we have in the academic lessons themselves. Our teachers do not have time to be teaching too many things outside of math and reading and writing. Those are really important academic skills. Social emotional engagement can be embedded right in those lessons when we're engaging in the academic curriculum.

This is a slide that's in your handout. It's also on the IDEA partnership website, and it talks about school climate. Positive behavioral supports are very strongly correlated with better outcomes at school. That's what you see in the upper row right up here. You're creating a learning environment that's safe and well-managed and participatory, it's going to lead to better academic success.

On the bottom row you see, if you hit social emotional instruction and you start working about initiation, self-determination, making good choices, self-regulation, those are skills that are also going to promote better outcomes in school. To me, if you put them together, aha, now we're in business. We got PBIS, we got social emotional, we are good to go.

I will say that if I were to have done this graphic I would have done it a little bit more circular, more collaborative. I'm not all about PBISs in one box and we're in another box, because this is really about concentric circles. It's all together. It's melded together, but nonetheless it kind of conveys that point.

So now I shift to what are we really going to do about this? How do we do this in the classroom? We do this through a Universal Design for Learning. When I was looking at frameworks at a Tier 1 level, what would educators think are the most important way to educate children? UDL is the way to go. And I think Tier 3 is the best. Tier 1 is the best Tier 3. I said that wrong. The best Tier 3 is a Tier 1, is that you've got to have a strong academic lesson. You've got to be able to hit instruction using the climate of social emotional engagement.

And what I love about UDL is that that first framework is foster engagement. You got to get emotional investment. If you're trying to teach a content standard like 2 plus 2 is 4, or three-digit addition, or how to tell the difference between a subject and a predicate. You've got to get emotional investment in your students. You've got to get the engagement there. That's the ticket to learning for every student, whether you have autism or not.

For children with autism it's crucial, because if you don't have their emotional investment, they're under the table. They're out the door. There like, what are you talking about? And you need that emotional investment. What have we been doing for years? What we do is, first do your work and then I'll reward you. And what do we do for child with minimal language? We reward them by bouncing on a therapy ball and blowing bubbles, and they're doing that all alone. Well, being on the ball and blowing bubbles is rocking awesome. It's a lot more fun than being with a person and learning math.

And then what about if you're putting them on a computer for ten minutes alone as a reward for your reading and writing lessons? Again, the computer's great. Reading, writing, not so good, people not so good. We've got to work hard on this intrinsic motivation. We've got to make our academic lessons engaging and motivating. And all children will benefit from that notion.

I'm going to shift us to just what you-- if you're interested in learning more about this, I do have a breakout session with my colleague Jennifer Townsend from Wisconsin. We're going to talk a little bit about how SEEKS can be implemented at a Tier 1 level across a variety of situations this afternoon at 2:45.

And one of the things I want to mention at this point is that SEEKS is unique in that it has a plan proactively to address social emotional needs of children across developmental stages. So what do we need at a Tier 1 level for a child who's not even talking yet? What do we need for a child who's at the emerging language stage? And what do we need for a conversational stage child?

This is important. It's heavily influenced by my work with SCERTS framework. This is even before we would identify a special education need. We would need to know, is this child who's not yet talking going to be well-suited in this educational placement, because we need to have the supports in place before they even show up. So that's a key thing.

There's going to be a handout in the breakout session handout that you can look at that's a quick reference. It will show you all the kind of dimensions of universal design along the left-hand side. And along the top it will show before words, emerging language, conversational stage. And what it shows you is, how do we foster engagement with children who are before words? How do we foster engagement who children are at conversational level?

And those are the things that we would expect to see before we even think about doing an individualized educational plan or a functional behavioral assessment, because that's what children at that stage need to be successful. And so you kind of quickly look. And I will go through that particular form a little bit later this afternoon.

What I'd like to do is just give you an example, one more. I'm going to fill this up. I'm going to get you all in right before we conclude here, and show you how can we use this in a classroom of general education students? Possibly there's a child in there with special education needs or a child with autism. How do we coach this? Because I think the implementation science of this needs to be key. We need to practice what we preach. We need to be engaged as teachers. We need to have multiple ways of understanding and expressing ourselves.

So when we deliver this to school systems, we build system teams. We build core teams at a school site, and we use a coaching process that we call appreciative inquiry. Appreciative inquiry is a coaching process which appreciates what do we do well, and then builds onto where we go next. Coaching should be about what's working and next steps. It should be about identifying problems and trying to fix them, because too much of that in our educational classrooms has led teachers to not really like having people come in. And we want people to be addicted to people. We want to engage them.

So I'm going to show you how this process works. There is a coaching form on, I think it's page 22 of your handout, if you happen to be following along on your iPads and so forth. It's there. You can print this form off, and you are welcome to use this form in your own work and schools beyond this training.

So let me show you an example of this in action. This shows a young boy named Jeron, and he is in a general education first grade math lesson. And we're going to look and see what is working ahead of time in terms of fostering engagement, providing information in multiple ways, and fostering expression, because that's how we give feedback. And then we're going to pose questions of, could he increase his initiation, his independence, his emotional engagement?

He's got a visual support in front of him, which kind of makes me nervous because it's a program within a program. It's not really part of the classroom fabric. He's got a visual support in front of him that has his daily schedule, and then it says math time, sit nicely and sit quietly. Those are nice expectations. If he has five happy faces for doing that from the aide sitting next to him, he'll obviously get a huge reward, because he's going to sit nicer and quieter than anyone else in the classroom.

In fact, if you look behind him, you'll notice interesting seated positions. There's the fetal position here. This kid's playing in his football jersey. You've got Disco Boy in the back over here. You're never going to see that kid sit down. He just dances the whole time. He's just there, right?

The interesting thing on the engagement ladder is, these children are actually pretty engaged. They're learning the math. They're engaging in the lesson. They're just not sitting nicely and quietly, which by the way, wasn't the content standard being taught at that moment. It was, they needed to learn that five pennies equals a nickel, two nickels a dime, two dimes and a nickel a quarter, all the way up to $1.00. They're learning math. And that's what the goal is, not necessarily the sitting nicely and sitting quietly.

Then in the latter part of the video, you're going to see he breaks into a group where they get to talk and engage with each other. The educational assistant in this environment, with the best of intentions, is going to do a lot of work for him. So when we think about this, having that extra support in a classroom, Jeron, it's your turn. Jeron, you roll the dice. Jeron, you've got a five. Iverson, why don't you get him a nickel? And so his opportunity to initiate and to engage is limited, not because of his learning difference, but because of the situation.

But we need to go in there and appreciate what are they doing well, and what are they doing effectively. So let's watch this very brief baseline video, and then I will show you what we can then coach off of.

[VIDEO PLAYBACK]

-So I'm going to roll my cube, and I got-- I got three dimes.

-She gets three dollars.

-So-- sit down-- I'm going to take three--

EMILY RUBIN: Is that Disco Boy over there? He makes me happy all over.

-Three pennies from the tray. One, two, three. Now I have three pennies. My turn is over, and it's Ty's turn.

[INTERPOSING VOICES]

-So Tyla, she takes-- two means $0.02.

EMILY RUBIN: Just a quick pause in case you didn't hear that. He's turned to the aide and says, did I do a good job? Did I get five happy faces? I mean, that's what he's turning-- he's asking for feedback on his behavior, which is fabulous. But if you look around, I don't see any nice sitting or quiet sitting. There's children on all fours. There's a child in a fetal position. Disco Boy's temporarily squatting down.

-Two of the brown pennies, OK?

[INTERPOSING VOICES]

EMILY RUBIN: She said, you got a five.

[INTERPOSING VOICES]

[END PLAYBACK]

And so at the end, I call that the disappearing dice act. We didn't have even an opportunity to pass the dice to the peer again. So those moments of opportunity are so key here.

I'm going to shift this now to, what do we do? How do we facilitate social engagement in all kids? Let's go universal here. Let's not just focus on Jeron. When we get out that coaching checklist that looks at what are we doing well to foster engagement, present information in multiple ways, and foster expression, the first kind of feedback I'm going to give to the teacher is, I'm going to say, wow, a good majority of your children are engaged in this lesson. They find it emotionally stimulating. They get to touch real-life money. It's hands-on. And I love that they get to break into small groups and actually interact with each other. That's engaging the children for the most part.

And presenting information in multiple ways. You're not just verbalizing, you're role modeling, you're role playing it out. In fact, they all want to see it. They're coming on top of you to see that. And I love that your fostering expression by breaking them into small groups so they can actually use their math skills in the social situation.

So this is how we appreciate. We don't go in there and say, why aren't you giving Jeron a visual support? I'd be shown the door, and I would deserve to leave, because that's not how we foster engagement and inspire adult learners as well. So we go in, we appreciate.

Then we pose some questions. Do you think there's an opportunity for Jeron to climb the emotional engagement ladder? Is there a way he can initiate more and be more independent? In fact, let's look at your whole group. Let's look at every child in the classroom during that mini-lesson. Could they be more initiating during that time? Could they increase their initiations? And the teacher says, you know what? Maybe I'll put the visual-- I'll put the content standard on the visual. Five pennies a nickel, two nickels is a dime. And I'll give it to each of the groups.

The teacher comes up with this idea, not me. She says, I'm going to put it into all their groups before we even start. They have a visual to share, and then they can be engaging with that while I'm modeling them what they're going to be doing.

Right on. So she comes up with ways to get them initiating non-verbally during that time. Then we talk about the educational assistant, which is that next slide right here. And we say, would you agree that Jeron could be more independent during that time? She gets agreement. Yeah, he's always responding to our directions, but he's not taking those things on himself. What could we do that would help all of the children in the class be more successful at that time? What could we do during that so that he could be successful? We could write down the instructions, roll the dice, count your dots, trade up, give your dice to the peer. Let's make a little help box and let's let all the children have those kind of help boxes too, so they can be successful.

And what you're going to see is the educational assistant in this video changes her title from being an aide to being an independence facilitator, because that's the role if we have extra staffing involved. It's to facilitate a child's access and facilitate independence. It's not to do for, or to teach even. It's to facilitate independent access to the teacher themselves. So let's see how this plays out. And this is about two weeks later.

-It says place your coins on the mat, and when you reach an equal sign, trade up and move the coin to the next line. So if I get--

EMILY RUBIN: There's Disco Boy in the background.

-Abbott, can you and Iverson share? Can you share with Jeron?

I want you to look together. Look together.

[INTERPOSING VOICES]

[END PLAYBACK]

I love to pause it right there, because you look around the room and you see a shift from partial engagement, where children were just kind of wiggling around in fetal position and dancing to, wait a second, now we're talking about math. The supports that we brainstormed related to this one child actually ended up benefiting the whole class through that universal design. So they're talking. Now let's see what happens when we have the visual during the small group.

[VIDEO PLAYBACK]

[INTERPOSING VOICES]

EMILY RUBIN: And what you see here is just a simple visual. Get dice, roll, grab money, trade up. And then you see an absence of that educational assistant who turns into an independence facilitator.

[INTERPOSING VOICES]

[END PLAYBACK]

I don't know if you heard Disco Boy in the background, but he's got ext

Wednesday, November 18, 2015 | 9:45-11:15 am | Keynote Stage

Research in the neuroscience of social emotional engagement fosters our ability to create a universal design for learning in our classrooms. When school communities gain knowledge of a social and emotional scope and sequence of skills and how to facilitate student growth in these domains, we create a positive school climate that is focused on the success of every student. The Social Emotional Engagement - Knowledge and Skills (SEE-KS) program is focused on ensuring that learning environments address the needs of our diverse learners by fostering student engagement, presenting information in multiple ways, and promoting student participation.


Emily Rubin, MS, CCC-SLP, is an educational outreach specialist at the Marcus Autism Center, at Emory University. As an adjunct faculty member and lecturer at Yale University, she served as a member of the Autism and Developmental Disabilities Clinic. Her publications focus on early identification, intervention models, and programming guidelines. She is also a co-author of the SCERTS Assessment Process. Rubin participated on the ASHA's Ad Hoc Committee on Autism Spectrum Disorders to develop guidelines for speech-language pathologists in the diagnosis, assessment, and treatment of ASD.