Camouflaging or masking in autism has far reaching effects on the person. In this post you’ll discover what masking is, what effects it has on the person, why it is damaging and how to avoid it in future children.
What is masking in autism?
Masking is when an autistic person behaves in a way that is unnatural to them in an effort to seem more ‘neurotypical’.
Why would someone mask autism?
There are some simple reasons that people would mask their autism. In general, people fear things that are different. While some celebrate difference and diversity, many are unkind to those they don’t understand. It is only natural to try and hide your true self when you’ve been punished or bullied. Many autistics describe masking to fit in. However, this behaviour doesn’t stop in childhood.
There are 4 times more autistic males than females. Recently, there has been a lot of discussion if autism is really more common in males or if females are more skilled at (and more likely to) mask their symptoms. Female autistics are often diagnosed at later ages, potentially because they’ve been masking their autism symptoms. Many female autistics report only discovering their diagnoses when their own children were struggling. These women simply believed that they were different and needed to pretend to be ‘normal’.
Autistics who mask have said that it has helped them get friends and jobs. Unfortunately, masking autism has many negative downsides.
Outcomes of masking
While having friends and getting jobs might seems like excellent reasons to mask autistic symptoms there are many downsides. Autistics who mask report higher incidences of depression and anxiety. They internalize that who they are inherently isn’t good enough. That’s a horrible feeling to have. It can lead to all sorts of other problems. Some autistics relate regressions or loss of skills to masking.
Another really damaging downside of masking autism is that it leads to late diagnosis. Children aren’t receiving the help they need early on because they’re pretending to be someone they’re not. Not accessing early intervention services will have lasting impacts on the person.
Acceptance of neurodiversity: a path forward
There has been a recent explosion of awareness of autism in North America. Most people know at least one autistic person. However, this isn’t enough to inhibit people from masking. Awareness isn’t nearly enough. We have to embrace neurodiversity and create acceptance and equity in the same way we do for other differences.
Some behaviours have to be targeted (because they’re dangerous). However, most ‘typical’ autistic behaviours don’t need to be addressed. If we created a world that was accepting of difference, it wouldn’t matter that the person didn’t look at your eyes for extended periods of time, or talk about the topics that interest you. We would recognize and celebrate the intrinsic value that each person brings to our lives.
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.
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?
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.
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.
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?
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.
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.
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.
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
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.
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.
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.
To recap, Skinner created the verbal operants and they are:
Echoics (repeating what is heard)
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:
Instructor: (Holding a picture of a star): “Twinkle, twinkle, little ______”
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.
Instructor: “Where do you sleep?”
Learner: “In a bed.”
Instructor: “What is your sister’s name?”
Why questions are generally kept until the end of an intraverbal program because they’re the most difficult to learn.
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!
To recap, Skinner created the verbal operants and they are:
Echoics (repeating what is heard)
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:
Instructor: (Holding a car) “What’s this? Car.”
Instructor: “Awesome job, it is a car!” (Gives car to learner to play with)
Instructor: (Showing picture of a dog) “What animal?”
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.
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.
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.
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:
The learner shows interest in an item or action.
We use an echoic procedure to name the item BUT we do not reinforce the echo.
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!).
When the learner repeats the vocal response then the instructor can reinforce!
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.
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:
Identify highly preferred items that will be exciting enough to prompt a request.
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!
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!
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:
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.
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!
One of the clinical indicators of autism is stereotypic and repetitive behaviours (AKA: stims or stimming). Stimming in autism is movements or other behaviours that are either calming or alerting. Most of the time it is not a problem and does not need to be stopped or changed.
Each person has specific behaviours or habits (stims) that they find comforting or alerting. When you’re nervous maybe you twirl your hair or rub your hands together. Maybe you bounce your leg to wake up when you’re tired. When you’re concentrating maybe you stick your tongue out of your mouth. Autistic people also do these same things, sometimes in a more obvious way. Common autistic stims are rocking back and forth, flapping hands, toe walking or spinning in circles.
When and why do autistic people stim?
Autistic people stim at the same times that other people do. Some autistic self-advocates explain that stimming helps them block out distractions to help them concentrate, while others say “it just feels really good”. Neurotypical people will sometimes avoid stimming in specific situations (for example, not fidget and bounce around while at the dentist, despite being nervous). It can difficult for autistics to stop stimming, especially when upset or nervous.
Some autistics say that stimming helps them regulate their emotions or to generate awareness of their bodies. Another really interesting function of stims is to communicate emotions or arousal to others in a non-verbal way.
In the show Love on the Spectrum, one of the show’s cast, Olivia, says stimming is “…a massive build-up, with a pleasant release” (Episode 4).
What should be done about autistic stimming?
Many autistic self-advocates have shared that being told to stop stimming is very damaging. Stimming can be intrinsic to the autistic and to expect them to change part of themselves because it makes us more comfortable is just wrong.
No one is telling a neurotypical kid to stop playing with their hair or to stop drumming their fingers on their leg. The same rules should apply for autistics.
There are times however, when stimming can be dangerous or disruptive to the autistic’s quality of life. For example, some people will injure themselves or others while stimming. If a stim is interrupting the autistic from engaging in activities that they need to do (like sit in a chair to learn) then alternative stims should be found. A BCBA would work with the family to identify the function of the stimming behaviour and would find replacements. An OT might suggest a sensory diet, if the stimming serves a sensory function.
Autistic children are often picky eaters. There are many reasons that this happens. Once you’ve figured out the reason your child is picky you can use these picky eating strategies to help them overcome their pickiness. Recent research has shown that 70% of autistic children have unusual eating behaviours.
Reasons for picky eating
Many children struggle with texture, flavours and a need for sameness that can make eating a variety of foods tricky. Muscle weakness in the mouth or difficulty with sensory experiences can also impact the foods that the child will tolerate.
Try these top 5 picky eating strategies:
Allow your child to tolerate the food being around before expecting them to eat it. Try putting just a single grape on their plate or a piece of cheese without any expectation that they will eat it. The goal is to have them tolerate it.
Once your child is able to tolerate the new food, you want to gradually shape the way they’re engaging with it. For example, they might start by simply touching the food, then smelling it, then bringing it to their lips, then licking, then chewing and lastly swallowing.
3. Give choices
This is one of the best picky eating strategies! Giving your child choice and control will help them feel empowered to overcome their picky eater habits. Examples of choices you could give include: how many bites of the target food the child will have, how the target food will be prepared or who will feed the bites (the child or the adult).
4. Use Positive Reinforcement
When it comes to picky eating, it’s REALLY IMPORTANT to use positive reinforcement to encourage your child. Remember it’s not bribery if you state the expectation first and the outcome second. Think “Have three bites then we’ll watch YouTube” vs “Wanna watch YouTube? Have three bites!”
5. Don’t get into a power struggle
Eating is one of the only things your child has actual control over. There is no safe way to force your child to eat, so if they’re not willing to, it’s not going to happen. By keeping the entire experience positive and not letting it fall into a power struggle you’re helping your child to feel empowered and in control.
Who can help?
Like most challenges, an interdisciplinary approach is often the most effective. Picky eating can be addressed by ABA, Speech or Occupational Therapy. Also, before you begin trying to address your child’s picky eating, make sure to consult your child’s physician to rule out anything medical that might be going on.
Parent coaching is one of the services that many ABA providers offer. In fact, it’s one of the keys to success in ABA programs. Teaching the parents the strategies and techniques that are successful with their child is parent coaching.
Generalization is one of the main goals of ABA. Generalization is doing behaviours in different environments, with different people and with different materials. Many children with autism have a very difficult time generalizing newly learned skills. Parent coaching helps parents learn how their child learns so they can set them up for success.
Parent coaching empowers parents and family members to not rely on clinicians to teach their children. By learning the strategies that are effective for your child you can make changes yourself.
In Ontario, there are a lack of Instructor Therapists to do direct therapy with autistic kids. Most of the ABA providers in the GTA have waitlists. When parents participate in coaching they are able to avoid some of the waiting time by teaching their children themselves. While there are some behaviours and skills that require a therapist to intervene, there are a number of techniques and principles that parents can implement with a lot of success.
What does parent coaching look like?
You’ll work with a Board Certified Behaviour Analyst (BCBA) or a Senior Therapist. When you begin with a new BCBA or ST they will discuss what your goals are. You can choose to work on reducing a challenging behaviour or teaching a new skill.
If you’ve decided to reduce a challenging behaviour your BCBA or ST will discuss the specifics of the behaviour to get a better idea of exactly what the behaviour is. They will ask you to take some data or keep track of the behaviour. They might want you to track the frequency or the duration of the behaviour. This is called baseline data. Baseline data is important because it helps us understand and measure if our intervention is making a difference.
Your BCBA or ST might use a protocol called Behavioural Skills Training (BST) to teach you the intervention. In BST there are 4 steps: instruction, modeling, roleplay and feedback. The therapist will use these steps to help ensure your success. Your therapist will likely give you a written description of the intervention for review later.
Parent coaching can be time limited or continuous. It depends on your goals.
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?
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 long until they’re like other kids their age?”
Each week I speak with 10 or so parents, most of who have newly diagnosed autistic children.
These are questions that many parents ask. It’s so difficult to ask these questions and it’s equally difficult to answer them. I am always honest when I answer. I tell them that I believe that each child can make change and learn new skills but that there is no cure for autism. It’s not for me to say how ‘normal’ they will become. I try to stress to these parents that their child has so much potential and with the right mix of learning opportunities they will grow into incredible little humans.
Taking the expectation of being ‘normal’ off the table is a relief for some parents. Others aren’t ready to hear my message. They’re still grieving the loss of the child they thought they’d have. One of the most difficult things for people to handle is uncertainty. Humans are hardwired to have a plan or at least a destination. We dream of the future. When your child is diagnosed with a special need your journey takes a turn. There is a wonderful poem that conveys this message so beautifully. It’s called ‘Welcome to Holland’ and it was written by Emily Perl Kingsley in 1987.
(I need to say that no one poem or piece of writing will perfectly sum up the experience of the entire special needs parenting population. This poem should be taken for what it is, one woman’s perspective, at one point in her life. Some people will identify with it and others will not.)
What Should Parents Do?
There are a number of evidence based treatments for autism. Research the options that are available in your area and decide which aligns with your beliefs and goals. Applied Behaviour Analysis (ABA) has the most research backing it’s effectiveness for autistic children. There is also Speech Therapy that can be essential for autistic kids as well as Occupational Therapy. There is a lot of overlap between the disciplines. Sometimes your child’s needs can be addressed by the ABA team alone, but sometimes the expertise of a specialist is required. Any therapy team you work with should be open to collaboration with other disciplines that provide evidence based therapy.
Alternative Cures For Autism
As with any issue that affects a group of people, there will always be bad actors who try to dupe vulnerable people. I always caution my clients against spending resources on non evidence based interventions. Resources can be money, time and energy. Very few people have unlimited resources. When you devote resources to one treatment, automatically you’re taking resources away from the others. You want to ensure that you’re putting your resources where you’ll get the most benefit. Some examples of non evidence based interventions are: biomedical interventions (chelation therapy, autism diets, supplements) or other treatments like swimming with dolphins or hyperbaric oxygen chambers. While these treatments may have many glowing reviews look for peer-reviewed, double blind controlled studies to use as your base of information when determining if something is evidence based.
Many parents are unsure of when or how to tell a child they’re autistic. It can be a very sensitive subject and without some thought it can be tricky conversation to navigate. Crane, Lui and Davies (2021) recently published a study. It highlighted some important themes in having this discussion.
Important themes when telling your child they’re autistic:
Theme 1: Having open and honest conversations about autism
The first theme highlighted in Crane, Lui and Davies (2021) was Normalizing the conversations about autism symptoms. Parents reported that by having frequent and frank discussions about the way that their lives are affected were important in creating an open dialogue. Conversations that began when the child was young helped the child avoid having preconceived ideas about what autism is. This allowed them to have their own experience without being weighed down by the ideas of others.
Theme 2: Creating a shared understanding
Many parents of autistics either have autism themselves or share some of the autistic traits. Showing your child that you experience the same things that they do will create a shared understanding. This gives you some ‘street cred’ when suggesting strategies for your child. The parents also discussed that sharing their lived experiences helped them to understand each other and brought trust.
Theme 3: Positively supporting the child’s differences
Many parents noted that they preferred to use difference as opposed to disorder when describing their child’s needs. They felt that this was less stigmatizing and easier for children to understand. Each person is different and that does not decrease their intrinsic value. Refocusing their child’s attention from their challenges to their strengths was also a common strategy among the parents surveyed.
Theme 4: Adjusting the conversations to the specific child’s needs
Many of the parents that participated in the study noted that the conversations should be specific to the child’s lived experiences and not broad and sweeping. Parents should try to identify areas of interest and capitalize on that motivation. Some referenced having autistic role models as being extremely helpful for their children.
When should you tell your child they are autistic?
There is no rule about when is the right time to tell your child about their diagnosis. It is important to take chronological age as well as developmental age into account when deciding if your child is ready. They need to understand the meaning of the words you’re using. However, they might be giving you clues about their readiness. When your child begins asking questions like “What’s wrong with me?”, “Why can’t I ________”, “Why is this so hard for me but everyone else can do it?” or even “What’s wrong with everyone else?!” they’re likely ready to learn about their diagnosis.
Time of day should also play a factor in your conversation. You want to make sure you’ve got enough time to answer all of your child’s questions. The conversation shouldn’t feel rushed or interrupted. Before school or at bedtime are not ideal times for this topic.
We’re here to help you if you’d like to talk about how to tell your child that they’re autistic. Connect with us for a no charge/no obligation consultation. You can also check out of Autism FAQ for some commonly asked questions.
ABA uses a number of different strategies. Way more than 5, but here are 5 of my favourite (in no particular order).
Strategies used in ABA
Cues or hints that help the learner know what they should do are called prompts. They can be either visual, verbal or environmental. There are prompt hierarchies that organize the different levels of prompts based on how much support they give the learner. The goal is to reduce the level of the prompt so that the learner is eventually independent. Most learners need some kind of prompting when learning a new skill. It is possible for the learner to become dependent on the prompt. This happens when the prompts are not methodically faded out. The learner never moves past the stage of requiring the prompt in order to engage in the behaviour.
Behaviour contracts are like other contracts. They spell out the expectations and what will happen if they occur or don’t occur. The Behaviour Analyst and the learner both agree to the contract. A behaviour contract is a collaborative effort. It’s not one sided. The learner has to have a stake in the contract or else they won’t participate. Here is an example of a behaviour contract. Both the learner and the BCBA write and sign the behaviour contract. Behaviour contracts are a great ABA strategy for older learners.
Reinforcement makes a behaviour more likely to happen again in the future. There is positive and negative reinforcement. Many people get negative reinforcement and punishment confused. But, they’re not the same! In ABA terms, positive and negative don’t have the same meaning as in regular english. Usually, we assume something positive is good and something negative is bad. In ABA, positive means adding something and negative means removing something. So… positive reinforcement is adding something to the environment that makes a behaviour more likely to happen. Meanwhile, negative reinforcement is removing something from the environment that makes a behaviour more likely to happen. Some examples of positive reinforcement are: praise, a high five and extra time to play. Some examples of negative reinforcement are: being excused from the dinner table after eating a specific amount of food or turning off your loud alarm clock.
Some learners are visual, they learn by watching. Video modeling is showing the learner a video of people engaging in the behaviour. Video modeling can teach all kinds of behaviours. Social exchanges are a very popular video modeling topic. Video modeling is popular strategy outside of ABA also. Have you ever gone to YouTube to learn how to do something? That’s video modeling. One of the benefits of video modeling is that the learner can watch the video many times. They can stop it and rewind to review and ask questions. Video modeling is especially useful now, during the pandemic while in person instruction might not be possible.
One of the keys to ABA is breaking big behaviour chains down into smaller more manageable steps; this is task analysis. To do a task analysis you first need to identify the target behaviour. Once you know the target behaviour you identify each step in the behaviour chain. When you’re ready to teach, there are three processes you can use: forward chaining, backward chaining and whole chain. These processes determine how you will be prompting the learner when you’re teaching. For example, in a forward chain, you would teach the first step but prompt the rest. Alternatively, in a backward chain, you prompt each step except the last. As your learner masters the steps you move either forward or backward on the chain. In a whole chain approach, you’re looking at whether prompting each step is needed.
These are just 5 of the strategies that are common in ABA. There are many more. You can use any combination of these strategies. Each ABA program should be individualized and designed specifically for your learner. BCBAs are the people who are best trained to design ABA programs.
Every day we hear fake news. Sometimes it’s hard to tell fake news from real news. When you’re choosing a therapy to help your child having real news is vital. Here are the top 5 myths about ABA briefly explained.
Top 5 Myths about ABA Explained:
Myth 1: ABA is only for autism.
While ABA is most well known for it’s use with autistic children there are many other applications. ABA can be used to address a wide variety of conditions: ADHD, substance abuse, anxiety and anger, traumatic brain injury are only a few. There is also a lot of really neat use of ABA in business and sports. The Florida Institute of Technology has a certificate program in Organizational Behavior Management (OBM). OBM addresses performance management, safety systems and behavioural systems analysis.
ABA is in classrooms around the world every day. But it’s not called ABA… it’s just called teaching!
Myth 2: ABA is all about drills at the table
Old-school ABA was drills at the table. However lots of research in education shows that young children learn best through play. As the decades pass and research continues, new naturalistic interventions are becoming common, like the Early Start Denver Model and Pivotal Response Treatment. Generalization is also becoming an integral part of all good ABA programs. The child needs to show the skills across settings, people and materials in order for it to be useful. Generalization doesn’t happen exclusively at the table.
Myth 3: ABA is only effective when it’s more than 40 hours per week.
This is one of the most widespread myths about ABA. Early research showed that ‘intensive’ programs of 40+ hours each week were the most effective. However a recent study showed that there was no difference in outcomes between 15 and 25 hours/week of therapy. It is very common to see children in 6-15 hours of therapy each week with great results. Comprehensive ABA is 20+ hours of therapy per week. It’s comprehensive because it delivers a full curriculum. 5-19 hours of therapy per week is called Focused ABA because it focuses on specific skills and teaches those to mastery.
Myth 4: ABA uses food as a bribe.
A big part of ABA is using positive reinforcement. We want to encourage the behaviours we want to see again. A surefire way to do this is by using positive reinforcement. By adding desirable things to the environment after a behaviour occurs you make it more likely that the behaviour will happen again. Anything can act as a reinforcer, as long as it makes a behaviour more likely to happen again. Sometimes that’s food, but more often it’s toys, praise and privileges. The ABA team should always be developing new reinforcers to keep the person motivated.
Myth 5: ABA will fix the autistic child.
ABA teaches skills and reduces challenging behaviour. This leads to improved quality of life. Autism is a neurological disorder. It has no cure. However, there is still plenty to be hopeful about. All children have the potential to learn and grow. It’s not about reaching a specific milestone, but rather about becoming the best that they can be.
Finding the right therapy for your autistic child is vital to improving their (and your) quality of life. Don’t be led astray by the fake news. ABA is one of the most studied and effective treatments for your child.
When you’re new to ABA it can be very daunting. There are many acronyms and words with unusual meanings. In this post we’ll discuss reinforcement in ABA and how you can use it to increase behaviour. You can read the dictionary of ABA terms that I wrote last July.
ABA is all about teaching skills. We change behaviour and increase independence. One of the many ways that we do this is using reinforcement. I sometimes think of reinforcement as a contract between two people. If you do this, then this will happen – which makes it more likely that you will do this again in the future.
REINFORCEMENT: a procedure that makes a behaviour MORE likely to happen again in the future.
There are two kinds of reinforcement: positive and negative. Many people get confused. They think of positive reinforcement as being rewards and negative reinforcement as being punishment. But that’s not the case!
POSITIVE REINFORCEMENT: adding something to the environment to make a behaviour more likely to occur again.
NEGATIVE REINFORCEMENT: removing something to the environment to make a behaviour more likely to occur again.
Every person responds to reinforcement. Some reinforcers are tangible (we can touch them) and some are abstract. Sadly, there isn’t a formula for knowing what will be reinforcing for everyone. Some people can tell us what they’ll find reinforcing. When that’s not possible we use a technique called a reinforcer survey or a preference assessment. These help the team know what the child finds reinforcing. To do a preference assessment you need to provide many options of reinforcers and observe what the child chooses.
Bribery vs Reinforcement in ABA
Importantly, there is a big difference between bribery and reinforcement in ABA. Bribery happens when you make a bargain in desperation. After you’ve already given the instructions but you encounter some resistance. Reinforcement lays out the contingency (the deal) at the beginning.
Parent: “Time for breakfast! Come eat some cereal.”
Child: “No way, cereal’s gross.”
Parent: “You love cereal. Come on, eat it. We’ve got to get to school.”
Child: “Nope!” (pushes cereal away)
Parent: “You’ve gotta eat something. Please? We’re going to be late.”
Child: “I’m never going to eat cereal again. “
Parent: “If you eat half a bowl, you’ll be able to watch YouTube in the car on the way to school.”
This is an example of bribery because the parent is desperate and is willing to change the ‘deal’ in order to get their child to eat.
Parent: “Time for breakfast. If you eat all your cereal you’ll be able to watch YouTube in the car on the way to school!”
Child: “I want to watch Paw Patrol.”
Parent: “Sure, that’ll be fun. Now eat up!”
This is an example of reinforcement because the parent isn’t changing their position after the fact in order to gain their child’s cooperation.
Is Reinforcement a bad thing?
Many opponents of reinforcement in ABA will argue that we’re teaching children to rely on tangible objects in order to ‘perform’. I like to highlight two things:
EVERYONE works to get stuff. No matter how much you love your job, you wouldn’t go every day if there wasn’t a paycheque in it for you. Or you wouldn’t volunteer your time if you didn’t get a warm and fuzzy feeling from it (or high school community service credits!).
Whenever we deliver a reinforcer, we pair it with social praise. This pairing will result in an increase in the value of the social praise as it is matched and presented with the reinforcer.
Many people are fearful of the power that we can exert over others by using reinforcers. And thats can be a very real concern. However, when we take the approach of using reinforcers to help teach skills that allow for more independence we are empowering the child and improving their quality of life.
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.
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.
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.
Robert Schramm has developed these 7 steps to get your child to cooperate. In applied behaviour analysis, cooperation or compliance is one of the first things we work to establish. The instructor must have instructional control, meaning that the child attempts to do the things that the instructor is asking. Instructional control is an effective working relationship. These 7 steps give you control and will motivate your child to engage with you to earn the things they want. These steps were developed with autistic children in mind but they work for all children!
Schramm’s 7 steps:
You need to be in control of the things your child wants and you decide when they will get those things.
You should be the ‘giver of good things’. Your child should not be able to freely access these items. Start by going around the house and put any toys or items your child enjoys playing with out of reach. It’s best if your child can see the items, but sometimes these things need to be put into cupboards or treasure chests etc.
Show your child how fun it can be to be with you. You want your child to enjoy the time they spend with you.
The focus of most of your interactions should be on pairing yourself with reinforcement. You need to be careful not to put too many demands on your child at the beginning. To do this, you want to comment and narrate your interactions WITHOUT asking questions. This can be tricky so you might have to practice! When looking at a book together, instead of saying “What do you see?” “Where’s the dog?” try “I see a dog”, “Here’s a red balloon”.
Be true to your word. The expression to ‘say what you mean and mean what you say’ is vital. Your child needs to know that they can trust you and you will be consistent.
Your child uses your words as a guideline for what will happen and what to expect. If you don’t follow your own rules, why should your child? Consistency is key in getting your child to cooperate.
Make it clear to your child that following your directions is the only way to get the goods. Provide frequent, easy to follow instructions and always provide reinforcement for cooperation.
We want to teach the child the contingency that they get what they want for cooperating. You can use high P’s or high probability requests to do this. You give your child directions they’re likely to follow and then reward them for cooperating.
At the beginning, you have to reward your child after each instance of cooperation. You want to really cement the idea that good choices lead to good things happening for your child.
By reinforcing each time your child cooperates, your child will start to make the connection between following your directions and receiving the outcomes they want. This positive working relationship will encourage them to try more and more challenging things in the future.
Know your child’s priorities and your own as well.
Write down your child’s preferred reinforcers. Use them. Try to expand that list as often as possible. While it’s important to know your child’s priorities (what they’re working for) it’s also vital to know what your goals are. You will often have many goals and they will sometimes compete. Knowing which is top priority will make it more likely that you will reinforce the most important goals and achieve success faster.
Teach your child that not cooperating will never result in being reinforced.
The same way that we need to be hyper vigilant to reinforce all cooperation, we need to be equally as vigilant in not rewarding non-cooperation. When we stop reinforcing a behaviour, sometimes we see a phenomenon called an extinction burst. This happens when the intensity and/or frequency of a behaviour increases dramatically before it disappears. The expression that it gets worse before it gets better is 100% true in behaviour. If we’re prepared and stick to our guns, extinction bursts are quickly overcome. If you’re unsure, it’s best to get help from a behaviour analyst.
When you employ these 7 strategies, your child will be the most cooperative! Try making one change at a time until you’ve mastered all 7. Using these ABA strategies with your child will help your child to cooperate as much as it will help you to be an effective teacher.
On Friday December 11th, 2020, the province published an announcement about the rollout of the newest variation of the Ontario Autism Program. The news came from Jennifer Morris, Assistant Deputy Minister, Ministry of Children, Community and Social Services. It was not the news we wanted.
The five pillars of the new(est) OAP are: core clinical services (therapy), foundational family services, early intervention, urgent mental health supports and service navigation. Arguably the most important and more valued pillar is the core clinical services. Sadly, this is also the most costly and will be delivered last.
The OAP announcement describes the upcoming ‘calls for applications’ from service providers who wish to bid to implement different pillars of the program. There was no mention of the core clinical services. It is incredibly frustrating and irresponsible for the provincial government to be focusing on these other elements of the OAP while ignoring clinical services. It is possible to implement multiple pillars at the same time.
The Conservatives decimated the program in 2018. They promised to have it fixed by April 2020. Then they said they needed another year. Now it seems as though it will be well into 2022 before we see any core clinical service funding. What do families do when their child’s one time interim funding over?
Some will argue that there is a pandemic and we cannot expect the government to focus on our issues exclusively. But I would argue that this is a problem that the government was ignoring for A LONG TIME before the pandemic began. Now is the time to support these families.
At least we should be clear on how it will be implemented and when. That’s what people expected in an Ontario Autism Program Announcement.
What’s happening now for families and providers
Because families are floating between 3 programs there is a lot of confusion. Legacy kids (mostly) get funding for the services they require – if they can find providers with clinicians available to do therapy. Childhood budget kids are using their funding and waiting for invitations to the interim one time funding. Interim one time funding families are worrying about what happens when their funding ends.
It is unconscionable that the Ford government is keeping families in the dark. ABA system capacity suffers the longer we are in limbo and chaos. Clinicians are leaving the field, for more consistent, stable work. Service providers are not able to meet the demand and waitlists continue to grow longer and longer.
How much longer will the autism community have to wait?
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
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.
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.
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
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.
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.
Paths to an autism diagnosis
There are three ways to get an autism diagnosis in Ontario.
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.
This will be the first instalment in a series about the funding for autism families in Ontario.
I’ve worked in the field of Autism and ABA therapy for 16 years. I’ve worked with a lot of children under different funding circumstances. Some (few, very fortunate) families have the means to pay out of pocket for the services that their child needs. Most families rely on provincial and federal funding to pay for therapy and other services that their child requires. When the funding is used up services are often put on hold.
Having my own therapy services company has allowed me to see the heartbreak of a family pausing services. Services that were improving their child’s life. Services they just cannot afford. We offer a sliding scale, we work with families to figure out payment plans, we advocate to the government. Sometimes families just don’t have another option and pausing services is necessary.
What autism funding is available to families?
There are a few different programs that cover some of the cost of raising a child with autism. Right now, families in the province can apply to the Ontario Autism Program for funding for their children with autism diagnoses. The funding allotments are based on age. With children under 5 years old receiving $20K and children over 6 years receiving $5K. In August, I wrote a short blog post about the OAP‘s history. The government claims to be working (but this post isn’t about politics!) towards implementing a needs-based funding model. Needs-based funding gives families the funding they need to get the therapy their child requires. Side by Side Therapy offers excellent ABA Therapy near me.
Special Services At Home (SSAH) is a provincial program that helps families pay for services both inside and outside of the home. The amount of funding that each child receives is based on what their needs are, what other services they are accessing and other available community resources. SSAH funds are meant to aid families in two broad areas: personal development & growth and respite. Also, there have been changes to the SSAH eligible expenses due to Covid19.
Assistance for Children with Severe Disabilities is a fund for low to moderate income families who have a child with a severe disability. The funds provide financial relief for families raising a child with a severe disability. The amount of funding received depends on the size of the family, the family’s income, the severity of the child’s disability and the costs associated with raising the child.
What else is out there for autism families?
Disability Tax Credit (DTC) provides tax relief to a person with a disability or their parents (if under 18) to account for some of the cost of living with a disability. To qualify, a medical practitioner has to complete a form that states that your disability is severe and prolonged.
Registered Disability Savings Plan (RDSP) is a savings plan that helps parents or others save for the future of a person with a disability. Withdrawals made from an RDSP they are not considered taxable. The beneficiary of the RDSP must qualify for the Disability Tax Credit.
Canada Disability Savings Grants (CDSG) is a matching program offered by the federal government. They will match your deposits up to 300% (Based on your income and your contribution). You must have a RDSP to qualify for the grants. Canada Disability Savings Bonds (CDSB) is the money that the Canadian government contributes to the RDSP’s of low and modest income families. You can receive up to $1,000/year with a maximum contribution of $20,000. The amount you receive is dependent on your family’s income.
Autism Ontario has some one to one worker reimbursements available for families. The child’s name is entered into a draw when the application and proof of diagnosis are submitted. Approximately 500 children receive the grant each year.
Jennifer Ashleigh Children’s Charity is available for families experiencing financial pressures of raising a child with special needs. The fund covers a variety of things from emergency costs to housing costs incurred while caring for your ill child. They also cover some therapies.
A parent pointed out to me that perhaps it isn’t the number of funds or the amount of money that’s available that is lacking in our province. But rather that the application process is too difficult and too confusing for many families. Come back soon to read more about the funding in Ontario.
Visual schedules can help an autistic child be less anxious. They present daily activities, as well as the sequence in which these activities will unfold. A high level of predictability brings comfort and will even reduce challenging behaviour.
Depending on the child’s developmental level, the schedule can be made with photographs, drawings or pictures. Sometimes they can have written words or actual objects. The schedule can be displayed on a wall or on paper. For children who go to school, the schedule can be placed inside a notebook.
Also, parents can add a todo list to each activity. This shows all of the steps the child needs to take in order for a specific task to be completed.
Are visual schedules effective at reducing challenging behaviour in autistic children?
Yes. According to a study published on solutions to decrease challenging behaviour, the use of activity schedules can help children who have been diagnosed with autism spectrum disorder.
The study showed that visual schedules worked for children with difficulty following rules. The authors point out that visual schedules promote self-regulation and independence.
The introduction of a visual schedule is particularly important when it comes to children who have academic demands to meet. These children sometimes have difficulties meeting these demands, and this is where the challenging behaviour commonly occurs. The visual schedule can reduce the stress experienced by parents as well as promote learning and cooperation in children.
Why should you consider visual scheduling?
Visual schedules offer the perfect opportunity to teach an autistic child to complete the required activities in a day. Thanks to the todo list, you can break down a task into smaller steps, which are easier to complete. Small steps are easily achieved and provide opportunities for more frequent reinforcement.
Visual schedules offer to the child one of the things they look for the most: predictability. As they will learn to use the schedule, they will often become less anxious. Moreover, by using prompts and reinforcement, as you have been taught by your Board Certified Behaviour Analyst, you can decrease resistance and escape maintained behaviours.
In simple terms, you can see the visual schedules as a constant reminder for your child. They will know exactly which activities to complete every day and where they will occur. Most importantly, they will know the order in which things will happen. .
How to use visual schedules to improve your child’s behaviour
As with any new intervention, you should expect for the child to resist the introduction of a schedule. Practice together, using plenty of praise and reinforcement.
Be patient and give your child the time they need to become comfortable with using the schedule. Keep in mind that some time might pass before they accept the visual prompt, following the routine as expected. At first, offer schedule check reminders frequently.
In time, and after plenty of practice, the child will indeed turn to the schedule, enjoying its predictability. The interesting thing is that, by predicting and in turn enjoying the activities you have included on the schedule, your little one will have fewer opportunities to misbehave.
Be sure to acknowledge the efforts the child is making in following the schedule. Use simple phrases like “good job checking your schedule” or “nice work keeping up with the to do list”. You can give your child thumbs up, offer a smile or offer a hug. What matters is that you recognize they are trying, celebrating even the smallest achievement together.
You can try adding a preferred activity at the end of the schedule alternatively, so that he/she will understand that he/she can engage in that activity once everything else has been completed. Offer options to children who are able to choose; if your child has trouble making choices, select an activity you already know he/she enjoys.
Will visual schedules bring a difference to our daily routine?
Once again, the answer is yes. The child will learn to follow a simple schedule, becoming more organized as a result. He/she will thrive from knowing what lays ahead, no longer feeling confused. The familiar routine presented through visual aids will genuinely reduce the level of anxiety your child feels.
Using visual schedules will help your child make transitions between activities as well as between tasks within an activity. By using the todo list, and presenting the child with the exact steps to follow for an activity, you will reduce the risk of inattention and/or misbehaviour.
Using a visual schedule will give your autistic child a better chance to succeed. Challenging behaviour meets an unmet need that your child is experiencing. Challenging behaviour can be attributed to one of the 4 functions of behaviour.
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.
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.
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.
The signs of autism can become noticeable around the age of 18 months. Despite this, on average, autistic children receive their diagnosis at age 4 or 5. The delay is often deliberate, hoping the child will grow out of his/her condition, or to avoid labels, such as “autistic”. Getting an early autism diagnosis for your child will only benefit them.
Unfortunately, the delay in the diagnosis equals lost years of intervention. No child recovers on his/her own from autism. It takes a lot of effort, therapy and a transdisciplinary approach to enhance the quality of life for an autistic child. The earlier the diagnosis, the more time that child will have to reach their full potential.
Taking advantage of the brain’s neuroplasticity
The human brain possesses an incredible ability called neuroplasticity. Basically, neuroplasticity refers to our brain’s ability to adapt and change. The brain can learn and grow to overcome challenges. If a specific part of the brain is damaged or not working correctly, it can develop ways to work around the deficits. Autistic children need to start therapy as early as possible and take advantage of this ability in our brains. The older the child, the more difficult it will be for their brain to change and adapt.
To understand how beneficial early diagnosis in autism is, try not to think of the brain as a static organ. The complex organ is more flexible than we might think, adapting over time and compensating for lost functions. Regular therapeutic interventions, like ABA therapy, can help the autistic child’s brain build new pathways.
Early diagnosis, also beneficial for parents
Parents are usually the first to notice that their child isn’t developing as expected. Getting an early autism diagnosis can relieve distress and help parents focus on next steps. They can seek early intervention, form a support network and they can access several benefits, such as the Registered Disability Savings Program.
Taking your child to a doctor for an assessment is the first step to getting them help. Under the guidance of autism specialists, you will come up with an intervention plan and help your child learn.
Starting therapy from a young age
With autistic children, the key word is “early”. The earlier autism diagnosis and the earlier intervention, the more of a difference it will make. In therapy, the child can develop social and communication skills, and work on challenging behaviours. They will learn new skills and become more independent.
An autistic child who goes to therapy from a young age can develop their strengths, and work toward a better life quality. A diagnosis made within the first three years of life offers the best long-term outcome. Most parents only seek intervention after receiving the diagnosis, but your child can go to therapy before that. You can address worrying signs and work on teaching skills. Reach out to us at Side by Side Therapy to hear about the Early Start Denver Model, an ABA/developmental approach to teaching children with or suspected of autism.
Warning signs of autism
Each child is unique. The warning signs might differ and they might be present at various levels.
Even though you might notice the following signs, getting an accurate diagnosis is vital. Only a specialist can determine if your child has autism and point you in the right direction. If your child gets a diagnosis, they will have access to services and programs that would otherwise not be an option.
Warning signs of autism:
Lack of facial expressions, child does not smile
Limited or absent eye contact
Speech delays (no words by 16 months, no two word combinations by 24 months)
Does not respond to his/her name
Loss of previously gained skills
Does not point to items of interest
Does not like changes (routine, environment)
Prefers to play alone, does not engage in pretend play
Echolalia (persistent repetition of words/phrases, heard recently or in the past).
Early diagnosis, the first steps of the journey
It’s hard to find out that your child has autism. But the diagnosis will give you clarity of mind and help you take the first step of the journey. Together with autism therapists and a powerful network of support, you will create a path forward for your child.
Trust your instinct, especially if you have noticed one or several warning signs. Do not wait until your child is older. Go to a specialist now.
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.
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.
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?
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.
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.
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.
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.
With screens being stared at for hours a day by children, the benefits of outdoor play for children is being overlooked. Primary school should be a place where children can enhance the health of their minds, bodies, and emotions. Thankfully, an easy way to do this is to encourage outdoor play. There are a few practical ways to do so, such as ensuring playground design is engaging for children. We will focus on the benefits of playing outdoors, so you can see just how critical it is for their health and well-being.
Greater Physical Health
When children are running around, jumping, crawling, and handling physical objects, they are using and developing their motor skills. These are essential functions that can be greatly improved with outdoor play. Children walking a trail can get some aerobic exercise while enjoying the outdoors. When playground design is considered in terms of maximizing movement, children will burn more calories, which leads to strengthening their muscles and preventing childhood obesity. Also, they will get much-needed vitamin D, even if it’s a cloudy day.
Improves Behaviour and Social Skills
School is a place where children spend a large portion of their day. They interact with other children throughout the day, which helps develop their social skills. However, outdoor play helps shape their ability to communicate, cooperate, and organize effectively. Even at home, children can play with their siblings and friends outside in the yard, while inventing new games to play. All the practice taking turns, sharing, and developing lead to the cultivation of critical behavioural skills and is one of the benefits of outdoor play.
Increase Sensory Skills
Studies have found that children who play outside more have better long-range vision than those who are primarily indoors. The younger a child is, the more they learn through their senses. When a toddler walks down a trail, they will light up with joy when they spot a new animal or smell aromatic flowers. Jumping feet first into puddles is another favourite pastime of theirs. All of these expand, improve, and enhance their sensory skills. Your child may benefit from the input of an Occupational Therapist in the development of their sensory skills. The development of a child’s perceptual abilities is key to having excellent sensory skills.
Increase Attention Span
When children play outdoors, they become more curious about the world around them. They explore and roam according to where they want to go. These self-directed explorations lead to them having the ability to stay focused on a task for longer. Children who play outdoors in a self-directed way have more initiative to do things on their own. They are also more eager to participate in activities they have never done before. Studies have found that children who have had ADHD had seen a reduction in their symptoms after spending more time playing outdoors, in playgrounds, backyards, and other outdoor spaces.
All that running, jumping, and exploring generates endorphins, which uplift the moods of children. When there is an intricate playground design, it challenges children to exert more physical effort. This, combined with being exposed to light outdoors, improves the mood of children. Playing outdoors can be a wellspring of happiness for them.
These are some of the top benefits of outdoor play for children. As you can see, there are several reasons children should be encouraged to play outside. Their physical, mental, and emotional well-being will increase, while developing essential skills that will help them navigate the world they grow up in.
The government announced a huge investment into a new program called the Ontario Autism Program. This announcement was very exciting at first. Once it was studied the reality sank in: children would be removed from intensive services at age 5.
In June 2016
Michael Coteau, the Minister for Children and Youth announced changes to the Ontario Autism Program. The plan was to offer evidence based Applied Behaviour Analysis services at amounts that were based on need. Families that had been removed from IBI would receive $10,000 instalments until the new program was introduced in 2017. The children entering the Coteau plan would be the luckiest in the province, receiving the most therapy for the longest duration.
From the start, the government presented it as a program that they would improve and expand. The foremost goal was to facilitate access to therapy and reduce the financial burden on families. Key points of the OAP included: family-centred decision making, individualized intervention and the possibility to choose a specific private provider.
Changes to the OAP in 2018/2019
Doug Ford became the Premier of Ontario in June 2018. He brought a new government, changing from a Liberal government to a Progressive Conservative majority. In September 2018, the Ford government quietly instituted a pause on new service offers to children on the waitlist. This freeze dramatically increased the waitlist. A few months later, Lisa MacLeod, the Minister of Children and Youth used the ballooning waitlist as the reason for making dramatic changes to the OAP Funding.
In February 2019
Lisa MacLeod, announced a “new and improved” version of the OAP. This plan provided Childhood Budgets to autistic children. The budgets were based on the child’s age when they began therapy. Younger children being eligible for much more funding than older children. One element of the childhood budgets was income testing, meaning that families with higher incomes would get less funding. There was no consideration for any extenuating circumstances (level of need or availability of services in the child’s location).
In March 2019
Lisa MacLeod announced that SLP and OT services would become eligible expenses for the childhood budgets. She also announced that the income testing would be removed. The announcement also allowed children currently under the Coteau OAP to have their funding extended for an additional 6 months.
In June 2019
Todd Smith took over the Autism file when Lisa MacLeod became Tourism Minister.
In December 2019
Todd Smith announced that the province would follow the recommendations of an Advisory Panel it had established. Despite having previously stated that the new program would be ready by April 2020, Minister Smith stated that the new program would be implemented by April 2021. The reason for the extra year was to let the province to ‘get the program right’. The main recommendation was to move back towards a needs-based funding model and to remove the childhood budget.
The province also announced that they would begin offering one-time funding payments to families. These payments were based on the child’s age to bridge the program until the needs-based funding could be rolled out. Children aged 1-5 years would receive $20,000 and children between the ages of 6-17 years would receive $5,000. The newest OAP would include 4 pillars:
Foundational Family Services
Early Intervention and School Readiness Services
Mental Health Services.
Where do families stand now?
Some children are still on the Coteau OAP program. These children are called ‘Legacy Kids’. Some children aged out of the program and received nothing. Some families accepted childhood budgets and have spent those funds. They should apply to receive one-time funding. Many other families on the waitlist still have not received invitations to apply for the one-time funding.
The Covid-19 pandemic has totally upended the therapy of autistic kids because most providers were forced to stop services. The province has extended the deadline to spend the one-time funding by 6 months in an effort to give families time to use their funds. Service providers are gradually beginning to reopen. Families are scrambling to put together teams for their children.
Confidence is not a parenting skill parents are born with, but rather a skill that is learned over time. Being the parent of a child with autism can challenge our confidence, but you must understand that this skill is vital in helping your children live better lives.
When you show your children that you are confident, as parents, you make them feel safe. Each child needs to feel that their parents can help them express themselves and handle everything thrown in their direction.
The diagnosis of autism, of course, will change your life and the way you will parent. But it will also give you added motivation to fight for your child and the life he/she deserves to live. You will not always have the answers and there will be plenty of times when you will have to show yourself as confident, despite feeling lost, confused or scared.
How do you become a more confident autism parent?
We have a couple of suggestions for you. The message to take home is: confidence is not necessarily always having a response to a certain situation. It is more about being there for your child, no matter what, and especially when he/she is having a hard time.
Even though this is not necessarily an autism parentingsecret, it is something we often forget. Living with autism, and the sometimes difficult behaviours presented by a child with this diagnosis, it is easy for parents to fall into a path of negative thinking and lose confidence along the way.
Positive thinking, on the other hand, can help you to become more confident in your skills and your parenting abilities. It can be useful when it comes to the way you respond to challenging situations.
You are not a bad parent
Every parent has been there. You felt inadequate, believing that your children deserve better parents. Just because your child has autism, does not mean you are a bad parent.
Whenever you feel terrible, like you have failed your child, remember this – children need love above all else. They need us to be present and show them how to live in a world that seems foreign.
Do not be afraid to ask for help
If you feel like your confidence has been shattered, it is time to get help. This can come from a family member, a friend or even a mental health professional. You might find help in joining an autism parent support group. Your child most likely benefits from therapy, so you should not hesitate to use this form of support as well. Respite might represent an option for you, so that you can have some time for yourself. In time, you will become a more confident parent, one who is calm and supportive of his/her child.
Don’t bend to peer pressure
Autistic children have meltdowns and tantrums, and these often take place in public. If possible, try to go home or choose a private place to help your child calm down. Do not allow others to dictate what you should do, and keep in mind that getting the child out of the respective environment will be quite useful. All children have tantrums, and it just happens that it’s your child’s turn today. Many parents are kind and empathetic in these situations, so just ignore the ones who aren’t!
A lot of parents make the mistake of thinking that they must always find a solution to a potential challenging situation the child is going through. Sometimes, this only adds pressure, causing your confidence to go down.
Instead of forcing yourself to come up with an answer, try to be there for your child. Do not let your confidence suffer, but rather offer your physical presence and this should be enough. Help your child calm down by being calm yourself.
Control your emotions
It goes without saying that no two children are the same, especially when they are autistic. Anger can only damage your confidence, since it will cause you to feel out of control. If the situation seems impossible to handle, it might be best to take a step back. Always try to acknowledge your emotions, but without giving into them.
What does an autistic child need? A confident parent! It might take time and you will make plenty of mistakes along the way, but you need to work on becoming more self-reliant. The bolder you are, the easier it will be to become the advocate your child needs for a better life.
Have you ever been in a situation where the music was just too loud or the lights were way too bright? How about being in a place that was far too overcrowded and you started to feel overwhelmed and panicky? Well, this is a common feeling for those that are diagnosed with autism or Sensory Processing Disorder (SPD). SPD is related to over or under sensitivity to certain sensory stimulation such as loud noises, bright lights, tastes and touch.
It is a condition that affects the way the brain receives and responds to information concerning our senses and has been found to create either an over or under sensitivity to certain things within our environment. Those that have (children specifically for the purposes of this article) SPD often receive a co-occuring diagnosis like Autism Spectrum Disorder (ASD) or Attention Deficit Hyperactivity Disorder (ADHD).
Since SPD is so prominent in children especially for those that also have additional disorders, life can become difficult for not only the child but for the parents and caretakers as well. This sensory sensitivity can be very debilitating and sadly can turn a task as simple as going to the grocery store into a very difficult undertaking.
Here in the Greater Toronto Area (GTA) in Canada, some companies have caught on for the need to provide alternative accommodations for those that live with special needs like SPD, ASD & ADHD etc. These establishments have collaborated with autistic focussed organizations to find ways to modify their businesses to provide a sensory-friendly environment.
Below you will find some of the places around the GTA that are now offering these autism and sensory-friendly settings.
Autism or Sensory Friendly Attractions in Toronto
1. Ontario Science Centre – 770 Don Mills Road, Toronto, ON M3C 1T3The Ontario Science Centre offers Sensory-friendly Saturdays on the first Saturday of every month from 3 – 7 p.m. They have partnered with Geneva Centre for Autism and other organizations to offer sensory-friendly events and programs. Sensory-friendly Saturdays were created to provide an environment that is inclusive, respectful and accessible. Their program is available to everyone and is appropriate for all ages and abilities.
The following dates are set for 2020:
February 1, March 7, April 4, May 2, June 6, July 4, August 1, September 5, October 3, November 7 and December 5
2. Toronto Zoo – 361A Old Finch Avenue, Toronto, Ontario, M1B 5K7
The Toronto Zoo has developed a downloadable app specifically for those with ASD. This app called MagnusCards (for more information please visit http://torontozoo.magnuscards.com/) was created to provide a structured, step-by-step program that has a game-like design which helps teach a variety of life skills through the use of the app.
This app is believed to provide empowerment and a welcoming environment for those living with autism and other cognitive special needs. The five-card decks include information on entering the zoo, Indo-Malaya, Tundra Trek, African Rainforest Pavilion, and Getting Help.
Cineplex theatres offer “Sensory Friendly Screenings”, which includes a “lights up and volume down” environment. In partnership with Autism Speaks Canada, Cineplex provides an atmosphere that allows those individuals with ASD or those who suffer from sensory sensitivities the opportunity to enjoy new releases at the theatre.
The website states that these screenings will take place approximately every 4 – 6 weeks on Saturday mornings at 10:30 AM, however it is best to check your local theatre in case any changes have taken place.
4. Royal Ontario Museum (ROM) – 100 Queen’s Park, Toronto ON, M5S 2C6
The ROM has teamed up with Autism Ontario to create a “ROM Sensory Friendly Guide”, where they provide helpful tips for visiting. The guide speaks on different areas in the museum that could affect someone with sensory issues (such as loud noises, lighting, scents, temperature, sloped floors and crowded areas). It also outlines where there are quiet areas around the museum.
For more information please visit their website at:
5. Ripley’s Aquarium of Canada – 288 Bremner Boulevard, Toronto, ON M5V 3L9, CANADA
Ripley’s Aquarium of Canada is the first autism certified attraction in Canada. This Certified Autism Center has been designated by the International Board of Credentialing and Continuing Education Standards (IBCCES) after completing comprehensive autism awareness and sensitivity training.
Ripley’s Aquarium is committed to ensuring that their visitors with ASD and other sensory sensitivities have the greatest time while at the attraction. The staff have undergone extensive training and each exhibit integrates some form of IBCCES sensory guidelines (https://www.ripleyaquariums.com/canada/files/2019/04/Sensory-Guides-Final.pdf) which provides the guests with additional information regarding the sensory impacts at each display or activity.
Please check out their website for dates and times as they will be hosting several additional sensory-friendly days that include quiet spaces, music-free environments and increased lighting.
6. Chuck E. Cheese – Various locations around the GTA
Chuck E. Cheese offers a sensory-friendly experience the first Sunday of every month at participating locations, this includes opening doors two-hours before their regular opening times. The organization realizes that the Chuck E. Cheese experience can be overstimulating and therefore wanted to provide an opportunity for those that suffer from sensory sensitivities to come out and have fun with well-trained staff. As it is their mission to provide an event that allows “ALL kids to be a kid”.
For more information please visit their website at:
Skyzone offers activities such as trampolining and jumping along with a wide variety of other programs. At Skyzone, visitors are provided with a fun experience that allows them to burn off energy in an extremely fun way. Skyzone offers sensory-friendly hours which provides a calmer, toned-down jumping experience for those with special needs.
For more information please visit their website at:
As mentioned, tasks for which most would think is simple such as grocery shopping can be an anxiety-ridden experience for both a child with ASD and their parent/caretaker. Grocery stores can have a lot of sensory stimuli such as loud music, bright lights and crowds which can be overwhelming for a child that suffers from sensory sensitivities.
Sobeys has taken notice of this issue and has now created an accessible and inclusive sensory-friendly shopping experience. To accommodate the sensory needs, Sobeys provides every week, a two-hour shopping window where they eliminate almost all the in-store lights and sounds.
Some of the sensory sensitivity measures taken by Sobeys are turning down the lights, turning off scanners, lowering music, having staff members speaking in softer tones and holding off on any announcements. According to Sobeys, the sensory sensitive shopping takes place currently on Wednesdays from 6 p.m. to 8 p.m. Please check with your local Sobeys for up to date information on dates and times.
For more information please visit their website at:
9. Young Peoples Theatre – 165 Front Street East, Toronto M5A 3Z4
Young Peoples Theatre offers “relaxed performances” where the performances are the same however there is a more relaxed atmosphere relating to noise levels and movement. The sensory sensitive measures include the house lights being adjusted so that they are not as dark as they normally would be. They have also created designated relief areas where you can go if a break is needed. For the ease of your child’s visit the theatre has also created a visual visiting guide that can be looked over with your child prior to your arrival to help eliminate any fears or surprises that could arise.
10. Upper Canada Village – 13740 County Road 2,Morrisburg, Ontario
Upper Canada Village is nestled up in Morrisburg Ontario and offers visitors an exciting experience of what life was like back in the 1860s. Through transporting back in time, visitors are able to explore authentic buildings, activities and the people of the time. Upper Canada Village offers ASD sensory-friendly Sunday mornings where a child with sensory sensitivities will be able to enjoy the attractions is a less chaotic and overwhelming environment. They provide some helpful tips on their website for visiting the village with a sensory sensitive child.
For more information please visit their website at:
Enjoying fun and memorable experiences is so important for children and even though your child may suffer from sensory sensitivities it is comforting to know that particular companies are working towards creating inclusive and accessible environments for ALL children to feel welcome and be able to enjoy their time.
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.
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.
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.
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.