How Yes-And Thinking Can Transform Teaching Neurodiverse Students with Mandy Ralston

Amanda "Mandy" Ralston

Founder of NonBinary Solutions 

CEO of KidsChoice Therapy

Quotes of the Podcast: “Wisdom is like frequent-flyer miles and scar tissue; if it does accumulate, that happens by accident while you're trying to do something else.” Barbara Kingsolver 

Introduction of Guest BIO – 

Amanda “Mandy” Ralston, M.Ed., BCBA, LBA, is a CEO, behavior analyst, and serial founder with more than 25 years of experience at the intersection of autism services, applied behavior analysis, and technology-driven innovation. She currently serves as Chief Executive Officer of KidsChoice Therapy, leading multi-site pediatric therapy and autism service operations with a focus on clinical excellence, scalable systems, and equity-centered care. Known for her signature nonbinary thinking framework, Ralston speaks nationally on compassionate care, cognitive flexibility, and the future of behavioral health, bringing a pragmatic yet creative voice to conversations about ethics, outcomes, and neurodiversity-affirming practice.

Interview

Agents of Change: Leaders/Innovators.

 30,000 Ft. View – Why so we, as a society invest in education?

• What drew you to education?
• How nonbinary thinking can help educators move beyond “compliant vs. noncompliant” and really understand student behavior in context. 
• What truly neurodiversity-affirming classrooms look like and how schools, families, and clinicians can partner so kids don’t have to be three different people in three different settings. 
• Using nonbinary thinking to rethink “behavior problems” in schools  
• What neurodiversity-affirming practice actually looks like in real classrooms  
• How schools, families, and clinicians can work together instead of in silos 
• How we move past binaries like “good/bad kid” or “compliant/noncompliant” and into more flexible, compassionate ways of understanding behavior. That ties into neurodiversity-affirming classrooms and better partnerships between educators, families, and therapy providers.
• What are the biggest challenges to you?
• What would you like decision makers to know?”

Podcast/ website/ book shoutouts

Thanks to Dr. Karly Kordvoa and the RBT Textbook that I was recently asked to contribute to. We also just talked about it on her podcast The Grey Area. 

Dr. Genevieve Leonard Series by Estelle Ryan

Transcript

Liza Holland [00:00:02]:
Welcome to Education Perspectives. I am your host, Liza Holland. This is a podcast that explores the role of education in our society from a variety of lenses. Education needs to evolve to meet the needs of today and the future. Solving such huge issues requires understanding. Join me as we begin to explore the many perspectives of education. And welcome back to Education Perspectives. We are so excited to have Amanda Mandy Raulston with us today.

Liza Holland [00:00:34]:
She's the founder of Non Balinary Solutions and CEO of Kids Choice Therapy. Mandy, so glad to have you here.

Amanda "Mandy" Ralston [00:00:43]:
Very nice to be here, Liza. Thank you for having me.

Liza Holland [00:00:46]:
Well, I want to kind of kick you off with our 30,000 foot view as it relates specifically to education. And so why do you think that we as a society in invest in education?

Amanda "Mandy" Ralston [00:00:58]:
Well, that's a loaded question because I'm not sure that we're actually investing in education at this point as a society. I think we've seen some real shifts in who gets educated and how they get educated recently. It's troubling to me. It's troubling to me to see sort of a reversal of education in many cases. So I think my answer is a non answer.

Liza Holland [00:01:22]:
Let me flip that. If you were able to make the change that you would love to see, what would the motivation be? Why, you know, if you were going to go to the legislatures and whatnot and say this is why we need to be educating people, what would your why there be?

Amanda "Mandy" Ralston [00:01:39]:
Because in order to have happy and productive members of society, they need to be empowered with certain skills. And if you're not given education, in many cases you're mental ecosystem is only as big as the world that you're surrounded by. And so education is an opportunity for people to have experiences outside of their lived experience and to create empathy and critical thinking. And that is necessary for a again happy and productive society.

Liza Holland [00:02:11]:
Oh, now that's an amazing answer. Thank you very much. I totally vibe with that.

Amanda "Mandy" Ralston [00:02:16]:
I guess.

Liza Holland [00:02:17]:
So you have been involved very deeply in the kind of autism and behavior space. What drew you to that as a career?

Amanda "Mandy" Ralston [00:02:27]:
I sort of fell into it and discovered a passion for it. So I wrote a paper about autism in 1999 in my last semester at Center College in Danville, Kentucky where I did my undergrad in psychology. And my textbook at the time had exactly two paragraphs related to autism, which included the information that autism was a diagnosis that was as Prevalen as one in every 10,000 individuals. And that the gold standard for quote unquote treatment for autism at that point was something called applied behavior analysis therapy. Or ABA therapy. And so I wrote a paper about autism and I met seven families in Lexington, Kentucky that were flying a consultant out from California once a quarter to share the cost of that consultant and have them come in on day one and basically do a quick assessment. And on day two, teach independent contractors that were usually family members, high school and college students, to be therapists for 30 to 40 hours a week, one on one with these kids. And so I met those families and after I graduated, I started working directly with those seven children.

Amanda "Mandy" Ralston [00:03:31]:
It was one girl and six boys, which was very much on track for the demographics at the time. They were all various ranges of profundity in terms of how much their autism affected them. And so I really got hooked on the science of applied behavior analysis and seeing what it could do in terms of changing the quality of life for kids and families that had real life struggles related to the impact of their diagnosis.

Liza Holland [00:03:56]:
Well, it sounds like you've made an incredible impact in that area for having kind of fallen into it. So I'm so glad that that opportunity presented itself.

Amanda "Mandy" Ralston [00:04:06]:
Yeah, I mean, I always liked kids and kids always seemed to like me. And then I found this sort of, you know, very personal, very one to one connection in this therapy. And again I hooked on the idea that I could teach people to communicate that otherwise we're struggling to do so and teach people to. To be more independent that otherwise were struggling to do so, at least as commiserate with their peers. So it was really a labor of love that I fell into.

Liza Holland [00:04:34]:
So that's fantastic. So a lot of our listeners are educators and so tell us what you think about how non binary thinking might be able to help educators move beyond maybe a compliant versus non compliant and really understand student behavior in context.

Amanda "Mandy" Ralston [00:04:53]:
Well, I mean there's a discussion about compliance and within ABA and certainly it extends into education and it sort of poses this compliance versus ascent model. Right. With non binary thinking that I'm trying to promote. It's not a black and white issue. It's not either or it's yes and right. That we should be considering both sides of that coin at the same time. And sort of like risk and quality of life are two sides of the same coin. You know, to reduce risk is to increase quality of life and to reduce quality of life is to increase risk.

Amanda "Mandy" Ralston [00:05:27]:
And so same thing with ascent versus compliance. There is a time and a place for both. I think is the long or the short version of the long story. But you know, do I care about compliance for the sake of compliance of Course not. I don't want kids, especially individuals with intellectual and developmental disabilities, that may have difficulty discriminating when to comply and when not to comply, especially with strangers versus people that they know, et cetera.

Liza Holland [00:05:55]:
Just thinking about how this concept. And perhaps it might be a good idea for us to back up just a little bit to explain. Educators are having tremendous behavior problems in their classrooms right now. They're talking, especially after the pandemic, they're experiencing a lot of behaviors that they just don't understand and know how to handle. And from my short amount of research looking at what you do and whatnot, it may be helpful for educators to understand exactly what non binary binary thinking really is, and then how you can look at how you get cooperation from your students as opposed to just compliance.

Amanda "Mandy" Ralston [00:06:36]:
Yeah, I mean, there's basically within behavioral science, there's two ways to motivate somebody. Right. I can either motivate you to get something good, so that's positive reinforcement, or I can motivate you to avoid something bad that's negative reinforcement. Right. So that's the carrot versus the stick. And in general, what we have found is people are more likely to be motivated longer term and more intrinsically when you start with positive reinforcement. So motivating them to do things, to get something good. And so if you are threatening punishment or threatening withdrawal of preferred materials or activities from somebody in order to motivate them to do work, you're going to have a long road to hoe there.

Amanda "Mandy" Ralston [00:07:15]:
At that point, I think I said road to hoe when it's actually row to hoe. But just as an aside, we'll put that in a different box. Yeah, malafores. It's a thing. So, yeah, I mean, with the non binary thinking philosophy, again, it's understanding that people are not black and white. They are not ones and zeros, they are shades of gray. And in order to treat somebody in their full humanity, you have to see the full amplitude of their potential and their intersectional identities. So they are not just male or female or boy or girl, black or white, this religion or this socioeconomic status or, you know, this marital status in their home, background or whatever it is.

Amanda "Mandy" Ralston [00:07:53]:
They are intersectional. They are all those things at the same time. And so trying to find common ground with people and how they identify themselves rather than you projecting identities onto them, I think is going to be very motivational for them to really feel seen as an individual in your classroom. So I'll start there. Does that help answer my own question?

Liza Holland [00:08:13]:
Yes, it does. So let's talk a little bit about neurodiversity, right? Just people and students, they think. Some think differently.

Amanda "Mandy" Ralston [00:08:24]:
And that's a good thing.

Liza Holland [00:08:25]:
It is a very good thing. But I know in talking to teachers, there is an increased number of students that are identified as having some sort of a physical or behavioral or mental type of challenge, up to like a third of their classroom, which is not necessarily what they have encountered before. And so what do you think? Think that we could share with educators that might help them in a classroom as they look at a particular behavior? Let me give you an example. This one is a cultural one, not necessarily a neurodiverse one. But I came to education as a very involved parent. And what I wound up seeing, particularly once we got to middle school level, was kids from different backgrounds came at problems and difficulty differently. And particularly there are some that were coming at teachers with a frustration in a combative type of an approach, which to me said, I'm frustrated. I don't understand this.

Liza Holland [00:09:34]:
Which to the teacher was, you're questioning my authority. Go, leave, go to the principal. And I think it's just a disconnect and a misunderstanding of how that particular student approached the teacher. But I feel like the same thing is probably true in your neurodiverse population. One of my favorite characters in fiction is a profoundly neurodiverse person. And the author talks through how she is thinking and how she realizes those neurotypicals we're thinking and then tries to adjust her behavior based upon that. And so I guess I just throw that out there to you as to how do we. How are we more accepting of a variety of behaviors and understanding them?

Amanda "Mandy" Ralston [00:10:19]:
Well, first of all, who is the fictional character?

Liza Holland [00:10:21]:
Genevieve lenard. It's a Dr. Genevieve Lenard. It's a whole series of books written by Estelle Ryan. And she turns out to be. She studied to be an expert in like micro expressions. She's working with a team combating art theft. But it's just such a cool character development and I love it.

Liza Holland [00:10:43]:
So this.

Amanda "Mandy" Ralston [00:10:45]:
I have to go down that rabbit hole after we get finished today, so.

Liza Holland [00:10:47]:
Yep, yep, I think you'll really enjoy. And I'll send you a link. Great.

Amanda "Mandy" Ralston [00:10:51]:
Okay, so question. With the upwards of one third of their classroom now being neurodivergent, slash, having some kind of physical or mental quote unquote disability. How to, how to rectify with that? Well, okay, let's start with a story. Do you know about the curb cut effect?

Liza Holland [00:11:10]:
I do not.

Amanda "Mandy" Ralston [00:11:11]:
So in the University of California, Berkeley, in the 70s, I believe, students with various disabilities were having difficulty, especially those in wheelchairs, were having difficulty getting around campus because they would go on the sidewalk and then there was a curb where they would drop down into the street for a period of time and then have to go to the other end of the curb and then try to get the wheelchair up onto the next part of the sidewalk. And so the university recognized this problem in terms of access. And so they came up with the little slope on the ends of the curbs that we are all now very familiar with, which is a curb cut. And what happened was that individuals discovered that it didn't just benefit individuals in wheelchairs, it also benefited people on bicycles, people with strollers, people on roller skates, and so on and so forth. And so the curb cut effect is this notion that by improving access, by offering modifications to the environment so that it's equitable for all individuals, actually benefits all individuals. And so I think when you're considering modifications to your classroom or your agenda or your programming for your students, when you're considering that one third of the individuals are the, quote, unquote, neurodivergent group, the modifications they may need may very well benefit the whole group because you've got individuals with different disabilities or diagnoses that fall into these neurodivergent conditions. So that's autism, adhd, obsessive compulsive disorder, dyscalculia, dyslexia, dysgraphia, Tourette syndrome, all these different things. Those are mental health conditions that are diagnosed.

Amanda "Mandy" Ralston [00:12:54]:
Right? And the threshold for achieving those diagnoses means that it has to impact your day to day functioning enough to warrant an actual diagnosis. Now that's a diagnosis. Those are all conditions on a spectrum. And again, the degree to which they affect you is how you actually cross the threshold into an actual diagnosis. But most of us can look at some of these diagnoses and say, gosh, I share a lot of characteristics or traits that are similar to these individuals, right? You know, people joke about, I'm very, quote, unquote OCD about this, which is not exactly kosher in terms of the language, sort of co opting a diagnosis. But what they mean is, I'm selective, I like things in certain order, so on and so forth, or I'm all over the place, I'm adhd, ADHD about this, right? Again, the threshold is the degree to which it actually impacts your day to day functioning that you actually receive a diagnosis of adhd. But the fact that we sort of verb that noun and say that we are adhding represents to us that we can actually empathize with what some of those feelings or sensory experiences might feel like to individuals. And so I would say to your classroom educators, look at all the different adaptations that tend to benefit your individuals with the different conditions and diagnoses and physical disabilities and some cases, and consider how might this also help the rest of my students.

Amanda "Mandy" Ralston [00:14:14]:
And therefore, it's not individual modification. It's an equitable modification for the entire classroom.

Liza Holland [00:14:21]:
I think that's fabulous. What else do you think would be. What does a classroom that is neurodiversity affirming look like to you? If you walk into a classroom and are sitting in and observing for a bit, what kind of characteristics or what types of things would you see that would make you feel like this was actually an affirming culture?

Amanda "Mandy" Ralston [00:14:41]:
Yeah. I mean, neurodiversity affirming is the understanding that there are natural variations in brain structure and thinking that are evolutionary and therefore not wrong. Right. So I always like to say there's no such thing as normal. There's only common and rare. And what I think we're finding in these younger generations, with the information era, that we're able to quickly share experiences and data on the Internet and otherwise social media, we have a lot more in common with each other than is actually rare anymore. You know, I think Gen Xers, we grew up getting teased for our differences, right? We got bullied for our differences, when in fact, I think if we would have been born 30 years later, I think we would have been embraced for our differences at this point. And I think that's part of a neurodiversity affirming classroom is saying, you're different.

Amanda "Mandy" Ralston [00:15:34]:
And it's not just okay, it's good.

Liza Holland [00:15:36]:
Right.

Amanda "Mandy" Ralston [00:15:37]:
Being different is good because again, if you get everybody together in a classroom or a kitchen for that matter, and give them all the same ingredients and they all think the same way, you'll always get the same dish. Right. But if you give people that think differently the same ingredients, you might get variation on the dishes, and that's a good thing.

Liza Holland [00:15:55]:
You know, I think about that in terms of art classes, and you go, and every single person in the art class has the exact same instructions, has the exact same color palette, and invariably they look different. Right. It may not be perfect difference. You know, it's just a variety, and that's. There's magic in that difference. And, you know, it's hard when you're trying to manage a classroom full of 30 students and one is taking a tangent or one is doing this and trying to make sure that the experience is relevant and fulfilling for each type of student.

Amanda "Mandy" Ralston [00:16:38]:
I love. I'm going to jump off on what you were saying though. I love the art analogy. Right. Because in art that is the one place, if nowhere else, that you are rewarded for being as different as possible. Right. The penultimate creativity or variation in theme is what's allotted in terms of the art world. And we see that so few other places.

Amanda "Mandy" Ralston [00:17:01]:
And so to your point, with the teacher having to manage 30 plus students in a classroom classroom and teach a task or teach a concept and then have wild variations in some cases from their students about how they're responding to that information, you know, maybe one solution is to have a rubric to which the students are graded towards that sort of says here's the hard line issues and here's an outlet also for how creative were you in approaching this project or whatever. So as they sort of recognize, hey, you were really good on the creative front and yet we sort of miss these bullet points over here so that the again the student might feel seen a little bit in their attempt. What's the word I'm looking for? Metabolized that information but maybe didn't hit the same points that the teacher meant for them to grab all.

Liza Holland [00:17:47]:
I've been doing a tremendous amount of work in recent years in deeper learning just looking at from a perspective of teachers trying to maybe go deeper into specific content as opposed to trying to teach a thousand little things. One of the hallmarks of deeper learning is giving students kind of more voice and choice as far as helping maybe to co create how they learn about things. Or I had a wonderful science teacher who had the same project, but you could execute it in multiple different ways. That one was kind of a building sort of a thing. One was a storytelling thing, one was a, I guess a manipulative sort of piece. But she had like six different ways that you could complete this same assignment. Do you think that that would be helpful for our neurodiverse students?

Amanda "Mandy" Ralston [00:18:42]:
My knee jerk reaction is yes. Just based on what you're describing, I'm not, I'm not totally familiar with deep learning, but in general, again, one of the superpowers of neurodivergent folks is the ability to hyper focus on things that they're interested in. And so that deep dive is very intrinsic when they find a piece of information that they find interesting. So I think, you know, co creating the idea of how you're going to approach this learning Vessel, I think, is a great idea for the Nerve Divergent crowd is that they get to sort of take ownership and do they want to make a video about it? You know, what particular subset of the information do they really want to go into? I've got a funny story for another time about how when I took German in college, 8am four days a week, we had to do a research project in German and present it in German with no notes. And so I made it interesting for myself by choosing to research the origin of the pink triangle in Nazi Germany. And that's now a symbol for gays and homosexuals that we use as the empowering thing. But again, different topic, different time.

Liza Holland [00:19:51]:
No, but how awesome to be able to give yourself something that is gripping and very interesting to you, to, you know, to be able to create that. That opportunity to. To learn a new language.

Amanda "Mandy" Ralston [00:20:02]:
That's absolutely. Yeah, that wasn't the point. As long as it didn't care what the vehicle was, as long as the vehicle was going to be in German. Right?

Liza Holland [00:20:09]:
Absolutely. So kind of getting back to that behavior issue just a little bit. I know when my kids were young, my favorite thing to do was to go in and read to their classrooms, and invariably it was the students in the back that couldn't sit still that were bouncing around and whatnot. That came up to me at lunch and had really, about what did I think that the character had done or, you know, what do you think would have happened next in this story? And to the untrained eye, you would think, well, they're just not paying attention. And, you know, so it's labeled as bad. What kind of accommodations do you think that teachers could make for folks that are in that type of a spectrum that, you know, just because it's distracting to you doesn't mean that it's necessarily impeding their learning. I guess maybe your thoughts and insight as far as how we might be able to approach those types of things differently to have the best success for students.

Amanda "Mandy" Ralston [00:21:10]:
Yeah. I mean, again, it's. What is the outcome you're seeking? Right. It's not how you get there. It's the outcome that you're seeking. And there's lots of different ways to get to a particular outcome. So if your outcome you're seeking is language comprehension or, you know, reading comprehension, who cares if they're moving a lot in the background? Right? Yeah. I have a thing that I talk about with professionalism.

Amanda "Mandy" Ralston [00:21:31]:
Right. How many of us have been called out for our behavior or our appearance being unprofessional? Right. So whether you have tattoos or your hair is different or your clothing is different, your earrings are too big. And most of those are a Trojan horse for othering right to control. And it's based on white supremacist patriarchy frameworks. So same thing with the notion of sitting still in classroom. I mean, the first thing imagery comes to mind is, you know, the very strict Catholic school teacher coming back to, you know, smack the ruler. Right.

Amanda "Mandy" Ralston [00:22:05]:
Which obviously we don't do that anymore, but we sort of still expect the same type of behavior out of our students in some cases. And again, that's like generational hazing, right? It's like, because I had to go through that, I expect that you have to hear those things as well. When again, what we should be focusing on is are we getting the outcomes in our education that we desire? And if so, why or why not?

Liza Holland [00:22:26]:
One of the initiatives that I'm working on right now is one called Better questions for brighter Futures. And it's really looking at building these durable skills that students are missing by the time they get to the work world and employers are frustrated and whatnot. Are there some better questions that teachers could ask kids to kind of work through maybe really distractive behavior problem or to better communicate with neurodivergent kids?

Amanda "Mandy" Ralston [00:22:56]:
I mean, I'm not sure it's a wide question. The first thing that comes to mind is again co collaborating with the students saying here's the outcome we're working towards. What would help you get there best? Right. And letting them sort of talk to you about the kinds of environment they may need. Some people may need a very quiet space free from distractions. Some people work better in the mornings than the afternoons. Some people can't take a lot of sensory stimulation around them. So again, one of the modifications you are willing and able to provide for the student and let them sort of self direct towards the North Star what you're trying to get to.

Amanda "Mandy" Ralston [00:23:36]:
Right. It's not just compliance for the sake of compliance. It is again something that you're actually co creating in terms of ascent to get to the outcome that you're looking

Liza Holland [00:23:44]:
for that makes sense. At what point do you feel that students might be self aware enough to really know what to ask for? Is that more a function of therapy? Is it a function of maturity? Is it, you know, because I, I think about some kids that are just upset, but they don't even know why they're upset.

Amanda "Mandy" Ralston [00:24:03]:
Absolutely. And I again, these kids are so different again, whatever their ecosystem that they're living in. Is only as big as, you know, their idea of themselves is only as big as what they've been surrounded by. So, yeah, I mean, depending on their parents, education level, depending on socioeconomic background, their demographic, like, where they actually live, you know, the more rural areas may not be as exposed to some of these concepts as others. You know, I'm certainly aware of that, having worked in Kentucky for 26 years. You know, the understanding of general education population within the larger school districts is very, very different than the more rural school districts that I've worked in. And you sort of have to adjust for those things. It's just a different culture.

Amanda "Mandy" Ralston [00:24:50]:
Right. So having some cultural sensitivity to your students and some cultural humility for your students about what they may have been exposed to or not exposed to will go a long way in tempering your expectations about what they're able to bring to the table.

Liza Holland [00:25:05]:
I know you do some great applied work with, you know, working directly with kids and families. What would your thoughts and suggestions be as far as schools and families and students being able to work better collaboratively together? I mean, I know we have our ARC meetings and those sorts of things, but what do you think could help that communication pathway be better so that maybe classroom norms could be reinforced at home and vice versa? And I don't know, I'm just kind of delving into that sort of, how do we collaborate better as adults to help students?

Amanda "Mandy" Ralston [00:25:44]:
Yeah, I mean, again, I think the neurodiversity affirming approaches are helpful in understanding that you may have to communicate things multiple different ways, depending on how your parents are able to hear you best. You know, some parents can read an email, Some parents can get a text message. Some parents need something printed out for them. Some parents might need an audio recording, Some parents might need a video recording. So I know it sounds like a lot of work, but it may reduce your work on the back end if you're able to present those things on the front end in multiple manners, you know, and finding out what. Again, these parents might not even know what works for them until they've had it presented to them in multiple different ways. And so if you sort of blast that information out in multiple channels, you very well will likely hear from parents saying, thank you. I don't have time to read an email or thank you.

Amanda "Mandy" Ralston [00:26:37]:
I only have this level of reading ability myself. And so having an auditory message actually helps me understand what you need from me as a caregiver.

Liza Holland [00:26:46]:
What, you know, kind of looking at that piece of the puzzle where it takes a lot of work. What do you feel like the role of AI might be in assisting with these therapies? I just, you know, immediately as we had that discussion, I thought, well, you know, AI could probably let you just talk to it and blast it out in all those different modalities. If you give it the information, you know, what can we do that will save time but create better systems, you know, to consistently help? I don't know, just, just your thoughts on that?

Amanda "Mandy" Ralston [00:27:18]:
Well, the first thing is we need to have a dedicated platform for those types of AI chats because as people know, hopefully more and more now with the large language models that are built on the Internet, you will get a different response almost every time because again, it's trained on the entire Internet. And the Internet includes information that is true and accurate and also includes information that is untrue and inaccurate. And so that's why you get hallucinations and they're getting better all the time, but it still doesn't erase the problem that you're boiling the ocean with information when you're using those large language models. So as an example, we have a large language model that we've specifically trained on the software from Non Binary Solutions called Noetic. And Noetic has a little AI chatbot that hangs out in the corner of the platform that his name is no Yeti. He's a little Sasquatch looking character and we'd like to say, you know, takes the mystery out of treatment planning or helps you see the forest from the trees, whatever you want, little tagline you want for him. But he only knows the HIPAA compliant medical record environment that he lives in. He doesn't know anything about the Internet, he is not on the Internet and he is only trained on the medical records in that patient's folder.

Amanda "Mandy" Ralston [00:28:34]:
So he would not be able to answer questions. And he's been trained not to answer questions. We trained him not to guess right about things that he doesn't know about. And so if teachers are going to use some kind of AI platform to communicate with families, they just need to keep those types of parameters in mind and not use just a blanket chat, GPT or any of the other large language models that are free and available on the Internet, they're wonderful for brainstorming, but they're not consistent and they will hallucinate if bullied long enough.

Liza Holland [00:29:06]:
So yeah, no, I've encountered that myself. Just the number one interviews that I've done with teachers, the number one scarce resource they have is time. And so I'm always looking for what Are some, like, little tips, something that doesn't take a whole lot of time and energy to spend time learning, Maybe a particular resource? That's a good question for you. What would be a great resource for them to maybe quickly learn a few things that might be helpful in communicating better with their clients, with their students?

Amanda "Mandy" Ralston [00:29:43]:
I would get no kickbacks for this, so I'm not giving any kind of paid commercial. But I would say the AI free model that I use the most is a group called Perplexity AI. And the reason I like them is because they do actually cite the individual locations where they pull the information from. So it feels slightly safer in terms of a citation as to where that data was collected. And so I think it's okay to get an outline of how to think about things with AI, Right. It's just trust but verify, basically.

Liza Holland [00:30:17]:
Absolutely. So you're kind of dealing in a space both on, you know, kind of the behavior piece and whatnot and some of the mental health piece that is a hugely in demand future, you know, job space. What would you recommend for students who might be interested into this type of work and what they might look for in a program, what they might want to study? I just don't think it's something that's brought out there. Kids don't know what they don't know. So what can we tell them about this field?

Amanda "Mandy" Ralston [00:30:50]:
Well, it's an interesting time to be in the field, especially as a dinosaur that's been in it for 26, 27 years. We've had a 500% increase in providers in the last 10 years, and now over half of the field has less than three years of experience. So it's quite a time to be alive. And there's not enough old folks like me to mentor or train them. And so again, part of the reason I started with Noetic, the software solution, which is a clinical decision support solution, was to give a digital bumper Rails version of myself to other people that were coming into the field and how to think about all the things that they need to think about in terms of treatment planning and goal development, et cetera. So first of all, this is a fantastic field to go into. You're helping people. So if you are a person that likes to help and you're a person that likes people, great start right there.

Amanda "Mandy" Ralston [00:31:41]:
This field is not going anywhere anytime soon. We've got the rate of diagnosis for autism is now 1 in every 31 individuals. We've got mandatory insurance coverage in all 50 states at this point. And there's not Enough providers, I mean, just again, over and over again, there's just not enough of us out there. And so it's a really growing field. What I would say for somebody that's considering getting into it, first of all, look at your program, the graduate program that you're going to be going into in order to have the master's degree that you need in order to start acquiring your supervised fieldwork hours. Look at the pass rate of the individuals that took the exam that came from that program before you give them your money. Because there's a lot of programs out here that have less than 50% pass rate that are very willing to take your money regardless.

Amanda "Mandy" Ralston [00:32:30]:
All right. Secondly, get a mentor if you can. Right? Get somebody that has more experience, that's been in the field much longer than you have, because that's the way that you're really going to learn. Again, the programs themselves are not standardized like a PT or OT or speech therapy programs often are. I can get 100 behavior analysts in a room and put one kid in front of them and say, how are you going to approach support or treatment for this person? And they'll all have completely different ideas. And most of the reason they do it that way is because that's how they've always done it. That's how they were trained, and that's all they know how to do. And so having a good mentor that actually has had the experience of making mistakes and being able to course correct from those mistakes and isn't just telling you this is how we do it, it always works is going to be wildly important to your professional development.

Liza Holland [00:33:19]:
It's a lot of art and science in there. It sounds like.

Amanda "Mandy" Ralston [00:33:22]:
Yes. And that's a whole other talk show we could go through.

Liza Holland [00:33:29]:
So as you work in this space, what are the biggest challenges to you?

Amanda "Mandy" Ralston [00:33:33]:
It's that, right? It's the, it's the wild variation in decision making, quality logic. And you know, we've, we've sort of got a payer versus provider aesthetic sort of that's come about within the field because we've reached a point again where we've got insurance coverage in all 50 states. And they are. There are some groups that are providing services to individuals year over year at 30 to 40 hours a week. Insurance companies are starting to ask about outcomes. Right. And rightfully so. Right.

Amanda "Mandy" Ralston [00:34:06]:
Like one of the big questions within our field is how did you come up with how many hours per week to prescribe to this child as a provider? And when you see organizations that are blanketly saying everybody gets 30 or 40 hours a week. That's. That's not a clinical decision. That's an operational decision. Right. And so really having an idea of which types of individuals with different disabilities and diagnoses do well with what types of supports for how long and in what types of environments, with what types of therapies is going to be really important to us as a field moving forward that we can demonstrate ethically and reliably that given a certain type of individual, we can reliably produce these types of outcomes knowing what we know about the types of supports and environments they need to be in. And so, sure, for every kid that they do need 30 to 40 hours a week of one on one treatment, there's plenty of other kids that may benefit from far less intense services. And so we should give those kids the reduced amount of services that they need to succeed and get out of the way.

Amanda "Mandy" Ralston [00:35:08]:
For the kids that actually do need that higher level of intense services in order to have their best possible outcome.

Liza Holland [00:35:15]:
That makes sense. What's the research landscape around that? Are there people out there studying to be able to kind of put those metrics together? Or maybe we need more of that too.

Amanda "Mandy" Ralston [00:35:24]:
We definitely need more of that too. You know, a lot of the research related to dosage or what we call intensity, the number of hours per week for these kids is predicated off of research that was done in the 60s and 70s, and there have been replications to that data. But I've also recently heard some folks suggest that we have quote, unquote data to suggest that these kids do just as well with 20 hours a week. And my question to those types of suppositions is always, who is in that data? Right. And who benefits from saying they do just as well with 20 hours a week as 40? Right. And so I always sort of question, who's in that data? Right. One of the things I like to think about is, or I don't like to think about for that matter, is that if we are predicating statements like that off of commercial insurance data sets, that is a very privileged group of individuals. Right.

Amanda "Mandy" Ralston [00:36:20]:
By virtue of the fact that their parents have a good enough job to provide commercial insurance for their coverage, that's a very particular set of demographics that is not representative of all individuals with autism or these other developmental disabilities. And to make matters even more complicated, it's rarely just autism. Right. Autism tells you about this much about the person. Right. That's just a label. And so even within autism, which is not a monolith, you've got individuals on one end of the spectrum that are profoundly affected and will need supports lifelong, all the way to the other end of the spectrum to individuals that used to be categorized as Asperger's syndrome, who now, you know, also under this umbrella of autism spectrum disorder. But those are the guys that are just getting called into HR on a regular because they're perceived as being rude.

Amanda "Mandy" Ralston [00:37:11]:
Right. And so if you talk about outcomes for autism, just as autism, that's as about as useful as individuals saying, well, we're going to talk about outcomes for cancer. Like never mind which kind of cancer, never mind your socioeconomic background or your social determinants of health. We're just going to report on this one general outcome. Well, that's unhelpful, at minimum, I would imagine.

Liza Holland [00:37:33]:
It's got to be, especially with the landscape that you're talking about as far as is, you know, bringing in a hundred APA practitioners for one kid and coming up with so many different ones. I mean, how do you control for any variables? How do you do any of that kind of stuff? So this is not going to be an easy task to take on.

Amanda "Mandy" Ralston [00:37:50]:
Yeah, no, I mean, that's, that's sort of the crux of what I'm, I'm trying to figure out now, again with being CEO with, with Kids Choice over in Oklahoma, which is, I'm happy to be part of this group because they are indeed targeting access for care for very rural areas, which I love about their approach. They're putting up clinics in places nobody else is going. And so we are getting, you know, a lot of variation in how people approach things. And there's some really great stuff in that. And also we need to figure out how to standardize some of the clinical decision making at the same time. So again, not binary. Both things are true and valid.

Liza Holland [00:38:25]:
So final question, because I could continue to pick your brain all day. What would you like for decision makers to know? You can define decision makers. It could be legislators, it could be insurance companies, it could be whoever you think needs to have some better information to be making their decisions.

Amanda "Mandy" Ralston [00:38:45]:
I mean, I'm just going to be skipping record on this issue. It's just things are not black and white. Things are shades of gray. And in order to support humanity, you have to see the full amplitude of the individuals standing in front of you. And so, yeah, it's not binary. More than one thing can be valid and true at the same time and you should hold space for that. Right. Decision makers, you are also allowed to say, I don't know there are a thousand wrong answers in the world and I don't know is not one of them.

Amanda "Mandy" Ralston [00:39:15]:
And in fact, it models humility that the rest of the world needs to see.

Liza Holland [00:39:19]:
Boy, that's a great quote to end this on. Absolutely fabulous. Mandy, thank you so much for taking the time. This has been a really interesting conversation and we appreciate you being here on Edge Education Perspectives thank you so much

Amanda "Mandy" Ralston [00:39:32]:
for having me, Liza. It's great.

Liza Holland [00:39:35]:
Thank you so much for listening to this episode of Education Perspectives. Feel free to share your thoughts on our Facebook page. Let us know which education perspectives you would like to hear or share. Please subscribe and share with your friends.