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

December 3, 2021

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

When Do the First Signs of Autism Appear?

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

1. Avoids Eye Contact

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

2. Lacks Response to Other’s Voices

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

3. Hand Flapping

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

4. Frequently Walking on Tip Toes

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

5. Trouble Controlling Emotions

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

6. Aggressive Behaviour

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

7. Rigid Play

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

8. Issues with Food and Textures

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

food issues as a sign of autism

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

9. Delayed Speech

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

10. Repeating Words and Phrases

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

How Do I Know if My Child has Autism?

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

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

November 17, 2021

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

Child sitting with therapist

What is Applied Behaviour Analysis (ABA)?

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

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

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

How Much ABA Therapy Does My Child Need?

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

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

What is Speech-Language Pathology (SLP)?

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

Speech therapists address 5 main areas:

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

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

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

What is Occupational Therapy (OT)?

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

Child exercising during Occupational Therapy for Autism

How Can OT Help with Autism?

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

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

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

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

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

What is Physical Therapy (PT)?

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

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

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

Choosing the Right Therapy

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

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

How to Toilet Train your Autistic Child (Part 2)

August 16, 2021

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


Day vs Nighttime Toilet Training:

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

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

Some strategies to avoid nighttime accidents are:

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

How to use Reinforcement to Toilet Train your child:

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

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

Lollipops used to Toilet train at Side by Side ABA Therapy

Some examples of reinforcers used to toilet train are:

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

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

Urine vs Bowel Training:

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

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

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

Conclusion:

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

Toilet Training Tips from ABA Therapy (Part 1)

August 9, 2021

Read time: 4 minutes

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

Toilet Training Readiness Signs:

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

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

2 Approaches to Training: schedule training and intensive training

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

Schedule Training:

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

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

Intensive Training:

When you take a very intensive approach to training.

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

Toilet Training Tips Side by Side ABA Therapy

Potty or Toilet?

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

Potty

Pros

  • Child-sized
  • Portable
  • Affordable

Cons

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

Toilet

Pros

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

Cons

  • Not usually child-sized
  • Flushing can be loud

Diapers, Pull-ups and Underwear

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

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

In Conclusion

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

What kind of therapy does a child with autism need?

June 21, 2021

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

What kind of therapy does a child with autism need?

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

What are the different therapies?

Applied Behaviour Analysis (ABA)

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

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

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

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

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

Speech-Language Pathology (SLP)

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

Occupational Therapy (OT)

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

What is an interdisciplinary team in autism therapy?

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

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

What Can An OT Do For My Autistic Child?

May 30, 2021

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

What is occupational therapy?

What can an OT do for my autistic child?

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

Source: National Autistic Society

What does an OT do?

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

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

Child during an OT session for autistic child.

What should you consider before beginning OT?

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

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

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

Source: Autism Speaks

How do you pay for OT services?

Is OT covered by insurance?

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

Does OHIP pay for OT?

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

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

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

Source: Ontario Society of Occupational Therapists

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

What is sensory processing?

How does an OT help with sensory processing?

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

Source: Harkla

What is a sensory diet?

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

Sensory diets:

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

Source: National Autistic Society

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

Early Intervention in Autism Treatment

May 10, 2021

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

What is early intervention in autism treatment?

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

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

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

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

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

What can we expect from early intervention?

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

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

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

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

NO!

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

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

Top 5 Picky Eating Strategies

February 21, 2021

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

Reasons for picky eating

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

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

Try these top 5 picky eating strategies:

1. Toleration

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

2. Shaping

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

3. Give choices

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

4. Use Positive Reinforcement

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

5. Don’t get into a power struggle

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

Who can help?

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

What is Parent Coaching?

February 14, 2021

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

Goals:

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

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

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

Mom and BCBA in a parent coaching session.

What does parent coaching look like?

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

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

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

Conclusion

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

How and When To Tell a Child They’re Autistic

January 25, 2021

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. 

Family hugging after telling child they're autistic.

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.

Strategies used in ABA: Top 5!

January 18, 2021

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

Strategies used in ABA

Prompting: 

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

Behaviour Contracts:

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

Teacher working with student using ABA strategies.

Reinforcement: 

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

Video Modeling: 

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

Task Analysis:

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

Conclusion

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

How to choose an ABA Provider

December 28, 2020

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

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

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

Home or centre based?

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

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

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

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

Credentials and Supervision

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

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

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

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

Reviews and Recommendations

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

Parent or caregiver involvement

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

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

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

Interdisciplinary Team

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

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

Questions to ask when choosing an ABA provider

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

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

How to get your child to cooperate!

December 21, 2020

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

Schramm’s 7 steps:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Conclusion

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

What is Social Communication?

November 2, 2020

Read time: 3 minutes

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

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

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

Why is social communication difficult?

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

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

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

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

Things to work on in therapy

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

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

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

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

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

How will therapy help improve social communication?

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

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

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

What about non-verbal children?

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

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

Conclusion

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

Things You Need To Know About Language Delays

October 19, 2020

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

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

Language delays add to the complexity of ASD

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

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

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

Receptive language disorder

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

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

How does therapy help?

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

Expressive language disorder

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

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

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

How does therapy help?

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

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

Mixed receptive and expressive language disorder

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

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

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

You can read about language development milestones here.

How To Choose A Speech-Language Pathologist

October 12, 2020

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

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

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

Things to consider in choosing a Speech-Language Pathologist

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

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

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

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

Questions to ask when choosing a Speech-Language Pathologist :

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

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

These are some questions you might ask:

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

Practical questions are important as well:

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

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

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

September 13, 2020

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

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

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

How to Build the Relationship:

Use the first meeting to paint a detailed picture 

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

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

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

Talk about goals 

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

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

Discuss communication expectations 

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

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

A plan to help the child succeed 

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

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

Don’t be afraid to talk about negative behaviours

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

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

Parent-teacher interview

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

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

Conclusion

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

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

 

What is Sensory Processing Disorder?

September 6, 2020

Read time: 4 minutes

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

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

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

SPD: Hypersensitivity vs Hyposensitivity

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

Hypersensitivity

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

Some hypersensitivities include:

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

Children that have sensory avoidance may do the following:

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

Hyposensitivity

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

Some hyposensitivities include:

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

Children that are sensory seeking may do the following:

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

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

Occupational Therapists can help

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

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

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

IBI and ABA: What’s the difference?

August 16, 2020

Read time: 3 minutes

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

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

What is ABA?

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

What is IBI?

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

What are socially significant behaviours?

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

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

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

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

How do I decide which program my child needs?

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

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

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

Who is on an IBI/ABA team?

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

How much does IBI/ABA cost?

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

The Side by Side Therapy Process

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

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

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

Early Start Denver Model (ESDM): Unleash Potential!

August 9, 2020

Read time: 4 minutes

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

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

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

ESDM: The earlier, the better

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

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

A better chance of addressing behavioural issues 

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

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

ESDM: Individualized intervention from an early age

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

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

Early Intervention: Families receive support early on

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

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

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

ESDM: A combination of ABA and play

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

Taking advantage of the brain’s neuroplasticity 

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

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

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

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

August 2, 2020

Read time: 4 minutes

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

What is the autism spectrum? 

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

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

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

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

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

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

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

Don’t forget…

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

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

9 Useful Occupational Therapy in Toronto Strategies

July 5, 2020

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

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

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

Try these Occupational Therapy in Toronto activities:

#1 Exercises for fine motor skills

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

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

#2 Exercises for gross motor skills 

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

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

#3 Heavy work 

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

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



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

#4 Sensory bins

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

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

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

#5 Homemade play dough 

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

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

#6 Painting with ice cubes

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

#7 Bring nature and sorting together 

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

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

#8 Deep pressure activities

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

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

#9 Crossing the midline

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

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



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

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

Top 6 Practical Social Skills Training in Toronto Tips!

June 28, 2020

Read time: 3 minutes

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

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

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

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

6 Social Skills Training in Toronto Tips

#1 Practicing different play scenarios 

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

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

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

#2 Imaginative Play

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

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

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

#3 Visual prompts

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

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

#4 Learning emotions 

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

#5 Social skills groups

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

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

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

#6 Gesture imitation 

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

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

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

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

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

June 14, 2020

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

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

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

Create a plan based in Applied Behaviour Analysis:

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

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

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

Here are 3 helpful tips to encourage mask wearing:

Make your Expectations Clear

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

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

Reinforcement and Praise

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

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

Work on your child’s mask tolerance

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

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

Pairing

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

Shaping

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

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

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

Chaining

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

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

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

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

June 7, 2020

Read time: 5 minutes

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

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

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

Speech Therapy in Toronto Strategies:

#1 Using non-verbal communication 

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

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

#2 Oral Motor Exercises

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

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

#3 Animal noises 

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

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

#4 Singing songs

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

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

#5 Technology as basis for communication

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

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

#6 Learning how to sequence and tell a story

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

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

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

#7 Pretend play

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

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

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

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

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

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

May 30, 2020

Read time: 3 minutes

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

Why should you consider ABA in Toronto for your child?

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

Boy with autism playing with toys during ABA in Toronto


#1 Play

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

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

Girls playing together learning social skills in ABA in Toronto


#2 Social Skills 

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

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

Boy learning to brush his teeth in ABA in Toronto


#3 Activities of Daily Living (ADLs) 

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

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

Boy demonstrating independence learned in ABA in Toronto


#4 Independence

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

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

Alphabet toy laid out in ABA in Toronto session


#5 Academics

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

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

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


#6 Self-Advocacy 

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

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

Girl with autism sitting on ground after ABA in Toronto session


#7 Quality of Life

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

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

Parent learning with son during ABA in Toronto therapy session


#8 Parent Involvement and Learning

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

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

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


#9 Renewed Optimism

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

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

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

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

May 24, 2020

Read Time: 5 minutes

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

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

Mom hugging autistic son after discovering autism therapy in Toronto.

Embracing the atypical 

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

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

Why is denial the first response?

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

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

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

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

Autism is neither good nor bad

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

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

Do not send the “you are broken” message

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

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

A message to take home about autism therapy in Toronto

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

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

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

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

April 7, 2020

Read time: 4 minutes

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

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

Working Memory and the Brain: from Understanding Working Memory

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

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

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

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

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

Working Memory is linked to AUTISM

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

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

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

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

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




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

**

References

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

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

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

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

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

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

March 30, 2020

Read time: 3 minutes

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


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

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

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

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

Applied Behaviour Analysis (ABA):

Boy and therapist doing applied behaviour analysis therapy in Toronto

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

Possible goals: 

  • Responding to name
  • Sorting items 
  • Reading

Speech Therapy (SLP):

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

Possible goals:

  • Increasing vocabulary
  • Improving articulation
  • Improving social skills

Occupational Therapy (OT):

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

Possible goals:

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

Therapeutic Recreation:

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

Possible goals:

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

Respite:

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

Possible respite activities:

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

Psycho-Educational Assessments:

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


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

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

Stay healthy everyone!

Lindsey

Autism: How to have great transitions – Part 2

March 23, 2020

Read time: 3 minutes

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

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

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

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

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

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

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

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

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

Autism: How to have great transitions – Part 1

March 16, 2020

Read time: 4 minutes


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

Toddler with autism smiling looking directly at the camera.

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

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

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

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

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

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

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

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

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

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

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

11 Tips to Help Those with Autism Transition

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

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

Come back next week to read the second part!

Autism Spectrum Disorder and Sleep Problems

March 8, 2020

Read time: 4 minutes

If reading’s not your thing, watch this YouTube video instead!

Research shows that children with autism spectrum disorder (ASD) tend to experience other problems that go hand-in-hand with ASD, which are known as comorbid conditions. This research estimates that the number of children with ASD who would qualify for also having a comorbid condition is approximately 70-80%. The range of comorbid conditions that exist can affect an individual’s mental and physical health, as well as impact them neurologically and medically. Some examples of how these comorbid conditions can manifest include an atypical reaction to one’s surroundings, sleeping disorders such as insomnia, and poor muscle development.

Child with autism spectrum disorder sleeping at her desk, with pencil in hand.

It is very common for children to go through a stage where they don’t sleep through the night. This is actually a normal stage within a child’s physical and cognitive maturation. However, it is a stage that, should it be persistent, is detrimental to not only their health and development, but also their daily functioning. This can affect how they interact with others on a daily basis, especially in children with autism spectrum disorder. Researchers have also demonstrated that insomnia, on its own, tends to worsen the symptoms of ASD and lessens an individual’s ability to thrive in their life.

Existing research shows that there is a strong tendency for those with autism spectrum disorder to have  problems with establishing proper sleep patterns and that they are impacted to a much greater degree than neurotypical children. Additionally, the studies also reveal that those with autism spectrum disorder are at a much higher risk of developing these sleeping disorders than neurotypical peers. The number of those with autism spectrum disorder who have trouble sleeping ranges anywhere between 44-86%. This is contrasted by the overall child population, where only 10-16% experience sleeping problems. 

Many autistic children who experience difficulties regulating emotions and behaviour are shown to also exhibit difficulties with their sleep. A past study of Asperger syndrome and other forms of autism discovered that the children who had persistent insomnia displayed greater emotional and behavioural symptoms than children without sleep disturbances. Parallel conditions are also known to disrupt sleep, some of which include gastrointestinal irregularities, stimulants, attention deficit hyperactivity disorder (ADHD), and anxiety. 

Young girl sleeping

A study found in the academic journal Autism looked at the frequency that sleep issues in children with symptoms that are commonly associated with autism spectrum disorder occurred. The study participants were evaluated for symptoms relating to autism, problems with their sleep, and emotional and behavioural issues. It was found that persistent insomnia was over ten times greater in autistic children than those who did not have ASD (39.3% vs. 3.6%).

The autistic children were shown to develop more sleep irregularities over a period of time, with a frequency of 37.5% compared to 8.6% of the children without autism. Both groups were children aged 11-13 years. Even though only a few girls were included in the study, it was discovered that sleep abnormalities occurred less in girls than boys and their sleep problems were temporary. Those with ASD who also had ADHD were more likely to develop sleep problems.

Without question, it is clear that there is significant scientific backing that demonstrates the link between autism spectrum disorder and sleep problems. Sleep disturbances can, in reverse, negatively affect the symptoms of autism spectrum disorder, such as experiencing an increase in repetitive and/or hyperactive behaviour, lack of focus/attention, displays of aggression, and an impairment in higher brain functioning. Given all these potential issues, it is important for parents to attempt to maximize their children’s sleep habits and put routines and strategies in place that will allow their children to get the most quality sleep.  

Sleep hygiene are the practices that we use to ensure that we have good nighttime sleep and as a consequence good daytime alertness. 

Some examples of good sleep hygiene for autism spectrum disorder are:

  • Avoiding daytime naps
  • Establishing a bedtime routine that offers time to relax and wind down before actually trying to sleep
  • Making sure the sleep environment is comfortable
  • Going to bed and waking up at the same time each day (even on weekends)
  • Getting regular exercise
  • Avoiding blue light producing screens for an hour before bedtime

If your child is having a difficult time with sleep, contact Side by Side Therapy for a no-charge 30 minute consultation and we can brainstorm some ideas to help! 

Autism Home Safety: 11 Useful Strategies

February 19, 2020

Read time: 5 minutes

“I just turned away for a second, he was right here!”, have said many parents in a panic when noticing their child was not in eyesight. This panic luckily is often only momentary, as the child usually reappears quickly. However, wandering by children, especially for children with autism spectrum disorder, can be frequent and for the parent/caretaker this can be frightening. 

Wandering is one of the top safety concerns facing a child with autism spectrum disorder, however, it is not the only concern to keep in mind and prepare for. Creating a plan can be overwhelming and finding a starting point may be difficult. In hopes of helping, I have provided some useful ways to assist in your planning to keep your child safe, especially within your home. 

Safety first road sign for children with autism.

Safety within the Home for Children with Autism

The home can become a dangerous place for children, especially those with autism, who face greater challenges around safety, awareness of surroundings and impulsivity. Parents put security and precautionary measures in place when all children are young but it is necessary to maintain these measures longer when their child has autism. Here are some things to keep in mind when you are creating your safety plan. 

  •  Household Toxins – Cleaning products and related hazardous materials must be locked away in a secure place.  As children are very crafty and persistent, it may be useful to lock the unsafe items in the garage, basement or any other area outside of the main living areas. 
  • Furniture – Top-heavy furniture and large electronics should be secured to the wall with brackets and straps.  Toppling furniture from climbing children is extremely dangerous and can easily occur if these heavy items have not been secured properly. 
  • Drowning – If you or a neighbour has a swimming pool, it is necessary to ensure that drowning prevention measures have been put into place.  As mentioned, with wandering being such a high concern, if a neighbour has a pool within close proximity to your home, you must communicate your concerns to your neighbours regarding the safety of your child and ask that the safety measures are put in place at their home. 
  • Some safety measures include:
    • Fences with self-closing latches
    • Keeping interesting toys/items out of eyesight to not draw the child’s attention to the dangerous area.
    • Enrolling your child in swimming and water safety lessons (if possible).
  • All municipalities have bylaws with regards to swimming pools in people’s backyards.  Research what the laws are where you live to ensure that your pool (or your neighbour’s pool) is following the law. 
  • Fire – Fire safety is of the utmost importance and needs to be practiced with the whole family.  As this training includes your child with autism, you may need to modify and tweak your plan to work with any additional needs and sensory issues that your child may have. There are a few extra things that a parent can implement to help the process. 
    • For instance, if your child becomes upset by loud noises, you can purchase fire detectors that you can record your voice giving directions to leave the house, removing the loud noise trigger and providing familiarity through your voice.
    • Additionally, since children with autism are more comfortable with routine and familiar places, it may be beneficial to take your child during a calm period to a local fire station so they may become familiar with the uniforms and equipment.  The hope is that these measures will prepare and help your child better manage a real-life situation.
    • Practicing fire drills at home in the same way they do at school will also be helpful for your child to become more comfortable if ever there was a real emergency. 
  • Hot Water – As many children with autism also have sensory issues, some children cannot perceive hot or cold temperatures and this can lead to accidental burns.  This can pose a safety concern especially if they are using the faucet independently. Some ways to teach your child the difference between the taps both in the sink and in the shower/bath is through practicing turning them on and off. As well, another tool you can use is a sticker to symbolize the dangerous tap or area of the tap. You can also control the temperature of the water on your hot water tank. 
  • Doors – With wandering being a high concern, the use of locks may be advantageous however they may not be full-proof. Keys may be well hidden but there is still the chance that they may be found, therefore, an additional safeguard through the use of an alarm system may be beneficial. If your child does find a way to leave unsupervised, you need to be vigilant in ensuring that they are always wearing some form of identification that contains their contact and any other pertinent information.   

Wandering in Autism

As wandering is one of the main safety concerns facing many parents of children with autism, it is necessary to take steps to reduce or eliminate this risk. 

Here are some ways to help keep your child safe from wandering: 

  • Understanding your child’s wandering triggers – Some children with ASD may wonder out of curiosity such as distractions from the park, train tracks, the beach – while other children wander to get out of a certain environment, such as ones that may be stressful, loud, bright, chaotic, etc. It’s important to know which type of wanderer your child may be to better understand how to avoid the behaviour. 
  • Keep your home secure – As mentioned previously, the security of your home is of the utmost importance in helping to eliminate wandering.  Locking doors, hiding keys and setting up an alarm system are tools that can be used to help in securing your home. 
  • Keep practicing and modifying communication and behaviour strategies – Teaching your child to request to go somewhere can be a very functional replacement behaviour for wandering. Helping your child learn self-calming strategies to use when they find themselves in stressful, boring or frustrating situations will help in them self-regulate and can potentially avoid wandering. Through trial and error, you will be able to find what works best for your child in these particular situations. 
  • Setting expectations are important – All parents know how difficult it can be preparing and accomplishing an outing, it can be even more difficult for a parent of an autistic child.  It is therefore imperative to outline and set your expectations with your child. You will need to communicate the plan, which can include approximate timelines and rules to be followed with your child and any other accompanying family members/caretakers. If everyone is on the same page and understands the expectations, the outing will likely be a more positive experience. 
  • Identification and monitoring technology are essential tools – Since many children with autism are unable to easily communicate, these identification and monitoring tools are extremely helpful in tracking a wandering child. Having your child wear a form of identification (such as a bracelet/necklace, GPS, marked information on clothing, medical alert tags) will ensure that should your child get lost and be unable to communicate, all their relevant information (name, address, phone number, medical needs, etc.) is available to get them help.  

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The first step to help ease the worry around safety and a child with autism is having an emergency safety plan in place. Evaluating and determining what your family needs to be safe and protected at home, school and the community will provide a helpful guide to protect your family for the dangers that exist. An example of an emergency safety plan can be found at family wandering emergency plan. 

The checklist below will provide you with a practical starting point.  

Safety Plan Checklist:

  • You need to determine if your child wanders, runs away or gets lost in a crowd?
  • You will need to evaluate areas such as home, school or community activities for safety concerns? 
  • Once areas of safety concerns have been reviewed, you will need to ensure that preventative measures have been put in place in each of those areas.
  • You could purchase wearable identification containing important contact and medical information that will always be worn by your child.
  • You should communicate with your neighbours and community that your child has autism and may have special needs to be aware of (i.e. wandering).
  • You should communicate with your child’s school to create a plan which ensures that safety skills are included in their Individual Education Program (IEP). 
  • You should communicate with the local emergency service providers and let them know that your child may be at risk at given times.

Remember, if your child should wander:

  1. Stay calm
  2. Call 911
  3. Search nearby water first
  4. Implement your emergency safety plan

If you would like help establishing your safety plan, please contact us.

10 Helpful tips on raising a child with autism in 2022

January 24, 2020

Read time: 5 Minutes
Last Updated: November 2022


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

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

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

1. Don’t make comparisons 

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

2. Help your child realize when they need a break 

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

Parent talking with a boy with autism.

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

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

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

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

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

5. Keep an open mind

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

6.Maintain a sense of humour

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

7. Never underestimate how much your child understands

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

Autism ABA Therapy Side by Side Therapy Toronto

8. Look into Applied Behaviour Analysis (ABA) therapy

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

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

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

10. Take a break yourself and seek support

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

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

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

January 20, 2020

Read time: 7 minutes

Therapist and child doing applied behaviour analysis.

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

Applied Behaviour Analysis Definitions of Common Words/Phrases:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Duration: The length of a behaviour.  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Behaviour Intervention Plans: The 8 essential elements

January 6, 2020

Read time: 2 minutes

Example of a behaviour intervention plan that addresses challenging behaviour.






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

Elements of a behaviour intervention plan

Operational Definition of Target Behaviour: 

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

Function of Behaviour:

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

Replacement Behaviour Definition:

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

Antecedent Strategies:

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

Skill Building Strategies:

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

Consequence Strategies:

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

Data Collection Procedures:

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

Generalization and Maintenance Procedures:

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

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

Lindsey Malc: Inspired Founder & Clinical Director

December 22, 2019

Read time: 2 minutes

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

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

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

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

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

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

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

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

Professional Services

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

Photograph of Lindsey Malc, Behaviour Analyst

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

Call me: 1-877-797-0437

Email me

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

Lindsey Malc, BCBA

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