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Is Your Child on the Spectrum? Recognizing 10 Early Symptoms and Signs of Autism

December 3, 2021

If you notice that your child is experiencing delays or is behaving differently from kids, as a parent you may be thinking to yourself, does my child have autism? It can be so hard to know what is “normal” and what could indicate an Autism Spectrum Disorder. Luckily, there are symptoms and signs of autism that parents should look out for. With enough awareness, parents can help their autistic children receive early intervention treatment. These early warning signs include sensory issues, repetitive movements, delayed communication skills, difficulties making eye contact or maintaining conversations with others, and social isolation. If you recognize any of these signs in your child and would like to learn more information about what therapies and assessments we offer for autism, please contact Side by Side Therapy to set up a no-charge consultation today.  

When Do the First Signs of Autism Appear?

Signs of autism become noticeable around 18 months of age.  Typically, parents begin to notice if their child starts missing speech milestones or if they’re not picking up on social cues as well as their peers or siblings. Children as early as 6 months can start to show symptoms of autism. Let’s talk about 10 early signs of autism to look out for:

1. Avoids Eye Contact

Avoiding eye contact is very common in autism.  If you notice your baby is not making eye contact by 6 months of age, this may be a sign of autism. Avoiding eye contact gets carried into adulthood sometimes, so you may notice autistic people of all ages engage in this behaviour. The reason for not making eye contact is different for each person.  Understanding social cues from a person’s eyes can be challenging for an autistic person.  This can be overwhelming and make them feel uncomfortable.  Sometimes they have a hard time focusing on making eye contact and listening to what someone is saying to them at the same time.  Therefore, even if they are not making eye contact with you when you are speaking to them, this doesn’t necessarily mean that they are not listening to you.

2. Lacks Response to Other’s Voices

If you notice your child doesn’t respond to or look at someone when they’re being spoken to, this may be a sign of autism.  Many parents assume this behaviour is associated with their child having hearing issues.  Over time, it becomes clearer that the child can hear fine and instead their behavior has more to do with being withdrawn.  When you’re trying to talk to an autistic child, they probably don’t seem engaged in the conversation and won’t respond in a timely manner.  For example, your child doesn’t respond to their name when it’s being called. Autistic people are also more sensitive to sounds and have a hard time filtering out these noises.  This means that they may be distracted by the sounds around them and are struggling to pay attention to the person talking to them.

3. Hand Flapping

One of the many signs of autism is stimming. Stimming is when a person repeats the same action over and over again. An example of this is hand flapping.  Autistic children do this as a form of stimming, which is calming for them.  Sometimes, autistic children also flap their hands when they get very excited or feel other strong emotions, like stress. It is common for some children to flap their hands, but make sure to pay attention to how long they’re doing this.  If the child stops hand flapping around the age of 3, there’s no reason to worry.  With children that hand flap all the time, take note that this may be an indicator of autism.

4. Frequently Walking on Tip Toes

Another type of stimming is frequently walking on tip toes. Instead of walking on their entire foot, they prefer to walk on their tippy toes and if you notice your child is doing this all the time, it may be a sign of autism. There are a few reasons why an autistic child prefers to walk on the tips of their toes. If the child has sensory issues, they may feel uncomfortable putting all their weight on the surface of the floor Although this behavior is often harmless, it can still put the child at risk of injury because they could lose their balance and fall. Both Occupational Therapists and Physical Therapists are qualified to develop strategies to help reduce toe walking.

5. Trouble Controlling Emotions

If you’re a parent and have been out in public with your child, there have probably been incidents where your child gets fussy or throws a tantrum.  For an autistic person, these tantrum behaviors can be more intense and last for long periods of time.  Usually, the fussiness isn’t a result of not getting access to a toy or treat, rather it can be happening because of the bright and loud conditions of the public space, which can lead to them experiencing a sensory overload.  A typical tantrum lasts only a few minutes, while a sensory tantrum can last hours. 

6. Aggressive Behaviour

Aggressive behavior is another indicator of autism.  Autistic children can be more aggressive than others and sometimes there’s no clear reason as to why they behave like this. If the autistic child is used to getting a strong response from others when they’re aggressive, sometimes it increases the chances of them acting this way again. Another example is if the child has previously been able to receive access to something they want, such as a toy, by acting aggressive towards others. If the child realizes that they can get what they want through aggression, they will most likely continue to behave this way. Therefore, it’s important that interventions, like Applied Behaviour Analysis (ABA), targets aggressive behaviour as early as possible, to prevent injury to themselves and others.

7. Rigid Play

You may notice that your child plays a little differently than their peers. Perhaps, they’re a little rigid in their play routines.  This means that they prefer to play with their toys in a certain way and may repeat the same play actions over and over again.  For example, you may notice your child lines up all their toys in a row, or repeatedly spins them. Most likely, they will play with the same toys all the time and rarely switch them up. When autistic children play with their preferred toys, most of the time they are playing by themselves, almost as if they are in their own little world.

8. Issues with Food and Textures

Problems with food, textures or clothes is also common for autistic people.  Being a picky eater is something an autistic child may experience due to their sensory related issues.  These sensory issues relate to the taste, smell, texture, and look of the food item.  Certain textures of food, like pudding, may not be appetizing for them.  They may even be particular about their foods not touching each other. Remember that these sensory issues are different in every autistic child.   If your child doesn’t like the food, it can be very challenging for a parent to get the child to eat it.  Being sensitive to textures is not always related to food though. 

food issues as a sign of autism

Clothes can also be an issue for autistic kids.   Sometimes they don’t like the feeling of the material rubbing against their skin.  Clothing tags can also be irritating.  To avoid these sensory issues, parents can try different clothing materials.  For example, switching to seamless materials for socks and underwear.  Tagless shirts are a great idea as well however, if you can’t find any you can always flip the shirt inside out.

9. Delayed Speech

Lack of speech and communication are big signs of autism.  It is not uncommon for autistic children to miss speech milestones.  Autistic children sometimes develop speech later than their peers.  By the age of 3, if your child has not started speaking yet, start paying attention to potential speech delays for them.  If the child is older than 3 years of age and still has limited speech, we recommend reaching out to your doctor or a Speech-Language Pathologist to help.

10. Repeating Words and Phrases

Another common sign of autism in speech, is when the child repeats words and phrases over and over again.  This is called echolalia, meaning the echoing of words.  This sometimes happens because it’s a form of stimming and helps them feel calm.  In addition, it is a way to communicate if they are learning to speak. Both ABA therapy and Speech-Language Pathology help with improving an autistic child’s communication skills.

How Do I Know if My Child has Autism?

In conclusion, there are many early symptoms and signs of autism for parents to recognize. Although we only touched on a few indicators of autism, we hope this helps parents have a better understanding of what to pay attention to if you think your child has autism. The sooner these signs of autism are recognized, the better. With intervention, autistic children can learn skills to develop independence and self-care. Parents should consult their pediatrician for more information on diagnosis and treatment options if they recognize these early signs of autism in their child.  If you would like to learn more about ABA therapy, Speech Therapy, and Occupational Therapy, please contact Side by Side Therapy to set up a no-charge consultation.

The Importance of Finding the Best Therapy For Autism-Is it ABA Therapy, Speech Therapy, a Combination, or Another Therapy All Together?

November 17, 2021

The goal of autism therapy is to help the child develop academic skills, communication and social skills, increase independence, and learn daily living skills. There are many different interventions that have been developed to aid in this process. Choosing an evidence-based treatment is important. This means that it is based on the best available scientific evidence and clinical expertise. There are several types of evidence-based therapies used to treat Autism Spectrum Disorder (ASD): Occupational Therapy (OT), ABA (Applied Behavior Analysis), Speech-Language Pathology (SLP) and Physical Therapy (PT). This is a guide for helping you find the best therapy for autism.  Learn more about what ABA, OT, SLP, and PT have to offer!

Child sitting with therapist

What is Applied Behaviour Analysis (ABA)?

ABA Therapy is the science of learning and motivation and is one of the most effective therapies for autism. It helps us understand how behavior works and how it is affected by the environment. The goal is to increase desired behaviors and to decrease interfering behaviors.  

ABA focuses on enhancing a variety of skills, including language, social skills, attention and learner readiness skills. There are lots of strategies we use in ABA, such as positive reinforcement (offering rewards) to increase desired behavior.  For example, a child gets a star for doing a good job of following the rules at school. And when they get enough stars, they earn a prize, like ice cream with their friends.

A Board-Certified Behavior Analyst (BCBA) is a Masters or PhD level therapist.  They are the clinical supervisors that assess and coordinate the autistic child’s treatment plan.  Their role is to make decisions to assist the rest of the child’s therapy team.  Depending on the size of your team and how many hours of therapy the child requires, a supervising therapist assists the clinical supervisor on assessing the child’s progress.  In addition, an instructor therapist works with the autistic child and collects data for the team to review.

How Much ABA Therapy Does My Child Need?

How many hours of therapy an autistic child receives depends on their skill level and areas of need.  The BCBA considers the parents goals along with the child’s assessment results to figure out how many hours of therapy they need. If they decide your child needs more of a Focused ABA approach, then the therapy ranges from 5-15 hours a week.  Focused ABA is when children are taught one or two areas of skill development.  On the other hand, if the child needs to focus on a variety of skills, they might suggest a comprehensive ABA approach, which is over 20 hours of therapy a week.  Comprehensive ABA focuses on both skill development and behavior reduction. 

There are many strategies and techniques used to address most areas of need in ABA, such as behavior, communication, social skills, motor skills, and many more.  Behavior analysts know that sometimes other specialists, like speech-language pathologists and occupational therapists, need to be added to the team to improve a specific area of need.  Let’s talk about the other therapies an autistic child can benefit from!

What is Speech-Language Pathology (SLP)?

Communication is challenging for autistic children.  They may find its difficult to socialize with others, to pick up on social cues, and to vocalize their needs.  Aside from ABA, Speech-Language Pathology (SLP) helps reduce communication issues.  Speech therapy helps your child improve their language and speech skills. A speech language pathologist is qualified to provide effective speech therapy. An autistic child sometimes struggles with speaking, language, and fluency.  Luckily, speech therapy helps with this and teaches them to express themselves better through verbal and non-verbal language. They first conduct an assessment to identify the best treatment method.  Next, they create a treatment plan that addresses the child’s individualized needs.

Speech therapists address 5 main areas:

  1. Receptive language
  2. Expressive language
  3. Speech (articulation),
  4. Pragmatics (social skills)
  5. Feeding and swallowing

Along with language issues, autistic children may not be able to articulate their speech well.  For example, struggling to pronounce sounds like “ch” or “th”. Not to worry, a speech therapist helps with the pronunciation of sounds and words too.

If your child needs help improving their language and speech, we recommend looking into speech therapy.  It is an important tool for autistic children to improve their communication skills. Children can use these skills throughout their lives to make friends and develop relationships with family members.

What is Occupational Therapy (OT)?

In our every day lives, we are expected to take care of ourselves.  Starting with self care, we brush our teeth, shower, get dressed, and cook ourselves yummy meals.  We go to work and school.  We also enjoy leisure activities, such as gardening and biking.  For an autistic person, these every day routines can be challenging.  Occupational therapy for autism can help make these every day routines a little easier. It teaches people skills that improve their leisure, productive, and self-care skills.  Occupational therapists have advanced degrees and receive a lot of training in the field. By using a variety of techniques, they work towards regaining and maintaining an autistic persons independence.   

Child exercising during Occupational Therapy for Autism

How Can OT Help with Autism?

An occupational therapist works with your child on improving many different skills, such as:

  • Printing and handwriting
  • Fine and gross motor skills (e.g. grasping objects)
  • Improving sleep and sleep hygiene
  • Leisure activities (e.g. gardening)
  • Improving self-care (e.g. teeth brushing)
  • Increasing attention and focus
  • Feeding skills
  • Improving self-regulation skills

For early learners, an OT focuses on sensory integration and sensorimotor issues.  This means, they are improving how a person processes and reacts to information coming from their senses. Learning a new skill requires the OT to break it down into small steps.  For example, if an autistic child is struggling to learn how to write, an OT breaks that skill down by first teaching the child fine motor skills that can improve their hand strength.  This small goal leads to acquiring other skills, such as being able to pick up a pencil and write. 

An OT also provides prescriptions of assistive technology and recommends equipment that helps the child. For example, if the child is at risk of falling out of their bed or falling down the stairs, an OT might recommend grab railings to prevent injury. 

Occupational therapists for autistic children can be a great help to teachers and parents working with this population. They are knowledgeable about the spectrum of conditions that affects these children. We recommend to start occupational therapy in important early childhood years because it helps children develop more functional skills that they will need later on in life.   

What is Physical Therapy (PT)?

Physical Therapy (PT) for autism is similar to OT because they both work towards teaching people skills to help them with their everyday routines.  An Occupational Therapist focuses on improving fine motor skills, such as writing, using utensils, grasping objects, and getting dressed. On the other hand, a Physical Therapist focuses on improving gross motor skills for larger muscle movements, such as walking or even learning to ride a bike. They also help with pain management and strength training. For autistic children, a physical therapist assesses their:

  • Postural strength
  • Body and safety Awareness
  • Mobility (e.g. walking and running)
  • Coordination and balance
  • Play skills (e.g. bouncing a ball)

Once the assessment is complete, the physical therapist develops goals to work on with the child.  Remember that each child has different needs and therefore, there is not only a single physical therapy treatment to use. The physical therapist personalizes the program to the children’s needs. To sum up, we believe that physical therapy is another great treatment that enhances an autistic child’s quality of life.

Choosing the Right Therapy

In conclusion, there are many methods that can be used to help autistic children.  There is no one way to treat autism and it is important to find the right treatment for each child with different needs. If you or someone you know has a child with autism, speak with your doctor to determine what type of treatment will work best for them.

At Side by Side Therapy, we offer interdisciplinary services.  This means that your child has the opportunity to not only access ABA therapy but also Occupational Therapy and Speech therapy with us.  An OT, BCBA, and/or SLP work together to create a therapy plan that works for your child’s individualized needs. If you would like to learn more about the different types of therapy treatments we offer, please contact Side by Side Therapy to set up a no-charge consultation today. 

How to Toilet Train your Autistic Child (Part 2)

August 16, 2021

In this second post on how to toilet train your autistic child, you’ll learn about: day vs night time training, urine vs bowel training and how to leverage reinforcement. Make sure to check out last week’s blog Toilet Training Tips from ABA Therapy (Part 1) for more information and tips!


Day vs Nighttime Toilet Training:

Many children, especially boys, continue to have nighttime accidents for years after they’ve become daytime trained. Often nighttime training isn’t possible because the child’s body isn’t waking up when they have to pee. It’s not a matter of motivating the child or setting a schedule.

If your child is above age 7 and is still having consistent nighttime accidents you should consult their paediatrician.

Some strategies to avoid nighttime accidents are:

  • Avoid beverages 2 hours before bed
  • Make one or two bathroom trips before putting your child to sleep
  • Gently wake your child to take them to pee before you go to bed yourself

How to use Reinforcement to Toilet Train your child:

When you’re beginning to toilet train your child, you should observe their interests and preferences. We want to use the things they like the most to motivate them to learn this new skill. Children need to be ‘paid’ to put in hard work, just like adults! When you have identified their most reinforcing items you want to begin to limit access to these items. If the child knows they can get the reinforcer later (without having to do the work) there won’t be any reason to do the hard stuff.

Some parents will put the reinforcer right into the bathroom, on a high shelf. The child should be able to see it but not touch it. Be very clear and explicit with your child that they need to pee or poo in the toilet or potty if they want to gain access to the reward. Stand your ground! If they don’t engage in the desired behaviour they can try again later. Don’t give them the reinforcer unless they use the toilet!

Lollipops used to Toilet train at Side by Side ABA Therapy

Some examples of reinforcers used to toilet train are:

  • Individually wrapped chocolates (snack sized)
  • Jelly beans
  • Lolly pops
  • Freezies
  • Hot Wheels Cars
  • Action figures
  • Special priviledges

When your child is successful and uses the toilet or potty, BRING THE CIRCUS TO TOWN! You want to pair social praise with the reinforcer so that eventually you can fade the reinforcer.

Urine vs Bowel Training:

Some children have a hard time learning to have bowel movements in the toilet. There can be feelings of loss of control, sensory needs or even fear (of pain) that can inhibit a child from reliably having bowel movements in the toilet. It is often necessary to toilet train for urine first before trying to teach bowel training.

When you’re tracking your child’s toileting schedule, you should take note of if the child voided their bladder or moved their bowels. Many children have a consistent bowel movement schedule while voiding urine can be more flexible.

You might also have to use different reinforcers for urine vs bowel training. A higher level reinforcer would be used for bowel training as it’s generally more difficult for the child to master. Sometimes we use the same reinforcer but a bigger portion (instead of just a few gummies giving a handful).

Conclusion:

When a family decides to toilet train, it can be a very stressful time for everyone. Using these ABA Therapy strategies will help make the process smoother and more enjoyable. Contact Side by Side Therapy today to get some advice about toilet training.

Toilet Training Tips from ABA Therapy (Part 1)

August 9, 2021

Read time: 4 minutes

Many children struggle with toilet training. Autistic kids can have a difficult time making the transition from diapers to the toilet. ABA Therapy offers several tried and tested strategies for training children. There are many things to consider when training your child. This post will outline many things you need to keep in mind.

Toilet Training Readiness Signs:

Children will engage in specific behaviours when they’re ready to begin toilet training. Some of the things to look out for are:

  • Wanting to be changed if wet or soiled
  • Always going to a specific place to have bowel movements (e.g.: behind the couch)
  • Touching/pulling on diapers
  • Asking questions about the toilet
  • Curiosity, wanting to watch others use the toilet

2 Approaches to Training: schedule training and intensive training

When you’re looking to toilet train your child you have to decide if you’re going to schedule train or teach initiation.

Schedule Training:

When you set a specific schedule that you’re going to have your child try to use the bathroom.

The most efficient way to set the schedule is to take data for a few weeks on when your child is wet and dirty. Most people have a routine or ‘schedule’ that their body follows for how frequently they urinate and defecate. Your child will be MUCH less stressed out about trying to use the toilet if most of the time they actually have to go when you get them to try. If your child is peeing every 2.5 hours, their schedule would be a trip to the bathroom every 2 hours and 15 minutes. Once the child is reliably holding between trips and is voiding in the toilet you can begin to lengthen the intervals to encourage the child to request a bathroom trip.

Intensive Training:

When you take a very intensive approach to training.

Some families choose vacations from daycare/school or times when they will be staying home for a few days consecutively. Usually, the child stays naked from the waist down and near the toilet or potty. Every 10-15 minutes they are prompted to ‘try’. This approach is very effective for children who are not holding for long periods of time. By frequently trying you increase the likelihood that the child will be successful and you’ll be able to reinforce their correct toileting behaviour.

Toilet Training Tips Side by Side ABA Therapy

Potty or Toilet?

Many families ask which set-up is better. There are pros and cons to each.

Potty

Pros

  • Child-sized
  • Portable
  • Affordable

Cons

  • Not always available
  • Child might outgrow it
  • You have to teach using a toilet after
  • Needs to be cleaned after each use

Toilet

Pros

  • Available everywhere
  • Less generalization required
  • Free!
  • You can model the behaviour for the child

Cons

  • Not usually child-sized
  • Flushing can be loud

Diapers, Pull-ups and Underwear

Transitioning from diapers to underwear can be stressful! From the child’s perspective, it’s a huge change and from the parent’s perspective, it can mean A LOT of laundry. It is important for the child’s learning to make this transition smoothly. It can be very confusing for the child if they’re back and forth between underwear and diapers.

Diaper technology is so advanced that children do not feel any discomfort when they’re in a wet diaper. Which is wonderful for babies but not an effective motivator when toilet training. We always recommend transitioning to underwear full time during the day and pull-ups at night. If necessary, some parents will put a diaper on over top of the child’s underwear to help contain any accidents

In Conclusion

There are lots of things to consider when starting a toilet training program. Next week’s blog will cover reinforcement, daytime vs nighttime training and urine vs bowel training. Contact Side by Side Therapy to discuss your child’s toilet training needs.

Pairing in ABA Therapy

August 7, 2021

To an uninformed observer, pairing in ABA therapy is a waste of time and resources. However, this could not be farther from the truth! Pairing is a vital component of all ABA therapy programs. This blog will answer all of your questions about pairing!

What is pairing?

In plain English, pairing happens when you’ve matched yourself with the learner’s favourite things. Each person has a favourite colour, a favourite song and favourite food. We also have preferences for people and are more likely to cooperate with someone we like.

In ABA English, pairing is aligning a neutral stimulus with a learner’s high-level reinforcers. The qualities of the highly preferred reinforcers will transfer to the neutral stimulus. This will change the stimulus from neutral to preferred.

How to do pairing in ABA therapy?

The first step in any pairing program is to identify the highly preferred reinforcers. For example, gather the learner’s favourite things and provide free access to them. Observe which items the learner spends the most time with and you can rank them.

Once the highly preferred reinforcers have been identified, you want to engage the learner with them. The goal is to have the learner WANT to come to you. You want to earn the title of “Giver of good things”. Most importantly, you want to have fun with the learner.

It is vital not to place demands on the learner while you’re pairing. Even simple instructions like “look at this” or “can I see?” can derail the pairing process for some learners. Instead of asking questions you should be narrating the play. For example: instead of asking “What colour car do you have?” you should say “You have a red car!”

Once you’ve established the foundation of your newly reinforcing relationship, you will begin to withhold the reinforcers in order to encourage the learner to interact with you to access them. At this point you can also bring some novel or new reinforcers for the learner to access. Having new reinforcers will keep the learner excited and will avoid satiation (to learn what satiation is, you can read this post with 59 ABA therapy terms defined).

When is pairing done?

NEVER!

You will constantly need to be building the relationship that you have with your learner. The work we expect of our clients is difficult and we need to make sure that they’re being rewarded and recognized for their efforts.

ABA Therapy: Behaviours and Consequences

July 31, 2021

Read time: 4 minutes

One of the most important principles in ABA Therapy is the three-term contingency or antecedents, behaviours and consequences. Whenever we change behaviour, we have to look at the function of the behaviour. What is feeding it or keeping it going? You can read this post about the 4 functions of behaviour.

What is the Three-Term Contingency?

Each behaviour has 3 parts:

  1. Antecedent
  2. Behaviour
  3. Consequence

Antecedents:

What happens before the behaviour. This is the signal that the behaviour should happen. In other words, it’s the trigger. In ABA terms we call the antecedent the Sd or Discriminative Stimulus. Certainly, check out this post with my list of 59 ABA definitions explained!

Antecedents cue the person that reinforcement is available if they engage in a behaviour. They can be either explicit or implicit. For example, an example of an explicit antecedent is giving an instruction. You’re telling the person exactly what to do. However an implicit antecedent can be something like how the space is laid out.

Behaviours:

This is what the person does. That is to say, behaviours are the actions (on inactions) that the person takes after the antecedent. Behaviours must be observable and measureable. Behaviours have to pass the Dead Man’s Test. . This means that if a dead man could do it, it IS NOT behaviour.

Before we can track a behaviour we define it so that we ensure that everyone is on the same page. This is called an operational definition. In other words, we don’t want to be comparing apples to oranges! It is usually helpful to put a non-example of the behaviour in the operational definition.

Here’s an example of an operational definition:

Tantrum:

Description: Laying on the floor, crying, yelling, throwing objects, and/or pounding fists on desk. The episode is counted if it lasts 10 seconds or more and is counted as a new incident if separated by 5 minutes or more.

EXAMPLESNON-EXAMPLES
Laying on the floor for 20 secondsThrowing pencil and yelling ‘no’, then re-directing to the task (lasting total of 7 seconds)
Sitting in chair and pounding on the desk without talkingSitting in the chair without working but not making any noise
Crying and yelling loudly about ‘fairness’ Crying after getting hurt
Retrieved from https://www.pps.net/cms/lib/OR01913224/Centricity/Domain/178/Example%20Definition%20of%20Measureable%20Behavior.docx on July 25, 2021.

Consequences:

Consequences are what happens after the behaviour that either reinforces or punishes it. Reinforcement makes behaviour likely to happen again in the future. Alternatively, punishment makes behaviour less likely to happen again. That is to say that the words we use, the things we do and even the looks we give someone after they’ve engaged in a behaviour will impact whether they happen again in the future.

Antecedents, behaviours and consequences in ABA Therapy.

Positive and Negative Consequences:

A tricky thing in ABA is the use of the words positive and negative. In plain English, positive generally implies good while negative implies bad. In ABA, when a consequence (a reinforcer or a punisher) is positive something is added to the environment . Alternatively, when a consequence is negative something is removed from the environment. As a result, people often use the incorrect meanings when talking about positive and negative reinforcers or punishers.

In conclusion:

To summarize, antecedents, behaviours and consequences are integral in changing behaviour. These are the tools that we use in ABA Therapy to be as effective and efficient as possible. Using the ABC’s of behaviour will consequently create opportunities to make long lasting improvements in people’s lives.

Why is Occupational Therapy Used for Treating Autism?

July 19, 2021

Read time: 5 minutes

Many people wonder why occupational therapy is used for treating autism. Read this blog to find out!

What are your occupations?

Every day, you do meaningful activities. You play games, garden, make meals and paint. They are an integral parts of our lives. Above all they allow us to access the best parts of our life and make it meaningful for us. OT help with your professional and personal concerns if you are unable to perform daily tasks due to injury, illness, or disability.

  • Offer solutions to problems that arise from social and environmental factors.
  • Enhanced participation in communities and life.
  • Ultimately, help us live the life that we desire.

What is Autism Spectrum Disorder (ASD)?

Autism Spectrum Disorder (ASD) is the most prevalent neurodevelopmental disorder. It affects about 500,000 people around the world. Autism diagnosis most often occurs in childhood. Moreover, Autism Speaks Canada predicts that 1 in 42 boys and 1 in of 189 girls will be autistic.

ASD can impact every area of a person’s life and each case is unique. Occupation performance refers to the ability to do daily activities, such as self-care and daily living. It also includes education, leisure and recreation for children. As well as their ability to communicate and socially engage. 

Why is Occupational Therapy Used for Treating Autism Side by Side ABA Therapy

What are the goals of occupational therapy?

OT’s main goal is to help clients achieve their highest level of independence. In other words, it is important to consider their personal goals, motivations and interests.

Above all OTs should:

  • Encourage participation in daily life.
  • Develop intervention plans and assess the abilities of the individual.
  • Assist children in achieving their developmental goals.
  • Encourage learning through their understanding of sensorimotor processing.
  • Fine/gross motor skills development and task analysis.
  • Recommend changes or accommodations to activities and environments.
  • Teach vocational skills and explore independent living options.
  • Assist clients in achieving independence.
  • Support clients and families with education, consultation, and advocacy.
  • Support clients in building intimate relationships through education about relationships and sexuality.
  • Participate in the inter-professional team (speech pathologists, behaviour analysts, physicians, early interventionists, social workers and educators).

How is occupational therapy used in treating autism?

Occupational therapists use their skills to improve sensory processing, emotional regulation and fine/gross motor development. Occupational therapy is a holistic approach that offers a unique perspective. They hold advanced degrees and have received a lot of training in the field. Moreover, they are highly skilled in doing assessments and in providing intervention. Occupational therapy interventions require input from family, educators, and caregivers. People transition from one setting into another with the help of occupational therapists. In other words, transitions include from home to daycare, from daycare to school, and from school to society. Occupational therapists provide support to families through education and consultation.

Why is Occupational Therapy Used for Treating Autism Side by Side ABA Therapy

Where can occupational therapists work?

Occupational therapists can be found working alongside health care professionals in many settings. That is to say these can include schools, long-term care facilities, hospitals, and community clinics. OTs also work in support services, family homes and on client health teams. Other organizations may be involved in the occupational therapy’s work, such as government policy-makers, community agencies, or care professionals.

Occupational Therapy at Side by Side

In summary, OTs play an important role on many of our client teams. Occupational Therapists can do direct treatment or consult to our ABA Therapy teams. If you’d like to discuss how we can use occupational therapy in your child’s program call Side by Side Therapy today.

Can parents do ABA therapy?

July 5, 2021

Read time: 3 minutes

Traditionally, trained professionals deliver Applied Behaviour Analysis (ABA). As a result of the COVID-19 pandemic and the skyrocketing costs of therapy, parents do ABA therapy more frequently.

On an ABA therapy team there are often 3 levels of clinicians. The Board Certified Behaviour Analyst (BCBA), the Senior Therapist (ST) and the Instructor Therapists (IT) /Registered Behaviour Technicians (RBT). The BCBA is responsible for overseeing the quality and directing the program. The ST oversees the IT/RBT. They also write the programs and do the assessment. On a traditional team, the IT/RBT deliver the therapy to the child. However, it is becoming more common for parents to receive Parent Coaching in order to implement the intervention themselves.

What is ABA Therapy anyway?

ABA is the science of learning and motivation. The goal of all ABA programs is to make meaningful changes to a person’s behaviour to help increase independence. Teaching skills and reducing challenging behaviours accomplishes this. Using a number of assessment tools, the BCBA will determine where the gaps are in the client’s learning and will design a program to fill those gaps. The BCBA will also determine the function of any challenging behaviour and will try to find replacements that meet the same need. In doing this, they’re looking to make the challenging behaviour unnecessary.

Some of the strategies used in ABA:

  • Frequent assessment and evaluation
  • Reinforcement
  • Shaping
  • Prompting and prompt fading
  • Task analysis and chaining

Can parents do ABA therapy?

The family and a BCBA will meet to discuss the child’s needs and what the family hopes to get out of therapy and coaching. The BCBA will help the family identify a goal or two. Subsequently, the BCBA will design a program that will either teach a new skill or replace a challenging behaviour with another more helpful behaviour. The BCBA will train the family in the program using Behavioural Skills Training (BST). There are 4 elements to BST: instruction, modelling, role play and feedback. That is to say, the family will be confident in their ability to implement the program. The family and the BCBA will meet weekly.

Parents are tasked with taking data, to monitor the child’s progress. Data is a foundation of ABA. In other words, all decisions should be based on and driven by data. If you’re having trouble with the amount of data that the BCBA is asking you to collect, please bring this to their attention. There are many ways to collect data and each has it’s own value and place in an ABA program.

The best ABA program will need changes and tweaks as it’s being implemented. Likewise, ABA programs must be individualized.

How do parents do ABA?

Father meeting with therapist to learn how parents do ABA.

Funding for Parent Coaching

If your child has OAP funding (Behaviour Plan Budget, Childhood Budget, Interim Funding) you can purchase parent coaching using your funding. According to the OAP website, in order for an ABA program to be funded it must be supervised by an approved Clinical Supervisor. In short, all of the BCBAs at Side by Side Therapy are eligible to supervise OAP funded programs.

How does virtual ABA therapy work?

June 27, 2021

With the end of the pandemic in sight, a lot of people are wondering if virtual ABA therapy will remain a therapy option. This post will explain what virtual ABA therapy is, how it works and some things to consider before registering your child.

Virtual vs in-person:

What is virtual ABA Therapy?

Simply put, virtual ABA therapy is ABA therapy where the sessions occur with the therapist in one location and the client in another and they’re both using a computer to communicate. Most other elements of virtual ABA are the same as in-person therapy.

The principles of ABA therapy don’t change when you’re virtual. The main elements of good therapy are:

  • Frequent assessment and evaluation
  • Reinforcement
  • Shaping
  • Prompting and prompt fading
  • Task analysis and chaining

How does virtual ABA therapy work?

For some children, virtual therapy will look very similar to in person therapy. If the child is working on academic tasks (literacy or numeracy based skills, for example) the sessions would be the same. However, if the child has difficulty attending, the therapist might need an in person supporter to prompt the child.

Some children require shorter sessions when they’re taking place virtually. It can be difficult for the child to focus on the screen and not be distracted by other stimuli in their environment. The therapist has much less control in a virtual session as they’re not able to physically prompt the child. This means that sometimes the expectations need to be altered to accommodate. For example, the schedule of reinforcement might need to be thickened (aka increased), to keep the child motivated and attending.

One of the benefits of virtual therapy is that there is no traveling required, so you don’t have to fight your child to get into the car!

Boy sitting at a desk with a tablet doing virtual ABA Therapy.

Is virtual therapy right for your child?

Things to consider before virtual therapy:

  • Does the therapist have experience delivering virtual therapy?
    • While the principles of ABA remain the same, the therapist will be using different tools and should also have a good grasp of the technology they’re using (Zoom, Teams, Google Meet).
  • What will the goals of therapy be?
    • As always, virtual therapy goals should be based on a thorough skills assessment.
    • The goals should be flexible taking the new teaching style into account.
    • Include mastery and revision criteria for each goal.
  • How long will the sessions be?
    • Having shorter more frequent sessions might be ideal for your child.
  • Do you have reliable technology?
    • You will need a computer or a tablet with a camera and a mic.
    • You will also need a stable high speed internet connection.
  • Does your child require a prompter to sit with them?
    • Some children can be entirely independent for the entire session while some need support setting up the technology. Others still require a prompter for the entire session.
    • Does the prompter need ABA training?

Virtual therapy was a lifesaver for many families during Covid19. However, many were not able to access virtual services because they were not appropriate for their child. Hopefully virtual therapy will continue to be available for those clients who benefit from it. Learn more about Side by Side Therapy’s virtual ABA program today.

What makes ABA effective?

June 13, 2021

Many families ask “What makes ABA effective?” when they’re starting their autism therapy journey. This post will describe a number of the factors and things that make ABA an evidence based approach.

Why is ABA an Effective Intervention Method for Autism?

Autism is a neurological condition that is often diagnosed in children under 5 years. Autism is a spectrum disorder meaning that it affects each person differently. There is no cure for autism. However, there are evidence based interventions like Applied Behaviour Analysis (ABA) that can help autistics (and really everyone else too!) learn necessary skills.

Autism affects the way the brain processes information. It can make learning new skills hard. Common teaching strategies often are not enough. The areas that autistics find challenging are: social communication and repetitive, restricted and stereotypic behaviours.

The autistic child’s specific needs should be at the forefront of an ABA program. Therefore, the therapist chooses the targets and programs based on the child’s current skills. Also, the teaching procedures are specific to the learner.

Teaching is a slow process.

This is where ABA comes in. ABA is a very thorough science. In straightforward terms, the objective of ABA is to utilize strategies to reduce unwanted behaviours and increase helpful behaviours.

ABA can be complex to implement. Because of the way autistics learn, achieving and maintaining skills often requires consistent and intensive intervention. Some children require 1 on 1 intervention while others require small groups to master their skills.

ABA can be used to teach any skill. The basic idea is to break down a skill into small steps and teach each step until the entire behaviour is mastered. Another important aspect of ABA is using reinforcement or rewards to encourage a behaviour to happen again. Generally, in the beginning, reinforcement has to be tangible, meaning that the person can touch and hold it, for it to be effective. The end goal is to reduce the frequency of reinforcement and to make it naturally occurring (think social praise instead of screen time).

These things and more are what make ABA effective.

Source: Special Learning Inc.

Therapist at a computer with a child. This individualized dynamic is what makes ABA effective.

Is there evidence that shows what makes ABA effective?

What is the evidence that ABA works?

According to the National Clearinghouse on Autism Evidence and Practice, ABA is an evidence based intervention. Evidence based means that ABA has passed scientific reviews of its uses, its effectiveness and if it can be replicated. ABA Therapy includes many different techniques.  All of these techniques focus on antecedents (what happens before a behaviour occurs) and on consequences (what happens after the behaviour). 

More than 20 scientific articles have been published that have proven that ABA is effective. Most of the research has focused on intensive, long term programs (40+ hours/week of therapy for 2+ years). However there is newer research coming out that demonstrates very clearly that focused ABA (limited number of hours each week for a shorter duration) is also very effective.

ABA is effective in many ways. However, it’s not effective for all skills and all children and families. That’s why an interdisciplinary team is so vital. Each discipline brings a lot to the table. At Side by Side Therapy, we believe in building a team that will be most effective for the child and family.

Two kids playing on the floor with blocks.

Parents of children with autism or other special needs often have a very difficult time helping their child overcome their challenges. We work as a trans-disciplinary team to create individualized, functional, evidence-based interventions that teach these missing skills. As a result, the family achieves an improved quality of life. 

What Can An OT Do For My Autistic Child?

May 30, 2021

Is your child autistic? Did their doctor recommend occupational therapy? Then you’re in the right place. Read on to find out what can an OT do for an autistic child.

What is occupational therapy?

What can an OT do for my autistic child?

Occupational therapists help autistic people using evidence informed strategies. OTs can also help to change or modify the environment to help the autistic person be as successful as possible. They will do an assessment that determine skills needing improvement and what changes should be made in the environment. Increasing independence is at the heart of most OT interventions. OTs take these areas into account when designing an intervention: physical, social, emotional, sensory, vocational and cognitive.

Source: National Autistic Society

What does an OT do?

An OT will assess the child’s skills in some or more of the following domains: fine and gross motor, activities of daily living, sensory functioning, social skills. OTs use standardized assessments. The therapist will develop an individualized treatment plan for the child. Occupational therapy sessions can take place in almost any setting (daycare, school, home, clinic or hospital). Often, OT sessions are an hour long. Some goals can being targeted in group therapy (eg.: social skills) while some need individual attention (eg.: toileting).

Most kids love OT. That is to say, OT sessions are fun and are driven by the child’s interests. In other words, knowing the child’s strengths, needs and interests is a key element in good therapy.

Child during an OT session for autistic child.

What should you consider before beginning OT?

What questions should you ask before beginning OT for your autistic child?

  1. Who will be working directly with my child?
  2. How many years they been working as a OT?
  3. Where will the services take place?
  4. How often will therapy occur?
  5. What are the goals of therapy for my child?
  6. What real-life skills will my child learn?
  7. How do you help with sensory issues?
  8. How is progress measured?

The therapist should be able to answer these questions easily. Above all, you need to feel comfortable with their style and perspective.

Source: Autism Speaks

How do you pay for OT services?

Is OT covered by insurance?

Some extended health plans have occupational therapy coverage. However, each plan is different and will have specific rules and qualifiers. You should ask your plan administrator to be sure. Also, make sure to ask when your benefit year renews to make the most of the benefits!

Does OHIP pay for OT?

The Ontario Health Insurance Plan covers OT services when it is provided through:

  • Hospitals and rehabilitation centres,
  • Family Health Teams,
  • Assertive Community Treatment Teams,
  • Community Health Centres,
  • Local Health Integration Networks (LHIN) that provide access to OT for eligible clients in their homes, schools, or long-term care facilities.

There are service limits with each of these programs. More information can be gathered from the service coordinator of the program or with the OT providing your treatment.

Source: Ontario Society of Occupational Therapists

Kids during an OT session for autistic children, playing on skateboards.

What is sensory processing?

How does an OT help with sensory processing?

Sensory processing is our body’s ability to understand the information it’s getting from the environment. Teaching sensory processing is one of the things an OT can do for an autistic child. Autistic people are often over or under sensitive to their environments. For instance, they might be very sensitive to loud noises or not appear to be hurt easily. An OT will help your child identify which strategies will help them get their sensory system working in top shape. Subsequently, the OT will teach your child to identify when to use these strategies and to do them!

Source: Harkla

What is a sensory diet?

A sensory diet is a specific routine of activities that helps regulate the child’s sensory systems. Children will run through the activities at predetermined times to help them prepare for the coming activities.

Sensory diets:

  • Restructure a student’s nervous system over time so that he is better able to tolerate sensations and situations he finds challenging/distracting
  • Regulate their alertness and increase attention span
  • Limit sensory seeking and sensory avoiding behaviours
  • Handle transitions with less stress.

Source: National Autistic Society

In conclusion, there are myriad ways that an OT can help an autistic child. At Side by Side Therapy, we work as an interdisciplinary team to combine our skillsets to achieve the maximum potential for each child. Our ABA Therapy teams work closely with the SLPs and OTs to create well balanced programs that propel the child towards their goals.

What does masking autism mean?

May 17, 2021

Camouflaging or masking in autism has far reaching effects on the person. In this post you’ll discover what masking is, what effects it has on the person, why it is damaging and how to avoid it in future children.

What is masking in autism?

Masking is when an autistic person behaves in a way that is unnatural to them in an effort to seem more ‘neurotypical’.

Why would someone mask autism?

There are some simple reasons that people would mask their autism. In general, people fear things that are different. While some celebrate difference and diversity, many are unkind to those they don’t understand. It is only natural to try and hide your true self when you’ve been punished or bullied. Many autistics describe masking to fit in. However, this behaviour doesn’t stop in childhood.

There are 4 times more autistic males than females. Recently, there has been a lot of discussion if autism is really more common in males or if females are more skilled at (and more likely to) mask their symptoms. Female autistics are often diagnosed at later ages, potentially because they’ve been masking their autism symptoms. Many female autistics report only discovering their diagnoses when their own children were struggling. These women simply believed that they were different and needed to pretend to be ‘normal’.

Autistics who mask have said that it has helped them get friends and jobs. Unfortunately, masking autism has many negative downsides.

Image of a woman looking at herself with a negative reflection. Representing masking autism symptoms.

Outcomes of masking

While having friends and getting jobs might seems like excellent reasons to mask autistic symptoms there are many downsides. Autistics who mask report higher incidences of depression and anxiety. They internalize that who they are inherently isn’t good enough. That’s a horrible feeling to have. It can lead to all sorts of other problems. Some autistics relate regressions or loss of skills to masking.

Another really damaging downside of masking autism is that it leads to late diagnosis. Children aren’t receiving the help they need early on because they’re pretending to be someone they’re not. Not accessing early intervention services will have lasting impacts on the person.

Acceptance of neurodiversity: a path forward

There has been a recent explosion of awareness of autism in North America. Most people know at least one autistic person. However, this isn’t enough to inhibit people from masking. Awareness isn’t nearly enough. We have to embrace neurodiversity and create acceptance and equity in the same way we do for other differences.

Some behaviours have to be targeted (because they’re dangerous). However, most ‘typical’ autistic behaviours don’t need to be addressed. If we created a world that was accepting of difference, it wouldn’t matter that the person didn’t look at your eyes for extended periods of time, or talk about the topics that interest you. We would recognize and celebrate the intrinsic value that each person brings to our lives.

Autism Severity Levels (DSM-5) in 2021

May 3, 2021

Read time: 4 minutes

When your child gets an Autism Spectrum Disorder diagnosis there is an avalanche of information. What do the autism severity levels mean? Many families have asked me this question. Some families have a lot of support. However, some are sent on their way with a one page diagnosis letter. If you’re looking to have your child assessed here’s a list of the ways you can get a diagnosis in Ontario.

What is the DSM-5?

The DSM-5 is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The American Psychiatric Association (APA) released the DSM-5 in 2013. It is where a doctor or psychologist finds the description and criteria of all of the disorders and behavioural conditions. As medical knowledge changes the APA releases updated versions of the DSM.

With the release of the DSM-5, one of the major changes to the autism section was the combining of the communication and social impairment criteria. Another change was adding the severity levels.

What are the autism severity levels?

One of the most confusing elements of a diagnosis is the severity levels. Instead of using high and low functioning, which are ambiguous, we use the severity levels. Severity levels create a common language. This is important so there’s a standard and we all know that we’re talking about the same thing.

There are 3 levels: Level 1 is equivalent to requiring support. Level 2 implies requiring substantial support. Level 3 denotes requiring very substantial support. A person can have different severity levels for each of the elements of autism. For example, a person can be Level 1 in social communication but level 2 in restrictive, repetitive behaviours.

Father walking with daughter along the street. Autism severity levels aren't clear.

How are they used?

The severity levels do not determine funding eligibility. But this might change as the province implements needs based funding. Above all, individual assessments should inform treatment decisions. Certainly, a therapist might use a severity level to pick which assessments to do. Severity levels give a glimpse of what the focus of ABA Therapy might be. That is to say that clinicians might use severity levels in guiding treatment planning.

Can autism severity levels change?

Absolutely!

As children grow and learn their needs will change. In other words, the amount of support the person needs will change depending on the environment and expectations. People are complex. That is to say there are many factors that impact their behaviour and the support they need. Often, removing one barrier can improve other areas as well. For instance, improving a child’s communication skills can (and usually does) reduce challenging behaviour.

If you have questions about your child’s diagnosis or autism severity levels and how an ABA Therapy program can help, contact Side by Side Therapy to set up a no charge consultation.

Autoclitics: 4 Things to Know in 2021

April 19, 2021

This is the last blog in our series about Skinner’s verbal behaviour. If you haven’t already, you should read the other posts about Manding, Echoics, Tacts and Intraverbals. This post will be about Autoclitics.

Skinner created the verbal operants which are: 

  • Echoics
  • Mands
  • Tacts
  • Intraverbals
  • Autoclitics

What Are Autoclitics?

Autoclitics are a complex verbal operant. They function to modify or give further detail about the meaning of the other verbal operants in a sentence. There are 4 types: descriptive, qualifying, quantifying and relational. If you’d like to read more about the different types of autoclitics check out this website. Autoclitics give information about the other parts of the sentence. For example in the sentence “I think that it’s going to snow tomorrow.”, the phrase ‘I think’ is an autoclitic because it refers to the certainty with which it might snow tomorrow.

How Do We Teach Autoclitics?

Once the other verbal operants have been acquired and are consistently being used appropriately, it might be appropriate to teach this new verbal operant. The research is still out on the best way to teach them. What we do know is that it’s important not to teach them too early. Learners need to have very robust mand and tact repertoires before we begin introducing autoclitics. One strategy to teach them is to establish parity. That means to model appropriate use of autoclitics and their meanings. One way to avoid rote responding is to avoid teaching carrier phrases (e.g.: “I want”, “I see”, “I hear” etc). By teaching multiple component mands the child will be better equipped to use autoclitics.

How Long Will It Take To Learn To Use This Verbal Operant?

Each learner has a their own pace. It’s not possible to predict how long it will take a learner to master a skill. However, it is clear that with solid foundational skills and lots of practice it is possible to master most skills.

Two girls laying in the grass, reading and talking using autoclitics in their language.

Why Do We Teach Autoclitics?

Understanding this type of verbal operant and using it correctly will enhance a learner’s ability to communicate. By understanding the speaker’s meaning more clearly they will be better positioned to respond to mands and tacts. An ability to use autoclitics in a learner’s speech allows them to be more clearly understood and helps others to act on their mands and tacts.

If you’d like to discuss your child’s language program, please connect with us at Side by Side Therapy to learn more. We offer ABA Therapy programs and Speech Therapy to help maximize your child’s language skills.

Strategies used in ABA: Top 5!

January 18, 2021

ABA uses a number of different strategies. Way more than 5, but here are 5 of my favourite (in no particular order). 

Strategies used in ABA

Prompting: 

Cues or hints that help the learner know what they should do are called prompts. They can be either visual, verbal or environmental. There are prompt hierarchies that organize the different levels of prompts based on how much support they give the learner.  The goal is to reduce the level of the prompt so that the learner is eventually independent. Most learners need some kind of prompting when learning a new skill. It is possible for the learner to become dependent on the prompt.  This happens when the prompts are not methodically faded out.  The learner never moves past the stage of requiring the prompt in order to engage in the behaviour. 

Behaviour Contracts:

Behaviour contracts are like other contracts.  They spell out the expectations and what will happen if they occur or don’t occur. The Behaviour Analyst and the learner both agree to the contract. A behaviour contract is a collaborative effort. It’s not one sided. The learner has to have a stake in the contract or else they won’t participate. Here is an example of a behaviour contract. Both the learner and the BCBA write and sign the behaviour contract. Behaviour contracts are a great ABA strategy for older learners.

Teacher working with student using ABA strategies.

Reinforcement: 

Reinforcement makes a behaviour more likely to happen again in the future. There is positive and negative reinforcement.  Many people get negative reinforcement and punishment confused. But, they’re not the same! In ABA terms, positive and negative don’t have the same meaning as in regular english. Usually, we assume something positive is good and something negative is bad. In ABA, positive means adding something and negative means removing something.  So… positive reinforcement is adding something to the environment that makes a behaviour more likely to happen. Meanwhile, negative reinforcement is removing something from the environment that makes a behaviour more likely to happen. Some examples of positive reinforcement are: praise, a high five and extra time to play. Some examples of negative reinforcement are: being excused from the dinner table after eating a specific amount of food or turning off your loud alarm clock. 

Video Modeling: 

Some learners are visual, they learn by watching. Video modeling is showing the learner a video of people engaging in the behaviour. Video modeling can teach all kinds of behaviours. Social exchanges are a very popular video modeling topic.  Video modeling is popular strategy outside of ABA also.  Have you ever gone to YouTube to learn how to do something? That’s video modeling.  One of the benefits of video modeling is that the learner can watch the video many times. They can stop it and rewind to review and ask questions.  Video modeling is especially useful now, during the pandemic while in person instruction might not be possible. 

Task Analysis:

One of the keys to ABA is breaking big behaviour chains down into smaller more manageable steps; this is task analysis. To do a task analysis you first need to identify the target behaviour. Once you know the target behaviour you identify each step in the behaviour chain. When you’re ready to teach, there are three processes you can use: forward chaining, backward chaining and whole chain. These processes determine how you will be prompting the learner when you’re teaching. For example, in a forward chain, you would teach the first step but prompt the rest. Alternatively, in a backward chain, you prompt each step except the last. As your learner masters the steps you move either forward or backward on the chain.  In a whole chain approach, you’re looking at whether prompting each step is needed. 

Conclusion

These are just 5 of the strategies that are common in ABA. There are many more. You can use any combination of these strategies. Each ABA program should be individualized and designed specifically for your learner. BCBAs are the people who are best trained to design ABA programs. 

Why is ABA Therapy so expensive?

November 23, 2020

Read time: 3 minutes

Imagine you’ve just been told your child has autism spectrum disorder. You rush home and start googling. You find that Applied Behaviour Analysis or ABA Therapy is the gold standard treatment for autistic children. You’re sold. That’s what you want for your child. You call some providers. You make a few appointments. At the first consultation, you ask about the cost of therapy.  The therapist explains that the fees are per hour and the total cost depends on the number of hours of therapy per week.  Oh, and don’t forget the cost of supervision (wait… what’s supervision?). At the second consultation the therapist explains the same thing, but adds on an ‘administrative fee’ that’s paid yearly. You rush home and start googling… again. Why is ABA Therapy so expensive? 

Mother researching ABA Therapy for autistic child.
Photo by Anastasia Shuraeva on Pexels.com

Here are 6 reasons ABA Therapy is costly:

Federal & Provincial reasons:

  • To begin with, Ontario doesn’t regulate Applied Behaviour Analysis.  Most of the other disciplines that work in autism treatment have regulatory colleges (Psychology has the College of Psychologists of Ontario, Speech has the College of Audiologist and Speech-Language Pathologists of Ontario, OT has the College of Occupational Therapy of Ontario etc). Nothing similar exists for Behaviour Analysts. Because there’s no regulation, getting services for your child can be like the wild west. There is the Behaviour Analyst Certification Board, but they’re not a regulatory body. 
  • Moreover, ABA isn’t considered a medical intervention and isn’t covered by OHIP or private health insurance. Again, this goes back to the lack of regulation. Considering ABA Therapy as medically necessary would mean that the government would fund it and insurance companies would pay for it. There is a movement to make autism therapy medically necessary. This change would mean that the federal and provincial governments have to fund autism therapy (ABA, as well as others like Speech, OT, Physio) at the prescribed dose. The prescribed dose would be different for each child, depending on their needs.
  •  Lastly, there aren’t enough clinicians for all the children who need them. System capacity is a big problem in Ontario. We’re in a bit of a catch 22. There aren’t enough clinicians. However, lowering the training standard for future clinicians isn’t an option. Children and families deserve the best therapists possible and that takes time and investments in education and training from the province. 

Structural Reasons

  • Many ABA Therapy programs are 1 on 1. You could be paying one person’s entire yearly salary. Group programs are less costly because the salary of the clinician is divided between the people paying for services. Some children can learn in a group setting and some just can’t.  
  • There’s more than just the therapist who works with your child. In most cases, an Instructor Therapist (IT) /Registered Behaviour Technician (RBT)  is doing the direct treatment with your child. One or two levels of clinical supervisors guides the ITs work: a Senior Therapist (ST) and a Board Certified Behaviour Analyst (BCBA) or Psychologist. Most Instructor Therapists have a college diploma or a bachelor’s degree related to ABA. Also, most Senior Therapists are working towards becoming BCBAs and have many years or experience doing ABA in a variety of settings. To become a BCBA you need to have a masters degree in ABA, complete 2000 hours of work experience and write a board certification exam. Having the layers of supervision is a way of cutting down the cost to the family (as backwards as that sounds). Most Instructor Therapists do not have the skillset to assess and design the intervention plan. However, most families do not want to spend their money on having the BCBA deliver the intervention. This is because the BCBA’s hourly rate is often 3 times higher than an Instructor Therapist. 
  • In addition, every ABA Therapy program is individualized for the child. This takes time and expertise. The basis of ABA is data analysis. And the IT, ST and BCBA should be spending time analysing the data, finding trends and making changes to ensure learning. Also, many therapists make teaching materials that are specific for the child. For example, if teaching colours and the child really likes the movie Cars, perhaps using pictures of the characters would be motivating. This individualization helps increase the rate of learning.  

Conclusion

There are a number of reasons that ABA Therapy costs as much as it does. These are just a few. Changes are needed. They will benefit the field and the children and families that access ABA services. Financial means should not be a barrier to receiving the best treatment. 

Autism in Ontario: What funding is available?

November 16, 2020

This will be the first instalment in a series about the funding for autism families in Ontario.

I’ve worked in the field of Autism and ABA therapy for 16 years. I’ve worked with a lot of children under different funding circumstances. Some (few, very fortunate) families have the means to pay out of pocket for the services that their child needs. Most families rely on provincial and federal funding to pay for therapy and other services that their child requires. When the funding is used up services are often put on hold.

According to a report released by the Ontario Association for Behaviour Analysis, the cost of supporting a child with autism can range from $26k to $130K per year.

Having my own therapy services company has allowed me to see the heartbreak of a family pausing services. Services that were improving their child’s life. Services they just cannot afford. We offer a sliding scale, we work with families to figure out payment plans, we advocate to the government. Sometimes families just don’t have another option and pausing services is necessary.

Mom sitting at desk, worrying about her child's Ontario Autism Program funding.

What autism funding is available to families?

There are a few different programs that cover some of the cost of raising a child with autism. Right now, families in the province can apply to the Ontario Autism Program for funding for their children with autism diagnoses. The funding allotments are based on age. With children under 5 years old receiving $20K and children over 6 years receiving $5K. In August, I wrote a short blog post about the OAP‘s history. The government claims to be working (but this post isn’t about politics!) towards implementing a needs-based funding model. Needs-based funding gives families the funding they need to get the therapy their child requires. Side by Side Therapy offers excellent ABA Therapy near me.

Special Services At Home (SSAH) is a provincial program that helps families pay for services both inside and outside of the home. The amount of funding that each child receives is based on what their needs are, what other services they are accessing and other available community resources. SSAH funds are meant to aid families in two broad areas: personal development & growth and respite. Also, there have been changes to the SSAH eligible expenses due to Covid19.

Assistance for Children with Severe Disabilities is a fund for low to moderate income families who have a child with a severe disability. The funds provide financial relief for families raising a child with a severe disability. The amount of funding received depends on the size of the family, the family’s income, the severity of the child’s disability and the costs associated with raising the child.

What else is out there for autism families?

Disability Tax Credit (DTC) provides tax relief to a person with a disability or their parents (if under 18) to account for some of the cost of living with a disability. To qualify, a medical practitioner has to complete a form that states that your disability is severe and prolonged.

Registered Disability Savings Plan (RDSP) is a savings plan that helps parents or others save for the future of a person with a disability. Withdrawals made from an RDSP they are not considered taxable. The beneficiary of the RDSP must qualify for the Disability Tax Credit.

Canada Disability Savings Grants (CDSG) is a matching program offered by the federal government. They will match your deposits up to 300% (Based on your income and your contribution). You must have a RDSP to qualify for the grants. Canada Disability Savings Bonds (CDSB) is the money that the Canadian government contributes to the RDSP’s of low and modest income families. You can receive up to $1,000/year with a maximum contribution of $20,000. The amount you receive is dependent on your family’s income.

Autism Ontario has some one to one worker reimbursements available for families. The child’s name is entered into a draw when the application and proof of diagnosis are submitted. Approximately 500 children receive the grant each year.

Jennifer Ashleigh Children’s Charity is available for families experiencing financial pressures of raising a child with special needs. The fund covers a variety of things from emergency costs to housing costs incurred while caring for your ill child. They also cover some therapies.

Conclusion

A parent pointed out to me that perhaps it isn’t the number of funds or the amount of money that’s available that is lacking in our province. But rather that the application process is too difficult and too confusing for many families. Come back soon to read more about the funding in Ontario.

How to use visual schedules to reduce challenging behaviour

November 9, 2020

Visual schedules can help an autistic child be less anxious. They present daily activities, as well as the sequence in which these activities will unfold. A high level of predictability brings comfort and will even reduce challenging behaviour. 

Depending on the child’s developmental level, the schedule can be made with photographs, drawings or pictures. Sometimes they can have written words or actual objects. The schedule can be displayed on a wall or on paper. For children who go to school, the schedule can be placed inside a notebook. 

Also, parents can add a todo list to each activity. This shows all of the steps the child needs to take in order for a specific task to be completed. 

Are visual schedules effective at reducing challenging behaviour in autistic children?

Yes. According to a study published on solutions to decrease challenging behaviour, the use of activity schedules can help children who have been diagnosed with autism spectrum disorder. 

The study showed that visual schedules worked for children with difficulty following rules. The authors point out that visual schedules promote self-regulation and independence.

The introduction of a visual schedule is particularly important when it comes to children who have academic demands to meet. These children sometimes have difficulties meeting these demands, and this is where the challenging behaviour commonly occurs. The visual schedule can reduce the stress experienced by parents as well as promote learning and cooperation in children. 

Example of a visual schedule on the wall of a classroom.
autism aba therapy lindsey malc side by side therapy visual schedule

Why should you consider visual scheduling? 

Visual schedules offer the perfect opportunity to teach an autistic child to complete the required activities in a day. Thanks to the todo list, you can break down a task into smaller steps, which are easier to complete. Small steps are easily achieved and provide opportunities for more frequent reinforcement.

Visual schedules offer to the child one of the things they look for the most: predictability. As they will learn to use the schedule, they will often become less anxious. Moreover, by using prompts and reinforcement, as you have been taught by your Board Certified Behaviour Analyst, you can decrease resistance and escape maintained behaviours. 

In simple terms, you can see the visual schedules as a constant reminder for your child. They will know exactly which activities to complete every day and where they will occur. Most importantly, they will know the order in which things will happen. . 

How to use visual schedules to improve your child’s behaviour 

As with any new intervention, you should expect for the child to resist the introduction of a schedule. Practice together, using plenty of praise and reinforcement.

Be patient and give your child the time they need to become comfortable with using the schedule. Keep in mind that some time might pass before they accept the visual prompt, following the routine as expected. At first, offer schedule check reminders frequently.

In time, and after plenty of practice, the child will indeed turn to the schedule, enjoying its predictability. The interesting thing is that, by predicting and in turn enjoying the activities you have included on the schedule, your little one will have fewer opportunities to misbehave. 

Be sure to acknowledge the efforts the child is making in following the schedule. Use simple phrases like “good job checking your schedule” or “nice work keeping up with the to do list”. You can give your child thumbs up, offer a smile or offer a hug. What matters is that you recognize they are trying, celebrating even the smallest achievement together.

You can try adding a preferred activity at the end of the schedule alternatively, so that he/she will understand that he/she can engage in that activity once everything else has been completed. Offer options to children who are able to choose; if your child has trouble making choices, select an activity you already know he/she enjoys. 

Will visual schedules bring a difference to our daily routine?

Once again, the answer is yes. The child will learn to follow a simple schedule, becoming more organized as a result. He/she will thrive from knowing what lays ahead, no longer feeling confused. The familiar routine presented through visual aids will genuinely reduce the level of anxiety your child feels.

Using visual schedules will help your child make transitions between activities as well as between tasks within an activity. By using the todo list, and presenting the child with the exact steps to follow for an activity, you will reduce the risk of inattention and/or misbehaviour.

Using a visual schedule will give your autistic child a better chance to succeed. Challenging behaviour meets an unmet need that your child is experiencing. Challenging behaviour can be attributed to one of the 4 functions of behaviour.

What is Social Communication?

November 2, 2020

Read time: 3 minutes

Autistic children face challenges daily, and social communication is one of the most difficult to conquer. What is social communication? Challenges in social communication are associated with autism diagnosis. However, each child is unique and is impacted to a different extent. Some children may  start an interaction, while others will prefer their peers initiate the exchange. While autistic children might show an interest in engaging with others they can still have challenges.

Don’t make the mistake of believing that autistic children do not want to interact. The key here is to support them in interacting with their peers, offering tools for adequate communication. 

Social communication is a group of skills that include both verbal and nonverbal communication, social interaction and understanding others (Children’s Minnesota) . Many people just seem to have this skill naturally. Autistics often need direct teaching in order to master this skill. 

Why is social communication difficult?

The first thing we have to remember is that many autistic children need support in learning how to communicate. Some of them may not respond when talked to while others require a bit of time to plan an answer.

Eye contact is a major issue. In our society, eye contact is a very important behaviour.  A lot of value is placed on looking ‘someone in the eye’ or showing that you’re paying attention by maintaining eye contact. Many autistic children avoid it altogether, while others find it uncomfortable.

Eye contact used to be considered an essential goal.  However, recent research and an effort to include the voices and experiences of autistic adults has decreased the value and necessity of these types of goals.  Many clinicians are adopting an approach that teaches replacement behaviours that meet the same goals as eye contact. For example, one of the biggest reasons people give eye contact is to convey that they are paying attention and understanding the other person.  Alternative behaviours, such as turning your body to the speaker, nodding, saying words like “I see”, “I know what you mean”, “I get it” all convey the same message and do not require eye contact. 

While a typical child will learn through imitation, an autistic child will likely need explicit teaching. It is important not to give up and consider the child’s point of view. If he/she cannot communicate his/her own wants and needs, frustration can easily build up.

Things to work on in therapy

Social communication represents one of the main therapeutic objectives in many ABA Therapy programs. Depending on the age of the child and his/her developmental level, the therapist will teach the child how to interact with others and interpret their behaviour correctly. With older kids, one might also work on teaching the effect one’s own behaviour has on others.

Therapy will involve teaching the child to recognize and understand social cues. As mentioned, these children do not show these behaviours instinctively and they need to learn how to adjust their behavior to fit each social context. 

Language is a huge part of social communication. Using social situations, the therapist will work on both the expressive and receptive language. Taking into account the potential of the child, they will work not only on verbal communication but also on body language and facial expressions. He/she will also teach the child to adapt his/her tone of voice when possible.

Two girls engaging in social communication, sitting on the ground in a forested area.

It is a fact that autistic children often take things literally, which can lead to frequent misunderstandings. For this reason, when appropriate, therapy will include teaching the child to understand figurative language, including metaphors.

How will therapy help improve social communication?

While the beginning might be slow, over time the child will develop their abilities to interact. They will become more confident, seeking interaction with peers. Improving social interaction skills will remain a primary aim throughout all therapeutic sessions.

As in all ABA programs, each objective will be broken down into manageable steps. Often, the therapist will provide visual support and plenty of opportunities for the child to practice the newly learned skills. Positive reinforcement makes the behaviour more likely to happen again and it has the added benefit of boosting the child’s confidence.

In time, and provided the child’s development allows it, the therapeutic objectives can become more complex. Autistic children can learn to interpret subtle non-verbal cues and also to recognize emotional responses. They can master conflict resolution and pick up the best ways to develop friendship skills. Social Communication therapy can be funded by the Ontario Autism Program.

What about non-verbal children?

Non-verbal children can communicate using various strategies, but they will need help. The therapist can teach them to use gestures or sign language to communicate and introduce augmentative and alternative communication systems.

Some autistic children might never speak. But this does not mean the gate to social communication is shut. They still have plenty of opportunities to communicate with their peers, and it is up to the therapist to find the best solution for a non-verbal child.

Conclusion

While we can improve social communication in therapy, it is also important to educate people on the challenges autistic children face in this area. It is all about accepting differences and meeting these kids on their level, welcoming and honouring any form of communication and/or interaction.

Early #Autism Diagnosis: Key to Successful Intervention

October 25, 2020

The signs of autism can become noticeable around the age of 18 months. Despite this, on average, autistic children receive their diagnosis at age 4 or 5. The delay is often deliberate, hoping the child will grow out of his/her condition, or to avoid labels, such as “autistic”. Getting an early autism diagnosis for your child will only benefit them.

Unfortunately, the delay in the diagnosis equals lost years of intervention. No child recovers on his/her own from autism. It takes a lot of effort, therapy and a transdisciplinary approach to enhance the quality of life for an autistic child. The earlier the diagnosis, the more time that child will have to reach their full potential.

Taking advantage of the brain’s neuroplasticity 

The human brain possesses an incredible ability called neuroplasticity. Basically, neuroplasticity refers to our brain’s ability to adapt and change. The brain can learn and grow to overcome challenges. If a specific part of the brain is damaged or not working correctly, it can develop ways to work around the deficits. Autistic children need to start therapy as early as possible and take advantage of this ability in our brains. The older the child, the more difficult it will be for their brain to change and adapt.

To understand how beneficial early diagnosis in autism is, try not to think of the brain as a static organ. The complex organ is more flexible than we might think, adapting over time and compensating for lost functions. Regular therapeutic interventions, like ABA therapy, can help the autistic child’s brain build new pathways. 

Black toddler smiling playing with toys in a white room during an early autism diagnosis.

Early diagnosis, also beneficial for parents

Parents are usually the first to notice that their child isn’t developing as expected. Getting an early autism diagnosis can relieve distress and help parents focus on next steps. They can seek early intervention, form a support network and they can access several benefits, such as the Registered Disability Savings Program.

Taking your child to a doctor for an assessment is the first step to getting them help. Under the guidance of autism specialists, you will come up with an intervention plan and help your child learn.

Starting therapy from a young age

With autistic children, the key word is “early”. The earlier autism diagnosis and the earlier intervention, the more of a difference it will make. In therapy, the child can develop social and communication skills, and work on challenging behaviours. They will learn new skills and become more independent.

An autistic child who goes to therapy from a young age can develop their strengths, and work toward a better life quality. A diagnosis made within the first three years of life offers the best long-term outcome. Most parents only seek intervention after receiving the diagnosis, but your child can go to therapy before that. You can address worrying signs and work on teaching skills. Reach out to us at Side by Side Therapy to hear about the Early Start Denver Model, an ABA/developmental approach to teaching children with or suspected of autism.

Warning signs of autism

Each child is unique. The warning signs might differ and they might be present at various levels. 

Even though you might notice the following signs, getting an accurate diagnosis is vital. Only a specialist can determine if your child has autism and point you in the right direction. If your child gets a diagnosis, they will have access to services and programs that would otherwise not be an option.

Warning signs of autism:

  • Lack of facial expressions, child does not smile 
  • Limited or absent eye contact
  • Speech delays (no words by 16 months, no two word combinations by 24 months)
  • Does not respond to his/her name
  • Loss of previously gained skills 
  • Does not point to items of interest
  • Does not like changes (routine, environment)
  • Stereotypical gestures
  • Prefers to play alone, does not engage in pretend play
  • Echolalia (persistent repetition of words/phrases, heard recently or in the past).

Early diagnosis, the first steps of the journey

It’s hard to find out that your child has autism. But the diagnosis will give you clarity of mind and help you take the first step of the journey. Together with autism therapists and a powerful network of support, you will create a path forward for your child.

Trust your instinct, especially if you have noticed one or several warning signs. Do not wait until your child is older. Go to a specialist now. 

Autistic Teenagers and Adults Getting Jobs

October 5, 2020

Read time: 2 minutes

An autism diagnosis should not stop anyone from being a productive person and bringing his/her contribution to society. Both autistic teenagers and adults can get jobs, but they will likely need more support to achieve their goals.

Woman standing on a ladder spray painting words related to autistic teenagers and adults finding jobs.

Whether a teenager looking for his/her first job or an adult who already has some experience, there are two things to remember.

  1. You should have a job you want, one that brings you a sense of purpose.
  2. You should consider both your abilities and potential challenges.

Employment as an Autistic Teenager

If your autistic teenager is on the lookout for his/her first job, there are plenty of things you can do to help. Have a discussion about potential interests, suggest where to search for a job. When suggesting jobs, take his/her strengths into account. For instance, some people prefer working alone on the computer, while others might like routine tasks.

As the parent, you are the one who knows your child best. You know what he/she wants and what he/she would be successful in. Consider both these aspects when thinking about employment goals. Talk to the career advisor at school about things that he/she should do first, such as vocational training, internships or volunteer work.

You can help by listening to what your teenager has to say. Offer encouragement but make sure his/her goals stay realistic. Work to develop a support network which might include people capable of understanding challenges that he/she needs to overcome. School teachers, family friends or other professionals can be part of this network.

Whether in ABA therapy or at home, work on developing communication and social skills. Seek opportunities for organized activities, such as teams and clubs, as these will help your teenager prepare for a real job. Use role play to practice for job interviews, teaching your child to make eye contact, smile or shake hands with a potential employer. 

Seeking Employment as an Autistic Adult

Having this diagnosis makes job hunting more stressful. However, if you are organized and give it your best, you might end up where you desire. The first thing to do is think about what you are best at and what you like to do. Where do you see yourself? 

As access to the job market can be difficult, it might help to work with a vocational counsellor or career advisor. This person can offer you the support you need, coaching you to pursue your desired field. He/she can become part of your personal network, joining family, friends or other people who know you and want to help you. 

Even though this is not something you might feel comfortable with, social networking can pave the way for finding great job opportunities. In applying for various jobs, be sure to highlight your abilities and not the things you feel less certain of. Keep going to therapy to practice communication and social interaction skills, and find effective ways to manage job-related anxiety. 

Access Employment Programs

There are employment programs for autistic adults, which offer work experience placement and free support. Check out Reach Toronto or Ready Willing & Able. If you are not interested in these, you can pursue regular jobs. It is up to you whether you want to disclose your diagnosis. But it might help to speak about who you are, your goals and challenges. The job you choose should match your strengths.

Your resume should include a detailed work history, even if you only did internships or volunteer work. At home, be sure to practice your interview skills. You can organize a mock interview together with a friend or a family member. Sometimes it helps to watch videos of other people doing interviews. Choose jobs that you will feel comfortable doing, who bring you satisfaction, so you feel that you are bringing your contribution to society.

The world changes one step at a time

There are limited employment opportunities for autistic teenagers and adults. Statistics show that. But nothing happens overnight. Find the courage and pursue jobs, teaching potential employers to see beyond your diagnosis. Every individual is a valuable person who has something to offer, including in the professional domain. Always show potential employers what they stand to gain by hiring you and never give up! It is possible for autistic teenagers and adults to get jobs

New diagnosis of autism? The most powerful things to do now.

August 2, 2020

Read time: 4 minutes

When your child get a diagnosis of autism, your world seems to dramatically change in the seconds before and after the words have been said. I have spoken with many parents who were simply not expecting the diagnosis when they went in for the assessment.  They had an image in their mind of a severely disabled person and that simply wasn’t the case for their child. 

What is the autism spectrum? 

Autism is a neurological (meaning it has to do with the brain) developmental disorder.  It affects how a child learns and develops in 3 main areas: social skills, communication skills and restrictive or repetitive behaviours.

Many people use the language ‘high functioning’ vs ‘low functioning’.  This can be very misleading. Many people think of the autism spectrum as being a linear spectrum. This representation doesn’t quite fit the autism spectrum, because there are three core symptoms of autism. There’s a newer way of conceptualizing it, that was created by Michael of 1autismdad.com in 2012. 

Imagine a blank sheet of paper with a dot in the middle.  This dot represents neurotypical development (non-asd). Near the top of the page in the middle imagine the words “communication deficits”, near the bottom left of the page imagine “social skills deficits” and on the bottom right corner imagine Stereotypic and repetitive behaviours. Each person with autism will develop needs in each of these areas differently.  You can visualize a person’s needs by how long the path is from the middle (neurotypical) to the core symptom. Some might be very impacted in the communication and social skills areas while they show very few (or none) stereotypic and repetitive behaviours. 

Autism triangle: a new way of thinking about the autism spectrum by asddad.com
Retrieved from: https://www.1autismdad.com/home/2012/03/14/visualizing-the-autism-spectrum on August 1, 2020

Top 5 things to do when your child get a diagnosis of autism: 

There are a number of resources that you can access when your child is first diagnosed.  Here are my to 5 recommendations of things to do: 

  1. Notice the small things – Your child might have difficulty with a lot of things, but try and pick out the things that your child excels at. You might need to be creative here, but it’s a good reframing exercise and will help you to focus on something positive instead of only the negative. 
  2. Reach out to others from the autism community.  There are a number of support groups on Facebook and other social media platforms.  You’ll find many people who understand exactly what you’re going through and who have been through it and survived.  It might take you a while to find your village, but once you do you’ll be so glad you spent the time to reach out. 
  3. Celebrate every victory. Learning something new might be very challenging for your child.  When they achieve a new milestone you should celebrate it loud and proud! 
  4. Create a self-care routine for yourself and your partner. You will feel compelled to spend every moment focused on your child’s therapy/friends/development. You must keep yourself healthy so you can be the best possible advocate for your child. Remember the flight attendant’s advice: always put your own oxygen mask on first.  You have to take care of yourself if you want to take care of others. 
  5. Create a team for your child.  There will be a lot of people in your child’s life: doctors, therapists, teachers, support workers and more.  You will need help to coordinate everything that needs to happen in order to set your child up for success. Find people you trust and who have values that align with your own.  

Don’t forget…

Your child is the same lovable, adorable, smart, deserving little person they were before they got a diagnosis of autism. There are times when the label is important and there are times when it is irrelevant. Try to think of the diagnosis as a path, that will lead you to treatments and strategies that will help your child. Also, having a diagnosis opens up doors for funding, supports and specialized programs.

Connect with Side by Side Therapy to discuss your options and what interventions would be best for your child and family. We offer no-charge and no obligation consultations to help guide you in making the right decisions for your child’s future.

Ontario Autism Program (OAP): a short history.

July 26, 2020

Early 2016

The government announced a huge investment into a new program called the Ontario Autism Program. This announcement was very exciting at first. Once it was studied the reality sank in: children would be removed from intensive services at age 5.

In June 2016

Michael Coteau, the Minister for Children and Youth announced changes to the Ontario Autism Program. The plan was to offer evidence based Applied Behaviour Analysis services at amounts that were based on need. Families that had been removed from IBI would receive $10,000 instalments until the new program was introduced in 2017. The children entering the Coteau plan would be the luckiest in the province, receiving the most therapy for the longest duration.

Boy reading a book as part of his Ontario Autism Program funding.

From the start, the government presented it as a program that they would improve and expand. The foremost goal was to facilitate access to therapy and reduce the financial burden on families. Key points of the OAP included: family-centred decision making, individualized intervention and the possibility to choose a specific private provider.

Changes to the OAP in 2018/2019

Doug Ford became the Premier of Ontario in June 2018. He brought a new government, changing from a Liberal government to a Progressive Conservative majority. In September 2018, the Ford government quietly instituted a pause on new service offers to children on the waitlist.  This freeze dramatically increased the waitlist. A few months later, Lisa MacLeod, the Minister of Children and Youth used the ballooning waitlist as the reason for making dramatic changes to the OAP Funding.  

In February 2019

Lisa MacLeod, announced a “new and improved” version of the OAP. This plan provided Childhood Budgets to autistic children. The budgets were based on the child’s age when they began therapy. Younger children being eligible for much more funding than older children. One element of the childhood budgets was income testing, meaning that families with higher incomes would get less funding. There was no consideration for any extenuating circumstances (level of need or availability of services in the child’s location).  

In March 2019

Lisa MacLeod announced that SLP and OT services would become eligible expenses for the childhood budgets. She also announced that the income testing would be removed. The announcement also allowed children currently under the Coteau OAP to have their funding extended for an additional 6 months. 

In June 2019

Todd Smith took over the Autism file when Lisa MacLeod became Tourism Minister.

In December 2019

Todd Smith announced that the province would follow the recommendations of an Advisory Panel it had established. Despite having previously stated that the new program would be ready by April 2020, Minister Smith stated that the new program would be implemented by April 2021. The reason for the extra year was to let the province to ‘get the program right’. The main recommendation was to move back towards a needs-based funding model and to remove the childhood budget. 

The province also announced that they would begin offering one-time funding payments to families. These payments were based on the child’s age to bridge the program until the needs-based funding could be rolled out. Children aged 1-5 years would receive $20,000 and children between the ages of 6-17 years would receive $5,000. The newest OAP would include 4 pillars:

  • Core Services
  • Foundational Family Services
  • Early Intervention and School Readiness Services
  • Mental Health Services. 

Where do families stand now?

Some children are still on the Coteau OAP program. These children are called ‘Legacy Kids’. Some children aged out of the program and received nothing. Some families accepted childhood budgets and have spent those funds. They should apply to receive one-time funding. Many other families on the waitlist still have not received invitations to apply for the one-time funding. 

The Covid-19 pandemic has totally upended the therapy of autistic kids because most providers were forced to stop services. The province has extended the deadline to spend the one-time funding by 6 months in an effort to give families time to use their funds. Service providers are gradually beginning to reopen. Families are scrambling to put together teams for their children.

Much of the information in this post was taken from the Ontario Autism Coalition’s website.

Top 6 Practical Social Skills Training in Toronto Tips!

June 28, 2020

Read time: 3 minutes

In describing the early features of autism, many specialists mention poor social interaction. Autistic children do not naturally gravitate to their peers, failing to take part in group activities or make friends. 

Many autistics need social skills training in Toronto in order to learn social skills. There are, however, a number of strategies that can be used for this purpose. When these skills develop the overall quality of life will definitely improve – which should always be our end goal.

Two children playing together after social skills training in Toronto by Side by Side Therapy.

Autistic children might lack social play skills, seeming to prefer to be alone. It is important to remember that we cannot know for certain that this is their preference, but rather might be a function of a skill deficit – they may simply not have the skills and knowledge to appropriately interact.

6 Social Skills Training in Toronto Tips

#1 Practicing different play scenarios 

Play skills can involve social interaction but, like any other skill, they require practice. So, take your child’s favorite toys, and create different play scenarios. You can create a scene of a farm or play with cooking utensils. A stuffed toy can be used to practice various skills, such as feeding or dressing. 

An added bonus about this type of activity is that you can teach the child to take turns and follow rules. In case of smaller children, it might be a good idea to opt for games that involve movement. Prompts can be offered to support the learning process, and every achievement, no matter how small, should be praised.

Interactive play is a skill that is taught as part of the Social Skills Training in Toronto curriculum.

#2 Imaginative Play

In order to play with peers, autistic children must be able to engage in role play and pretend. As a parent, you can practice these skills at home, choosing games that are simple and fun. Young children often enjoy pretending to be their favourite animals or characters. 

If the child is older, and there are no significant cognitive delays, you might opt for a situation that requires a problem to be solved. For example, you can pretend a toy has been lost, asking the child to be a detective and help you find it. 

Pretend play is an important skill that is included in the social skills training in Toronto curriculum.

#3 Visual prompts

There are many children who learn better with the help of visual prompts, especially when it comes to complex skills. You can use pictures to discuss social situations and teach the child appropriate behavior. Use the pictures as a way to remind your child of the expected behaviour.  It is much easier to eliminate visual prompts than verbal prompts. 

Allow your creativity to run free and turn the learning experience into a game.

#4 Learning emotions 

To improve your child’s social skills, you might consider helping the child develop an emotional vocabulary. You can use pictures, moving on from simple examples, such as someone feeling sad or happy, to more complex possibilities, such as acting surprised, bored or confused. 

#5 Social skills groups

Nothing beats practicing a skill as close to reality as possible. For this reason, you should consider social skills groups, where the child has the opportunity to practice interaction with other autistic and neurotypical peers, on a regular basis. 

Every parent is free to decide whether the group will contain only autistic children or a mix and there is value in each option. Another important tip would be not to overly schedule the activities but rather opt for free play, trying not to intervene too much. There needs to be a goal for the group and the activities that are selected should endeavour to support that goal. 

A group of children smiling after a social skills training in Toronto group at Side by Side Therapy.

#6 Gesture imitation 

Autistic children often do not use gestures purposefully and they might not understand our gestures either. Gestures can be learned using imitation and the use of prompts. You can begin with simple gestures, such as waving goodbye, nodding your head or blowing a kiss. After a gesture is learned in imitation it should be generalized to the natural environment so your child will begin to use it without prompting and in the correct contexts.

Once these gestures are learned, you can move on to more complex ones, including physical actions and pretend play. For instance, you can pretend you are drinking a glass of water. Do not hesitate to use spoken words, finding a way to match them to the gestures you are teaching the child. And, remember, all should be done through play!

Hands together doing a cheer after social skills training in Toronto by Side bySide Therapy.

When it comes to social skills training in Toronto, we are proud to offer this foundational skill set to all of our clients. Contact Side by Side Therapy to set up your child’s no-charge consultation. We will discuss not only social skills training in Toronto but also the other therapeutic solutions we offer.

ABA in Toronto: 9 Life-Changing Benefits for Autistic Children

May 30, 2020

Read time: 3 minutes

ABA stands for applied behaviour analysis. It is a form of therapy based on the sciences of behaviour and learning. In some, it will lead to remarkable progress, helping them acquire an important number of skills. ABA is the most widely studied and most effective therapy for autism and related developmental disorders. 

Why should you consider ABA in Toronto for your child?

We have gathered nine of the most important reasons why one could benefit from this type of therapy. ABA in Toronto focuses on teaching socially significant behaviours, meaning behaviours that have a high probability of being important and pivotal to the child and family. 

Boy with autism playing with toys during ABA in Toronto


#1 Play

Autistic children often play in a stereotypical manner, engaging in repetitive behaviours. Through ABA in Toronto, they can be taught how to engage in spontaneous play, using a wide range of toys and learning to take turns. 

The therapist might facilitate the learning experience, prompting the child with the appropriate behavior. The therapist can also teach leisure skills, helping one develop a hobby, or an interest for personal enjoyment. 

Girls playing together learning social skills in ABA in Toronto


#2 Social Skills 

If a child already has good language skills, ABA in Toronto would be useful in teaching the necessary social skills for making friends. The more one practices social situations, the easier it will be to interact with peers in real life. 

ABA in Toronto can help the child develop additional skills (i.e: sharing, turn-taking, rule following etc) which might be useful for daily interaction with other children. These skills are addressed using structured play dates, social games and role play, among other strategies. 

Boy learning to brush his teeth in ABA in Toronto


#3 Activities of Daily Living (ADLs) 

For an autistic child, going through the normal routine can be challenging. In ABA in Toronto, he or she can learn and practice the tasks associated with the routine, including dressing and feeding. 

In teaching how ADLs should be performed, the therapist will take into account the child’s gross and fine motor skills, as well as their cognitive and speech skill levels. At-home practicing can help to jumpstart generalization and maintenance. 

Boy demonstrating independence learned in ABA in Toronto


#4 Independence

A big part of ABA in Toronto involves helping the child communicate more effectively. As the language skills develop, it will be less challenging to interact with peers. 

The child will learn how to handle situations by him/herself, developing the necessary confidence for more complex tasks and to be more independent. Positive reinforcement is used to foster skills, so that the child is less reliant on his parent or caregiver. 

Alphabet toy laid out in ABA in Toronto session


#5 Academics

Autistic children can struggle from an academic point of view, requiring help in that learning as well. ABA in Toronto can help develop reading and writing skills, as well as mathematical abilities.

The strategies used in therapy can and should be implemented not only at home but also in the classroom. Many classrooms are built on a foundation of ABA, without even intending to be. Most good teachers utilize the principles of ABA (even if they don’t call it ABA). 

Cartoon of boy saying "I need", self-advocacy skill learned in ABA in Toronto


#6 Self-Advocacy 

All children grow and become adults. As the child advances in age, ABA in Toronto will be useful in teaching self-advocacy – it will teach the child to speak up for him/herself, asking for what s/he needs. All children need to learn to become self-advocates.

Even in non-verbal children, ABA therapy can teach the child how to communicate immediate needs, preferences and how to protest and stop undesired situations. 

Girl with autism sitting on ground after ABA in Toronto session


#7 Quality of Life

As mentioned at the beginning, ABA in Toronto aims to improve socially significant behaviour. All of the things that the child will learn in therapy will contribute to a better overall quality of life. Even though the days might seem long and the therapy sessions will require a lot of dedication, in the end, you will have a child who likes his/her life. 

By fostering independence, language and social interaction, just to name a few, ABA empowers the child and his/her family. 

Parent learning with son during ABA in Toronto therapy session


#8 Parent Involvement and Learning

As a parent, it is normal to want your child to reach his/her full potential. In autistic children this path to reaching full potential can seem impossible. ABA can help parents benefit from a positive change in themselves, teaching them the skills needed to fight for their children. 

Taking part in therapy sessions, you will learn how to help your child develop useful skills and assess the progress he/she has made. The therapist can also guide the at-home teaching process. 

Parents looking happily at their child after ABA in Toronto therapy session


#9 Renewed Optimism

Sometimes, parents have a hard time seeing the strengths of their autistic child, as they rather concentrate only on the challenges their children face. ABA can help to highlight these strengths and transform them into learning opportunities. You will see your child being successful in ABA in Toronto and it will give you a new lens with which to view your child. 

During the ABA therapy sessions, you might also learn what motivates your child, allowing you to use these preferences later on to teach or maintain skills outside of a therapy session. 

If you are looking for ABA in Toronto, we recommend you connect with us. We can talk more about the services we offer and schedule a no charge consultation to assess your child’s needs. Looking forward to hearing from you!

The Value of Using Autism Therapy in Toronto for Support with an Autism Diagnosis

May 24, 2020

Read Time: 5 minutes

Finding out that your child has autism is probably one of the most difficult things in the world for a parent. You might go through a period of denial, believing that there has been a mistake. Then you might have a period of grief and loss, thinking about the way things would have been. You might cry about the loss of  your “healthy” child, feeling all sorts of negative emotions. Using the resources available from autism therapy in Toronto can help you right from diagnosis.

Accepting your autistic child as he/she is can be a liberating experience. The moment you stop fighting the diagnosis of autism, you will be in a better place to support your child’s needs. By embracing his/her uniqueness, you will be better able to make decisions and pursue the strategies and supports that your child requires.  

Mom hugging autistic son after discovering autism therapy in Toronto.

Embracing the atypical 

Do you love your child less because he/she is on the autism spectrum? The answer is clearly no. But parents are human beings nonetheless and they tend to turn into saviors, wanting for their autistic children to be “typical”. 

In truth, your child needs to be loved, first and foremost. You have to embrace the atypical and be accepting of who he/she is. Remember that you are your child’s greatest advocate. Acceptance is a gradual process and one that will help you fight for your child. 

Why is denial the first response?

In a beautifully written piece for The Autism Society, Dr. Robert Naseef says: “Acceptance is not about giving up or resignation, but rather learning to live with something that is hard to face.”

You received the diagnosis, but, deep down, you likely already knew something was not right. There are few parents who can accept this diagnosis and think about solutions on the spot. Most parents automatically go to denial as a first response – this is a defence mechanism, one that we have selected to keep pain at a distance. 

Even if your child has been confirmed to be on the autism spectrum, he/she is still your child. And you should try and see the diagnosis as the start of a journey, the one toward helping your little one achieve his/her maximum potential. Accessing autism therapy in Toronto is one way to help them.

Instead of fighting the diagnosis, it is best to accept it and learn how to live with it. Let go of the things you imagined and celebrate your child, and his/her abilities. The diagnosis will only help you cater more effectively to his/her needs and provide the needed support. A diagnosis can also help you access provincial funding for autism therapy in Toronto. You will have a happy child as a result and feel less stressed in your parenting. 

Autism is neither good nor bad

Are you familiar with the concept of radical acceptance? It refers to accepting something as it is, without fighting it. Acceptance is the first step to creating a plan. You have to acknowledge that something has to be done before you can create a plan to tackle it. When it comes to autism, this concept can be very freeing and can help you advocate for your child. Autism is neither good nor bad, and it is certainly not the only defining characteristic that your child has. 

Therapeutic solutions, such as autism therapy in Toronto, can help your child learn new skills and achieve new levels of potential. At home, you will have to work with him/her as well but make sure that you leave plenty of time for fun. Spontaneous play, led by your child, can be of tremendous importance. Do not insist for typical play, as this can only cause frustration. Follow your child’s lead and interests. 

Do not send the “you are broken” message

Even if an autistic child is non-verbal, you have to pay attention to your words and to your gestures. If you are constantly pushing for normality, you are sending a message that they are somehow “broken” or “damaged”. While it is not possible to separate autism from the child, you have to refrain from seeing your child exclusively from that autistic perspective. 

Challenge yourself to accept your child, with the good and the bad. Try not to see your child’s skill deficits as permanent, there is always something to be learned or a way to improve a skill or situation.  Use their needs as a jumping off point for new learning and skill development.   

A message to take home about autism therapy in Toronto

There will be plenty of moments when you will feel challenged, wanting things to be ‘normal’. In those difficult situations, remind yourself that autistic children are, first and foremost, children. And like all children, they need our love to thrive. 

Stop thinking about the things that are “missing” and embrace the child you have. Celebrate each small success and avoid comparing your child with others. With the help of a team of therapists, create a personalized plan using all the avenues available at autism therapy in Toronto, making sure that you are actively involved in the therapy process. You have the insight into what is important to your child and family and should feel comfortable to direct the therapy team towards achieving those goals. 

Contact Side by Side Therapy to have a no-charge 30 minute consultation to discuss the best options for your child.

Applied Behaviour Analysis isn’t all we do – we’re adding 5 amazing disciplines!

March 30, 2020

Read time: 3 minutes

Lindsey-Malc-Autism-ABA-Therapy-Side-by-Side-Therapy-Toronto


In these uncertain times, it’s important to have a goal and work towards achieving something. At Side by Side, that’s exactly what I’ve been working on! When I began Side by Side, I envisioned a group of talented therapists who would use applied behaviour analysis to improve the lives of special needs kids and their families by empowering parents to implement the strategies we use every day. 

What I very quickly realized is that parents want the support of a team of professionals, not only behaviour analysts.  Each of the disciplines brings a valuable skill set to the table and families deserve to have access to all of these skill sets under one roof. While I believe in applied behaviour analysis with my whole heart, I recognize that it doesn’t hold all the answers and that my ability to be helpful is amplified when I work with a team. 

I would like to announce that Side by Side Therapy is expanding our services and will be offering applied behaviour analysis, speech therapy, occupational therapy, therapeutic recreation, psycho-educational assessments and respite. I have been working hard to put together an excellent team of therapists who are dedicated to our mission of empowering parents to empower their children. Check the blog in the next few weeks for some short profiles of our team members. 

Please read below for a short description of each of the disciplines and some examples of goals that might be targeted:

Applied Behaviour Analysis (ABA):

Boy and therapist doing applied behaviour analysis therapy in Toronto

A therapy based on the science of learning and behaviour. At Side by Side, the main goal of ABA Therapy in Toronto is to change socially significant behaviours. A socially significant behaviour is one that is stopping you from fully participating in your life.  Some examples are: communication skills, social skills, play skills, life skills and decreasing challenging behaviours (aggression, self-injury etc). applied behaviour analysis can also be used to teach academics. 

Possible goals: 

  • Responding to name
  • Sorting items 
  • Reading

Speech Therapy (SLP):

A therapy that revolves around increasing speech, language, social communication, cognitive communication and swallowing disorders. Speech Therapy in Toronto involves work with children with autism or other special needs to increase their ability to communicate their needs and this often has an added bonus of decreasing challenging behaviours.  

Possible goals:

  • Increasing vocabulary
  • Improving articulation
  • Improving social skills

Occupational Therapy (OT):

A therapy that focuses on teaching the skills that a person needs to fully participate in their daily activities (or occupations).  Occupational Therapy in Toronto can help address mobility difficulties and how a child accesses their environment. OTs can suggest ways that the environment can be modified to allow the child to participate. 

Possible goals:

  • Learn toothbrushing
  • Improve handwriting skills
  • Expanding variety of foods eaten

Therapeutic Recreation:

A therapy that addresses goals from all domains of a person’s life using recreation and play as a vehicle for change. It’s about more than just playing. Therapeutic Recreation in Toronto will use recreation (play and leisure) to achieve goals and push your child to learn and grow. 

Possible goals:

  • Increasing engagement in social interactions with a peer
  • Improve fine motor skills
  • Increase time spent engaged in independent play

Respite:

Respite in Toronto is a service available to families of special needs children.  This service offers you the peace of mind to know that while you’re having a much needed and deserved break your child is being cared for and entertained. Our respite workers are informed of your child’s specific needs and interests and will design respite sessions to highlight these needs and interests. 

Possible respite activities:

  • Play at the park
  • Swimming at the community centre
  • Cooking with your child 

Psycho-Educational Assessments:

autism aba therapy lindsey malc side by side therapy doing therapy with a therapist


If your child requires a psycho-educational assessment in Toronto to determine his or her learning needs, our psychometrist can help you. We will walk you through the entire process and will provide you with recommendations for services and strategies that your child will benefit from. We can also help you convey your child’s needs to their school.

If you would like to know more about how your child and family might benefit from any or all of these services please contact me directly by phone at 1.877.797.0437 or by email at [email protected]. 

Stay healthy everyone!

Lindsey

10 Helpful tips on raising a child with autism in 2022

January 24, 2020

Read time: 5 Minutes
Last Updated: November 2022


As a parent raising a child with autism spectrum disorder, you are faced with many difficulties and daily challenges which require adjustment in your parenting skills to include flexibility, patience, understanding and strength. You need to become very aware of your child’s specific needs while all along ensuring your own wellbeing and mental health.

It is important to realize that no two children with autism (as with all children) are the same. This therefore requires you to have the flexibility and open-mindedness to try numerous strategies and techniques to find the best fit for your child and family. This discovery may take some time and will include ups and downs, however, with persistence and the help of your child’s team you will find the path that will provide the direction necessary to seek positive change.

Here are 10 helpful tips to try with your child with autism:

1. Don’t make comparisons 

Every child is unique and faces their own challenges. It is important to not compare your child with siblings or classmates. All children develop at their own pace and react to situations differently. Situations that don’t cause one child to bat an eye might be devastating for another.  Comparing your child’s behaviour to that of others can cause your child to feel guilty for something that might be out of their control. 

2. Help your child realize when they need a break 

When your child with autism starts to feel frustrated, it is important for them to be able to identify their emotions and to be able to access the tools that will help them to calm and regulate their emotions. You can teach your child the tools they need in order to seek a break in a calm, comfortable and safe environment. This break will provide a safe place to allow them to calm down whichever way works best for them. This skill is crucial for all children but specifically for children with autism.

Parent talking with a boy with autism.

3. Listen to your child calmly and do your best to understand

Dealing with any young child can be quite difficult and trying to rationalize with them often is not successful, this is especially true of children with autism where there are language skill deficits. This ongoing challenge often leads parents to become frustrated and overwhelmed.

As a parent, it is crucial to maintain calmness (regardless of how difficult the situation becomes) to prevent escalation in the child’s behaviour. If you can calmly understand your child’s perspective you may then be able to adjust your methods so that you’re working with our child instead of against them. 

4. Help your child apply new skills to different situations (generalization)

Many children with autism don’t generalize their learning, meaning that they cannot apply a skill in novel situations. They might be able to use the bathroom at home but seem unable to use a public washroom, for example. It is important to practice the same skills in different situations and through repetition. Your child will eventually learn to apply them more easily regardless of the circumstances.

5. Keep an open mind

Our life experiences dictate our perspective and how we view the world. This simple fact can get in the way of understanding our child’s experiences. Neither yours nor your child’s beliefs are wrong. It is therefore important that you as a parent of a child that looks at the world differently is open-minded. Through tolerance and acceptance, you will be better able to understand your child’s point of view as well as acknowledging that there are alternatives and various approaches to helping them.

6.Maintain a sense of humour

Some of your child’s behaviours may not initially (or ever) fit within societal norms and may be perceived as unconventional. As mentioned earlier, these are only perceptions that we have been taught, if you were to look at the difference with an alternative lens using humour, you’ll likely find that you are bothered less and feel less judged. 

7. Never underestimate how much your child understands

 There is a difference between receptive language (what we understand) and expressive language (what we can communicate with words, sign language, picture exchange or augmentative communication). Many children with autism have difficulty with expressive language while their receptive language falls within normal development.  This means that they cannot express all the things they understand. There may appear a lack of understanding but this is likely not the case. 

Autism ABA Therapy Side by Side Therapy Toronto

8. Look into Applied Behaviour Analysis (ABA) therapy

As mentioned, it is important to be open-minded and this involves looking into therapeutic methods and techniques to help your child. ABA therapy has been established as one of the most effective methods in working with children with autism. It is important that your ABA team is lead by a BCBA (Board Certified Behaviour Analyst). You should investigate the ABA providers in your area because not all people practice in the same way.  ABA should be individualized to the child so if you’re concerned about a specific aspect of your child’s ABA therapy, you should feel confident to bring it up with your provider. 

9. Work with the school and be an advocate for your child’s needs

School plays a large and critical role in your child’s development. Your relationship with the school is important as your child will require additional services, support and programs.  These additional resources can and should be provided through the educational system. If you feel that the school is not recognizing your child’s additional needs or working with you for your child’s betterment then you need to advocate for them. You know what is best for your child and it is up to you to convey your needs and concerns. Ongoing communication and feedback will help keep you and the school on the same page and will align every player on your child’s team. 

10. Take a break yourself and seek support

Raising an autistic child may come with many challenges however on the flip-side it comes with many rewards. You need to remember to be kind to yourself, know you are an amazing parent doing your best in a demanding situation.  You need to ensure that you are in a place that you can handle and manage all that is needed of you. Don’t take everything onto yourself, reach out to your support network frequently. Seeking help will take care of yourself and in turn you will be the best parent you can be. 

Check out the Autism resources page to find links to valuable information about autism spectrum disorder.

Applied Behaviour Analysis: 59 Terms and phrases translated for easy understanding

January 20, 2020

Read time: 7 minutes

Therapist and child doing applied behaviour analysis.

There are so many terms and acronyms that you’ll be encountering when you enter the world of applied behaviour analysis. It can be very confusing, especially because some of the words that are commonly used in ABA are used with another meaning in common language. I’m going to give the definitions in terms of children but they can be applied to anyone (adult or child).

Applied Behaviour Analysis Definitions of Common Words/Phrases:

ABA Therapy: Applied Behaviour Analysis is the application of the sciences of learning and behaviour to teach, increase or decrease behaviours that are meaningful to the client and their family. 

ABLLS-r (The Assessment of Basic Language and Learning Skills – revised): This is a tool that is used as an assessment, curriculum guide and skill tracker when doing applied behaviour analysis. It was created by Dr. James Partington. Similar to the VB MAPP, it tests whether the child has specific language skills. The skills that are measured are sequenced from easiest to most difficult.  There are 25 domains, some of which include: expressive language, receptive language, writing, imitation, fine and gross motor skills. 

Accuracy: How close to the target something is or how correct it is. 

Acquisition Target: A target that is currently being taught.  This is a behaviour or skill that has not been learned yet. 

Adjusted Age: This refers to the age of your child based on their due date. For example, if your child was born 6 months ago but was 2 months early, they would have an adjusted age of 4 months. Doctors or therapists will sometimes use adjusted age when speaking about the development of your child.  People usually stop referring to adjusted age when the child is around 2 years old. 

Antecedent: In applied behaviour analysis an antecedent is what happens before a behaviour. Think of it like the trigger for the behaviour.  

Aversive: A stimulus that your child finds unpleasant or bothersome.  Aversives can be used as a punisher to decrease behaviour or the removal of an aversive can be used as a reinforcer to increase behaviour.  Your therapists should not be using aversives in your child’s programming without having a discussion with you and gaining your consent.

Behaviour: This is what the child does. Behaviours have to be measurable and observable. 

Behaviour Intervention Plan (BIP): This is a plan that will target the reduction of challenging behaviour for your child. They should always include: a specific definition of the behaviour, antecedent strategies, reactive strategies, a replacement behaviour and a mastery criteria.

Board Certified Behaviour Analyst (BCBA): This is a masters or PhD level therapist who has completed the requirements (specific courses, over 1500 hours of work experience and passed a credentialing exam) of the Behavior Analyst Certification Board.  

Chaining:  In applied behaviour analysis chaining is when a skill is broken down into steps and then the steps are taught in isolation then brought together to form a longer sequence (or a chain). You can forwards chain (teach the first step then the second and so on), backwards chain (prompt all steps except the last, then prompt all steps except the last two and so on) or you can teach the whole chain (fade prompting across each step of the chain at one time). 

Chronological Age:  This refers to the amount of time your child has been alive. Even if they were born prematurely, this is the number of days/months/years that they’ve been on the planet. 

Clinical Supervisor (CS): In Ontario, a CS is the BCBA who is responsible for overseeing your child’s ABA program.  They make clinical decisions (decisions about what and how to teach) and collaborate with you and the rest of your child’s team in supporting your child as much as required. 

Consequence: In applied behaviour analysis, this is what happens immediately after a behaviour.  Consequences are neither good nor bad, they simply follow a behaviour. 

Deprivation: When your motivation for something is really high because you haven’t been exposed to it in a long time.  When you stop using or consuming something your desire, your need for that item grows. 

Developmental Age: This is the age at which your child demonstrating most of their skills. Doctors and researchers have set all of the developmental milestones to specific age windows.  For example, most children learn to speak in two-word sentences at around 18-24 months. Your child’s developmental age is the age at which they’re functioning emotionally, physically, cognitively or socially. Developmental age is not always correlated to chronological age.

Discrete Trial Training: This is a method of presenting the child with small segments of learning that are repeated, known as trials. Often the skill is presented in 5 or 10 trial blocks.  The blocks are repeated a few times a day until the child can demonstrate the skill without prompting. 

Discriminative Stimulus (SD): In applied behaviour analysis this is the demand, request or question that elicits a specific response.  The presence of an SD signals the availability of reinforcement.  

Duration: The length of a behaviour.  

Echoic: A verbal operant meaning repeating.  When the speaker repeats what they heard from someone else.  For example, when a father says “bedtime” and the child repeats “bedtime”. In applied behaviour analysis programs, echoics are usually one of the first language goals targeted.

Expressive Language: This describes our ability to use language, gestures and writing to express ourselves. 

Extinction Burst: A rapid escalation in the frequency, intensity and/or duration of a behaviour once the reinforcement for this behaviour has been removed.  Usually, the pattern during extinction is that there is a small reduction in the behaviour, a big spike and then the behaviour disappears completely. There is something known as spontaneous recovery, which can happen after extinction is used.  The child will test the waters and re-engage in the challenging behaviour that has previously been extinguished. By sticking to the plan and not reinforcing the behaviour, spontaneous recovery is usually short lived. 

Extinction: When you intentionally stop reinforcing a behaviour with the goal of reducing that behaviour. For example, if you don’t answer the phone when someone calls, they will eventually stop calling you.  Often leads to an extinction burst.

Fine Motor Skills: These are the skills that require movement and coordination of the small muscles of the body, specifically the muscles of the hands.  Cutting, writing and pointing are all fine motor skills. 

Functional Analysis or FA: This is a highly specialized process that BCBAs use to determine the function of the behaviour targeted for intervention.  By manipulating reinforcement the BCBA will see if they can influence the behaviour. By controlling the reinforcement for a behaviour, you’re able to determine the function of the behaviour and can create function based replacement behaviours. One specific type of FA is called IISCA (Interview Informed Synthesized Contingency Analysis), it was created by Dr. Greg Hanley. 

Functional Behaviour Assessment or FBA: This is a process for hypothesizing the function of a behaviour that is being targeted for intervention. In an FBA the BCBA does some or all of the following: observes the behaviour, completes interview style questionnaires and takes data. 

Generalization: When your child is able to demonstrate a skill using novel materials, with novel people and in novel environments. All ABA skill acquisition programs should have generalization steps built into the program because generalization does not always happen automatically. 

Gross Motor Skills: These are the skills that require movement or coordination of the large muscles of the body, specifically the muscles of the arms, legs and trunk. Walking, running and sitting are all gross motor movements. 

Intervention: This the strategy that will be used by the team to change a behaviour or teach a skill. Intervention is another word for program. 

Intraverbal: A verbal operant meaning conversation.  When the speaker responds to another person’s language in a conversational way. For example, if someone asks you “What’s your favourite colour?” your response “Red” would be an intraverbal. 

Latency: In applied behaviour analysis, this is the time between when an instruction is given and the beginning of the behaviour.  

Maintenance: When a skill or behaviour is able to be demonstrated long after it was originally taught and with less reinforcement than was used during teaching.  Sometimes a skill will be ‘moved to maintenance’ this means that the child will be asked to demonstrate the skill on a regular basis to avoid losing it.  Often there is a maintenance schedule that the applied behaviour analysis team will use to practice the learned skills so that they are not forgotten. 

Mand: A verbal operant meaning request.  When the speaker uses a word to make their needs known.  For example, saying “apple” when you want to eat an apple. Mands can be requests for objects, people or attention.  Mands can also be requests for the removal of something you don’t like. 

Mastery: The requirement for something to be considered learned.  Mastery criteria are always set before the behaviour is taught.  Often in applied behaviour analysis programs mastery criteria is 80% correct (or above) over 3 consecutive days with different instructors and novel stimuli. 

Natural Environment Teaching (NET): A form of applied behaviour analysis where learning occurs naturally or incidentally in the child’s typical environment.  Examples of programs that are best run in the NET are tooth brushing or feeding programs run at a family table during meal times. 

Negative Reinforcement: When something is removed from the environment that makes a behaviour more likely to happen again in the future. In applied behaviour analysis, negative reinforcement is not the same as punishment.

Neutral Stimulus:  Something in our environment that does not affect our behaviour.  We have not associated that object or event with anything else. 

Positive Reinforcement:  When something is added to the environment that makes a behaviour more likely to happen again in the future. 

Program: The specific strategies that will be used to change a behaviour or teach a skills. Each skill should have it’s own program description. Program is another word for intervention. 

Prompt Hierarchy: These are the graduated steps that a therapist will use to methodically remove support for a child to be able to perform a skill independently. Having a prompt hierarchy in place is important in order to ensure that all team members are using the least intrusive prompt required. An example of a most to least prompt hierarchy is: full physical, partial physical, verbal, gestual, modeling, pointing, gaze and no prompt (independent). 

Prompting: These are the strategies that are used to help a child learn a new skill. Generally, BCBAs will put a prompt hierarchy in place to guide the therapists in how to support the child. 

Punisher: Anything that makes a behaviour less likely to happen again in the future. 

Punishment:  A procedure that is used to decrease the likelihood that a behaviour will happen again in the future.  Punishment weakens behaviour. Your child’s therapy team must gain your consent before implementing punishment procedures in their applied behaviour analysis programming.

Rate: This is how many times a behaviour is displayed within a specific time frame.  Rate is always described in relation to time. For example, 7 incidents per day or 2 incidents per minute. 

Ratio: This is the number of responses required before a reinforcer will be delivered. It is possible to have either a fixed ratio (for every 5 responses reinforcement will be delivered) or a variable ratio (on average reinforcement will be delivered every 5 responses – sometimes it is delivered after one response and other times it is delivered after 9 responses). 

Receptive Language: This describes our ability to understand the words that are spoken to us. 

Registered Behaviour Technician (RBT): This is a credential offered by the Behavior Analyst Certification Board.  An RBT is a person who practices applied behaviour analysis under the close and ongoing supervision of a BCBA. RBTs are not allowed to practice independently (without supervision) because they have not met the standards set by the BACB for that level of work. 

Reinforcement: A procedure that is used to increase the likelihood that a behaviour will happen again in the future.  Reinforcement strengthens behaviour. 

Reinforcer: Anything that makes a behaviour more likely to happen again.  

Response: An observable and measurable behaviour.  Often applied behaviour analysis folks talk about response classes, or groups of behaviour that fit into a category. 

S-Delta: A stimulus whose presence indicates that a behaviour will not be reinforced.  For example, an “out of order” sign on an elevator will decrease the likelihood that you’ll push the elevator call button. 

Satiation: When your motivation for something is really low because you’ve been exposed to it too much.  This happens when you use a reinforcer too frequently or in amounts that are too big. 

Schedules of Reinforcement: The frequency that reinforcement is delivered. There are fixed and variable schedules as well as ratio and interval schedules. Fixed Interval (FI) schedules provide reinforcement for the first example of the target behaviour after a predetermined amount of time has expired. Fixed Ratio (FR) schedules provide reinforcement after a specific number of correct responses (think of a token board). Variable Interval (VI) schedules provide reinforcement after an unpredictable amount of time has passed. Variable Ratio (VR) schedules provide reinforcement after an unpredictable number of responses have been given.

Scrolling: Rotating through a set of answers when you don’t know the specific answer. For example, if you showed your child an apple and asked “what’s this?” If your child was scrolling they would say “Orange, ball, tomato, apple”.  This happens if the prompting procedure is not applied correctly. Scrolling can happen with any of the verbal operants, not only tacting/labeling.

Self-Injurious Behaviour (SIB): Actions that the child does that cause injury to themself. Hitting oneself, biting oneself and headbanging are examples of self-injurious behaviour. 

Stims/Stimming: Self-stimulatory behaviour. These are some of the repetitive or stereotypic behaviours that a person with autism might engage in. For example, hand flapping, rocking and repeating movie scripts are all stims. Some people with autism report that they engage in stimming because they’re either under or over responsive to sensory stimuli and it helps to balance them. 

Tact: In applied behaviour analysis this means a label.  When the speaker names what they see or perceive in the environment. For example, smelling pie and saying “pie” or hearing a dog barking and saying “dog”. 

VB MAPP (Verbal Behavior Milestones Assessment and Placement Program): This is a curriculum assessment that is based on Skinner’s Verbal Behaviour. It was created by Dr. Mark Sundberg.  Similar to the ABLLS-r it tests whether the child has specific language skills. The sections or domains of the assessment are based on Skinner’s verbal Operants. The assessment is divided into 5 parts: Milestones Assessment, Barriers Assessment, Transition Assessment, Task Analysis & Supporting Skills and Placement & IEP Goals. 

Verbal Behaviour: A branch of applied behaviour analysis based on the work of B.F. Skinner.  Skinner identified verbal operants or different parts of our language, each serving a different purpose or function.  There are many verbal operants but the basic ones are: mands, tacts, echoics and intraverbals. 

If you’re embarking on your applied behaviour analysis adventure and would like to discuss anything with us, please contact us for a no-charge 30 minute consultation.

Lindsey Malc: Inspired Founder & Clinical Director

December 22, 2019

Read time: 2 minutes

Hello, my name is Lindsey Malc. I’m the founder and Clinical Director of Side by Side Therapy. In 2013, I became a Board Certified Behaviour Analyst. I have spent my entire career working with children with special needs and their families.  I have extensive experience in clinical as well as community settings. I have worked primarily with autistic children but have considerable experience working with typically developing children with challenging behaviour as well. 

I graduated with a Master of Applied Disability Studies degree from Brock University. I also hold an Honours Bachelor of Social Work degree from Lakehead University. I worked for many years at Zareinu Educational Centre (now known as Kayla’s Children Centre).  At Zareinu, I held many positions, from classroom assistant to Behaviour Analyst.  In my 14 years at Zareinu, I was fortunate to learn from a trans-disciplinary team of therapists who were passionate about helping our students achieve their maximums. Working with Psychologists, Speech-Language Pathologists, Occupational Therapists, Physiotherapists, Social Workers, Special Education Teachers, Early Childhood Educators and Recreational Therapists provided me with a very well rounded understanding of and respect for these vital disciplines. 

How I, Lindsey Malc, can help your child and family

I offer 4 services based on your family’s needs.  

I will help you better understand how you and the environment are impacting and maintaining your child’s behaviour.  Using Applied Behaviour Analysis, I will provide you with alternatives and help guide you to effective ways that you can change your child’s behaviour. Looking at the antecedents, behaviours and consequences will be the starting point for this service.  We will meet weekly or biweekly and will discuss what has happened since our last meeting. I will ask you to take some data because it can be difficult to remember everything and then analyze the information and identify patterns.  

I work with private schools or daycares to identify the function of challenging behaviour and to develop intervention plans that will be effective and easy to implement. Individual programs or class-wide behaviour interventions can be developed.  Realistic data tracking and follow up are provided.  These meetings can happen weekly, bi-weekly or monthly depending on your needs.

If your child with autism or other developmental disability is struggling with a specific skill or skill set, I can develop a targeted intervention to address this need.  I would develop the intervention and teach you or a caregiver how to implement it. We will meet weekly or bi-weekly. Manageable data collection would be an integral part of this intervention with the goal of empowering you to implement the same strategies to address future goals as they arise. 

If you’re looking for a comprehensive ABA Therapy program, to address all areas of your child’s development I can be the Clinical Supervisor for your child’s ABA program.  I qualify as a Clinical Supervisor for the Ontario Autism Program and am listed on the  OAP provider list.  I will complete a curriculum assessment and develop all of the teaching programs and targets for your child’s ABA program. I am happy to work with you to develop your child’s treatment team and to train the staff in all of the behavioural interventions that they will be implementing.  Supervisions would occur either weekly or monthly, depending on the supervision structure of your ABA team.

Professional Services

If you are pursuing BCBA or BCaBA certification, I am also available to supervise all of part of your experience hours.

Photograph of Lindsey Malc, Behaviour Analyst

I would be happy to discuss your ABA Therapy programming needs. Please don’t hesitate to contact me.

Call me: 1-877-797-0437

Email me

Thanks for your time and I look forward to working with you to address your child’s special needs.

Lindsey Malc, BCBA

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