Tag: Challenging Behaviour

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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.

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.

Manding: 4 things to know

March 14, 2021

Last week I introduced Skinner’s Verbal Behaviour. This week we’re going to focus on the first verbal operant: mands.

1. What are mands or manding?

Another word for mand is request. Mands can be single words or complex sentences. When we ask for something we’re manding for it. It is vital for a child to know how to mand for their needs. The ability to ask for the things we need is a sure way to avoid challenging behaviour.

Meme of a baby boy with a suprised look on his face with the text "So let me get this straight I don't have to cry and yell to get my cookie?" Example of how manding can reduce challenging behaviour.

Mands can take many forms: spoken words, picture exchange, voice output devices or signs and gestures. Even eye gaze can be considered a mand!

2. How should we teach manding?

There are 3 main steps to mand training:

  1. Identify highly preferred items that will be exciting enough to prompt a request.
  2. Withhold the item and prompt the mand. Model, give cues and opportunities for the child to use the mand. Don’t give them the item unless they mand for it!
  3. Reinforce and shape! Give the child access to the item IF they made an attempt or were successful in their mand.

This clip from Supernanny shows the process beautifully (keep in mind they had to edit it to fit in the length of the show. It usually takes longer than one session to get a full word)

3. How long does it take to learn to mand?

Every parent wants to know how quickly their child will learn. But, it’s impossible for anyone to predict. What we do know is that consistency is key. Children who are given lots of practice will have better outcomes. It’s also important for all people to have the same expectations of the child. Generalization (learning to do skills in all environments, with all people and all materials) does not always happen spontaneously. Once a mand is mastered it should be practiced all the time to ensure it’s maintained and generalized.

4. Why teach manding?

As mentioned before, children who can mand often have lower rates of challenging behaviour. All behaviour has a function (to escape, to get things, to get attention or for sensory purposes). If the child can communicate their need (to escape, to get things, to get attention or for sensory) they won’t have to engage in challenging behaviour. We often teach replacement behaviours to help children mand without challenging behaviour.

Communication is everyone’s right. Communication is spoken language, signs, picture exchange or voice output devices . But mands are only one of the verbal operants!

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 2

February 7, 2021

In last week’s post we discussed that some parents are searching for a cure for autism. This week we’ll be looking at IF there should even be a cure.

Should we be looking for a cure for autism?

Toddler blowing bubbles. Should her parents try to cure her autism?

I think that thinking autism needs to be cured is an outdated philosophy. This idea is perpetuated by the belief that we need to all be the same. There is wonderful beauty in difference, but we must learn to look for that beauty.

What is neurodiversity?

Neurodiversity refers to the idea that differences in how brains work are not deficits but rather just differences. Different diagnoses fall under the neurodivergent umbrella. Some examples are: Attention Deficit Hyperactivity Disorder, Autism Spectrum Disorder and Sensory Processing Disorder. Neurodiversity accepts the person’s differences instead of pathologizing them.

If autism doesn’t need a cure, why do therapy at all?

There are some behaviours that are harmful to the person or their environment. If we believe that all children deserve a safe and fulfilling life, then we should do our best to help them achieve this. One of the core features of autism is difficulty with communication. Each child should have a reliable way of communicating their needs. We must do what we can to empower them to communicate in any way they can. This might look like vocal speech for some children or sign language for others. When we accept the child’s neurodiversity we open up our beliefs about how they should ‘be’. By broadening our beliefs, we’re making the world more accessible to them.

One time that it is important to intervene is if the child in engaging in dangerous behaviours. Behaviours such as aggression, self-injury and property destruction can all have very serious outcomes. The best intervention for these behaviours is to do a functional analysis and determine the function of the challenging behaviour. Once the function has been determined, a replacement behaviour can be chosen and taught.

Autism doesn’t need a cure but our goal should be to improve the child’s quality of life. What that looks like will be different for each person.

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.

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.

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. 

Speech Therapy in Autism Treatment

September 28, 2020

Read time: 2 minutes

Communication represents one of the core challenges for autistic children. Speech Therapy in autism treatment is essential. They may have difficulties engaging in a conversation. Not picking up on social cues, they might find it hard to interact with their peers.

A speech-language pathologist can help autistic children improve their communication and social skills. Addressing key areas, the therapy team will help the child overcome daily challenges and learn how to function within a social context.

What are some of the challenges caused by autism?

It depends on the severity of the condition – autism is a spectrum. Some children may not understand non-verbal communication easily, while others will have trouble with spoken language. They may need help learning to read or write or engage in conversations with others.

Speech Therapy in autism treatment with a young boy and a Speech-Language Pathologist

In severe forms of autism, the speech/language impairment will be more obvious. These children might not speak at all, or they might resort to challenging behaviours to express themselves. They may not seek interaction with others or prove unable to maintain eye contact.

Red flags 

Speech/language delays are among the first noticed by parents. Many go to their paediatrician or family doctor stating their concern that the child has lost some or all of the previously gained words.

Others are worried that their child constantly repeats certain words or phrases, either heard on the spot or weeks before. This is called echolalia. It can also serve the purpose of communication. The therapist will help the child resort less to repetition and rely more on novel speech.

How can Speech-Language Pathology help?

The first thing a Speech-Language Pathologist (S-LP) does is assess communication, articulation and social skills. The S-LP will notice any red flags, and work out an intervention plan to improve the areas. The primary goal is to help the child become more communicative within the home, school and social environments.

When we say communicative, it is important to remember that might not always refer to verbal language. There are children who will use other communication methods to interact with other people, and they will need help to master these. Some examples of other methods of communcation are: sign language, picture exchange, typing/writing or high-tech speech output devices.

During S-LP sessions, autistic children might work alone or in groups. The therapist will facilitate interaction, teaching the child to use appropriate communication behaviours. The child will learn to maintain eye contact, take turns and communicate according to the context and other’s cues. They will also work to develop reading and writing skills where possible.

A non-verbal child can communicate 

You might not know this, but 90% of communication is non-verbal. If an autistic child presents severe language impairment, he/she might still communicate. Through speech-language pathology, he/she can learn alternative means of communication.

The S-LP can teach him/her to understand and use gestures correctly. Communication systems can be helpful, including those based on pictures or visual supports. Some children find it easy to communicate with the help of electronic devices. The goal is to find the best method for each child, taking his/her abilities and challenges into consideration.

What about verbal children?

Once again, the intervention depends on the language and communication difficulties the child is experiencing. All children must learn the appropriate use of language and how to have a conversations with their peers and those around them.

At more advanced levels, Speech-Language Pathology might help the child understand the complexity of language. For instance, that a word can have more than one meaning or how certain expressions are used figuratively.

Social communication, one of the primary goals of S-LP

Human beings are social creatures by nature, and autistic children do not represent an exception. With the help of S-LP, they can learn how to interact with their peers and overcome the communication their challenges.

The Speech-Language Pathologist will work with the child to adapt his/her language to the correct context. They will explore non-verbal cues in a social setting and practice with other children.

It takes time, but some children can learn to recognize verbal and non-verbal cues, improving their communication abilities. This will help them feel less frustrated. When these skills improve, the challenging behaviours often become less frequent. This will have a positive effect on the academic outcome.

S-LP, helping with early diagnosis of autism

When parents have concerns about their child’s development, speech and language delays are present at the top of the list. The Speech-Language Pathologist can help with the early diagnosis of autism, recognizing the red flags associated with communication and social skills problems. The earlier the diagnosis of autism is made, the more successful the specialized intervention can be.

S-LP and the Ontario Autism Program

Your child can access S-LP services using their OAP funding (legacy funding, childhood budgets and one-time interim funding). Here is a list of eligible services and supports that can be purchased with the funding.

Read about how Side by Side Therapy can develop a transdisciplinary team to address your child’s needs and use their Ontario Autism Program funding.

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?

 

What is Sensory Processing Disorder?

September 6, 2020

Read time: 4 minutes

Has your child recently been diagnosed with Sensory Processing Disorder? Has your child ever had an over the top reaction to what seems to be a regular situation? Obviously, all kids can have challenging behaviour, however, some children have a hard time processing and tolerating certain physical, situational, environmental and sensory experiences. Sensory Processing Disorder (SPD) is the inability to process sensory stimuli. That means it can lead to reactions and behaviours that are disruptive to the child and those around them. Difficulty in processing sensory input can leave both the child and the parents/caretaker overwhelmed, stressed-out and anxious.  

Child with sensory processing disorder covering ears and smiling while playing outside.

SPD has made its way into mainstream culture. A quick Google Search will lead you to lots of information. Since ASD children have more difficulty processing sensory input, they may become easily overwhelmed or overstimulated by situations (i.e. bright lights, loud noises, crowded spaced) or things (i.e. textures of food or clothing). Many children with ASD also experience sensory processing problems. But SPD is not limited to children with autism. Children with ADHD or no other diagnosis at all can have SPD. Every child who has sensory difficulties will have a challenging time until their needs are identified and addressed.

SPD: Hypersensitivity vs Hyposensitivity

Sensory Processing Disorder is a neurological disorder that affects that way that a person receives and processes sensory information.   In everyone, messages from the senses are sent to the nervous system where they are processed. However, in SPD, this processing is faulty. This can lead to an uncomfortable experience for the individual. There are two kinds of sensory processing difficulties: hypersensitivity and hyposensitivity.

Hypersensitivity

Hypersensitivities can lead to oversensitivity and sensory avoiding. Several things can act as triggers to sensory meltdowns. For example, some of the triggers include crowded spaces, specific clothing, smells and textures of food, sudden or loud noises and bright lighting. 

Some hypersensitivities include:

  • Severe response to sudden loud or high-pitched noises
  • Easily distracted by background noises and movement
  • Does not like unexpected touching, hugs or cuddling
  • Uncomfortable around crowds or busy places
  • Fear of falling or getting hurt

Children that have sensory avoidance may do the following:

  • Become overwhelmed easily by places and people
  • Look for a quiet place when in crowded or noisy situations
  • Sudden noise can easily startle them
  • Bright lights can be bothersome
  • Clothing and fabric can make the child uncomfortable
  • Avoid hugging or touching others
  • Textures and smells of food can be bothersome
  • Transitions and change can be very upsetting and difficult

Hyposensitivity

Hyposensitivities can lead to under-sensitivity and sensory seeking. Often, sensory seeking children have a need for movement and have a lot of difficulty sitting still. They also like physical contact and pressure. 

Some hyposensitivities include:

  • A constant need to touch textures and people, even when it’s not appropriate
  • Lack of understanding of personal space
  • Uncoordinated and awkward movements
  • High pain threshold
  • Unable to sit still, constant movements
  • Rough and aggressive when playing with other kids

Children that are sensory seeking may do the following:

  • Constantly need to touch things
  • Be unaware of rough house playing and physical risk-taking
  • Have a high pain threshold
  • Constantly be moving and bouncing around
  • Show a lack of respect for other people’s personal space
  • Be easily distracted
  • Be clumsy and bumps into walls, trip over their own feet etc. 

It is important to realize that no two children are alike and each child’s sensory experience and coping mechanism are unique. And, your child may actually be affected by sensory issues from both categories. The journey to understanding your child’s sensory issues and ways of managing them can be an overwhelming task but there is help.  

Occupational Therapists can help

Occupational Therapists (OT) are trained in sensory regulation and can help to understand, identify and manage sensory stimuli issues. Accordingly, they can provide helpful tips, resources and supplies. For example, an OT might suggest a sensory diet to ease the anxiety and discomfort of your child. In effect, These strategies help children to manage their emotions and behaviours through specific activities and self-regulation techniques. 

Children with sensory processing disorder playing in sensory bins made by an occupational therapist.

Identifying and managing a child’s sensory difficulties will allow the child to cope with SPD. As a result, having a handle on their sensory triggers will provide them with the opportunities to use tools and strategies that will aid in their successful social interactions and day to day well-being.

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!

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.

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. 

Autism: How to have great transitions – Part 2

March 23, 2020

Read time: 3 minutes

This post continues from the last post about autism and transitions. To recap: transitions happen any time you end one activity and begin another. Transitions can be big (graduating high school and starting to work) or small (ending an episode of your favourite tv show and watching something else). Transitions are often difficult for autistic kids because of the way that they are impacted by the core symptoms of autism spectrum disorder (communication, social skills and restrictive and repetitive behaviours). These core symptoms can negatively impact how easy it is for a child to transition.

The first 5 tips that were listed in the previous post are:

  1. Talk about and prepare for transitions before they happen.
  2. Give warnings about upcoming transitions.
  3. Use countdowns.
  4. Create visual schedules.
  5. Give options to increase feelings of control.

Here are the last 6 tips to help those with autism transition:

Kids with autism sitting in a group at school. All smiling with hands raised to answer a question.
  1. Use Natural Breaks – Using natural breaks is one method that can ease transitions naturally for those with autism.  For instance, if your child is playing with a puzzle, upon completion it would then be an appropriate and ideal time to move into a transition. Since the activity had an end point, this allows the child to feel closure and more willingness to move onto the next event. 
Child with autism playing with dinosaurs.
  1. Likes and Interests – As transitions can be daunting, especially transitions that are not preferred by your child, it is helpful to try and make the transition fun or exciting.  This playful and creative method can alleviate some of the associated stressors through distracting your child with games/activities that they enjoy. Let’s say you need to go on a long drive, and you know being in the car for long periods is a trigger for your child, try playing “I spy”. Or, how about if getting to school in the morning is a challenge try hopping on one foot all the way there. Use your imagination!  
Child with autism and parent talking.
  1. Objects or Songs – Using a physical object can help your child with autism in understanding a transition. Have your child grab their towel before bath-time, this will then alert and prepare them for the upcoming transition. Transition objects offer a visible reminder for your child to help recognize an approaching transition.   Songs can also offer concrete cues for the upcoming change such as singing or creating a bedtime song. Once the child hears or sings the song, they will then associate it with their bedtime. You can also have your child keep a favourite coping tool on hand, perhaps their special stuffed animal or blanket.       
Child with autism smiling, a closeup.
  1. Use Appropriate Forms of Rewards – Using a reward system is a very effective tool when dealing with transitions. By arranging a plan with your child prior to an event/transition with the understanding of what can be earned is a great motivator. It is important to be able to differentiate between a reward and a bribe.  Where a reward can have positive effects, a bribe can have the opposite outcome. For instance, if you plan to go out grocery shopping and agree to a reward of a chocolate bar should your child behave as expected then a reward is in play. However, if you go out to the store without an agreement  and your child has a meltdown because they want a chocolate bar, when you give in to this behaviour and buy them the chocolate, it is actually a bribe. Therefore, ensure you are making the distinction between rewards and bribes to ensure you’re using this transition tool effectively.

Additionally, rewards can be earned through using a First/Then Chart (or first/then language) which is a tool that visually explains what activity needs to “first” be done in order to “then” receive or do something the child may want.  For instance, if you have trouble getting your child to brush their teeth, you can say, ‘first’ we brush our teeth and ‘then’ we can read a book. With this sense of involvement and essentially partial control usually will lead the child to participate unknowingly.  

A sand timer, used in autism treatment to visually represent the time for a student.
  1. Slow down – As discussed, there can be numerous transitions in a day, and you may find that too many transitions are just too difficult for those with autism. It may be for the benefit of the parent, childcare worker, teacher and especially the child to slow down and even eliminate some transitions. Not every transition is necessary.  Find the transitions that can be cut out and structure your child’s day for maximum success. 
Parent or therapist doing a yoga routine with a child with autism.
  1. Deep Breathing / Calming Strategies – Deep breathing and calming strategies are not only important for children, but they are also useful for parents, caregivers and teachers alike. In learning how to use breathing and other calming strategies one is better able to self-regulation thus helping ease the anxiety surrounding the transition. In trying to teach your child deep breathing, it is helpful to have your child start with blowing bubbles and after practice, they should have a good grasp of the breathing action. Keeping bubbles on hand can help during times of need and once the action is mastered it is a calming mechanism that can then be used anytime and anywhere. 

Your child must realize that transitions are not punishments and should therefore not be associated as such. Instead, your child should understand these are necessary throughout the day in order to follow the daily schedule. Having the parent, caregiver or teacher show excitement in moving through transitions may help in easing your child’s anxiety and difficulties. With your enthusiasm alongside your well thought out plan and tons of praise and encouragement, you will see changes in your child’s ability to transition smoothly. Be aware though, there may need to be frequent tweaks to your plan and schedules as this ensures the best modifications are being made.

In keeping in mind the many factors that contribute to your child’s difficulties with transitions and maintaining flexibility and open-mindedness you will help in easing their transition and in turn, set them up for success.

Autism: How to have great transitions – Part 1

March 16, 2020

Read time: 4 minutes


This post is quite long, so it will be divided into two parts for your reading pleasure!

Toddler with autism smiling looking directly at the camera.

Transitions happen many times throughout our day and for the most part, as adults, we don’t necessarily even realize how often. While these transitions may not seem noticeable or bothersome to us, they are in fact quite difficult for most children and especially for those with autism spectrum disorder.

Being able to effectively transition between activities in our daily routines is imperative to leading a successful life: at home, school or at a job. Transitions include any change, big or small, such as a change of activity (especially from a fun one to a less enjoyable one), environment or teacher.

Autism Spectrum Disorder (ASD) influences the way children process and interact within their environment and presents communication challenges, sensory issues and deficits in social skills.  All these challenges have an impact on the child’s ability to smoothly make transitions. It can be difficult for autism spectrum disorder children to shift attention or change from the comfort of their routine. These difficulties and stressors can lead a child to experience agitation, sadness or anger.  

All of these concerns need to be considered and addressed in order to help your autism spectrum disorder child thrive. The first step in dealing with transitions is dealing with the associated worry around transitions. Understanding how your child’s autism spectrum disorder is impacting their transitional issues, sensory sensitivities and concerns combined with creating a plan will better help your child to manage their worry connected to transitions.

Being prepared and well equipped to assist your child with autism before, during and following transitions is the absolute greatest support you can provide them. 

When strategies are used to help autism spectrum disorder children with transitions you can expect: a reduction in transition times; behaviours will improve during transitions; there will be less need for adult reminders and participation in school and community excursions will become easier.

Sometimes, creating a plan for your autistic child can feel like you’re trying to solve a calculus equation.

In the preparation of your plan, it is important to understand what transitional issues you are dealing with, including your child’s sensory needs.  By observing your child for 3 – 5 days and jotting down each time your child gets frustrated or angered you will have a better understanding of what is going on. This review should include identifying the patterns and triggers that led up to the problems transitioning.

For instance, does your child not like being interrupted to move onto the next activity if they are still working on the present one?  Do line-ups and busy hallways at school make it difficult for your child? Is there sensory stimulation such as bright lights or cold temperatures that may impact them and therefore affect the transition? Once you have identified the transitional issues then you can move towards creating a plan to account for these barriers. 

Transitional strategies are methods that can help autistic individuals manage during times of change or disruption in activities, routines or situations. As challenges can exist at any point during the transition, it is helpful to go over the techniques before, during and after a transition. This preparation strategy can (and probably should) be explained verbally and/or visually with the hopes of increasing predictability and maintaining consistency in their routine. 

Your child must realize that transitions are not punishments and should therefore not be thought of as such. Instead, your child should understand that they are required throughout the day in order to follow the daily schedule. Having the parent, caregiver or teacher show excitement in moving through transitions may help in easing your child’s worry and the challenging behaviour they exhibit. With your enthusiasm alongside your well thought out plan and tons of praise and encouragement, in time, you will see changes that are heading in the right direction. 

11 Tips to Help Those with Autism Transition

Here are 11 useful tips and strategies to use in the development of your plan; they are the stepping stones to helping ease your autism spectrum disorder child’s transitions:

  1. Prepare & Talk About Transitions – To help in ensuring a smooth transition, it is useful to plan out and discuss the plan with your child and support them before, during and after the transition. It is easier to deal with and manage your behaviour when you know what to expect. For instance, if you know you only have an hour at the zoo, then you should discuss this with your child prior to arriving. Knowledge is power and if your child knows what to expect the element of surprise will be removed and this will likely help with the transition. 
  1. Time Warnings – Providing time warnings prior to a transition is quite helpful.  This allows the child to be aware that a transition is coming up shortly and can then better prepare themselves. Therefore, half an hour before the change of an event you can start to give 30, 15, and 5-minute warnings. As these verbal warnings may be too abstract for some autism spectrum disorder children, especially when time-telling is not yet learned, it is suggested to use a concrete tool such as a clock or a timer that can visually help to alert your child of the upcoming transition.  This visual tool can be reassuring during an unenjoyable activity as it shows the child that there is an end in sight. 
  1. Countdowns – To go alongside the time warning strategy, it is also helpful to give final countdown notice.  So, instead of expecting your child to move right into the next transition once the final 5 minutes have finished, giving them a 10-second further countdown will continue to help with the transition.  Even though you may have provided the time warning, which may seem enough, the transition may still seem sudden to a child with difficulty transitioning. Adding in the additional and final 10-second countdown will certainly make your expectations clear. If visual tools are more effective then you can show your child a visual that has a countdown from 10-1. As you’re counting down you remove the numbers until your visual is empty and your child knows that the transition is imminent. This final countdown method can also be useful when doing unfavourable tasks such as cutting nails, bathing or brushing teeth as the child will know the end is near which helps with their coping.
Picture from
Pocket of Preschool
  1. Create Visual Schedules – A visual schedule is a very useful tool when managing transitions. The schedule helps to reinforce the predictability that your child requires alongside outlining the events in a way that your child can review throughout the day. As autistic children often thrive with routine and consistency this visual method helps them see things in a format that they can clearly understand and remember especially if out of the ordinary things are going to happen. Being able to understand what the schedule holds can create opportunities for the empowerment of your child as they may be able to move through the transition on their own without coaching or reminding. 
  1. Offer Options – Just like adults, children like choices. Having options gives them a feeling of empowerment and control. Therefore, offering two realistic choices allows your child to feel part of the decision.  For instance, when getting ready to leave the park you can ask would your child prefer to play on the slide or the swings in their last 5 minutes at the park. Achoice can be as simple as asking would they rather skip or walk to the washroom.  It is surprising how willing children are to participate when choices are offered.

Come back next week to read the second part!

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.

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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