[00:00] Timothy A. Zercher: So our first question for you Matt is that we know you've had over a million downloads on your podcast. What is one theme or insight that seems to come up over and over again in those conversations?

[00:11] Matt Cicoria: Well, the question I, you know, I have kind of like a beginning and an end points that I usually ask the same question of each guest and then it's kind of who knows where it goes between those two points. But so the first question I always ask is how do you get, how'd you get into applied behavior analysis and what made you want to pursue it as a career? And that is a recurring question and I really enjoy hearing people's backstory. 

I do also sometimes wonder if it gets old and anytime I'm talking to somebody who's a listener to the podcast, I you know, I might kind of retire that intro. Maybe, you know, after almost 10 years, maybe that's getting and to a person and like, no, don't ever do that. I love hearing that. So that's, that's something that I get a lot of consistent feedback on. And that's something the listener hears in just about every show, unless I'm having someone back on for a second time.

[01:00] Timothy A. Zercher: Yeah that makes complete sense. I bet I know why, right? It's because people hear themselves in people's answers, right? They hear their reason for joining. They hear their reason for getting involved, which I bet is gratifying.

[01:11] Matt Cicoria: Yeah, yeah, that's a very plausible hypothesis for sure.

[01:15] Timothy A. Zercher: Absolutely, absolutely. So your episodes go beyond autism and cover more broad behavioral science. Why was that important for you to kind of incorporate in I think some of your even your early, early episodes?

[01:28] Matt Cicoria: Well, I am a psychology major. So I approached behavior analysis before I even knew much about autism at all. And when I was a undergraduate and graduate student, I actually worked with animals. So I was steeped in behavior analysis as a sub-discipline of, of experimental psychology. And in my graduate training and elsewhere, I got broad exposure to various aspects of behavior analysis. Actually, I got very little ABA per se. I learned most of that on the job through colleagues and mentors and supervisors and things like that. part of the mission of behavioral observations is to quite frankly expose people to some of these other applications of behavior analysis that transcend autism, especially since autism relative to everybody else autism is a is a small population It's growing of course, and that's certainly a whole nother conversation, but There's so much more to behavior analysis. In fact, I like calling it behavior analysis not say applied behavior analysis because ABA seems to be You know framed with autism, you know Just in colloquially speaking. So Yeah, so I try to approach it and again to answer your question directly. It's just That's what I've always been interested in because of approach behavior analysis as a, you know, more or less as an experimental psychologist.

[02:54] Timothy A. Zercher: Yeah, that makes complete sense. Yeah, and I think ABA is synonymous with autism services. I think I've heard it one time in the last five years of us being specialized in behavioral health. I've heard it once, some other psychologist mentioned and they weren't talking about behavioral, about autism.

[03:09] Matt Cicoria: There's so much more, know, and that's one of the things I get into a lot, know, like behavioral economics contingency management for substance use disorders and OBM all sorts of this. Yeah, it's it's it's limitless.

[03:22] Timothy A. Zercher: Absolutely, absolutely, makes complete sense. So what trends or maybe new techniques, new technologies do you think are being overlooked in the ABA space, as well as kind of the broader behavioral analysis space right now?

[03:35] Matt Cicoria: one of the things I'm trying to get up to speed on, and you can't get away from this topic at all. You probably know where I'm going with this. It's AI. and, I am starting to dabble with it here and there. And there are many, many other people who are light years beyond where I am in terms of their, you know, their competency with using it. but I think that has a lot to offer for sure. it, it really is remarkable sometimes when you. put a prompt into chat GPT and how, you know, even I've just tested with like some, you know, de individualized data, raw data, or just, you know, notes on a behavioral incident. And it's remarkable how good the analysis of those data are. and, these aren't like precise ABC data or anything like that. You know, this is more narrative. so just from that standpoint alone, and I think the future of data collection, in an ABA session, that it's going to be all automated. The therapist won't be taking any data on tablet or otherwise, I would suspect. And the analysis and the feedback will be coming real time. it's certainly a game changer. I'm merely a spectator, I suppose, because I don't do that actual type of work.

[04:37] Timothy A. Zercher: Yeah, yeah.

[04:47] Matt Cicoria: But I'll be, uh, I'll be, you know, cheering it on so long as it's, you know, being used in a, in an appropriate and ethical manner.

[04:54] Timothy A. Zercher: Absolutely, absolutely. was speaking at a conference last month and one of the other speakers, one of the sessions that I was able to attend was on AI note taking and AI prompting actually. They were using it for counseling, I think it was primarily addiction and substance use counseling, but it could apply to a number of different kind of subsets and their tool actually would prompt. and encourage the therapist down certain routes when it heard opportunities and it said, hey, he mentioned the same thing four sessions ago and you asked about this, maybe a good follow-up would be blah, blah, blah. Yeah, it was crazy to see some of their examples. And of course, scrubbed of any real patient data, but it was very, very interesting and I think scary and exciting both at the same time.

[05:32] Matt Cicoria: wow. Mm-hmm.

[05:45] Timothy A. Zercher: Yeah, that's always how it is with new technologies, but especially AI. hosting a long form, deep content show is not easy. What is one moment that really struck you and kind of challenged how you think about behavioral analysis? Do you have a specific guest or something that really challenged you?

[06:05] Matt Cicoria: So probably about three or four years ago, I had this guy on Dr. Carl Hart from Columbia University. And he's an experimental psychologist, but he's also written some, what's the word, kind of like more mainstream science books, I guess, for the public press, as it were. and his main thing is about... drug taking and he's a big advocate of drug legalization. Uh, and so that was back in session one 44. Um, and he wrote a book called drug use for grownups. And the fun fact is that he wanted to get the podcast released. You know, he was doing a big book launch. And so my interview with Carl Hart went out the same day. His interview on Joe Rogan went out and his interview on all these other, you know, massive platforms went out. So that's my, you know, kind of like, uh, you know, some tenuous link. to some of the largest shows in the world, but ⁓ Yeah, yeah and I Honestly didn't agree with a lot. Well not with a lot but with some of what what he's saying and but it was good to have the conversation and I I obviously chose not to debate him because his level of expertise is orders of magnitude beyond mine But

[06:55] Timothy A. Zercher: That's very cool.

[07:16] Matt Cicoria: It was a fun conversation. It a challenging conversation. He's the only guest I think who dropped an f-bomb on my show. I try to keep my show some like PG PG 13 ish or whatever. And I chose to leave that in just because it was pretty authentic in the moment. And he was he was responding to a to a point I was trying to make and he was disagreeing with me. And the disagreement started with F that. So That was a memorable moment. I'm kind of agnostic on the legalization of, he's an advocate of legalizing everything. Anyway, it's not an issue that I'm terribly deep in. I have deep knowledge in policy-wise. I'm kind of agnostic on the topic more generally. But yeah, was a moment. like, whoa, okay. And it's also a moment too, I don't really get nervous when interviewing kind of big names in our field, but this was a big name more generally. And I was a little nervous and then for him to, you I mean, he was joking around a little bit, but he was, I could tell he was trying to make a serious point. He wasn't angry with me, but it was, so that stuck out as a memorable moment for sure.

[08:26] Timothy A. Zercher: That's cool. That's really cool. Well, I think, yeah, when people challenge us, that's sometimes the ⁓ most exciting conversations are when someone's disagreeing, right? Not always, but often. Yeah, that's really cool. ⁓

[08:35] Matt Cicoria: Yeah. Yeah. I'm not sure he was interested in my perspective. I can't say it was a free flowing exchange of ideas, but, you know, the point of bringing guests on the show is not to debate them. It's to let them kind of share their views. And I only try to mix it up. If you will, if I feel like I have some level of expertise in the topic that I can make informed points.

[08:50] Timothy A. Zercher: Absolutely. Yeah, yeah, which is hard when you're talking to subject matter experts and really refined specific topics. Yeah, that makes complete sense. That makes complete sense. So for BCBAs or RBT's that want to improve their communication skills, improve how they engage with people, what are some lessons that you've learned doing the podcasting that maybe they could apply in how they go about their... their everyday sessions or even just everyday life.

[09:28] Matt Cicoria: I think one of the big things I try to is to slow down. Now I speak slowly and generally, and I'm sure I think I've gotten an email or two from someone saying like, can you just spit out the question, please? But the thing is, especially doing an hour or two hour long interview, I'm reacting to what the guest is saying and I'm thinking about what they're saying and I'm trying to process it real time. And so a lot of times when I'm pausing or worse, I'm adding like this God awful string of filler words, which I tend to do. I'm thinking I'm trying, you know, I'm trying to process what they're saying. I'm trying to respond with a. a follow-up that is thoughtful and extends the conversation or deepens it or probes for better or more information. And so sometimes pausing, guess to be more brief would be to, you don't always have to fill the space. So if you're not sure what to say, it's okay to pause. Think about what you're gonna say, and then say it.

[10:22] Timothy A. Zercher: Absolutely, well and sometimes the silence speaks more than words can too, right? And one of my great mentors that I loved working with, although it frustrated me, my ADHD was like, get to the point, what are you gonna say? He would do the same thing. I would ask him a question, And then he would just sit there and it would be like, it felt like eternity, but it would probably be like eight seconds or something. And then he'd be like.

[10:44] Timothy A. Zercher: So here's what I think Tim, and then he would go into it and it killed me, but at the same time, it was always insightful and truly thoughtful and really considered because he took his time and he made sure that what he said was valuable.

[10:58] Matt Cicoria: Yeah. I mean, I think there's a continuum of communication styles where, know, you've got the people who can like shoot right from the hip with something really helpful or thoughtful or on target or whatever. And then there's people like myself who need to take a moment to gather their thoughts and whatnot. I really wish I had that ability to just rattle stuff off. And when I have guests on the show who can do that, I'm always amazed. but. I also think that it's, I think interviewing someone adds another, you know, it's almost like if you're looking at tracks in like GarageBand or something like that, there's like another track going where you're trying to, or maybe two or three, where you're trying to run the conversation, run the interview, think of a follow-up question. So this to me is, you know, in terms of effort-wise is quite different, you know? So I can be more extemporaneous and so.

[11:45] Timothy A. Zercher: Absolutely. Yeah, because you don't have to worry about what's the next question and how long is this running and are we close to our mark and do I need to wrap up and exactly. Well, and prioritization of which questions should I ask next, where should we go next? I totally get it. I totally get it.

[11:52] Matt Cicoria: Right. Mm-hmm. Yeah, we up against a heartbreak or whatever. Yeah

[12:02] Timothy A. Zercher: Exactly, exactly. That makes complete sense. going kind of zooming out a little bit, what excites you most about the autism service community, about the like where we're headed right now?

[12:15] Matt Cicoria: Yeah, I have a couple of thoughts on that. I guess the first one would be to circle back to the AI revolution that seems to be happening right before our eyes. That seems very, very exciting. I think more generally the idea that behavior analysis or applied behavior analysis in this case, as it relates to supporting individuals with autism, is a service. I first, um, got into behavior analysis, not necessarily in the way in which we understand it today, but in the mid to late nineties. And, uh, I was, you know, I got my first certification in 2002. was the 755th certificate. And now we have 75 plus thousand or maybe 80,000 by now, who knows? so that excites me that the field is growing and that it's a recognized. you know, kind of in the healthcare industry space.

[13:11] Timothy A. Zercher: Absolutely, it's a mature field now. It's not just this new thing that people are doing, right? And maybe, yeah, it's maybe not there, but it's on its way, which is nice. Which I think also, it opens the doors for both concerns over quality, when the number is so large, and also really good opportunities for professionals to do incredible work, because there's so many more young, ambitious professionals that are in the space.

[13:36] Matt Cicoria: Indeed.

[13:47] Timothy A. Zercher: Yeah. So then flipping it kind of on the other side, what are some of the areas that you're most concerned about where the general ABA and autism service space is headed?

[13:47] Matt Cicoria: I could give the very same answer for the reasons that you just described, meaning that the growth is, I don't think there's been a profession that's had this type of growth and who knows where it's going to go. And I think that, you know, I've heard different stats, but I think the rule of thumb is that you the field has doubled, more than doubled in the last, you know, three to five years. Uh, and it, know, so we're, we're in this, you if you look at the number of certificates on a, on a line graph, you know, we, we're in this kind of like hockey stick, you know, acceleration or, uh, as it were. And, um, that's awesome on the one hand, because there are more of us and that's terrifying on the other hand, because. You know, we've got clinical directors with one year of experience or, you know, and there's all these perversive incentives, know, so yes, yes, we're recognized healthcare practice. Uh, and that also creates opportunities for, uh, you know, uh, sketchy incentives. that is definitely a challenge for the field about how, you know, how do we move forward, how we provide high quality care in a way that's, you know, competent and ethical. 

And that's a challenge for the field related to that too I think that when I first had Jim Carr the CEO the behavior analysis certification board on the on the show He mentioned something that I hadn't thought of at the time but He was worried about us not having enough people at the BCBA-D level to do the applied research. And that is a really good point. If everyone's going in to be practitioners, a certain point, we're going to run out of science. We need the scientists along with the practitioners. 

And we can get a debate whether a line staff BCBA is a scientist or not. I have opinions on that that will probably take like three of these podcast episodes to elaborate on. But doing the clinical research at the Monroe-Meyer Institutes, at the Kennedy Krieger Institutes, at the New England Center for Children, do we have enough of those? people in the pipeline telling us how to make the field better. ⁓

[15:57] Timothy A. Zercher: Or are they all being sucked into the doing role because the salaries are high and the demand is insane and the incentives are there?

[16:03] Matt Cicoria: sure. Yeah, definitely. Definitely. I think that is something that the field needs to keep its eye on as well.

[16:10] Timothy A. Zercher: Absolutely, I completely agree. I think, like I just learned about in a, we were recording an earlier session about like really cool, like robotic devices being incorporated into therapy services for autism, which are, it's just crazy new and crazy interesting and maybe exciting, but there's like one tool out there total that's even considering that. because everybody else who is BCBA certified and who understands the space and understands the patients is desperately trying to provide services and not inventing new products or tools to help make the work better or easier, faster, more effective. Yeah. Yeah. I think it's really space is exciting, but it's also scary. Which I think most people would probably agree, especially the more they understand about how the work is actually being done in ABA practices on a day-to-day