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Speech Therapy – Alternative and Augmentative Communication (AAC): a powerful tool

Autism Spectrum Disorder (ASD) affects a great number of children and often these children have difficulty communicating.  In addition to having an applied behaviour analysis team, these children benefit from speech therapy.

Updated: August 30, 2021

This by no means, should suggest, that these children understand less. Rather, they just have difficulty expressing what they understand. Speaking is one of the most effective ways of communicating and it allows us to successfully interact and navigate our way through life.  However, many ASD children, do not have this option and sadly have a challenging time having their needs met. 

How can Speech Therapy help?

Being the parent of an ASD child can be very stressful and overwhelming.  It is important to know that there is help. Communication and language development have been helped by numerous tools and programs. These are known as Alternative and Augmentative Communication (AAC) systems.

AAC is an alternative method of communicating, outside of traditional speech, that has been developed to assist those with communication and language issues. These systems can be added to your child’s existing speech therapy programs. In some cases, they also introduce new and alternative ways of dealing with communication issues.

AAC is a way to provide your ASD child with the ability to relay their thoughts and needs through alternative ways that include the use of pictures, gestures, sign language, visual aids or speech-output devices such as an iPad or Tablet. 

AAC systems help your child access their basic human right of communication. AAC also helps ensure that their needs are heard. Every person deserves the right to share in the decisions surrounding their care and well-being.

Sounds liberating, (not only for your child but for you, the parents and caregivers), doesn’t it? Taking the guesswork out of what your child is trying to communicate helps to reduce stress, for everyone, and opens up the opportunity to build stronger relationships between your child and the rest of their world. 

Unaided and Aided & Low and High Tech Systems in Speech Therapy

Unaided systems – These systems don’t require the use of any equipment. Gestures, facial expressions, body language and sign language are some examples of unaided systems used to communicate.

Aided systems – These systems use tools or materials and can be either low-tech or high-tech. Some examples of low-tech are symbol boards, choice cards, communication books, alphabet boards or cards. High-tech examples include speech-generating devices (SGD) or communication devices and AAC apps on mobile devices.  Often the Speech Therapy team will advise which system is best for the child.

Below I will further elaborate on four of the aided systems that I feel may be helpful with your ASD child’s path to achieving successful communication.

LOW-TECH



Picture Exchange Communication Systems (PECS) – This program is a tool to aid in communication with non-verbal ASD children. Pictures of desired objects are exchanged (such as clothes or food) as a way of communicating.  These pictures can be photographs, digitally created images or hand-drawn pictures.

When a child wants something, they would hand a picture of the desired item to their communication partner (the parent, peer or caregiver) in exchange for the desired object. PECS begins with a basic request which will be extended to include sentences and eventually comments as well. 

As with most things that are of value and worthwhile, this program can take a long time (months) to become independent.  It also requires special training and materials and is able to be supervised by anyone who has taken the PECS training (usually speech therapists or BCBAs). Often Speech Therapy is used to introduce PECS.

While some children will be able to pair a vocalization with the exchange, PECS itself does not teach the use of vocal language. Creating a ‘verbal’ child is not the goal but rather creating a ‘communicative’ child is the end goal.

HIGH-TECH

Speech Generating Devices (SGDs) or Voice Output Devices

These are hand-held electronic devices that when a child presses a button or flips a switch, the device will play pre-recorded words or phrases. These SGDs allow non-verbal people to communicate electronically. Therefore, in its most basic form, if a child would like a banana, they would press a picture of a banana and the device would then say “banana”, “banana please”, “I want banana” or I would like a banana, please” (or some other variation) in a pre-recorded human voice. 

Here are three examples of apps that become SGDs when paired with a dedicated device:



TouchChat HD with WordPower – Although this is one of the most costly communication apps on the market, this program offers a range of options that far outweigh the competition. Utilizing Its voice recording capabilities allows you to touch individualized set-up cells and the program will then conveniently speak.   

Linggo Logo, an app used in speech therapy to help non-verbal people communicate.


LINGGO – Created by a team led by a behaviour analyst in Toronto. The app lists words that are most used and relevant to the child’s daily needs, preferences and social activities. Linggo learns the language patterns of its users through machine learning.  It also aims to enhance literacy by transitioning the learner from using picture-based communication to written words and phrases.

Linggo also encourages vocal speech in the learner with the optional time delay feature to allow time for the learner to vocalize before the app. One of the most exciting parts of Linggo is that it gathers data on the learner’s independent vs prompted communications which will help the speech therapy team fine-tune the teaching program to achieve maximum learning and communication.


LAMP Words for Life – This is an AAC app that is available for the iPad.  It is based on the motor planning theory of language acquisition. It utilizes pre-designed vocabulary pages that do not require much individualization or adjustment. This allows the user to transition between pages without having to re-learn the positions of previously acquired words.  There is evidence to suggest that children can become more proficient AAC users using motor planning because there is less searching for icons and specific phrases or sentences become almost rote. 

Now that you know about some of the AAC systems, the implementation may be another challenge. Finding professional help can be useful and will play a very important role in your child’s communication development.  It is important to work closely with a Speech Therapy team to ensure that you are using the correct AAC systems.

Some AAC programs can be quite costly, you want to be sure they are worthwhile and effective for your child’s specific needs. A Speech Therapy team will often include a Speech-Language Pathologist, a communication disorder assistant or a speech therapy assistant. The Speech Therapy team will take into consideration which AAC is appropriate and valuable for your child and will be able to address the many questions you will have.  Furthermore, they will create and implement a program that will work with your child at their current stage of communication development and capabilities.

Some advantages of AAC as described by users include:

  • Improved ability to communicate
  • Stronger friendships and relationships 
  • Increased ability for social interactions
  • Improved independence
  • Increased involvement in decision-making and autonomy regarding their lives
  • A feeling respected
  • Access to employment and volunteer opportunities
  • An improvement in physical and mental health.

AAC systems have proven to be tools that can open up doors for your ASD child by empowering them to communicate their needs and wishes.  Through the set-up of a well-designed communication program with the help of a Speech Therapy team, including the use of AAC tools and consistent practice, your child will find that a whole new world of opportunities can become available.  

If you would like help to develop your child’s communication skills using AAC or otherwise, please contact us to set up a no-charge consultation today. 

Should my toddler see a speech therapist?

Read time: 4 minutes

Many new parents aren’t confident in their child’s milestone mastery. They often wonder ‘Should my toddler see a speech therapist?’ In their first two years, children accomplish many things. They learn how to walk, crawl, talk and socialize in just a few months. The expected age range for most skills that your child will learn is usually around 6-10 months. Most babies crawl between 6-10 months old, while the majority of children are able to walk by age 15.

Speech milestones are the same. Your child should be able to say their first words by the age of 1, and should know 20 words by the age of 18 months. Don’t panic if your child falls short of these goals. You may find your child slow to develop their language skills. A speech therapist could help.

Should my toddler see a speech therapist? Side by Side ABA Therapy

Side by Side Therapy can help your child if they are having difficulties with their development. Our therapists are warm and inviting, and we can help your child develop the skills necessary to live a happy and independent life. We have paediatric occupational therapists, speech therapists and behaviour analysts to help your child learn the skills necessary to face whatever challenges lie ahead.

Speech and Language

Speech therapy can be used to help your child improve their language and speech skills. While speech and language are closely related, they are quite different. Children might have difficulties with speaking, with language, with fluency or with any combination of the three.

Speech

Speech includes articulation, voice and fluency. Effective verbal skills require the integration of all three components. Articulation refers to the movement of our lips, tongue, mouth, and mouth in order to produce certain sounds. Children who have difficulty with articulation might have difficulties with the “r” and “th” sounds. Voice refers to the use of breath and vocal folds in order to produce sounds. Your child does not need to speak loudly, but they should be able and able to communicate clearly at a consistent volume. Fluency refers to the ability to speak in a rhythmic manner. 

Language

Language is the use of words and how they are used to communicate ideas and achieve our goals. It can be understood, spoken, read, and written. One or more of the skills that a child may struggle with is language.

Including:

  • What does the word mean? Some words can have multiple meanings. A bright object in the sky, or someone famous can both be considered “star”.
  • How to create new words.We can use the words “friend”, “friendly”, or “unfriendly” to mean different things.
  • How to combine words.In English, we use the phrase “Peg walked to new store” rather than “Peg walk new store”.
  • What to say at different times.We might say, for example, “Would your mind moving your feet?” If the person doesn’t move, we may say “Get off my foot!”

A receptive language disorder is when you have difficulty understanding the meaning of others’ words. Expressive language disorders are when you have trouble sharing your thoughts, ideas and feelings.

Fluency

Fluency refers to continuity, smoothness, rate and effort. In other words, how easily a person is able to retrieve words and use them. Fluency disorders like stuttering and cluttering are common in children with autism.

Should my toddler see a speech therapist?

Each child learns at their own pace and there are many milestones to reach. If your child shows any of these signs, then it might be time to consider speech therapy.

Number of words

Your 18-month-old child will use less than 20 words and 50 words by the age of 2.

Numerous sounds

Only a few sounds are required to make all words sound right. This is due to articulation.

Understanding

Most children can understand 300 words by age 2. Speech therapy may be necessary if your child is having trouble understanding simple sentences such as “Get your coat!”

Social situations

Your child speaks infrequently and struggles to use language socially. Sharing and turn taking are also important social skills that are related to speech and language development

If you’re looking for services for your child, please contact Side by Side Therapy to arrange a no-charge consultation to discuss your child’s development and needs.

What kind of therapy does a child with autism need?

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.

Early Intervention in Autism Treatment

There is a lot of hype around early intervention in autism treatment. However, this hype can be very confusing. This deep dive into early intervention will help you understand the goal, how and where to access it, why it’s important and more.

What is early intervention in autism treatment?

Intervention or therapy that happens before a child enters school. Parents and caregivers work with therapists to learn skills and strategies that will help their child. Services can take many forms (in home, in daycare, in clinic). Early intervention can be delivered by a number of different professionals (speech therapists, occupational therapists, behaviour analysts, early childhood educators).

What are the different kinds of early intervention in autism treatment?

There are a number of different approaches to take that will be helpful for an autistic child – or a child who is showing red flags for autism. The approach that you take will depend on the professional that you work with. Some of the options are: a Board Certified Behaviour Analyst, a Speech-Language Pathologist, an Occupational Therapist, and an Early Childhood Educator.

If you choose a Board Certified Behaviour Analyst or Speech-Language Pathologist, you’ll potentially be using the Early Start Denver Model (ESDM). This model blends naturalistic teaching with behavioural concepts. It is a play based model that shares control between the child and the therapist. ESDM is very flexible in where it’s delivered. Some examples of therapy settings are: the child’s home, their daycare or a clinic. The Early Start Denver Model is based on a curriculum checklist that tracks a child’s skills based on typical development. From this, the therapist makes decisions about what skills should be the target of therapy.

If you live in Ontario, your child may be eligible for provincially funded Early Intervention. You can self-refer or have a professional you’re working with make the referral for you. However, the program names vary by region, so make sure you’re accessing everything that’s available.

What can we expect from early intervention?

Whenever you begin a new intervention it’s important to set goals. Likewise, when you begin an early intervention in autism treatment program you should determine what outcomes are realistic and possible for your child. As previously discussed, there is no cure for autism. The goal of early intervention should be to change the developmental trajectory of the child. If the child does not receive any intervention their developmental trajectory won’t change. With some intervention, the child’s development will more closely align with typically developing peers.

Handwritten graph of developmental trajectories of typical, autistic without intervention and autistic with early intervention in autism treatment children.

Your goal should be for the child to learn as many skills as possible. Communication, self-help/independence and play skills are all critical for very early learners. These domains should be the focus of intervention.

Does your child need to have a diagnosis to begin early intervention?

NO!

Beginning early intervention with your child as soon as you notice red flags is key. There is a lot to be learned for both the child and the caregivers. Waitlists for assessment and then treatment can be long. If you have an opportunity to begin therapy take it!

Each child has potential. Having early intervention for autism will only benefit your child. Reach out to us if you’d like to discuss your child’s early intervention program.

Autism Severity Levels (DSM-5) in 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

Read time: 3 minutes

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

Language matters

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

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

Father carrying his toddler who is engaging in challenging behaviours.

Challenging Behaviours are Communication

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

4 Functions of Behaviour and Replacement Behaviours

There are 4 functions of behaviour.

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

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

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

Safety First with Challenging Behaviours

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

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

Autoclitics: 4 Things to Know in 2021

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

Skinner created the verbal operants which are: 

  • Echoics
  • Mands
  • Tacts
  • Intraverbals
  • Autoclitics

What Are Autoclitics?

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

How Do We Teach Autoclitics?

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

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

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

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

Why Do We Teach Autoclitics?

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

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

Intraverbals: 4 Things To Know in 2021

This week’s post continues the series on Skinner’s Verbal Behaviour. If you haven’t already, you should read the other posts about MandingEchoics and Tacts. This post will tackle Intraverbals.

To recap, Skinner created the verbal operants and they are:

  • Mands (requesting)
  • Echoics (repeating what is heard)
  • Tacts (labeling)
  • Intraverbals (Answering questions or conversations)
  • Autoclitics (phrases that impact the other operants)

What are Intraverbals?

Intraverbals are the verbal operant that happens in response to another’s verbal behaviour. Basically, that means that the words, comments, phrases we use to reply to another person. In other words, intraverbals are conversations we have with others.

How do we Teach Intraverbals?

At the beginning, intraverbals as taught with songs using a fill in the blank format. Some learners need visual supports for prompting. You can use this assessment by Dr. Mark Sundberg to get an idea of where your learner’s skills are:

For example:

  • Instructor: (Holding a picture of a star): “Twinkle, twinkle, little ______”
    • Learner: “Star”
  • Instructor: “Head, shoulders, knees __________”
    • Learner: “And toes!”

Once the learner has mastered fill in the blanks, ‘WH’ questions can be used in expanding the learner’s intraverbal repertoire.

For example:

  • Instructor: “Where do you sleep?”
    • Learner: “In a bed.”
  • Instructor: “What is your sister’s name?”
    • Learner: “Avery”

Why questions are generally kept until the end of an intraverbal program because they’re the most difficult to learn.

Two boys smiling who have large intraverbal repertoires.

How long will it take to learn them?

As with all the verbal operants, the time it takes to master intraverbals will vary depending on the learner. Once the child has a strong mand and tact repertoire, it is appropriate to begin teaching this new verbal operant. There are many phases to this skill and it can become quite complex. This verbal operant isn’t generally mastered in a short time.

Why do we teach intraverbals?

Having a large intraverbal repertoire will help the leaner to engage in conversations. That is to say, that knowing how to respond to questions will allow the learner to be more sociable. Many learners spontaneously learn to ask questions once they have learned to answer them. Importantly, asking questions demonstrates to other our interest in them and helps build relationships.

If you’d like to discuss your child’s language program, please connect with us at Side by Side Therapy to learn more!

Tacting: 4 Things To Know

This week’s post continues the series on Skinner’s Verbal Behaviour. If you haven’t already, you should read the other posts about Manding and Echoics. This post will tackle Tacts and tacting.

  • To recap, Skinner created the verbal operants and they are:
    • Mands (requesting)
    • Echoics (repeating what is heard)
    • Tacts (labeling)
    • Intraverbals (Answering questions or conversations)
    • Autoclitics (phrases that impact the other operants)

What Are Tacts?

Another word for tact is label. It is important for people to know the names of items so they can clearly communicate about them. When an instructor holds up an item and asks ‘What is this?” the learner will respond with the name of the item. Learners can label the things they see, hear, smell, feel or taste.

How Should We Teach Tacting?

Similar to the other verbal operants, when teaching tacts the first step is to gauge the child’s motivation. Once you know what you’ll be using as reinforcement (paired with social praise), you can hold up the item and say “What is this?” If it is a new target, you want to immediately give the learner a prompt (errorless teaching) to avoid accidentally reinforcing an error. If the learner responds correctly, you can reinforce. It would sound something like this:

Errorless Trial:

Instructor: (Holding a car) “What’s this? Car.”

Learner: “Car.”

Instructor: “Awesome job, it is a car!” (Gives car to learner to play with)

Regular Trial:

Instructor: (Showing picture of a dog) “What animal?”

Learner: “Dog.”

Instructor: “That’s right! This is a dog!” (Gives learner token and high five)

Some children have a difficult time learning to label items when the question “What is this?” is asked. Some of the issues that could arise are the child repeating the question or the answer being given only when the question is posed. As a way to avoid these problems, it is a good idea to mix trials so that sometimes the instructor only holds up the item being tacted with an expectant look on their face to indicate to the child that a response is expected.

Common 300 word noun list for tracking tacting in autism and aba therapy.

How Long Does It Take To Learn To Tact?

This depends on the learner. Each person will learn at their own pace. What happens in some cases is bursts of new vocabulary being learned at once with time between the bursts to consolidate the language. Typically developing children will have between 200 and 1,000 words by the time they’re 3 years old. Here is a list of the first 300 nouns that are commonly learned.

Why Do We Teach Tacting?

Tacting expands the learner’s vocabulary. Teaching them to label the things in their environment will help them expand their world. They will be able to speak about things with specificity. This is helpful so they’re not reliant on phrases like “that one” or more general categories to identify things.

Tacting can be tricky for some children to learn. Reach out to Side by Side Therapy if you’d like to discuss your child’s language development.

Echoics: 4 Things to Know

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

1. What are Echoics?

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

2. How do we teach Echoics?

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

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

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

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

3. Why Teach Echoics?

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

4. What are transfer trials?

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

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

Manding: 4 things to know

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 Skinner’s Verbal Behaviour?

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

Skinner developed the verbal operants:

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

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

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

How is Verbal Behaviour Different than ABA?

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

How to teach Verbal Behaviour?

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

What about assessments?

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

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

How does verbal behaviour help my autistic child?

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

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

Is There a Cure for Autism? Part 2

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.

How to choose an ABA Provider

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

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

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

Home or centre based?

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

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

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

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

Credentials and Supervision

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

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

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

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

Reviews and Recommendations

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

Parent or caregiver involvement

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

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

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

Interdisciplinary Team

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

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

Questions to ask when choosing an ABA provider

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

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

Red Flags for Autism: 8 Behaviours to look for

Each child develops at their own pace. However, there are general guidelines, called milestones, that are used in monitoring if your child is progressing. When a child doesn’t meet their milestones, it can be a red flag for autism. Red flags don’t necessarily mean your child will be diagnosed, but they are considered when determining if further assessment is needed.

Red flags for autism are divided into 3 categories. These categories align with the 3 diagnostic domains for autism: language, social skills and repetitive and stereotypic behaviours.

8 Red Flags for Autism

Language

No words by 18 months or no two-word combinations by 24 months

Most children will have 10 words by the time they’re 18 months old. These words might not be complete but will be easy to understand and consistent. By 24 months many children are using two-word combinations. These combinations are often a name + item to make a request (e.g.: “Julia Milk”, “Daddy bed” etc.)

No pointing or use of gestures

Pointing is a very important skill. It allows a child to share their thoughts and interests in a non-verbal way. Most children point with their whole hand at first (reaching) but will eventually begin to extend their index finger to point. Likewise, gestures allow us to understand a child’s meaning without spoken language.

Inconsistent responding to name

By about a year old, your child should be consistently looking when you call their name. Responding to their name demonstrates that the child is able to divide their attention from what they’re doing when they hear a specific auditory cue.

Toddler boy covering his eyes. Lack of eye contact is a red flag for autism.

Loss of previously mastered language skills

One of the biggest red flags for autism is a regression in language skills. Regression is when a child has mastered a skill but is then unable to demonstrate the same skill. Many parents of children with autism describe their child’s language development as typical until around 2 years of age, when the child lost the words, comprehension, pointing and gestures they were using.

Social Skills

Inconsistent eye contact

Many children with autism do not make eye contact naturally. In fact, adults with autism have said that eye contact can be painful or anxiety provoking. This goes beyond shyness.

Lack of joint attention

One of the red flags for autism is the inability to show joint attention. Joint attention happens when a child and their communication partner use gaze and gestures to divide their attention between a person and an interesting object or event.

Stereotypic or Repetitive Behaviours

Unusual or repetitive behaviours with their hands or other body parts

One of the red flags for autism is moving hands and the body in general in unusual ways. Some children will wave their fingers near their eyes, flap their hands, rock their body or walk on their toes.

Preoccupation or unusual interests

Another red flag for autism is intense preoccupation with non-toy items. Some children become very attached to random objects (a spoon, a block, a piece of clothing) and will become upset if it is removed.

What to do if you notice red flags for autism in your child

Bring them up with your paediatrician! Getting early intervention is wise because even if your child does not end up with a diagnosis, the early intervention will teach a skill that was lacking. Speech Therapy, Occupational Therapy and Applied Behaviour Analysis can all be helpful.

Conclusion

While none of these red flags for autism are enough to get a diagnosis on their own, it is important to notice them. When a child’s displaying a combination or stops making gains make an appointment with your paediatrician for advice and potential referrals.

How To Get An Autism Diagnosis

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

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

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

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

Image of  testing materials used during autism diagnosis.

Paths to an autism diagnosis

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

Medical:

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

A diagnostic hub:

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

A private assessment:

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

Do you need an autism diagnosis to start treatment?

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

What is Social Communication?

Read time: 3 minutes

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

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

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

Why is social communication difficult?

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

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

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

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

Things to work on in therapy

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

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

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

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

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

How will therapy help improve social communication?

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

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

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

What about non-verbal children?

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

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

Conclusion

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

Things You Need To Know About Language Delays

Often autistic children have language delays. Receptive language is the ability to understand information provided by other people, either verbally or in writing. Expressive language is the ability to put our own thoughts into words, both spoken and written. Speech therapy can help your child learn these valuable skills.

Autistic children might have a language delay, meaning their communication skills are not developing as expected. This delay can affect the receptive or expressive language and, in some situations, both. When the child does not follow a typical developmental pattern, all areas of their learning and development are impacted.

Language delays add to the complexity of ASD

Language delays add to the complexity of an autism diagnosis, having a negative impact on socialization and academic performance.

When a child has poor language abilities, she might find it hard to interact with peers. Children rely on verbal cues to play and take part in games, not to mention they need to understand language to follow instructions. The struggle is complex. The child cannot use expressive language to convey her thoughts. In addition, she might have a hard time understanding explanations or directions.

Toddler sitting on mother's lap with a speech therapist discussing her language delay

Receptive language disorder

When receptive language is delayed, the ability to understand words and associated concepts suffers. During the initial assessment, the therapist will determine the level of comprehension and establish an intervention plan.

Receptive language disorder is common in autistic children, affecting their ability to understand spoken language. The child might not follow directions, answer questions, or identify various objects. she might not understand gestures and their reading comprehension might suffer.

How does therapy help?

The speech-language pathologist can help the autistic child improve her receptive language. After identifying areas of need, the S-LP will use strategies to increase the level of comprehension. During therapy the S-LP will work on expanding comprehension, identifying pictures, following instructions and more. Progress will result in a higher level of independence and participation in activities of daily living.

Expressive language disorder

Many autistic children have difficulties in expressing their thoughts using words. Very often the expressive language is more affected than the receptive. Thus, the speech-language pathologist will concentrate on helping the child with the production of sounds and words. Visual support might facilitate the learning process.

Initially, the therapist will assess the child’s ability to use spoken language. She will also assess the child’s non-verbal communication. Based on the identified weaknesses, she will develop an intervention plan.

Autistic children who suffer from an expressive language disorder might have difficulties communicating their wants and needs. For instance, they might not say when they are hungry or if they need to use the toilet. Common struggles include using appropriate gestures and facial expression, correct choice of words and asking questions.

How does therapy help?

The S-LP will work to improve expressive language. During therapy, she will use strategies to teach the child to communicate her wants and needs. As therapy progresses the child will learn to express more complex thoughts and ideas.

The therapist might also use an augmentative and alternative communication system (AAC) to increase the expression of thoughts and feelings. Some examples are PECS, high-tech systems (LAMP etc) or even sign language. For more information about AAC read this blog post.

Mixed receptive and expressive language disorder

It can happen that both the expressive and receptive language abilities are impacted. In this situation, the speech-language pathologist will have to work on both areas, helping the child progress towards greater ease of communication. The earlier one starts intervention, the better the outcome is likely to be.

The most important thing to remember is that language impairments become visible as early as the first two years of life, when one can still take advantage of the brain’s neuroplasticity. Parents should be active in the intervention process, as they need how to communicate with their child and meet her on her level.

Patience is key in working to develop language abilities in autistic children. In the beginning, prompting and offering instructions in multiple steps might be highly beneficial. Also, one should provide the child with adequate time to respond. Visual supports can be useful in helping the child overcome any existing challenges and even to establish long-term communication.

You can read about language development milestones here.

How To Choose A Speech-Language Pathologist

For parents knowing how to choose a Speech-Language Pathologist can be tricky. The diagnosis of autism often involves language delays, causing parents to wonder what steps they should take in terms of intervention. Naturally, every parent wants the best for his/her child, including in therapy.

A Speech-Language Pathologist can help your child learn to communicate more effectively. But how can you be certain you have chosen the right S-LP? What are the things you should look for and what are the right questions to ask?

Two women sitting at a table talking about how to choose a speech-language pathologist.

Things to consider in choosing a Speech-Language Pathologist

This might sound like a given but you need to choose a therapist that has experience in working with children. This kind of specialist will know how to approach the child so he/she feels comfortable. Therapy should look like play, especially for young children.

Experience is essential. A knowledgeable Speech-Language Pathologist should interact with the child through play, opting for subtle strategies to improve communication. He/she should involve the parents in the intervention. A transdisciplinary approach always guarantees the best results, and he/she should include parents at all times.

A good therapist knows that parents play a major role in the therapeutic progress the child will make. The S-LP should teach parents strategies to use at home, taking parental input and comfort level into account.

From a pragmatic perspective, you can get referrals or research for Speech-Language Pathologists online, looking at your province’s College of Speech-Language Pathologists. You can also ask your child’s paediatrician or the school counsellor for a recommendation. Other parents are also a good resource. Once you have found a therapist, be sure to inquire about certification and additional education on autism intervention.

Questions to ask when choosing a Speech-Language Pathologist :

When choosing a Speech-Language Pathologist it is normal to ask questions. It might be a good idea to start by asking about the experience that they have.

Don’t be afraid to ask about the methods used and the reasoning for choosing these. The S-LP should also be able to provide evidence supporting her/his recommendations and point you toward resources where you can learn more.

These are some questions you might ask:

  • Who will work with my child?
    • Often, the Speech-Language Pathologist is part of a transdisciplinary team, which includes a speech therapy assistant, a behavioural therapist, occupational therapist, educator and so on.
  • What are the primary objectives of intervention?
    • You will work on these together but as a general rule the principal aim is to improve communication and social interaction. In some children, feeding and swallowing issues might also be addressed.
  • How many years of experience do you have with autistic children?
    • This is not necessarily relevant, but it can help you get an idea about how knowledgeable the SLP is in this field. Follow up with some discussion about previous cases and outcomes.
  • What is your treatment philosophy?
    • You are putting your trust in a new person, so it is important to know this. A good therapist will work with the family. He/she will always take the child’s needs into account.
  • Do you use AAC (Augmentative and Alternative Communication)?
    • This is important, as it is beneficial for many autistic children at the beginning of therapy and even later on.
  • How do you gain the trust of a child?
    • Some children require time to trust a new person. A good therapist will respect the child and his/her uncertainty, putting his/her emotional well-being in first place. Therapy should be offered through a lens of caring and empathy.

Practical questions are important as well:

  • What does the initial assessment entail?
  • Can I use my insurance to pay for therapy?
  • Are your services available right now? Or do I have to join a waiting list?
  • How many hours of therapy are recommended per week? And how long is a therapy session?
  • Are parents allowed to observe therapy sessions?
  • How is the intervention plan established? Are we allowed to offer suggestions?
  • How is the progress the child has made assessed?

Do not hesitate to ask as many questions as possible, as this process will help you choose a Speech-Language Pathologist for your child. It never hurts to follow your instinct, as parents often have a gut feeling telling them they found the right person for the job.

Speech Therapy in Autism Treatment

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 Pick The Right Autism Therapy: 8 Questions

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?

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!

Read time: 4 minutes

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

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

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

ESDM: The earlier, the better

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

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

A better chance of addressing behavioural issues 

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

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

ESDM: Individualized intervention from an early age

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

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

Early Intervention: Families receive support early on

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

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

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

ESDM: A combination of ABA and play

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

Taking advantage of the brain’s neuroplasticity 

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

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

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

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

Read time: 4 minutes

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

What is the autism spectrum? 

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

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

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

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

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

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

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

Don’t forget…

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

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

9 Useful Occupational Therapy in Toronto Strategies

Using strategies from occupational therapy in Toronto will be helpful to autistic people who often have sensory processing issues. They might exhibit poor impulse control, be unable to handle self-care tasks or show reduced awareness of social cues.  

A diagnosis of autism should always guide the parent toward a multidisciplinary approach in terms of intervention  and occupational therapy (OT) should definitely be on the team! Keep reading and discover some fun and useful the activities that grew out of OT.

Child writing using a pencil grip in an occupational therapy in Toronto session.

Try these Occupational Therapy in Toronto activities:

#1 Exercises for fine motor skills

The purpose of these exercises is to strengthen the tiny muscles of the fingers and hands in general. The more often they are performed, the better the fine motor skills are going to be. 

For instance, a great occupational therapy activity would be to take an ice cube tray and put cotton balls in each ice cube opening. Your child can pick up the cotton balls with his/her fingers, tweezers or tongs. 

#2 Exercises for gross motor skills 

As a general rule, when addressing gross motor skills try to find activities that require the child to use his/her whole body. The goal is to focus on the larger muscle groups (arms, legs, core).  Building coordination, flexibility and stamina in these muscle groups is really important. 

Here is a simple exercise you can try. Take balls of different sizes, colors and textures, and place them around a room. Ask the child to retrieve each ball, using different types of movement: crawling, skipping, jumping and climbing. 

#3 Heavy work 

Another hidden gem from the OT world is heavy work. Activities that require the usage of major muscle groups can help children develop their gross motor skills even further. Heavy work activities have been shown to be calming for many children. They help the child understand and coordinate their body. You can ask the child to push a heavy object, pull on a rope or carry various items from one point to the other. 

Boy taking out the trash after an Occupational Therapy in Toronto session



One can push a laundry basket or a wheelbarrow filled with toys, carry a box loaded with toy cars or even engage in outdoor activities, such as digging, shoveling or raking. 

#4 Sensory bins

The sensory bin remains one of the easiest and fun activities to try. Many autistic children are sensitive to certain textures so this exercise is a great way to address this issue. You provide opportunities for your child to gradually become desensitized to different textures. 

Child's hand playing in multicoloured rice during an occupational therapy in Toronto session

You can fill several different containers with objects of various textures, including rice, beans, corn, cotton balls, and beads, asking him/her to explore each. Be creative! There are endless possibilities of what you can put into a sensory bin. 

#5 Homemade play dough 

Making homemade playdough isn’t only an occupational therapy activity! This activity serves not only as a teaching opportunity but it also offers a way to acquire valuable skills. This is an easy recipe to try. Once you’ve made the dough, you can use cookie cutters, kids knives or other toys to cut and make shapes. 

A simple activity, it will help with sensory exploration, improvement of visual skills and direction following. Some children like adding different scents to the dough (vanilla, mint, lemon etc.).  

#6 Painting with ice cubes

Take an ice cube tray and fill it with water and watercolor paint. Place in the freezer for a few hours. Give the frozen cubes to the child to use to paint. You can paint on regular paper or try coffee filters for an added sensory element. 

#7 Bring nature and sorting together 

Sorting and nature exploration represent two activities that many children enjoy and you can easily combine them. Just go outside and gather rocks, flowers, leaves and twigs, then ask the child to sort what you have gathered. 

The game of sorting nature can also facilitate the development of problem-solving skills, expand language as well as logical thinking. 

#8 Deep pressure activities

Many OTs will advocate for the use of deep pressure to calm children (and adults too!) Deep pressure can be used in children who have frequent meltdowns or tantrums, having a calming effect and offering much-needed tactile input. In all children, it is vital to ensure that you have consent before touching them. In children who are sensitive to touch, however, it must be performed gradually. 

You can take a blanket and roll up the child, burrito-style, or ask him/her to lie on the floor, placing pillows on his/her body. A large ball can be used to go over the child’s body, avoiding the head area. Bear hugs and squishes are other examples! 

#9 Crossing the midline

Crossing the midline is an important part of motor development, and something some autistic children struggle with. Crossing midline means being able to reach across the body (from left to right and right to left). Imagine that your body is divided down the middle with an imaginary line.  Using your right hand to scratch your left thigh is an example of crossing midline.  

Young Boy stretching his arm across his body during an occupational therapy in Toronto session.



Playing clapping games with a partner or a game of Simon says are great ways to practice crossing midline. 

These are some of the activities recommended for children diagnosed with autism. If you are looking for occupational therapy in Toronto, we are more than pleased to help you out. Call us for a free consultation and we will schedule an appointment as soon as possible. 

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

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.

Top 7 Effective Speech Therapy in Toronto Strategies to Try With Your Children

Read time: 5 minutes

Parents are often the first ones to notice that their child isn’t developing, especially in terms of communication. The lack of infant babble, the absence of eye contact and reduced interest in interaction are just a few of the features that cause one to question a potential diagnosis of autism. It is possible and often practical to begin speech therapy in Toronto before a formal diagnosis is given.

Mother and child sharing a tender moment before speech therapy in Toronto.

Autistic children might also present a limited range of facial expressions, being unable to comprehend language or show a regression (loss of words). The sooner Speech Therapy in Toronto is started, the better the outcomes are going to be. In this article, you will find a number of therapeutic strategies which might be of help. 

Speech Therapy in Toronto Strategies:

#1 Using non-verbal communication 

Interestingly, non-verbal communication accounts for 90% of all communication. Our body language, the gestures we make, along with eye contact, help us interact with other people and communicate our needs. 

A good strategy is teaching the child, through imitation, gestures that can be used daily. You can begin with gestures that are easy to imitate such as: clapping the hands, waving, stomping feet or raising arms in the air. 

#2 Oral Motor Exercises

For children who exhibit few or no facial expressions, this strategy might be quite useful. Performed regularly, it can strengthen the oral muscles, especially the ones around the mouth and jaw. 

The exercises can be practiced with a  mirror, so your child is able to see what their face looks like when they make the specific movements.  You can get some ideas of exercises from this Youtube Channel: Speech Therapy Practice. They have a series of different videos depicting different exercises you can try with your child. 

#3 Animal noises 

A fun beginning step to teach vocal speech might be to try and have the child make animal noises, especially if the child is motivated by animals. Capitalizing on this motivation might be helpful in engaging your child in doing the difficult work of learning to make the sounds. 

Various toys or books can be used to introduce the child to animal sounds. As his/her interest becomes visible, you can move to more complex games – perhaps you can create a toy barn or an animal train, having fun in the process. Be patient and have fun. 

#4 Singing songs

Very few children dislike music. Singing can help the child to learn new vocabulary, rhythm and even new topics or ideas.  

In choosing songs, it is important to take into account not only the current communication abilities of your child, but also their cognitive level. Nursery rhymes are a great place to start for younger children but older children can be introduced to all kinds of music. 

#5 Technology as basis for communication

We are lucky to live in an age where technology is advanced, creating opportunities for us to help autistic children communicate. Augmentative and alternative communication represents an option for children with limited or no functional speech, allowing them to communicate desires, needs, preferences, dislikes and comment. 

There are devices that contain recorded messages, which the child can use with the push of a button. As progress is made, these messages can become more complex. A low tech alternative is a picture exchange communication system.  You can read more about Alternative and Augmentative Communication in this blog I wrote at the end of April. 

#6 Learning how to sequence and tell a story

This is a strategy which is generally used in children with more advanced receptive language, allowing them to continue to develop their language. You would present them with images of the parts of a story, and ask them to put them in order.

For example, you might provide a picture of an empty glass with a carton of milk beside it, another picture with a full glass of milk and a third picture with half the glass of milk drank by a child in the picture. 

In opting for this activity, you would choose to begin by presenting the stories or situations that your child has experienced. This makes it more concrete and is easier for the child. In time, he/she can do this activity alone, or even draw his/her own pictures to tell a story. Many children enjoy ‘authoring’ their own stories. 

#7 Pretend play

Pretend play is a difficult skill for an autistic child to achieve but, with perseverance, it will help improve many aspects of the child’s development. On the plus side, it helps with social interaction, reinforcing communication again and again. 

The strategy would be to choose some of the child’s favorite activities, expanding on their existing sounds, words or sentences. Once you’ve identified what your child is doing naturally, you want to encourage the next step.

For example, if your child is building towers with blocks, you might begin labeling the colours of the blocks or dividing the blocks into colour groups to make red buildings and blue buildings.  You could also create a road (by laying the blocks side by side instead of on top of each other) to expand their play. 

With expanded play comes the opportunity for you to model expanded language use. The more you speak to the child, the more likely it will be for new words to appear in his/her vocabulary. 

These are some of the strategies that might be used in promoting speech and language development in autistic children. We offer speech therapy in Toronto, as well as a number of other useful therapies: Applied Behaviour Analysis, Occupational Therapy and Recreation Therapy – do not hesitate to contact us for a no charge consultation.

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

Read time: 3 minutes

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

Why should you consider ABA in Toronto for your child?

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

Boy with autism playing with toys during ABA in Toronto


#1 Play

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

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

Girls playing together learning social skills in ABA in Toronto


#2 Social Skills 

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

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

Boy learning to brush his teeth in ABA in Toronto


#3 Activities of Daily Living (ADLs) 

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

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

Boy demonstrating independence learned in ABA in Toronto


#4 Independence

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

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

Alphabet toy laid out in ABA in Toronto session


#5 Academics

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

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

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


#6 Self-Advocacy 

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

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

Girl with autism sitting on ground after ABA in Toronto session


#7 Quality of Life

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

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

Parent learning with son during ABA in Toronto therapy session


#8 Parent Involvement and Learning

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

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

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


#9 Renewed Optimism

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

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

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

2 Necessary Social Skills you should teach your child!

It is often said that a parent is a child’s first teacher, playing an important role where development and learning are concerned. A diagnosis of autism only reinforces this belief, in the sense that the parent will work harder to help his/her child develop strengths and overcome challenges. Social skills, specifically self-awareness and self-determination are vital to your child’s future.

You can teach social skills

Self-awareness is a difficult concept for almost all autistic children, but nonetheless, it is a social skill that they must learn and use every day. As parents, you bear the responsibility of “equipping” your children with such skills, preparing them for becoming their own advocates in adolescence and adulthood.

Parent talking to her son about his social skills.  They're both smiling.



We can empower autistic children from an early age, helping them become more aware of their own self and also to discover self-determination. Our efforts will allow them to express themselves in an capable manner, to better understand those around them and engage in suitable behavior in response. 

What are the factors affecting self-awareness in autistic children?

Autistic children might battle language and communication impairment, as well as social difficulties and sensory differences. They might exhibit stereotypical behaviors or intense interests. It goes without saying that all of these impairments will affect self-awareness. 

Imagine your child as being equipped with the wrong skills. He/she does not know how to express how he/she is feeling, and they have serious difficulty understanding others. An autistic child might not know the expected behaviors and emotions, and he/she will rarely consider how others are feeling or what they are thinking. 

Main factors affecting self-awareness are:

  • Difficulty with transitions/changes 
  • Deficits in understanding emotional exchange
  • Lack of attention to others
  • Language and social communication impairments 
  • Impaired ability to take another’s perspective

Empowering your child to develop self-awareness 

Your child has both strengths and weaknesses. As mentioned in the beginning, you can empower your child by working together on developing his/her strengths. 

Parents have an amazing power, in the sense that they can help their children understand not only how the world functions but also how they should function in that world. Self-regulation will appear as a natural result, allowing the child to advocate for himself/herself, especially in difficult situations.

Activities/solutions for improved self-awareness from study.com

  • Drawing a bug on paper and adding pictures of things that “bug” him/her – encourage the child to be as specific as possible, adding foods, animals, etc. 
  • Glue a photograph of your child to a piece of paper and ask them to draw things he/she is good at; images might be used for non-verbal children. Encourage the child to reflect on his/her strengths. 
  • Yes/no – read your child simple sentences, waiting for his/her answer. If non-verbal, use gestures to signify approval or negation. Examples: “I like to eat…”, “I prefer (toys)”, “My favorite activity is…” The goal of this activity is to help your child be able to identify their preferences and communicate them to others. 
  • Mirror self-awareness – working in the mirror, together with your child, to develop self-recognition; the more you work, the more aware the child will become of his/her body and its position in space. Work on gestures and making eye contact as well. 

Self-determination 

This is also a critical skill to achieve, as it will guarantee independence in adolescence and adulthood. Research has confirmed that it plays an important part in academic success, as well as in personal life. Social skills can predict the capacity for self-determination – as a parent, you need to work on these every day. 

How to help your child achieve self-determination 

  • Provide your child with opportunities to make decisions and then follow through with them even if you know the outcome might not be ideal.
  • Teach your child the specific behaviours for specific situations, and do not make the assumption that an autistic child will know the correct behaviour without being taught.
  • Be patient and offer concrete examples of the behaviour you expect to see. Tell your child what to do, not only what not to do. Give your child plenty of opportunities to observe adequate behaviour.
  • Practice, practice and practice. Do not expect for your child to learn social skills automatically, but rather keep in mind that learning requires both observation and practice. Offer your child the support he/she needs, and plenty of encouragement. 
Parent and child working on sharing as a social skills.  They are sharing some building blocks.



While it is true that applied behaviour analysis can help autistic children develop a lot of valuable skills, you have to remember that in many autistic children, skills don’t automatically generalize. The skills learned in therapy must be practiced at home in order to be solidified and maintained. The earlier you teach self-awareness and self-determination, the easier it will be for your child to advocate for himself/herself later in life.

Autism and Memory: Can you guess the amazing superpowers of a child with autism?

Read time: 4 minutes

This post was written by Dr. Tracy Alloway. She is an award-winning psychologist, professor, author, and TEDx speaker. She has published 13 books and over 100 scientific articles on the brain and memory. Her research has also been featured on BBC, Good Morning America, the Today Show, Forbes, Bloomberg, The Washington Post, and Newsweek, and many others.

Autism is characterized by a difficulty to recognize and respond appropriately to social and emotional cues, which causes problems with social interactions. Yes, they have unique strengths that can give them an advantage in certain areas. Watch a clip.

Working Memory and the Brain: from Understanding Working Memory

The brain of a child with autism develops differently from children without it. Recent research has found that the prefrontal cortex (PFC), the home of working memory, is one of the brain regions most affected by autism. Initial results show that the PFC of a child with autism has a much greater volume of neurons, up to 67% more. One possible explanation for this excess growth is that the genes controlling neuron development are overactive, resulting in greater brain volume. Exactly how this is related to autistic behavior is unclear at the moment, but the link an abnormal PFC and autism suggests that there may be a working memory connection to the behavior. (Courchesne & Pierce, 2005).

Children with autism also display less activation in the PFC when they are asked to remember and process information. This pattern seems to be evident regardless of the nature of the task. In one experiment they were asked to process letters, in another, shapes, and in another, faces. In all instances, the result was the same: there was less activation in the PFC for children with autism than in those without it.

The study with faces, also found that children with autism tend to analyze facial features like objects, rather than in light of social relationships, which may explain their trouble interpreting social nuances (Koshino et al., 2005; 2008).

Furthermore, when a child with ASD is presented with two tasks and has to focus on one while ignoring the other distracting task, their brain activity reveals that they do not actually shift their attention to the more important information (Luna et al., 2002). They have a difficult time determining what information is important.

In the classroom, some students with ASD might appear to struggle with certain memory-heavy activities. However, this may be connected to their difficulty in knowing what they should focus on, rather than a working memory deficit per se.

Working Memory is linked to AUTISM

The working memory profile of the student with ASD depends on whether they are low or high functioning. In some cases, high functioning students can have an above-average verbal working memory, while low functioning students perform at the same level of a student with a specific language impairment. In general, low functioning ASD students also have a poorer working memory than their typically developing peers do.

However, even high functioning ASD students can display verbal working memory problems. In my own research, I found that the type of material they have to remember provides us with a clue to their working memory profile. They struggle in particular with abstract information like nonsense words or new vocabulary. Why? One explanation is that when they are presented with abstract ideas that they have to both process and remember, they spend too long trying to comprehend the material and so forget what they need to do.

For example, during a verbal working memory test, Daniel, a 14-year-old with ASD, was presented with the sentence: Dogs can play the guitar. Daniel spent a long time thinking about the sentence before finally answering “True”, because “you can train a dog”. As a result of the lengthy time spent deliberating the answer, he forgot the final word in the list of sentences (Alloway, Rajendran, & Archibald, 2009).

The strategies they use to remember information can also over-burden them. Studies confirm that when remembering information, high-functioning ASD individuals do not use their long-term memory, visual strategies, or even contextual clues. Instead, they rehearse things over and over again. While this can be useful in remembering short sequences of information, it is ultimately a time-consuming and inefficient strategy to simply keep repeating things. These students are aware of their own memory problems. Alistair, a high-functioning 13-year-old, commented that he had “number overload” when he failed a test that required him to repeat numbers in backwards order.

Now, let’s look at their visual-spatial working memory profile. The majority of individuals with ASD do not have deficits in this area.  In one task, students are shown a matrix with dots that appear in random locations and they have to recall their location in a backwards sequence. Both my own research, as well as other studies, confirms that students with ASD do as well as their peers without autism. In the classroom, this means they should be able to remember information that is presented visually. 




To find out more about the memory superpowers of a child with autism, check out Dr. Alloway’s new children’s book here.

**

References

Alloway, T.P., Rajendran, G., & Archibald, L.M. (2009). Working memory profiles of children with developmental disorders. Journal of Learning Difficulties, 42, 372–82.

Courchesne, E.,  & Pierce, K. (2005).  Brain overgrowth in autism during a critical time in development: implications for frontal pyramidal neuron and interneuron development and connectivity. International Journal of Developmental Neuroscience, 23, 153-170.

Koshino, H., et al. (2005). Functional connectivity in an fMRI working memory task in high-functioning autism. Neuroimage, 24, 810–821.

Koshino, H., et al. (2008). fMRI investigation of working memory for faces in autism: visual coding and underconnectivity with frontal areas. Cerebral Cortex, 18, 289-300.

Luna, B., Minshew, N.J., Garver, K.E., Lazar, N.A., Thulborn, K.R., Eddy, W.F., & Sweeney, J. (2002). Neocortical system abnormalities in autism: an fMRI study of spatial working memory. Neurology, 59, 834-840.

Autism: How to have great transitions – Part 2

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.

Autistic People or People with Autism: 2 Completely Opposing Perspectives

Read time: 5 minutes

The subject of language is such an important factor in shaping the way we look at and interact with society. The connotations and assumptions that have been learned with language have moulded (intentionally or unintentionally) our perspectives and outlook. 

These learned assumptions play a large part in influencing our way of understanding and looking at things and sadly, at times, one’s outlook can be detrimental to others. Stereotypes and labels, unfortunately, are often a misrepresentation of what some believe to be the truth and regrettably place barriers before those they view as ‘different’ or as ‘other’. We view difference as being bad. However, what does different mean and who decided this?   

Autistic community targeted as different

When speaking on difference, the autistic community has struggled with being labelled and stereotyped as ‘different’. You can read about autism spectrum disorder here. If we, as a society, could change our perspectives and look at autistic people not as ‘different’ or as an ‘other’, but instead see that in a lot of cases, the difference simply lies in their approach to how they cope in and interact with society. This shift in thinking could truly offer this community the respect and acceptance they deserve.  

Couple arguing about whether to use person first or identify first language, meaning whether to say person with autism or autistic person.

To that note, there has been much debate and controversy surrounding the appropriate choice of language used when identifying or communicating with an autistic person.  This debate is focused on identity-first language (“autistic person”) versus person-first language (“person with autism”). Now, you may look at the above two forms of language and think these nuisances are based on semantics, however, if you look to understand and break it down the difference is not only important but rather quite clear. 

The concepts are:

  • Identity-first language which is the preferential choice of language for those within the autistic community. It is their preference for the use of words such as “Autistic” or “Autistic person” when being addressed, spoken or identified with. Since we know that autism is an inherent part of a person’s identity, it is believed that identity should be recognized first. The person cannot break away from autism. Therefore, from this perspective, identity-first language is a choice for empowerment, shared community beliefs, culture and identity.  It speaks to the fact that being autistic is nothing to be ashamed of and differences are to be respected and celebrated not criticized.

Versus

  • Person-first language has been adopted by parents, caretakers and professionals of autistic people and they use terminology such as “person with autism”. This viewpoint explains in essence, that person-first language puts the person before the disability or the condition and focuses on the merits and worth of the individual by accepting them as a person instead of a condition. This outlook taken on by caretakers, family members and professionals are based on the idea that they do not consider autism to be part of the child’s identity and therefore don’t want them to be labelled as such.      

The controversy, therefore, surrounding the use of person-first language as recognized by many within the autistic community, is that it suggests that a person can be separated from autism.  Autism is a neurological, developmental condition that’s considered a disorder with disabling effects. It is lifelong and does not on its own cause harm or death such as another disease might (such as measles… but don’t get my started on vaccine safety).

Diseases, unlike autism, are often labelled through the use of “with”, such as, “person with cancer”. Autism, on the other hand, is part of a person’s individuality and make-up which shapes a person’s way of understanding the world and interacting in it. In labelling autistic people in the same way you would someone with a disease puts autism as inherently bad just like a disease, which clearly could not be further from the truth.

Consequently, this is why those within the autistic community are fighting to change this use of language to a more identity focused instead of disability focused point of view. Is it too far-fetched for us to respect the wishes of those to whom we are referring  and who can, in fact, speak on real-life experience and their identity? 

By understanding the differences and connotations associated with language and its use, alongside, respecting the wishes of those that identify as autistic is crucial. When in doubt of which language should be used while engaging with the community it is best to check amongst the group and its members. If you are still unclear, then I recommend you reach out and ask. 

In my writing, I will use identity- first language, unless I am asked to do otherwise by my collaborators or the person I am writing about. This goes against my training and habits, but I want to honour the voices and opinions of the autistics who have shared their wishes with us.

Remember, language is important and impactful in so many ways and can, unfortunately, have harmful consequences if used inappropriately.  For this reason, we need to recognize the way in which we choose to use language and continue to be cognizant of its outcome, always. 

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

Read Time: 5 minutes

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

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

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

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

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

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

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

2. Find Help through Technology

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

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

3. Get Intervention as Soon as Possible

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

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

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

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

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

5. Trust your BCBA, Treatment Team and the Process

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

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

6. Celebrate the Successes

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

7. Make Safety a Top Priority

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

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

8. Work on Establishing a Good Sleep Routine

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

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

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

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

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

Your child’s written diagnosis must include:

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

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

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

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

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

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

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

10 Helpful tips on raising a child with autism

Read time: 5 Minutes


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

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

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

1. Don’t make comparisons 

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

2. Help your child realize when they need a break 

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

Parent talking with a boy with autism.

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

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

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

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

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

5. Keep an open mind

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

6.Maintain a sense of humour

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

7. Never underestimate how much your child understands

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

Autism ABA Therapy Side by Side Therapy Toronto

8. Look into Applied Behaviour Analysis (ABA) therapy

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

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

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

10. Take a break yourself and seek support

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

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

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

Read time: 7 minutes

Therapist and child doing applied behaviour analysis.

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

Applied Behaviour Analysis Definitions of Common Words/Phrases:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Duration: The length of a behaviour.  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lindsey Malc: Inspired Founder & Clinical Director

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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