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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.

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 kind of therapy does a child with autism need?

June 21, 2021

Many parents of children recently diagnosed with autism ask themselves “What kind of therapy does a child with autism need?” This blog will cover therapy options and some guidelines for what to avoid when picking a therapy model and provider.

What kind of therapy does a child with autism need?

There are many evidence based therapies for autistic children. Applied Behaviour Analysis, Speech-Language Pathology and Occupational Therapy are 3 options. Each child is different and will need an individualized therapy program. In any case, therapy should begin with an assessment that is updated regularly. Each kind of therapy will have it’s own way of setting goals but the goals should be specific to the child. The type of therapy that a child needs will likely change as they grow and learn.

What are the different therapies?

Applied Behaviour Analysis (ABA)

ABA is a scientific discipline that focuses on analysis and evaluation of social and environmental shifts to produce meaningful changes in a person’s life. One of the main ideas behind ABA is the identification of functional relationships. In other words, functional relationships are the correlation between the person’s environment and their behaviour.

ABA can be used to both teach new skills and to reduce challenging behaviours. In fact, it is very important to do both of these things when implementing ABA. When a behaviour is reduced, it needs to be replaced with an alternative that meets the same need or serves the same function. You can read more about the functions of behaviour in this post.

ABA programs can be Comprehensive (more than 20 hours per week) or Focused (between 5 and 15 hours per week). The intensity of your child’s ABA program will depend on a number of factors (age, needs, challenging behaviours, other programs or therapies etc.).

ABA can be a bit like your family doctor. ABA has lots of strategies and techniques to help with most areas of need (behaviour, communication, social skills, motor skills etc), but there are times when a specialist is required – like a speech-language pathologist or an occupational therapist.

Child playing with wooden toys. What kinds of therapy does a child with autism need?

Speech-Language Pathology (SLP)

Speech therapy or SLP focuses on a number of areas: communication, language, pragmatics (or social skills) and feeding/swallowing. Speech therapy is a very popular therapy for autism. Your child’s SLP will do an assessment to determine where your child is in terms of skills and what needs to be targeted and taught. Sometimes the SLP will do a standardized assessment (where the child’s performance is measured against other same aged peers). Other times the assessment is informal. Sessions will usually take place for an hour or two each week.

Occupational Therapy (OT)

OT can be an incredibly effective therapy for autism. The OT will look at a number of domains (or areas) when they’re assessing the child. Some examples are: motor skills, sensory integration skills, self-help/adaptive skills, even academics. OT sessions can happen anywhere: at home, at a clinic, in school even at the park or grocery store. It’s most important that the OT is able to see the child in their natural environments in order to give the best suggestions and be the most effective. Similar to Speech, OT sessions are usually an hour or two per week.

What is an interdisciplinary team in autism therapy?

Interdisciplinary teams happen when clinicians from different disciplines work together to achieve the child’s goals. For example, the OT would give strategies and set goals around a child’s sensory needs while the SLP guides the child’s language program. Both the sensory goals and the communication goals will be carried out by the ABA team, as well! Interdisciplinary teams are the best kind of therapy for a child with autism.

There are lots of decisions to be made when you’re picking a therapy for your autistic child. Let Side by Side Therapy help you understand your options and what services are available.

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.

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.

Challenging Behaviours in Autism Treatment

April 26, 2021

Read time: 3 minutes

This blog post will discuss challenging behaviours: why language matters when describing behaviour, behaviour as communication, functions of behaviour, replacements and safety when addressing behaviours.

Language matters

Challenging… problem… interfering… There are many words that describe behaviours. However, how you label a behaviour speaks to how you feel about it. Calling a behaviour a ‘problem’ gives blame to the learner. Naming a behaviour as challenging can lead to the question “Who is this behaviour challenging?”. Labeling a behaviour as interfering might lead people to ask “interfering with what?”

Like most topics in the autism and ABA world, there is controversy around this. At Side by Side Therapy, I use challenging or interfering to describe these behaviours. I feel that it helps to focus our efforts on the behaviours that aren’t helpful to the learner.

Father carrying his toddler who is engaging in challenging behaviours.

Challenging Behaviours are Communication

If we take the view that all behaviour is communication, the learner isn’t to blame for their behaviour. They’re simply communicating a need in the most effective way they have. This attitude also leads us to look for alternative ways to communicate this need. It focuses us on helping the learner as opposed to stopping the behaviour.

4 Functions of Behaviour and Replacement Behaviours

There are 4 functions of behaviour.

  • ATTENTION
  • ACCESS to items
  • ESCAPE or AVOID situations
  • SENSORY or AUTOMATIC reinforcement

When we’re targeting interfering or challenging behaviours we must identify their function. Some behaviours serve more than one function. We can ask: What does doing this behaviour give the learner? Does it let them off the hook for something undesirable or difficult? Having this information will help us find a replacement behaviour that meets the same need but is better for the learner. Better, in this case, means: easier, safer, more efficient and more effective. It can also be more socially acceptable.

More often than not, when we’re addressing challenging behaviours, one of the first things we teach is functional communication. This can be any form of communication (spoken words, signs, picture exchange, gesture etc). What’s important is that the learner is able to use the communication independently and that it is effective in meeting their need.

Safety First with Challenging Behaviours

Unfortunately, some behaviours are just dangerous. It is critical to keep safety at the forefront of any behaviour reduction plan. The learner’s safety, as well as the other people in their environment (family, peers, staff). Sometimes (often!) the plan needs to be revised and changed. Some behaviours are merely bothersome to the people around the learner. These behaviours do not always need to be targeted for reduction.

Contact Side by Side Therapy to discuss your learner’s challenging behaviours.

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.

Echoics: 4 Things to Know

March 23, 2021

This post continues the series about Skinner’s Verbal Behaviour. Last week we spoke about Mands and their value in improving a person’s quality of life. This week we’ll talk about Echoics!

1. What are Echoics?

An echoic is a verbal operant that happens when a person repeats exactly what was just said by the first speaker. In other words, echoics are verbal imitation. An example is a teacher saying “Good morning” to a student and the student replying “Good morning”. Echoics are identical to their verbal model.

2. How do we teach Echoics?

As in all ABA programs, teaching starts with an assessment. In this case, the Early Echoics Skills Assesment (found in the VB MAPP) is an ideal tool.

Image of the VB MAPP, a verbal behaviour skills assessment. It contains the Early Echoics Skills Assessment.

In a vocal imitation or echoics program the goal is to teach the learner the behaviour of repeating what has been said. Some people get hung up on the content of what the learner is echoing, but what’s most critical at the outset is the intention. The learner needs to understand that you want a verbal response from them. In essence, they need to understand what you’re asking them to do. Articulation can be shaped and perfected but if the learner doesn’t know that we want them to say something the program won’t get very far.

Like most ABA programs, echoics programs use shaping and reinforcement to gradually change the learner’s behaviour. You always start at the learner’s current level. The first step of an echoics program might be having them make an approximation that sounds similar to the target. For example, If the target is ‘Mommy’ it would be okay if the first response the learner emitted was ‘Ma’. Once the learner is consistently saying ‘Ma’ we would change our expectation to something more complex.

3. Why Teach Echoics?

Vocal imitation is a precursor skill for many other verbal operants. The learner will repeat the words they hear and assign meaning to them. Being able to imitate is a fundamental skill that all learners need to more easily learn new behaviours. When the learner’s able to imitate our language we’re opening doors for the other verbal operants to be taught.

4. What are transfer trials?

As previously mentioned, echoics are a foundational skill that is required before more complex skills can be introduced. Once a learner has mastered vocal imitation, one way to move on is to use transfer trials. A transfer trial bridges the mastered skill of vocal imitation with the new skill (manding, tacting etc). Simply put, it usually goes like this:

  1. The learner shows interest in an item or action.
  2. We use an echoic procedure to name the item BUT we do not reinforce the echo.
  3. The instructor uses a short phrase or question (“what did you say?” “Huh?” “What do you want?”) to prompt the learner to use the vocal response to request or label (to transfer the response!).
  4. When the learner repeats the vocal response then the instructor can reinforce!

What is Skinner’s Verbal Behaviour?

March 8, 2021

B.F. Skinner was an American psychologist. He was one of the founding fathers of ABA. He developed Verbal Behaviour (VB) as a way of understanding language. An American Psychological Association survey, from 2002, ranked Skinner as the most influential psychologist of the 20th century.

Skinner developed the verbal operants:

  • Mands (requests)
  • Tacts (labels)
  • Echoics (repeating)
  • Intraverbals (answering questions and having conversations)
  • Autoclitics (using phrases that impact the other verbal operants in the sentence)

Upcoming posts will discuss each of the verbal operants in greater detail.

Sketch of B.F. Skinner, the creator of Verbal Behaviour

How is Verbal Behaviour Different than ABA?

VB is a way of thinking about language. ABA is the science of behaviour and learning. A VB program will incorporate the principles of ABA to teach the different verbal operants. For example, a VB program would use reinforcement, chaining and shaping.

How to teach Verbal Behaviour?

Many people pick one or two verbal operants to focus their teaching on. However, this is not the best way to teach language. Whenever possible it’s best to teach across operants. That means teaching a child to identify something as well as request it and be able to answer questions about it. Knowing the tacts for objects won’t be helpful if the child can’t use those tacts to mand for items.

What about assessments?

The VB Mapp (Verbal Behavior Milestone Assessment and Placement Program) assesses children’s language development. It is a criterion-referenced assessment meaning it measures student performance of a specific skill. This is different than a norm-referenced assessment. These look at a student’s performance compared to other students.

The VB Mapp has 3 levels. Included are specific tests for echoics, barriers and transitions. As the child grows and learns they move from level 1 to 3. In each level there are a number of domains. A child should master the earlier skills in a domain before moving to the more complex skills. To measure the child’s progress, the VB Mapp should be re-administered every 6 months.

How does verbal behaviour help my autistic child?

Understanding the purpose of the words we use is extremely important to being an effective communicator. The person learns that communication can help them have their needs met. Communication isn’t always spoken language.

To learn more about how your child can benefit from a Verbal Behaviour based ABA program, reach out!

What is Stimming in Autism?

February 28, 2021

One of the clinical indicators of autism is repeating the same actions over and over again (AKA: stims or stimming). Stimming in autism is movements or other behaviours that are either calming or alerting. Most of the time stimming is not a problem and does not need to be stopped or changed unless it is causing harm.

Who stims?

EVERYONE.

Each person has specific behaviours or habits (stims) that they find comforting or alerting. Most of the time, we aren’t aware when we are stimming. When you’re nervous, maybe you are twirling your hair or rubbing your hands together. Maybe you are bouncing your leg to wake up when you’re tired. When you’re concentrating, maybe you stick your tongue out of your mouth. Autistic people also do these same things, sometimes in a more obvious way. There are many common stims that you may see a person with autism repeat frequently. Let’s talk about the different types of stims.

What are Some Examples of Stimming?

There are several different types of stimming that you may notice someone do. These different types of stims can include all of the senses, such as taste, smell, touch, sight, balance, and movement. You can refer to them as auditory stimming, tactile stimming, vestibular stimming, visual stimming, and olfactory or taste stimming.

Auditory stimming means the person is using their hearing and sounds to stim, such as humming or making high-pitched sounds.


If a person is using their sense of touch to stim, such as tapping their fingers repeatedly or rubbing their skin, it is tactile stimming.


Hand flapping, lining up objects, turning the lights on and off a lot are all examples of visual stimming. This is when the person uses their sight to repeatedly do something.

Vestibular stimming, such as toe walking, spinning in circles, hand flapping, and rocking back and forth, is when a person is using their balance and movement to stim.

The last type of stimming behaviour is olfactory and taste stimming. This type of stimming is when the person is using their taste and smell to repeat actions, such as licking or sniffing objects and/or people.

When and why do autistic people stim?

Autistic people stim at the same times that other people do. The intensity of these stims and types of stims vary. You may find that one autistic child is doing it all the time, while another only stims occasionally. Some autistic self-advocates explain that it helps them block out distractions to help them concentrate, while others say “it just feels really good”. People who don’t have autism may avoid stimming in specific situations. For example, despite being nervous, the person is not bouncing around or fidgeting while at the dentist. It is difficult for autistics to stop
stimming, especially when upset or nervous.

Some autistics say that stimming helps them control their emotions, such as fear, excitement, and stress. Stimming also helps make them more aware of their bodies. Another really interesting function of stims is to communicate emotions or arousal to others in a non-verbal way.

In the show Love on the Spectrum, one of the show’s cast, Olivia, says stimming is “…a massive build-up, with a pleasant release” (Episode 4).

What should be done about autistic stimming?

Usually… nothing.

Child spinning in circles outside engaging in stimming.

Many autistic self-advocates share that being told to stop stimming is very damaging. Stimming is intrinsic to the autistic and to expect them to change part of themselves because it makes us more comfortable is just wrong.

No one is telling a neurotypical kid to stop playing with their hair or to stop drumming their fingers on their leg. The same rules should apply for autistics.

Stimming is usually harmless. There are times however when stimming is dangerous or disruptive to the autistic person’s quality of life. For example, some people injure themselves or others while stimming. This can sometimes be seen in the form of headbanging or excessively rubbing or scratching skin. Also, if a stim is interrupting them from engaging in activities that they need to do (like sitting in a chair to learn) then alternative stims should be found. A BCBA works with the family to identify the function of the stimming behaviour and finds replacements. An Occupational Therapist might suggest a sensory diet if the stimming serves a sensory function.

Top 5 Picky Eating Strategies

February 21, 2021

Autistic children are often picky eaters. There are many reasons that this happens. Once you’ve figured out the reason your child is picky you can use these picky eating strategies to help them overcome their pickiness. Recent research has shown that 70% of autistic children have unusual eating behaviours.

Reasons for picky eating

Many children struggle with texture, flavours and a need for sameness that can make eating a variety of foods tricky. Muscle weakness in the mouth or difficulty with sensory experiences can also impact the foods that the child will tolerate.

Young child refusing to eat spaghetti because she's a picky eater.

Try these top 5 picky eating strategies:

1. Toleration

Allow your child to tolerate the food being around before expecting them to eat it. Try putting just a single grape on their plate or a piece of cheese without any expectation that they will eat it. The goal is to have them tolerate it.

2. Shaping

Once your child is able to tolerate the new food, you want to gradually shape the way they’re engaging with it. For example, they might start by simply touching the food, then smelling it, then bringing it to their lips, then licking, then chewing and lastly swallowing.

3. Give choices

This is one of the best picky eating strategies! Giving your child choice and control will help them feel empowered to overcome their picky eater habits. Examples of choices you could give include: how many bites of the target food the child will have, how the target food will be prepared or who will feed the bites (the child or the adult).

4. Use Positive Reinforcement

When it comes to picky eating, it’s REALLY IMPORTANT to use positive reinforcement to encourage your child. Remember it’s not bribery if you state the expectation first and the outcome second. Think “Have three bites then we’ll watch YouTube” vs “Wanna watch YouTube? Have three bites!”

5. Don’t get into a power struggle

Eating is one of the only things your child has actual control over. There is no safe way to force your child to eat, so if they’re not willing to, it’s not going to happen. By keeping the entire experience positive and not letting it fall into a power struggle you’re helping your child to feel empowered and in control.

Who can help?

Like most challenges, an interdisciplinary approach is often the most effective. Picky eating can be addressed by ABA, Speech or Occupational Therapy. Also, before you begin trying to address your child’s picky eating, make sure to consult your child’s physician to rule out anything medical that might be going on.

What is Parent Coaching?

February 14, 2021

Parent coaching is one of the services that many ABA providers offer. In fact, it’s one of the keys to success in ABA programs. Teaching the parents the strategies and techniques that are successful with their child is parent coaching.

Goals:

Generalization is one of the main goals of ABA. Generalization is doing behaviours in different environments, with different people and with different materials. Many children with autism have a very difficult time generalizing newly learned skills. Parent coaching helps parents learn how their child learns so they can set them up for success.

Parent coaching empowers parents and family members to not rely on clinicians to teach their children. By learning the strategies that are effective for your child you can make changes yourself.

In Ontario, there are a lack of Instructor Therapists to do direct therapy with autistic kids. Most of the ABA providers in the GTA have waitlists. When parents participate in coaching they are able to avoid some of the waiting time by teaching their children themselves. While there are some behaviours and skills that require a therapist to intervene, there are a number of techniques and principles that parents can implement with a lot of success.

Mom and BCBA in a parent coaching session.

What does parent coaching look like?

You’ll work with a Board Certified Behaviour Analyst (BCBA) or a Senior Therapist. When you begin with a new BCBA or ST they will discuss what your goals are. You can choose to work on reducing a challenging behaviour or teaching a new skill.

If you’ve decided to reduce a challenging behaviour your BCBA or ST will discuss the specifics of the behaviour to get a better idea of exactly what the behaviour is. They will ask you to take some data or keep track of the behaviour. They might want you to track the frequency or the duration of the behaviour. This is called baseline data. Baseline data is important because it helps us understand and measure if our intervention is making a difference.

Your BCBA or ST might use a protocol called Behavioural Skills Training (BST) to teach you the intervention. In BST there are 4 steps: instruction, modeling, roleplay and feedback. The therapist will use these steps to help ensure your success. Your therapist will likely give you a written description of the intervention for review later.

Conclusion

Parent coaching can be time limited or continuous. It depends on your goals.

Is There a Cure for Autism? Part 1

February 1, 2021

“Is there a cure for Autism?” 

“How long will my child have to be in therapy?” 

“How long until they’re like other kids their age?” 

Each week I speak with 10 or so parents, most of who have newly diagnosed autistic children. 

These are questions that many parents ask. It’s so difficult to ask these questions and it’s equally difficult to answer them. I am always honest when I answer.  I tell them that I believe that each child can make change and learn new skills but that there is no cure for autism. It’s not for me to say how ‘normal’ they will become. I try to stress to these parents that their child has so much potential and with the right mix of learning opportunities they will grow into incredible little humans. 

Mom holding son while searching the internet for a cure for autism.

Taking the expectation of being ‘normal’ off the table is a relief for some parents. Others aren’t ready to hear my message. They’re still grieving the loss of the child they thought they’d have. One of the most difficult things for people to handle is uncertainty. Humans are hardwired to have a plan or at least a destination. We dream of the future. When your child is diagnosed with a special need your journey takes a turn. There is a wonderful poem that conveys this message so beautifully. It’s called ‘Welcome to Holland’ and it was written by Emily Perl Kingsley in 1987. 

(I need to say that no one poem or piece of writing will perfectly sum up the experience of the entire special needs parenting population.  This poem should be taken for what it is, one woman’s perspective, at one point in her life. Some people will identify with it and others will not.) 

What Should Parents Do?

There are a number of evidence based treatments for autism. Research the options that are available in your area and decide which aligns with your beliefs and goals. Applied Behaviour Analysis (ABA) has the most research backing it’s effectiveness for autistic children. There is also Speech Therapy that can be essential for autistic kids as well as Occupational Therapy. There is a lot of overlap between the disciplines. Sometimes your child’s needs can be addressed by the ABA team alone, but sometimes the expertise of a specialist is required. Any therapy team you work with should be open to collaboration with other disciplines that provide evidence based therapy. 

Alternative Cures For Autism

As with any issue that affects a group of people, there will always be bad actors who try to dupe vulnerable people. I always caution my clients against spending resources on non evidence based interventions.  Resources can be money, time and energy.  Very few people have unlimited resources. When you devote resources to one treatment, automatically you’re taking resources away from the others. You want to ensure that you’re putting your resources where you’ll get the most benefit. Some examples of non evidence based interventions are: biomedical interventions (chelation therapy, autism diets, supplements) or other treatments like swimming with dolphins or hyperbaric oxygen chambers.  While these treatments may have many glowing reviews look for peer-reviewed, double blind controlled studies to use as your base of information when determining if something is evidence based. 

Here is a list of evidence based interventions for you to consider with your child. 

Come back next week as I discuss if we should even be trying to cure autism. 

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. 

Top 5 Myths about ABA

January 11, 2021

Every day we hear fake news. Sometimes it’s hard to tell fake news from real news. When you’re choosing a therapy to help your child having real news is vital. Here are the top 5 myths about ABA briefly explained.

Top 5 Myths about ABA Explained:

Myth 1: ABA is only for autism.

While ABA is most well known for it’s use with autistic children there are many other applications. ABA can be used to address a wide variety of conditions: ADHD, substance abuse, anxiety and anger, traumatic brain injury are only a few. There is also a lot of really neat use of ABA in business and sports. The Florida Institute of Technology has a certificate program in Organizational Behavior Management (OBM). OBM addresses performance management, safety systems and behavioural systems analysis.

ABA is in classrooms around the world every day. But it’s not called ABA… it’s just called teaching!

Myth 2: ABA is all about drills at the table

Old-school ABA was drills at the table. However lots of research in education shows that young children learn best through play. As the decades pass and research continues, new naturalistic interventions are becoming common, like the Early Start Denver Model and Pivotal Response Treatment. Generalization is also becoming an integral part of all good ABA programs. The child needs to show the skills across settings, people and materials in order for it to be useful. Generalization doesn’t happen exclusively at the table.

Myth 3: ABA is only effective when it’s more than 40 hours per week.

This is one of the most widespread myths about ABA. Early research showed that ‘intensive’ programs of 40+ hours each week were the most effective. However a recent study showed that there was no difference in outcomes between 15 and 25 hours/week of therapy. It is very common to see children in 6-15 hours of therapy each week with great results. Comprehensive ABA is 20+ hours of therapy per week. It’s comprehensive because it delivers a full curriculum. 5-19 hours of therapy per week is called Focused ABA because it focuses on specific skills and teaches those to mastery.

Myth about ABA: It's all about drills at the table.

Myth 4: ABA uses food as a bribe.

A big part of ABA is using positive reinforcement. We want to encourage the behaviours we want to see again. A surefire way to do this is by using positive reinforcement. By adding desirable things to the environment after a behaviour occurs you make it more likely that the behaviour will happen again. Anything can act as a reinforcer, as long as it makes a behaviour more likely to happen again. Sometimes that’s food, but more often it’s toys, praise and privileges. The ABA team should always be developing new reinforcers to keep the person motivated.

Myth 5: ABA will fix the autistic child.

ABA teaches skills and reduces challenging behaviour. This leads to improved quality of life. Autism is a neurological disorder. It has no cure. However, there is still plenty to be hopeful about. All children have the potential to learn and grow. It’s not about reaching a specific milestone, but rather about becoming the best that they can be.

Myth about ABA: It will cure your autistic child.

Conclusion

Finding the right therapy for your autistic child is vital to improving their (and your) quality of life. Don’t be led astray by the fake news. ABA is one of the most studied and effective treatments for your child.

What is reinforcement in ABA?

January 4, 2021

When you’re new to ABA it can be very daunting. There are many acronyms and words with unusual meanings. In this post we’ll discuss reinforcement in ABA and how you can use it to increase behaviour. You can read the dictionary of ABA terms that I wrote last July.

ABA is all about teaching skills. We change behaviour and increase independence. One of the many ways that we do this is using reinforcement. I sometimes think of reinforcement as a contract between two people. If you do this, then this will happen – which makes it more likely that you will do this again in the future.

REINFORCEMENT: a procedure that makes a behaviour MORE likely to happen again in the future.

There are two kinds of reinforcement: positive and negative. Many people get confused. They think of positive reinforcement as being rewards and negative reinforcement as being punishment. But that’s not the case!

POSITIVE REINFORCEMENT: adding something to the environment to make a behaviour more likely to occur again.

NEGATIVE REINFORCEMENT: removing something to the environment to make a behaviour more likely to occur again.

Every person responds to reinforcement. Some reinforcers are tangible (we can touch them) and some are abstract. Sadly, there isn’t a formula for knowing what will be reinforcing for everyone. Some people can tell us what they’ll find reinforcing. When that’s not possible we use a technique called a reinforcer survey or a preference assessment. These help the team know what the child finds reinforcing. To do a preference assessment you need to provide many options of reinforcers and observe what the child chooses.

Little girl getting a high five as reinforcement in ABA.

Bribery vs Reinforcement in ABA

Importantly, there is a big difference between bribery and reinforcement in ABA. Bribery happens when you make a bargain in desperation. After you’ve already given the instructions but you encounter some resistance. Reinforcement lays out the contingency (the deal) at the beginning.

Bribery…

Parent: “Time for breakfast! Come eat some cereal.”

Child: “No way, cereal’s gross.”

Parent: “You love cereal. Come on, eat it. We’ve got to get to school.”

Child: “Nope!” (pushes cereal away)

Parent: “You’ve gotta eat something. Please? We’re going to be late.”

Child: “I’m never going to eat cereal again. “

Parent: “If you eat half a bowl, you’ll be able to watch YouTube in the car on the way to school.”

This is an example of bribery because the parent is desperate and is willing to change the ‘deal’ in order to get their child to eat.

Reinforcement…

Parent: “Time for breakfast. If you eat all your cereal you’ll be able to watch YouTube in the car on the way to school!”

Child: “I want to watch Paw Patrol.”

Parent: “Sure, that’ll be fun. Now eat up!”

This is an example of reinforcement because the parent isn’t changing their position after the fact in order to gain their child’s cooperation.

Is Reinforcement a bad thing?

Many opponents of reinforcement in ABA will argue that we’re teaching children to rely on tangible objects in order to ‘perform’. I like to highlight two things:

  1. EVERYONE works to get stuff. No matter how much you love your job, you wouldn’t go every day if there wasn’t a paycheque in it for you. Or you wouldn’t volunteer your time if you didn’t get a warm and fuzzy feeling from it (or high school community service credits!).
  2. Whenever we deliver a reinforcer, we pair it with social praise. This pairing will result in an increase in the value of the social praise as it is matched and presented with the reinforcer.

Conclusion:

Many people are fearful of the power that we can exert over others by using reinforcers. And thats can be a very real concern. However, when we take the approach of using reinforcers to help teach skills that allow for more independence we are empowering the child and improving their quality of life.

How to choose an ABA Provider

December 28, 2020

This post will describe the elements you need to consider when you choose an ABA provider for your child.

As soon as you get an Autism diagnosis the first place you turn is likely Google. When you’re reading you find again and again that Applied Behaviour Analysis (ABA) is the most recommended therapy. If you live in a bigger city, you’ve got many options to choose from – but how do you choose an ABA provider?

Here are 5 things to consider when you choose an ABA provider:

Home or centre based?

There are many benefits to both home and centre based programs. What you need to decide is: which will benefit your child and be most manageable in your life?

In home based programs, the clinicians come to your house for each therapy appointment. Generally, a responsible adult has to be home with the child and clinician during sessions. You can see what the clinician is doing and how they’re teaching your child. You can participate in therapy sessions. Depending on the age and goals of the child, the clinicians might need a desk or table that’s free from distractions. Home based programs typically focus on using the toys and materials you have in your home to do the programming. This is a great strategy because it will allow you to continue the interventions when the therapist leaves.

Clinic based programs allow you to drop your child off and get things done while they’re in therapy. Your child will have access to a lot of novel toys and games. There will likely be peers around for social skills programming and they will hopefully learn to be a bit independent as they’re away from you and the ‘safety’ of home. Clinic based therapy sessions can often mimic school more closely than home based sessions can.

Black father and son laying on a bed reading about how to choose an ABA provider.
Black father laying on bed with son searching on a laptop.

Credentials and Supervision

In Ontario, behaviour analysis is not a regulated profession. The title ‘Behaviour Analyst’ is not protected like psychologist or social worker. Anyone can say they’re a behaviour analyst. That’s a terrifying thought.

There is a certification board that credentials Behaviour Analysts. It’s called the Behavior Analyst Certification Board. To become a Board Certified Behaviour Analyst (BCBA) the candidate must have completed an approved graduate degree, completed 2000 hours of supervised work and passed a board exam. To utilize provincial funding for evidence based behavioural services (aka: ABA!) the program must be overseen by a BCBA.

It is vital when you choose an ABA provider that there is a BCBA on the team who will ACTUALLY SPEND TIME WITH YOUR CHILD. It is not enough to have a BCBA who simply signs off on the reports. They should spend a minimum of 2 hours each month supervising and monitoring your child’s progress. The BCBA also trains the front line staff on the interventions.

Some agencies employ Senior Therapists to take over some of the supervision of the BCBA. Often, senior therapists are in training to become BCBAs. This is totally okay, as long as the BCBA remains involved. At Side by Side Therapy, we do 10% supervision (for every 10 hours of ABA a client has they will have 1 hour of supervision). That’s a reasonable standard to look for when you choose an ABA provider.

Reviews and Recommendations

Rely on word of mouth. Other families have walked your path and can often be reliable sources of information when you choose an ABA provider. Most businesses have Google reviews that you can read. Also, there are many support groups on Facebook or other social media platforms that can provide recommendations for ABA providers in your area. You can also ask for references when you’ve narrowed down your search to a few providers.

Parent or caregiver involvement

Instructing parents not to participate in therapy is a huge red flag. There is no reason that you should not be in the room or able to watch what’s happening (whether in a home or centre based program).

Parent training is vital to a child’s success. You must learn the strategies and techniques that will be most effective for your child. One of the best ways to learn is called Behavioural Skills Training (BST). There are 4 steps in BST: instruction, modelling, rehearsal and feedback. You need to practice the skills with the clinician there to provide feedback in order to learn them.

You should also have an equal voice in the direction of the programming and how the programs are chosen. Each ABA program is ABA is individualized to each client so it is important that your family’s goals and values are taken into account when creating the programming. The goal development should be guided by two things: the curriculum assessment and your input.

Interdisciplinary Team

While ABA is the most evidence based intervention for Autism, there is definitely an important role for the other disciplines to play in your child’s autism therapy. Speech-Language Pathology, Occupational Therapy, Recreation Therapy and respite all bring valuable insights and skills to the team.

Bringing an excellent team together with clinicians from multiple agencies is possible, but it is WAY easier to have everything under one roof. Choosing an ABA provider that is open to collaboration with other disciplines is super important.

Questions to ask when choosing an ABA provider

  • What does a typical session look like?
  • How do you measure success?
  • How frequently are revisions made to the programming?
  • Who does parent training? How often is it done?
  • What is your philosophy on punishment?
  • What training do the instructor therapists have?
  • How many years have you been a BCBA?

Call or email Side by Side Therapy today to schedule a no charge/no obligation consultation to learn about our ABA program or for advice on how to choose an ABA provider.

How to get your child to cooperate!

December 21, 2020

Robert Schramm has developed these 7 steps to get your child to cooperate. In applied behaviour analysis, cooperation or compliance is one of the first things we work to establish. The instructor must have instructional control, meaning that the child attempts to do the things that the instructor is asking. Instructional control is an effective working relationship. These 7 steps give you control and will motivate your child to engage with you to earn the things they want. These steps were developed with autistic children in mind but they work for all children! 

Schramm’s 7 steps:

  1. You need to be in control of the things your child wants and you decide when they will get those things.

You should be the ‘giver of good things’. Your child should not be able to freely access these items. Start by going around the house and put any toys or items your child enjoys playing with out of reach. It’s best if your child can see the items, but sometimes these things need to be put into cupboards or treasure chests etc. 

  1. Show your child how fun it can be to be with you. You want your child to enjoy the time they spend with you. 

The focus of most of your interactions should be on pairing yourself with reinforcement. You need to be careful not to put too many demands on your child at the beginning. To do this, you want to comment and narrate your interactions WITHOUT asking questions.  This can be tricky so you  might have to practice! When looking at a book together, instead of saying “What do you see?” “Where’s the dog?” try “I see a dog”, “Here’s a red balloon”. 

Book cover for Robert Schramm's book: The 7 steps to successful parenting. A guide to gaining cooperation while building better relationships.
  1. Be true to your word. The expression to ‘say what you mean and mean what you say’  is vital.  Your child needs to know that they can trust you and you will be consistent. 

Your child uses your words as a guideline for what will happen and what to expect.  If you don’t follow your own rules, why should your child? Consistency is key in getting your child to cooperate.

  1. Make it clear to your child that following your directions is the only way to get the goods. Provide frequent, easy to follow instructions and always provide reinforcement for cooperation. 

We want to teach the child the contingency that they get what they want for cooperating. You can use high P’s or high probability requests to do this.  You give your child directions they’re likely to follow and then reward them for cooperating.  

  1. At the beginning, you have to reward your child after each instance of cooperation. You want to really cement the idea that good choices lead to good things happening for your child. 

By reinforcing each time your child cooperates, your child will start to make the connection between following your directions and receiving the outcomes they want.  This positive working relationship will encourage them to try more and more challenging things in the future. 

  1. Know your child’s priorities and your own as well. 

Write down your child’s preferred reinforcers. Use them. Try to expand that list as often as possible.  While it’s important to know your child’s priorities (what they’re working for) it’s also vital to know what your goals are.  You will often have many goals and they will sometimes compete.  Knowing which is top priority will make it more likely that you will reinforce the most important goals and achieve success faster. 

  1. Teach your child that not cooperating will never result in being reinforced. 

The same way that we need to be hyper vigilant to reinforce all cooperation, we need to be equally as vigilant in not rewarding non-cooperation. When we stop reinforcing a behaviour, sometimes we see a phenomenon called an extinction burst.  This happens when the intensity and/or frequency of a behaviour increases dramatically before it disappears.  The expression that it gets worse before it gets better is 100% true in behaviour.  If we’re prepared and stick to our guns, extinction bursts are quickly overcome. If you’re unsure, it’s best to get help from a behaviour analyst. 

Conclusion

When you employ these 7 strategies, your child will be the most cooperative! Try making one change at a time until you’ve mastered all 7.  Using these ABA strategies with your child will help your child to cooperate as much as it will help you to be an effective teacher.

Ontario Autism Program Announcement…?

December 14, 2020

On Friday December 11th, 2020, the province published an announcement about the rollout of the newest variation of the Ontario Autism Program. The news came from Jennifer Morris, Assistant Deputy Minister, Ministry of Children, Community and Social Services. It was not the news we wanted.

Many people write about the Ontario Autism Program. You can read my blogs about the OAP, the Ontario Autism Coalition‘s website, Facebook and myriad news articles to learn more.

The Ontario Autism Program Announcement

The five pillars of the new(est) OAP are: core clinical services (therapy), foundational family services, early intervention, urgent mental health supports and service navigation. Arguably the most important and more valued pillar is the core clinical services. Sadly, this is also the most costly and will be delivered last.

Logo of Ontario Autism Program

The OAP announcement describes the upcoming ‘calls for applications’ from service providers who wish to bid to implement different pillars of the program. There was no mention of the core clinical services. It is incredibly frustrating and irresponsible for the provincial government to be focusing on these other elements of the OAP while ignoring clinical services. It is possible to implement multiple pillars at the same time.

The Conservatives decimated the program in 2018. They promised to have it fixed by April 2020. Then they said they needed another year. Now it seems as though it will be well into 2022 before we see any core clinical service funding. What do families do when their child’s one time interim funding over?

Some will argue that there is a pandemic and we cannot expect the government to focus on our issues exclusively. But I would argue that this is a problem that the government was ignoring for A LONG TIME before the pandemic began. Now is the time to support these families.

At least we should be clear on how it will be implemented and when. That’s what people expected in an Ontario Autism Program Announcement.

What’s happening now for families and providers

Because families are floating between 3 programs there is a lot of confusion. Legacy kids (mostly) get funding for the services they require – if they can find providers with clinicians available to do therapy. Childhood budget kids are using their funding and waiting for invitations to the interim one time funding. Interim one time funding families are worrying about what happens when their funding ends.

It is unconscionable that the Ford government is keeping families in the dark. ABA system capacity suffers the longer we are in limbo and chaos. Clinicians are leaving the field, for more consistent, stable work. Service providers are not able to meet the demand and waitlists continue to grow longer and longer.

How much longer will the autism community have to wait?

How To Get An Autism Diagnosis

November 30, 2020

Many parents are unsure of where to turn or what steps to follow to have their child assessed for autism. They simply don’t know where to start to get an autism diagnosis.

  • Do you have concerns about your child’s development? 
  • Have you brought them up to your child’s physician? 
  • Are you wondering what the process is to get an autism diagnosis in Ontario? 

At your child’s 18 and 24 month check-ups the doctor should be screening your child for autism. They’re likely using a tool called the M-CHAT-R (Modified Checklist for Autism in Toddlers – Revised). The M-CHAT-R is 20 questions about your child’s behaviour. No screening tools catch EVERY child so even if your child passes the M-CHAT-R, you can still request the doctor make a referral to a specialist for further testing.

To diagnose autism, the person will use formal assessment tools and their clinical judgement. There isn’t a blood test or a scan that you can do that will show autism. Diagnosticians need to have a lot of training and experience identifying autism.

Image of testing materials used during autism diagnosis.

Paths to an autism diagnosis

There are three ways to get an autism diagnosis in Ontario.

Medical:

A family physician, a child’s paediatrician, a developmental paediatrician, a neurologist or a psychiatrist can all diagnose autism. OHIP pays for this assessment and it will not cost you anything. If your doctor is not able to reliably make the diagnosis, they would refer you to someone with more experience and training. Many physicians do not give a detailed report of the child’s level of functioning but will simply write a diagnosis letter. However, as with all OHIP services, there could be a wait to be assessed, especially if you need a referral.

A diagnostic hub:

There are 5 diagnostic hubs in the province. The hubs use a multi-disciplinary approach and perform standardized test. Specifically, there is usually a psychologist, an occupational therapist, a speech-language pathologist and a behaviour analyst on the diagnostic team. They will interview you and interact with your child for a few hours, usually over a few appointments. The provincial government pays for the assessment if it’s done at a hub. Nonetheless, the wait for an appointment can be OVER A YEAR. After the assessment you will receive a written report, describing your child’s behaviour and current level of functioning. Usually, the hub will have you come in for a summary meeting to discuss the findings and talk about next steps and referrals. The hub will give you a list of many resources in your community where you can turn for help.

A private assessment:

Some families choose to use a psychologist to provide the assessment and diagnosis. In fact, Autism testing can cost between $3000 and $5000. The psychologist will interview you and will do standardized tests with your child. Many psychologists use a test called the ADOS (Autism Diagnostic Observation Schedule). Often, psychologists recommend that parents not be in the room during testing. It can be very difficult for parents to watch. This is because your natural instinct is to help your child, but the point of the testing is to determine how your child behaves without assistance. Generally, the full assessment takes place over 3 or 4 visits. The first visit is a parent interview. The second and third are the testing with the child. The last appointment is usually the review of the findings and referrals.

Do you need an autism diagnosis to start treatment?

No! Every child who is not meeting their milestones would benefit from early intervention. Accessing Focused ABA , S-LP or OT services would benefit your child, especially while you’re waiting for a diagnostic assessment.

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

How to Build a Good Relationship with Your Child’s Teacher

September 13, 2020

As a parent, it is normal to have worries about your child’s academic success. How will your child integrate in the school environment? Will they establish positive relationships with their teachers and peers? These are only two questions among the many going through your head. Read on to learn how to build a good relationship with your child’s teacher.

The teacher is the number one person who can help your child integrate and achieve their full potential within the school. This is the major reason you need to build a positive relationship with your child’s educator. Together, you can set common goals and positively influence their long-term academic outcome.

In this blog, we will present a few strategies on how to build a relationship with your child’s teacher. The most important thing to remember is that teachers require time to get to know your child, so keep an open mind. Work towards the relationship you want to have and always state your goals.

How to Build the Relationship:

Use the first meeting to paint a detailed picture 

Parent building a relationship with their child's teacher in a meeting at the school.

Teachers are familiar with the diagnosis of autism. But they don’t know your child, and this is where you come in. To build a good relationship with the teacher you need to help them understand your child. Offer solutions on how to handle certain behaviours, meltdowns in particular.

Be sure to highlight your child’s strengths and what helps in interacting with them. The more information you provide, the easier it will be for the teacher to see beyond the diagnosis.

Talk about goals 

Once school starts, the teacher becomes part of the team. You need to mention the things you are working on in therapy, and how educators can reinforce them at school. It always interests teachers to help their students achieve their full potential. They will want to know about the goals you have for your child. Some teachers are open to Behaviour Consultations from the therapy team.

By informing the teacher about your child’s goals, you will develop a positive, team-based approach. The purpose is to create a team that works together, helping your child achieve new skills. Everyone on the team should be familiar with the things you want to improve or change.

Discuss communication expectations 

It is best to communicate regularly with your child’s teacher. However, remember that they are only one person who has to communicate with a lot of parents. Establishing communication expectations from the start can pave the way for a great relationship with your child’s teacher.

Some teachers prefer after school conversations, while others rely on emails and phone calls. What matters is that you ask and see what works best for both you and the teacher. When engaged in a conversation, stay on the subject. Try to place yourself in the educator’s shoes and see how hard they are working to help your child.

A plan to help the child succeed 

Work with your child’s teacher to develop a plan for how your child will achieve their goals. Modifications and accommodations can be made to the curriculum. Therefore, they should be used to make your child as successful as possible. Talk about behavioural issues and how they influence learning, and set goals based on the strengths of your child.

The key is to develop a partnership with the teacher, working towards a common aim: helping the child succeed. Ask the educator to offer his/her input and work on creating a road map for progress. Meet regularly to review the progress made and update the initial goals.

Don’t be afraid to talk about negative behaviours

Meltdowns and challenging behaviours can be part of life with autism, and teachers deserve open communication as much as anyone else. Don’t be afraid to talk about these issues, as the teacher is not there to judge your child but to help them. The teacher will be grateful that you were up front and this will help build the relationship.

It might help to discuss specific situations. Find out what caused a meltdown, and how the teacher saw fit to intervene. Have a talk about potential triggers and also about school-related behaviors that could be worked on during therapy. The more you are open about your child, the easier it will be for the teacher to relate and offer help.

Parent-teacher interview

A structured interview can be useful in developing a positive relationship with your child’s teacher. During the interview, you can talk about your child, and any issues related to his/her diagnosis. By doing this, the educator finds out more information about his/her students.

From your perspective, such an interview represents a sure way of starting things on the right foot. You can speak about emotional and behavioral difficulties, and academic goals. Depending on how much time you have available, you can also discuss how your child will integrate in the school environment.

Conclusion

It takes time to develop a positive relationship with your child’s teacher, but the effort is all worth it. The educator becomes part of the intervention team, fighting to help your child grow and overcome the challenges they face.

Interested in reading a New York Times article about how a Florida mom works to build a good relationship with her daughter’s school?

 

How To Pick The Right Autism Therapy: 8 Questions

August 23, 2020

Read time: 4 minutes

Thanks to the internet, information on autism therapy is unlimited.  Some of it is very valid and helpful.  Some of it is not.  Use common sense when picking interventions or treatments to try.  If it sounds too good to be true, it just might be.

As of now, there is no cure for autism. There are lots of treatments that can teach skills and there are some medications that can improve some physical symptoms but there is no cure. That’s hard to hear as a parent and hard for me to say as a therapist.  I believe that every child is capable of learning and becoming a better version of themselves.

The interventions you choose should fit with your values and be evidence-based. Evidence-based means that different groups of researchers studied them and have repeated the results many times.  However, there are many autism therapy interventions that are not evidence-based. 

One of the problems with choosing an intervention that is not evidence-based is that it takes valuable time, energy and resources away from interventions that are shown to work. Very few families have unlimited funds for therapy. Therefore it’s important to try and get the most value out of the things you can do.

Parents interviewing team for autism therapy.

Ask these 8 Questions when choosing an autism therapy or provider:

1. What research is there that supports this intervention?

Look for studies that have been peer reviewed (that means that other experts in the field have reviewed the study and can vouch for the way the study was designed). 

Anyone can write a blog or publish an article on the internet.  That is to say you want to be sure that the information you’re using comes from reputable sources like Universities (and not just your aunt’s best friend’s cousin who had the same problem as you). 

At Side by Side Therapy, we only utilize evidence-based practices in our autism therapy. 

2. What training do you and your staff have?

In Canada, there is no standard credential for behaviour therapists.  In Ontario, in order to use your provincial funding on behavioural services, the program must be supervised by a Board Certified Behaviour Analyst or a Clinical Psychologist with experience in ABA. To be an Instructor Therapist (IT), most agencies require that the candidate have a post-grad diploma or certificate in Autism and Behaviour Sciences. It is slowly becoming the standard that ITs are Registered Behaviour Technicians (RBT) but it’s not mandatory. 

At Side by Side Therapy, all of our clinicians are encouraged to maintain the highest standard for their discipline. We are actively training the next generation of behaviour analysts. 

3. How will this intervention be individualized for my child? 

There’s an expression in the autism world: “If you know one person with autism… you know one person with autism”. Each child is an individual and learns differently.  In other words how they are taught, which reinforcers and prompting procedures are used and how success is measured should all be individualized.  It is impossible to pick up a textbook or curriculum and have an ideal autism therapy program. 

4. How do you measure progress?

Some clinicians are focused on the end goal – total independence.  Some children will never achieve total independence. It’s important that the way progress is measured is meaningful to the client and family. There are different dimensions that can be used to measure progress: frequency, intensity, duration and more! 

5. How will we work as a team? 

You want to ask about how frequently team meetings are held, how to contact the clinical supervisor if you need them (phone, email, text?) and how frequently parent training sessions are held. 

Parents should be involved in every aspect of their child’s autism therapy program. 

6. What are the goals of this autism therapy – in general and for my child? 

You want to ensure that the goals of the intervention align with your goals for your child. Some programs focus on language, while others focus on challenging behaviour reduction. You want to ensure that the goals reflect your child’s needs and your beliefs about education and will be in line with your thinking. 

7. What are your feelings on stim behaviours? Should we be trying to stop them?

For many years it was believed that therapists should stop children from engaging in self-stimulating behaviours (stimming).  Many autistic advocates have expressed how damaging suppressing stims was for them. A new belief is taking hold –  as long as the stim is not hurting anyone, destroying property or stopping the child from participating in activities, it should not be addressed. No one stops typically developing people from engaging in stims as long as they’re not hurting anyone or destroying property – why should it be any different for autistics?

8. What is the process for terminating services if I do not wish to continue? 

You should never be locked into a service.  If it is not working for your child or family you should be able to openly discuss this with the team.  In Ontario, specifically, you should not be pressured to sign over your entire Childhood budget or Interim One Time Funding Cheque to a provider. 

Connect with Side by Side Therapy to schedule a no-charge/no obligation consultation to discuss our autism therapy solutions for your child.

IBI and ABA: What’s the difference?

August 16, 2020

Read time: 3 minutes

When your child receives an autism diagnosis you are introduced to an alphabet soup of acronyms. IBI, ABA, OAP, FA, IEP, IPRC; the list is endless.  In this post you’ll learn the differences between two of the most used and often confused: IBI and ABA. 

Boy working with therapist in an IBI session for autism treatment.

What is ABA?

ABA stands for applied behaviour analysis and it is the science of learning and behaviour. There are a few laws of behaviour, very much like the laws of gravity. These rules are reliable, observable and measurable. The focus of ABA is to change socially significant or meaningful behaviour.  That  means that the goal is to improve people’ lives by helping them achieve more independence and access to the things that matter to them.

What is IBI?

IBI stands for intensive behaviour intervention. IBI is the intensive application of the science of ABA. For a program to be considered IBI, it has to occur more than 20 hours per week.  Because of the intensity, IBI programs are usually comprehensive. This means that they cover many domains of learning.  IBI programs are often recommended for children with level 2 or 3 autism (previously known as lower functioning children).

What are socially significant behaviours?

Socially significant or meaningful behaviours are the behaviours that matter to you and your family. Some examples are: communication, self-care (toileting, hygiene, self-feeding) and reducing challenging behaviour. Independence in these areas will allow your child to participate more fully in life.

Neither IBI nor ABA is better than the other. Some children learn best in a very structured environment (like IBI) while others learn best in a naturalistic setting (like school). Your child will make progress in both. There is a lot of research that shows that early intensive behaviour intervention has the best outcomes for young children. 

In an IBI program, your child will learn communication and language, social skills, play skills, pre-academic or academic skills, self-help skills, motor skills and much more.

In an ABA program, the therapy will focus on one or two specific goals that you want to address. Some parents choose to focus on challenging behaviour when doing a focused program. Also, some families find it helpful to focus on ‘high impact’ behaviours like toileting or feeding.

How do I decide which program my child needs?

Choosing which program is best for your child is a difficult decision. There are many factors that will play a role: your child’s needs, their other programs/therapies, location, finances, waitlists and your beliefs about education. You know your child best and it’s important that the therapy you choose fits your lifestyle and beliefs.  Therapy plays a big part of your life and it needs to make sense for your family. 

Working with a Board Certified Behaviour Analyst (BCBA) that you can trust is really important. The BCBA will do an assessment to figure out what skills and needs your child has. Some common assessments are: the Assessment of Basic Learning and Language Skills – revised (ABLLS-r), the Verbal Behaviour Milestones and Placement Program (VB MAPP) and PEAK Relational Training System. These are curriculum assessments that determine current skills and areas of need. They do not provide a new diagnosis. The BCBA might also do a Functional Analysis (FA) to determine the function of a challenging behaviour. Based on the results of the assessments your BCBA will make a recommendation that is specific to your child.

You should be fully aware of and give permission for each part of your child’s program. The clinical team must explain how the skills will be taught. Behaviour does not happen in isolation, so you will need to implement the same strategies outside of therapy.

Who is on an IBI/ABA team?

There are 3 levels of clinicians on an IBI team: instructor therapists, Senior Therapists and the BCBA or Clinical Supervisor. The instructors are delivering the therapy on a daily basis.  The Senior Therapist does the assessment and follows the programming to ensure that it is being properly executed and that the child is making progress. The BCBA works with the Senior Therapist to do the assessment and determine what the goals should be.  They will work together with the Senior Therapist to write the programs and train the instructors.

How much does IBI/ABA cost?

Each centre is different and ABA is not regulated in Ontario (yet!) but you can expect to pay roughly $55/hour for the Instructor Therapist, $75/hour for a Senior Therapist and $150/hour for the BCBA.  At Side by Side Therapy, we use a 10% supervision model. That means that for every 10 hours of therapy your child  will have 1 hour with either the Senior Therapist or the BCBA.

The Side by Side Therapy Process

At Side by Side Therapy we determine which of our 4 streams of ABA service (IBI/Comprehensive ABA, Focused ABA, Parent Coaching or Behaviour Consultation) will meet your child and family’s needs. We write programs specifically for each client. Each program is different.

You are able to use your Ontario Autism Program (OAP) funding with Side by Side Therapy. We will help you navigate the process and will ensure that our services fall within the OAP guidelines.

Connect with Side by Side today to schedule your free no obligation consultation.

Early Start Denver Model (ESDM): Unleash Potential!

August 9, 2020

Read time: 4 minutes

The brain has a unique property called neuroplasticity. This means that our brains are constantly able to change and grow. Children under 5 years old have the easiest time with neuroplasticity. Even when the child has been diagnosed with autism, it is possible to make significant gains that are life changing. We can achieve this through early intervention. Specifically by using the Early Start Denver Model, we can begin even before a diagnosis is made. 

Child playing with is mom during an Early Start Denver Model session.

Within a therapeutic environment, the autistic child presents a higher chance of developing language, cognition, and social interaction abilities. We can teach skills to overcome the challenges associated with the autism diagnosis. But the essential thing is for the intervention to begin early on.

ESDM: The earlier, the better

Developmental specialists recommend the therapy to start as early as possible, as this leads to the best outcomes. Parents should not wait for the diagnosis but seek the help of a therapist as soon as they have suspicions about their child’s development. 

The sooner we start the intervention, the better the outcome is likely to be. Parents might struggle to accept the diagnosis, but they should waste no time in pursuing therapy.

A better chance of addressing behavioural issues 

Autistic children often have challenging behaviours which become more challenging over time. Addressing challenging behaviours is generally easier in younger children because they don’t have a long learning history. Having a long learning history means that the behaviour has been reinforced for a long time. Similar to a habit, behaviours with long learning histories are hard to break.

If there are challenging or non-adaptive behaviours present early intervention can replace them with alternative behaviours. The key is teaching replacement behaviours that meet the same needs but are more effective. For example, if a child is taught that they will get your attention if they cry, they will keep crying. They do this because that strategy works. But if you reward a child for using another strategy (e.g.: a word approximation, directed eye gaze or pointing) they will use the new behaviour instead. And then the challenging behaviour will fade away.    

ESDM: Individualized intervention from an early age

The therapist will develop an individualized intervention plan, based on the child’s needs, behavioural issues and the use of the Early Start Denver Model Curriculum Checklist. The Curriculum Checklist is a list of skills that are divided into levels that represent different ages.  The therapist uses the Curriculum Checklist to assess your child’s strengths and areas of need relative to same age peers. The purpose of the intervention plan is to help the child develop a wide range of skills including: attention, communication and interaction. 

As mentioned above, a structured environment will offer opportunities for learning. It facilitates the growth of skills, while it allows the therapist or parent to monitor the progress being made on a consistent basis. The therapist can adjust the plan as necessary, but the chief goal will remain the same: the child learns through play while having fun.

Early Intervention: Families receive support early on

As parents of special needs children, especially autistic children, it is normal to feel helpless and frustrated. Early intervention, though, can be highly beneficial for the entire family. It can provide support early on, reducing the amount of stress parents experience. Having an action plan and strategies to use will help parents to feel empowered and as though they are taking action. 

It is vital that the parents are also implementing the strategies and using therapeutic interventions with their children. The child has a limited number of hours with the therapist each week but many more hours with their parents. These hours should be maximized! 

What matters is that they capture the attention of the child and pursue communication. Being creative and silly will go a long way. 

ESDM: A combination of ABA and play

An experienced therapist will give the child time to become accustomed to the unfamiliar environment, chaining skills together to create a smooth session. It takes time to build the relationship, and only then will the therapist focus on addressing behavioural issues, cognitive and speech delays, etc.

Taking advantage of the brain’s neuroplasticity 

We see the best results up to the age of five years, as that is when the child’s brain is most malleable. We can unleash the learning potential in therapy and limit the effects of the autism diagnosis. As a result, the overall quality of life can improve, thanks to the newly learned skills. 

The benefits of early intervention using the Early Start Denver Model in autistic children are obvious. The earlier the child enters a structured, therapeutic environment, the better his/her progress will be. Parents should actively collaborate with the therapist, practicing taught strategies at home and helping their children unleash their full potential.

To learn more about how Side by Side Therapy can help your child with an Early Start Denver Model program, please connect with us!

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.

3 Applied Behaviour Analysis Tips to Get your Child Wearing a Mask

June 14, 2020

In these changing times, due to COVID-19, we have had to change our behaviour in a lot of uncomfortable ways. We’ve done this to follow the rules and recommendations set out by the government and public health officials.  The field of Applied Behaviour Analysis has a lot to offer to help!

One of the recommendations is the wearing of masks while out in public where physical distancing isn’t possible. Wearing masks may be uncomfortable and foreign to most adults. Parents of autistic children have been particularly concerned with how to get their children to safely and effectively wear masks.

Parents of children that have sensory issues already know how the struggle of the basics such as underwear and socks! Now with the expectations of wearing masks, there is the introduction of yet another stressor (for both child and parent!).

Create a plan based in Applied Behaviour Analysis:

Developing a plan to help desensitize your child to masks is essential. It is best to work with your therapy team to ensure you are taking the right steps for your child.

As changes in routine can be more difficult for children on the spectrum, I am providing you with these guidelines as a starting point.

If you don’t have a therapy team, feel free to reach out to Side by Side Therapy for a no-charge consultation. 

Here are 3 helpful tips to encourage mask wearing:

Make your Expectations Clear

Explaining to your child what you expect regarding mask-wearing will help to clearly outline what needs to happen and why.  It may be helpful to use the “If-Then” or “First-Then” language approach.  For instance, “If you want to go outside, then you have to wear your mask”. “First we put your mask on, then we can go to the store”. 

Boy sitting at desk wearing a mask after using applied behaviour analysis to learn to tolerate the mask.

Reinforcement and Praise

One of the foundations of ABA is reinforcement. Since wearing a mask is a huge accomplishment for your autistic child, it’s important to provide tons of reinforcement and praise. This will help make wearing a mask as motivating as possible. A few suggestions are:

Mom fixing a mask on her daughter using the principles of applied behaviour analysis.
  • Purchase a mask that has a preferred character or personalized touch on it.
  • Provide a favourite reward for wearing the mask for the agreed-upon time.  Remember, start slow so you can work to build up your child’s tolerance. 
  • Initially, you could have your child wear the mask while doing their favourite activity, such as playing on their iPad or Lego. 
  • When you have your first practice run in public you should do something fun! Going to your child’s favourite place or visiting loved ones are great ideas.  

Work on your child’s mask tolerance

Mask tolerance is going to be a challenge for a lot of autistic children and it is necessary to make the experience as fun and pleasant as possible.  This can all start with having your child, pick out their own material or mask while paying special attention to their sensory needs.  Once you have chosen a mask that you feel will be appropriate for your child, your next step is to create a plan of action for introducing and then successfully wearing the mask. 

The field of applied behaviour analysis suggests adopting three strategies to help in the desensitization of mask-wearing: Pairing, Shaping and Chaining. Read more about ABA terms and meanings.

Pairing

Pairing is a way that introduces unfamiliar objects, in this case a face mask, to a person. Present the unfamiliar object at the same time as a preferred object and the pleasant qualities of the preferred object are transferred to the unfamiliar one. To make the mask seems fun and welcoming present it to your child at the same time as you give reinforcers. It can take many presentations before the unfamiliar object becomes ‘paired’ with the preferred one. Once your child becomes comfortable holding it, it is then time to introduce shaping. 

Shaping

Shaping takes place once your child has become familiar and comfortable with the mask, and at this time, you can then, using the same positive reinforcers, have your child begin to gradually engage more and more with the mask. For example the process in a shaping procedure for mask wearing might be to:

Mom and son using the applied behaviour analysis concept of pairing.
  • Hold the mask;
  • Bring the mask close to their face;
  • Then touch the mask to their face;
  • Allow you to pull back the elastic bands or bring the ties around to the back of their head;
  • Fitting the mask to their head. This piece may need to be started in very short increments. You may want to use a visual timer to help cue your child to how much time is left. 

After your child engages in each step without challenging behaviour you need to reinforce their efforts. This may seem easy and straightforward but it may take some practice and many trial runs before success is achieved. As you know, practicing and learning a new skill takes patience, so too will becoming comfortable with mask-wearing. Be sure to initially practice pairing and then shaping at home or in a safe environment and once the comfort level is achieved you can try it out in public. And remember, your ABA therapist is always available to guide you and provide you with the resources you need to help manage this challenging situation.   

Chaining

Chaining is the idea of putting a number of behaviours together to create a sequence (or chain). In this example, a chain for mask wearing would include washing hands before putting the mask on, securing the mask to the head, wearing the mask, removing it safely, putting it in the trash or washing machine and washing hands again.

Chaining is a helpful way of teaching complex behaviours that happen in a specific order each time.

As wearing a mask can be difficult and uncomfortable in general, the challenge, unfortunately, may become magnified for those that have sensory challenges such as autistic children.  Therefore, it is important to work with your therapy team to come up with a plan and strategies to help your child manage successfully wearing a mask.

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!

Autism: what’s more important equality or equity?

April 13, 2020

Read time: 6 minutes

Equality and equity are words that are often understood as being synonymous as they both have the implication of fairness, however, the two meanings are actually very different. Equality means to have the same opportunities as everyone else. Equity speaks to ensuring that everyone has the opportunities they need to be successful.

There have been many political movements that have espoused equal rights: women’s groups, minority groups, autism advocacy groups and other disability rights groups.

With equality, it is assumed that everyone has the same starting point and should be treated in exactly the same way. While with equity, the belief is that not all people start at the same point and for that reason, each person should receive (based on their distinct abilities) what they need to be successful. In understanding the difference between the two, we can conclude  that fairness does not mean equality. 

Modifications and Accommodations for Autism

While the idea behind equality is to treat everyone “fairly” and “equally”, it has sadly missed the mark when looking at fairness around Autism Spectrum Disorder (ASD). Assuming that everyone is equal and is starting from the same place (which we know is not true, especially in autism) can actually create unintentional barriers. For instance, modifications are necessary for those with autism to be successful in their daily routines.

Making practical changes allows the starting point to truly become one of fairness. Simply put, modifications and adjustments are how we can promote fairness and ensure that all people are provided with the tools they need to achieve success. 

An example of these modifications put into action is an autism framework is that of a child who has sensory concerns or challenging behaviour and has trouble sitting in a circle on the floor with the rest of the class.  Pressuring the child to join on the floor may create resistance or even a meltdown which affects not only the autistic child but the class as a whole. A small concession that a teacher may make is to allow the child to sit on a chair in the circle to help with engagement and integration.

Yes, this may seem to some degree “unfair” to the other children or “special treatment”, however with this minor adjustment being made to accommodate a child that has additional needs, the teacher has effectively created a more positive and successful learning environment not only for the autistic child but for the entire class as well.

We cannot and must not expect every child to fit into one box and hope that success will be the same across the board. We have to realize that accommodations and flexibility provided by parents, professionals and autism caregivers are not only kind but are actually essential to achieving true equity. 

Autism ABA Therapy Lindsey Malc Side by Side Therapy Equality vs Equity Cartoon of boys trying to see over a fence.
Equality vs equity cartoon showing the practical difference between the two terms.

As these adjustments are necessary, we need to position them as being so. Instead of the modification being looked at as unfair, it rather should be seen as levelling the playing field to ensure fairness. If we don’t make a big deal about these accommodations than others (classmates, siblings etc.) won’t either. We need to keep in mind that it’s not only those with autism that are different, but we are also all different in our own way and therefore have different capabilities and needs.

In focussing too much on equality and  fairness, we end up overlooking the wonderfulness of difference. Instead, we need to look at each person individually to ensure equity and flexibility are at the forefront. Then and only then we can indeed provide fairness in its truest form.  

To further exemplify, here in Ontario, Canada all of the changes that are being proposed and made regarding the Ontario Autism Program’s funding is a prime example of the misunderstanding surrounding equality and equity.  The province seems to be under the impression that allocating the same amount of funds for children who fall within provincially designated categories (age, etc). will provide equality across the board.  However, where the mistake lies is that autism does not affect each person in the same ways.

Therefore, funding and resources should not be allocated based on provincially set rigid categories such as age, and should instead be provided and distributed based on individual need. As autism falls on a spectrum from mild to severe, one child who is nonverbal may require, for example, far more Applied Behaviour Analysis (ABA) Therapy or Speech Therapy, than a verbal autistic child. This example is just one of many reasons why “equality” in this case will just not work.    

Below is a helpful example of a lesson that can be played with your children to help explain this confusing topic:  

The One Size Fits All Band-Aid Lesson – Ask the children to share their most serious injury: some may say a broken arm, a dislocated shoulder or a cut on the forehead. Once the injuries have been acknowledged, explain to them that your solution to heal them is to provide them each with a band-aid. 

This solution will most likely raise some confusion to the children, as how is a band-aid supposed to fix a broken arm or a dislocated shoulder? This unhelpful solution shows that there is not one solution to all situations and that each situation needs to be addressed in it’s own way. Even though using the same solution (the band-aid) may in theory seem fair, how can this “equal” method of treating three different injuries be acceptable? All that is accomplished is that only a small number of people actually get the help they need while the rest of the group suffers. 

Once again, it is important to remember that there is a difference between equality and equity. Fairness can only truly be gained with compromises and modifications which ensure that all people are indeed given the tools they need to be successful.  Would you not agree to a person with bad eyesight getting glasses or a non-english speaker having a translator at the hospital? It is a similar situation when making adjustments for autistic children and others with exceptionalities.

We know that not all people are born the same, and in keeping this in mind, we need to continue to work towards levelling the playing field to ensure actual fairness is received. 

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

Autism Spectrum Disorder Diagnosis? 8 Steps to help kickstart your child’s success

February 10, 2020

Read Time: 5 minutes

The word autism in a magnifying glass, demonstrating that this article is about autism spectrum disorder.

Receiving a diagnosis that your child has Autism Spectrum Disorder (ASD) is not only scary but overwhelming too. There are so many questions and while there is a vast amount of research to turn to these answers often only result in further questions and possibly further confusion.

It is important to rely on your treatment team including a Board-Certified Behaviour Analyst in Toronto (BCBA) for support and guidance as they understand just how exhausting and challenging such a diagnosis can be. Working together will help with your child and family’s success both at home and at school.

Here are some helpful tips to try when your child gets an autism spectrum disorder diagnosis:

1.  Become an Expert in your Child’s Needs, Likes and Dislikes

Each child with autism spectrum disorder is different and we need to embrace, understand and support their differences. This can be achieved through research and asking questions about autism spectrum disorder and more specifically your child’s individual needs. As each child is unique, you must remain open minded about their experience of having autism. Once you gain some knowledge you will then be able to ask insightful questions to help build the best treatment plan for your child. 

The best place to start is with your child’s family physician, they will be able to refer you to an autism consultant who can work with you to develop a team. Your physician should also be able to provide you with useful resources such as finding the best Applied Behaviour Analysis (ABA) therapist or group including Board Certified Behaviour Analysts (BCBA) for your child. Remember finding the right therapist may take time and patience. There is no such thing as “one size fits all” in a treatment plan. 

2. Find Help through Technology

As technology has become an integral resource within our society, it has become a very useful tool for parents of children with autism spectrum disorder. Firstly, a vast array of knowledge and research regarding your child’s diagnosis and treatment can be gained through the internet. Secondly, technology is also used as a resource for community building through social media including parenting groups and intervention discussion forums.  Here there is an opportunity to seek the support and experiences from parents in similar situations and professionals in the field. These communities are amazing and can help one to realize they are not alone. 

Lastly, and perhaps most importantly, technology holds a critical use for autism spectrum disorder children that have communication difficulties and is used as a tool to remove this barrier. AAC (Alternative and Augmentative Communication) gives a voice to children who cannot speak using tablets or computers with specialized apps that utilize text or image to speech technology. These are sometimes called SGD (Speech Generating Devices). 

3. Get Intervention as Soon as Possible

Parents that feel that their child might have autism spectrum disorder should speak with their child’s physician as early as possible to investigate a diagnosis. Don’t allow your child’s doctor to dissuade you or convince you to ‘wait and see’. With an early diagnosis and then prompt invention parents are able to start working towards helping their child to address interfering behaviours and increase communication skills.

Intervention is most effective in younger children. If your child’s interfering or challenging behaviour (e.g.: outburst in public) is addressed and dealt with early on, then the hope is that through reinforcing positive or desirable behaviour, the child will eventually be independent in the future in the same situations. Positive outcomes are possible for older children as well, so don’t give up if your child is older when they begin to receive treatment. 

4. Ensure your Child’s Treatment is a Family Affair

An autism spectrum disorder diagnosis not only affects the diagnosed child but it affects the entire family. It’s therefore necessary that the therapy plan includes siblings’ and parents’ opinions and experiences. Since schedules and rules set out in the plan will put expectations on the entire family, their input and buy-in is imperative for the success of the program.

It is also vital that family members are involved in the treatment plan to ensure that generalization occurs. This means that your child is able to demonstrate all the skills they are learning in new settings and with new people instead of only with the treatment team. It may become a balancing act for you, however with support, consistency and careful consideration and execution of the therapist’s recommendations your day-to day routines will become less overwhelming. 

5. Trust your BCBA, Treatment Team and the Process

As mentioned, finding the right BCBA and program can be a difficult journey, however, once this is accomplished you will soon see that you are on the right path. As your child is unique in their needs you must remain optimistic and open-minded. There will be necessary tweaks and adjustments along the way and through trial and error, you will certainly see positive changes.

Finding a team that suits your family’s needs and expectations is extremely important. You will also need to ensure there is a constant flow of communication between your family and your child’s BCBA so that modifications can be implemented and changes made whenever required. 

6. Celebrate the Successes

As you continue to fill your toolbox with more tips and knowledge it will open the door for greater success. At times there may be a lot of growth and positive changes and at others, there may be little or none. It is important to stay focused on the positive and reflect on the successes and celebrate them frequently. Continuing to stay on course and provide consistent routines and expectations for your child. The more you celebrate the successes the more likely it will be that you feel good about your child and family’s future. 

7. Make Safety a Top Priority

The challenges and long-term responsibilities that come with an autism spectrum disorder diagnosis can be additional stress placed upon an autism parent. To help ease the sense of being overwhelmed it is important to get organized and put proper measures into place for a “just in case” situation (for example, looking into life insurance for family members). As children with autism can engage in more dangerous behaviour (wandering, mouthing and self- injury) a safety plan is essential.

It is necessary to develop a plan to address these safety risks with your treatment team. For example, you should ensure that your child always carries or wears identification, especially if they are a wanderer. A simple google search will yield many options for safety tools for your child with autism spectrum disorder.

8. Work on Establishing a Good Sleep Routine

One of the challenges many children with autism spectrum disorder face is difficulty sleeping. Poor sleeping can exacerbate some of the challenging behaviours associated with autism such as impulsivity, compulsions, hyperactivity and physical aggression.  Good sleep hygiene is vital to providing your child with quality restful sleep.

Keep in mind a few things while creating a routine, for instance: maintaining consistent times for going to bed and waking up; how much light is in their bedroom while they’re trying to sleep; ensuring your child has enough play time during the day and not too much screen time prior to bed; perhaps instituting a wind-down quiet period before bed; taking sensory issues into account, i.e. itchy pajama’s, white noise etc.  

If your child has recently received an ASD diagnosis and you are looking for ways that the Ontario Government can support you, please know that changes to the Ontario Autism Program are in the process of being established. They are working towards creating a new “needs -based and sustainable autism program”. Eligibility for this program has the following criteria:

To register for the Ontario Autism Program, your child must:

  • be under age 18
  • currently live in Ontario
  • have a written diagnosis of autism for a qualified professional

Your child’s written diagnosis must include:

  • your child’s full name and date of birth
  • the date of your child’s assessment
  • a statement indicating that the child meets the diagnostic criteria for autism spectrum disorder
  • the qualified professional’s name and credentials

For registration information please contact the central intake and registration team at:

Ontario Autism Program
Ministry of Children, Community and Social Services
P.O. Box 193, Toronto, Ontario M7A 1N3
1-888-444-4530 [email protected]

The site notes that if you have registered in the Ontario Autism Program before April 1, 2019 you do not need to register again.  As well, they mention that once your registration is complete, your child will be added to their waitlist and you will receive a letter from the ministry when it is time to complete further steps to receive funding.

Additional services and support are provided by the Ontario government for children with special needs, these are listed below:

For more information please visit:  https://www.ontario.ca/page/ontario-autism-program

If your child was recently diagnosed with autism spectrum disorder, please connect with us. We can help you navigate these distressing times.

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.

Behaviour Intervention Plans: The 8 essential elements

January 6, 2020

Read time: 2 minutes

Example of a behaviour intervention plan that addresses challenging behaviour.






There are many ways to intervene to address challenging behaviour.  In Applied Behaviour Analysis the Behaviour Intervention Plan (BIP) is used. Here are the essential parts of a behaviour intervention plan to look out for when designing one or if one is being implemented with your child.

Elements of a behaviour intervention plan

Operational Definition of Target Behaviour: 

This is the definition of the target behaviour.  It is used throughout the behaviour intervention plan. It is important that this definition is accurate and explicit so that anyone who reads the definition would be able to identify the behaviour. The operational definition should include descriptions that are measurable and observable. It is good practice to include a non-example of the behaviour. For example, if the target behaviour was crying, you would not track crying if the child was hurt. Everyone needs to be working from the same framework and that begins with a solid operational definition. 

Function of Behaviour:

It is important to identify or hypothesize the function of a behaviour before you attempt to change it.  Knowing the function will lead you to a function based replacement behaviour. Functional replacements are more effective because they meet the need that the original behaviour as serving. Read more about the functions of behaviour here.

Replacement Behaviour Definition:

Each target behaviour should have a replacement behaviour that will be taught and reinforced.  This behaviour also needs a proper operational definition to ensure that there is consistency across implementers and to ensure that each instance of the behaviour is reinforced. 

Antecedent Strategies:

These are the things in the environment that will be modified to avoid the target behaviour in the first place.  Some examples of antecedent strategies are to reduce distraction, provide scheduled or free access to reinforcers or proactively reducing demands. 

Skill Building Strategies:

In a behaviour intervention plan, these are the strategies that will be implemented to teach new skills.  These strategies can be tools like visual schedules, token boards or the specific steps that will be taught to the child to accomplish a new skill. 

Consequence Strategies:

These are the strategies that will be employed once the behaviour has happened.  These are important so that everyone on the team is aware of how to respond when the target behaviour happens. Consequence strategies are not exclusively negative, they are simply what happens after the target behaviour. Examples of positive consequences are receiving praise for completing an assignment on time, getting a high five for trying a new food or earning extra time on a device.  

Data Collection Procedures:

Data is an important part of any applied behaviour analysis intervention.  Data is taken to measure change, how quickly that change is happening and to identify when that change is not occurring. Treatment decisions like when to change targets, when to revise interventions or when a skill is mastered should all be made based on the data that has been collected. Data collection should be specific to the situation and able to be gathered with consistency and integrity.  Bad data doesn’t help anyone.  

Generalization and Maintenance Procedures:

Generalization and maintenance needs to be programmed from the outset of treatment in order for them to occur. It is very unlikely that a skill will be generalized without specific planning. Generalization is when a skill can be demonstrated in a number of settings or environments, with different materials and with different people. Maintenance occurs when a skill is reliably demonstrated with a level of reinforcement that is less than what was used to teach the skill. 

If you would like to discuss your child’s behaviour intervention plan please contact us for a no-charge 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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