Cultural Considerations in ABA Clinical Practice

What Culture Means in a Behavior Analytic Frame

Sandler started with a definition and kept it plain. Culture is the shared values, beliefs, and practices of a group. That group can be millions of people. It can also be three people in one kitchen. Size does not matter. What matters is the why behind the behavior.

She tied this straight to applied behavior analysis (the science of changing behavior). Skinner wrote in 1953 that group practice shapes daily life. What a person eats and drinks. How he builds a house or rows a boat. What he talks about, and what he stays silent about. Sandler read that as a set of plain behavior questions. What gets reinforced in this group? What gets avoided? What gets escaped?

Attendees added that culture passes down through generations. Sandler agreed, then added a twist. If you live around people who behave like you, culture can feel invisible. Same language, same beliefs, same routines. You may think you have no culture at all. You do. You just have not had to notice it.

culture is the shared values, beliefs, and practices of a group reflecting their collective identity and way of life.

From the talk — Mackenzie Sandler

The Ethics Principle That Grounds Culturally Responsive Work

Sandler anchored the hour in one core principle from the BACB ethics code (the rules behavior analysts follow). Treat others with compassion, dignity, and respect. She did not read the code aloud. She used it as a filter for every clinical choice that followed.

Treating people equitably means age, ability, race, ethnicity, and education do not change the service. Personal choice matters too. That means consent, assent (the learner's own yes), choice, and real individualization. Doing that well takes listening more than talking.

To listen well, she said, you first have to look at yourself. Cultural humility (an ongoing habit of self review) is a lifelong commitment. You keep checking your own behavior, your perspective, and your biases. You keep learning through articles, conferences, and sessions like this one. You also learn from families, clients, supervisees, and colleagues in other fields. She named OTs, PTs, teachers, psychologists, psychiatrists, and medical providers.

Then she added a piece many analysts skip. Check your bias about supervisees and trainees, not only clients. New BCBAs (newly certified behavior analysts) in their first year need a mentor who does that work too.

I always say that cultural humility really is a lifelong commitment to self evaluation and critique.

From the talk — Mackenzie Sandler

Map Your Own Culture Before You Map a Family's

Some parts of your identity you were born into. Where you were born. Your skin color. The religion in your house. Other parts you choose as an adult. Where you live. Where you worship. Your tattoos. The teams and clubs you join.

Sandler modeled this out loud. She shared her race and gender, her marriage, and her two daughters. She named her roles: behavior analyst, mentor, ethics enthusiast. She named hobbies like art, painting, and yoga. She named a regional identity too. She is a New Yorker who talks fast, and she asks families to tell her to slow down. She also grew up around many religions, including a household that was half Catholic and half Jewish.

Then she named a harder category: groups you join without asking. About ten years ago she lost a sibling with no warning. That put her in a group she never chose. Those shared experiences create their own quiet communication. They can also create barriers. Walking into a home that echoes your own loss, you may not be at your best.

Her suggested exercise is a self identity map. Put yourself in the middle. Branch out to heritage, work, education, values, languages, community, and hobbies. Look at which branches keep growing and which ones shut down. Those are the places where bias, or strong rapport, tends to live.

There's things that we're born into and there's things that, um, you experienced throughout your life that obviously shape your behavior.

From the talk — Mackenzie Sandler

Microcultures: The Culture Inside the Culture

Big group culture is the easy part. Religion, region, city or country, education level, socioeconomic status (income and access to resources), gender expression, generation, language, race, and ethnicity. Sandler's warning is about what we assume before we arrive. A parent without a degree does not need a simpler conversation. An accent is not a language barrier. An age does not predict tech skill.

The useful layer is the microculture (a small group inside a group). Two families can share a religion and still attend very different places. One congregation is loud and musical. Another is quiet and formal. The dress, the noise, and the rhythm all differ.

She walked through the ones we all live in. Your neighborhood. Your school and its mascot. Your workplace, with its cliques and its turnover waves. Your family, your friends, your hobbies. Swearing is the clean example. Most people curse with friends and not at work. Same person, different group, different behavior.

Geography drills down the same way. New York is not one place. Long Island, the city, the Hudson Valley, and upstate all behave differently. Attendees pointed out that the boroughs differ too. The smaller the group, the stronger the shared practice. So observe before you suggest a change. If you work in OBM (ABA applied to whole workplaces), you are the outsider walking in.

We're experiencing microcultures around us all of the time.

From the talk — Mackenzie Sandler

Access and Comprehension in the Treatment Plan

Sandler moved from culture to the plan itself. Start with access. Can the family reach the goal you wrote? Is transportation reliable? Does it reach the clinic or the school? Is a hybrid schedule an option?

She described a call from that morning about a rural area. Around 80 percent of those families had no internet. Telehealth (therapy delivered over video) is not a backup plan there. She reminded the attendees outside the United States that access varies even more widely for them.

Then comprehension. Most insurers require a caregiver to review and sign the treatment plan. Signing is not understanding. Plans get written at an insurance reading level, full of clinical words. They also describe the child at their worst, because funding follows deficits. Few parents want to read 30 pages of that.

Her fix is low tech. Sit down and walk through it together. Use everyday language. Ask what each goal means to them. Use interpreters when languages differ. She also leans on siblings, aunts, uncles, and neighbors to confirm the family fully understands. And find out who really decides. In one family the grandfather made every call, over the parents.

Most treatment plans talk about the kid on their worst day.

From the talk — Mackenzie Sandler

Reinforcers, Visuals, and the Myth of One Right Answer

Reinforcers (anything that makes behavior repeat) carry culture too. Can the family afford the item? Do they even agree to it? In her clinic, families now sign off on tablet access. Some say their child gets plenty of screen time at home and wants none in therapy. That is a complete answer. Consent and assent should cover every type of reinforcement, not just the awkward ones.

Visuals get less attention and cause real damage. She has heard from clinicians locked into one branded picture set. In one case, a learner loved mangoes. There was no mango card, so that skill could not be taught. Technology helps here. AI tools can reshade communication picture cards to match a learner's skin tone. An AAC device (a tool that speaks for someone) should sound like its user, not like a stranger.

Then the fill-in-the-blank trap. She showed an intraverbal target (answering what another person says): you eat with a. Attendees named injera and dosa. All of those answers were right. You drive a. You eat at a. You sleep in a. It may be a bed, a couch, a cot, or a sleeping bag. You do not know until you ask and observe.

Eye contact belongs in the same bucket. In some cultures, looking straight at an elder is rude. Most teenagers look at a phone, everywhere. Sandler said some insurers now reject plans that include eye contact goals. She put stereotypy (repeated body movements that soothe) and noncompliance goals under the same test. Those should come from a values conversation, not from a template.

So make sure that as you write, your goals and targets, you make sure that the answer that you're putting there is correct for the person, not your right answer.

From the talk — Mackenzie Sandler

Case Examples Where Culture Was the Missing Variable

One example stuck with the room. A learner was strong at sorting and matching. The team ran a food versus non food program and it went nowhere. The cards showed pizza, cookies, cheese, and spaghetti and meatballs. A parent looked at the pile and started laughing. The home was vegan and dairy free.

So they photographed the foods the child actually ate. The program was mastered in three days. Nothing was wrong with the learner or the teaching. The pictures were wrong.

A second example involved a school age learner who was still hand fed by family. Sandler asked about fork and spoon goals. The family said no. Hand feeding was a source of pride and connection for them. She did not push. She named the possible benefit: more access to settings with fewer limits. Then she left the door open for either side to raise it later.

A third example is smaller and easy to copy. One family asked her to say 'washroom' instead of 'bathroom'. She says bathroom out of habit, so she built herself a prompt. Ask what a family calls things, then use their word.

He literally had never seen most of the foods that we had put down in pictures.

From the talk — Mackenzie Sandler

Questions to Ask in the First Family Meeting

Her opening questions are simple and repeatable. What values are important to your family? What is hard right now? Are there beliefs or traditions we should know about? Then the house rules. Should I take my shoes off? Do you want socks, or is barefoot fine? Which rooms should we stay out of? Is the pantry open to your child? What should we ask before we enter a room?

Holidays get their own questions. Ask the family to show you how they celebrate. What behaviors are expected? Does the food change? Does travel or family time change? Does screen time change? You learn more by observing than by reading about a tradition.

Name communication barriers out loud, and make them mutual. Sandler tells families she talks fast and asks them to interrupt her. That request lands better when it runs both ways. Pause on jargon too. ABC (antecedent-behavior-consequence), RBT (registered behavior technician), BCBA, BACB, and insurer acronyms are not common knowledge. Make asking questions the normal thing to do.

For caregivers without buy in, she builds momentum (small early wins that build trust). Pick one short goal the family can see working in a week. One change, one program, one visible result. And know your limits. When a teen's values clash with a parent's, she brings in a school counselor or mental health provider. That work usually sits outside our scope.

The first question I ask families when I work with them is what values are important to your family?

From the talk — Mackenzie Sandler