I’m Meg Proctor, an occupational therapist, autism specialist, and feeding therapist. I love helping children with autism and other disabilities participate more fully in their lives. But even more, I love helping parents learn some practical, realistic things to try out during their daily routines. Read our blog to find Up-to-date strategies from an occupational therapist and autism..
If you work with non-verbal or minimally-verbal kids with autism, teaching them to ask for the things they want and need is one of the most important things you can do.
However, there are several mistakes that most therapists make when teaching requesting to kids with autism. These mistakes can make your well-intended intervention so much less effective at helping your clients really communicate with those around them. Check out my video below to see if you are making one (or all!) of these five mistakes.
After watching the video, if you want help figuring out what to do, I've got you covered there too! My short, actionable self-study course on communication exchange is open for registration until June 15, 2019: TEACHING COMMUNICATION EXCHANGE TO KIDS WITH AUTISM
At some point in our careers, most of us turn a corner: we no longer feel like we are “faking” our clinical skills, we don’t spend hours preparing for every session, and impostor syndrome finally fades away. But what does a truly confident therapist look like? Does it involve having a solid answer to every question a parent or teacher asks us? Does it mean we are always the expert? Does it entail coming up with interventions that work the first time, every time? I’d say, unequivocally, it does not.
I remember the intense pressure of being new and working with parents. They’d ask me a question and I’d tell them everything I knew while their eyes glazed over. I just had to prove myself and that I knew things. Then at the end of the session I’d assign ten homework activities to make sure that they were really getting alllll of the therapy they possibly could. But all it really served to do was to leave them feeling even more lost and confused.
Meanwhile, I wasn’t very brave with my interventions. I’d find something that worked and stick to it. Client won’t do adult directed activities? Stick with child-led play. Child’s not engaged in social play? More parent consult. My feeling was it was best not to try something that wouldn’t work…because then what would I do?
Unfortunately, I was just spinning on the hamster wheel of new therapist anxiety. Parents and teachers weren’t really interested in whether or not I knew my stuff. They wanted to have their own experiences validated and respected and to feel genuinely supported in figuring out how to help the kids meet their goals. But I didn’t have the confidence to tell them that the situations they were trying to figure out were actually really tough, and that I didn’t have all of the answers.
And the kids, too, were trying to tell me something. They were trying to tell and show me what they needed, what did and didn’t make sense to them, and how I could help them learn better. But I couldn’t see it because I didn’t know how to truly listen to them and I didn’t have the intervention skill, confidence, or experience to respond adeptly to what they were teaching me.
The process of being a new therapist, or an experienced therapist in a new setting, is truly stressful. And while it’s totally normal to feel this way, we all want move past this feeling as quickly as we can. We want to feel honest, calm, and present in our work, whether things are going great or our sessions are descending into chaos.
The good news is, there are things we can do to mitigate the learning curve and bring ourselves into a more confident and competent state as quickly as possible. Keep reading to explore what it really looks like to be truly confident, relaxed, and effective in our work.
What If We Just Keep Spinning Our Wheels?
Imagine you are a parent of a young child with autism. A new therapist comes over, and you start to tell them about something that has been so impossible to figure out. You’ve absolutely tried everything. The therapist quickly spouts off a quick and easy answer. Does this make you think, “Wow, she knows her stuff!” No! More likely, it makes you shut down and feel invalidated, and like this therapist isn’t going to listen to you about how tough this really is. That they actually think there is a quick fix.
Now imagine you’re a teacher of 20 kids, and your one student with autism is struggling. The new OT comes in and gives you list of 10 things that might help. You roll your eyes and wait for her to leave so that you can go back to your impossible job. When and how could you do these 10 things? And would they really help that much anyway?
But Could It Look Different?
When I talk with families now, the need to prove myself doesn’t get in the way of truly being helpful. I can listen, ask open ended questions, and validate that what they are working on is really truly challenging. I don’t show up as someone who has the answers, but rather as someone who, with the permission of the parent or therapist, has some new things we can try together and just see how they go.
I often talk with therapists about putting on a “detective hat” when doing therapy. I make a new learning activity, try it out, and see what happens. Did the child go under the table and leave? Did they throw or tear up the activity? “What good information for me!” I think. I go back to the drawing board and restructure the activity, or I change the instructions, or rearrange the environment. I talk through my planning with the parent or teacher so that they can learn this process, too.
When the child has a total meltdown, I simply say to the parent or teacher, “I’m glad I got to see that. Is that what you’re seeing during your day with him?” (I learned this line directly from one of my own amazing mentors and I use it all the time. And I mean it when I say it.) The parent or teacher doesn’t actualize my old fears and say “I thought you were supposed to know what you are doing! Why did you cause a meltdown!?” Instead, they look relieved as they say “YES!! That’s what I deal with!! I’m glad you got to see it too.”
How to Get There
While there are certain skills that only come with experience, there are others that you can intentionally learn in order to become more confident and effective. Here are three strategies to incorporate into your work right away:
Make leveling statements. Whether we like it or not, usually we come into a therapy situation as the expert. A leveling statement is something that brings you and the parent or teacher back to the same level where you can really work together. When talking with a parent or teacher, try making statements like:
- “Wow that does sound really tough!”
- “You’ve tried so many things to try and figure this out!”
- “It sounds like he’s really lucky to have you problem solving and working so hard to help him."
Listen before you advise. When we come in nervous and start spouting off ideas, they are often really off target and don't respect that the parent or teacher has already had a long road to get here. Before making suggestions, try these questions:
- “Tell me what you’ve tried and how it went.”
- “What would you like this activity to look like?
- “Is it okay if I watch what’s happening now?”
You might be surprised by the answers, and you'll certainly learn a lot from the parent or teacher's experiences that can help guide what you say and do next.
Become a detective. If your goal is to develop interventions that work the very first time and never fail, you’ll miss out on so many opportunities to learn from your clients about how they think and learn, and about what is really meaningful to them. Being an anxious therapist means feeling stressed when something doesn’t work. But b
ecoming a detective means:
- Starting with informal assessment. Before you start teaching, you want to see exactly what the child is doing now. That way, you can learn about what supports they need, and you can tell if you’re truly making progress.
- Not spending too long making your activities the first time around. You want to be willing to make changes if the child shows you that they need something different. For instance you can make a quick and dirty picture schedule (not even velcroed or laminated!) so if the child throws it or ignores it you’ll be willing to say, “Oh that must not make sense to him! Let’s try an object schedule and see what happens.”
- When things don’t go as planned, watching with interest, thinking about what is happening, and exploring it with the parent or teacher. You can ask questions like:
- “Is this what you’re usually seeing during your daily routines?”
- “Tell me what you noticed.”
- “What usually helps when this happens?”
When you watch and listen, you’ll learn so much that you might have otherwise missed, and you'll be able to go way deeper into creating effective interventions that really help your clients and their families thrive.
But It’s Not Just About Saying the Right Words
Watching, listening, learning, assessing, and restructuring are indispensable pieces of the puzzle for confident and effective therapy. But without a whole lot of intervention tools in your toolbelt, you’ll still find yourself feeling stuck. To be able to do a solid informal assessment with a child with autism, you need a deep understanding of autism learning styles. And when you design and restructure your interventions, you’ll need lots of ideas to pull from, including an understanding of how to embed visual instructions at every level (even if the child doesn’t understand pictures) and how to teach to the unique way a child with autism thinks and learns.
If autism interventions are your stumbling block, I’ve got you. In The Learn Play Thrive Approach to Autism, I teach:
How to use a deep understanding of autism learning styles to effectively problem solve challenging behaviors (this is so much more than just sensory or behavior)How to use informal assessment to truly guide your interventions for your clients with autismHow to create visual instructions and structure based on the individual child’s way of learning and their own level of understandingHow to teach your learning activities in a way that promotes independence, flexibility, and generalizationAnd so much more including teaching play and social play, creating effective schedules, making visual to-do lists, teaching self-care, and getting out into the community!
Do you use a sensory processing frame of reference in your behavior problem solving for kids with autism? If so, learn how you may be limiting the efficacy of your work:
Let’s talk about behavior problem solving for autism. If you work with kids with autism, you’re using some type of behavior problem solving whether it’s a formal process for you or not. And if it’s not a formal process, what happens is we tend to use the strongest framework that we have and work from there. For many OTs, that’s a sensory processing framework. I’m going to talk about why just using that framework will give you limited results in generating interventions for your kids with autism, and how that can leave you feeling ineffective.
You may think I’m going to say, “It’s not always sensory, sometimes it’s behavior!” But I would argue that a behavioral perspective is just as limited as a sensory processing perspective.
Let’s think about a behavior probably all of us are familiar with: a child who has trouble transitioning between activities. If we just have a sensory processing frame of reference, we’ll hypothesize that this transition struggle is due to over or under-sensitivity or sensory-seeking behaviors. We’ll develop interventions to increase, decrease, or change the sensory input in the activities and in the transition.
Now if we just have a behavioral perspective, we’ll hypothesize that the behavior is either to get out of doing the next activity or to gain attention. And we’ll develop interventions like rewarding the desired behavior and ignoring the challenging behavior.
BOTH of these perspectives may have some validity, but they are inherently limited in their scope. And here’s why: kids with autism have a different learning profile than we, as neurotypical people, do. And we can’t think and hypothesize from their perspective without a formal process to help us shift our outlook. Every kid with autism is different, but they all share some components of how they think and learn.
A truly rich framework to start from with your behavior problem solving for autism is that of AUTISM LEARNING STYLES. You’ll want to consider the child’s difficulty with social communication and social interaction:
1. The child pays less attention to relationships. They may have limited imitation, limited imaginative play, and limited or no social engagement.
2. The child has challenges with their social skills. They likely have difficulty understanding the expectations, understanding subtle social cues, sharing their interests, and adjusting their behavior to different contexts.
3. The child has difficulty with perspective taking. It’s probably hard for them to imagine and understand that other people think, perceive, and feel differently than they do. Which often makes emotion-based consequences and incentives very ineffective.
4. Expressive language may be hard for them.
You’ll also want to consider that the child probably has restricted and repetitive patterns of behavior and interests:
1. They probably have fewer interests than their peers, and these interests may be very strong or rigid.
2. They likely form routines quickly, and these routines can be hard to change once they are formed.
3. They probably have some sensory differences (Yes this is one piece of it!! It’s just not the whole piece).
And, finally, they probably have a different learning profile:
1. Receptive language is a relative weakness, which may present as a visual learning style. This doesn’t mean that they have particularly strong visual learning skills, just that it is a relative strength.
2. Implicit learning may be limited. They likely have trouble learning certain things that have not been explicitly taught to them in a way they can understand.
3. And they may have executive functioning challenges, including:
a. Difficulty understanding time
b. Trouble breaking things down into smaller steps
c. Challenges with initiating
d. Difficulty with the concept of finished
e. Trouble identifying main point versus details (central coherence)
f. Difficulty shifting attention (attentional set shifting)
This is the framework we need to do truly rich behavior problem solving for our kids with autism. When we start from a deep understanding of autism learning styles, we can generate so many more relevant and effective hypotheses and interventions.
If you want to dive even deeper into how kids with autism think and learn and really improve your behavior problem solving, I’m going to be teaching a live webinar on autism learning styles and behavior problem solving. I’ll teach you my exact process that helps me generate a rich and thorough list of hypotheses and interventions every single time, and I’ll give you my workbook and my fillable PDF with the whole process laid out for you each time you sit down to figure out what interventions you want to use for a particular behavior.
If you never learn an autism-specific process, you’ll keep muddling through with pieces of an intervention that never really add up to something truly effective. It’s time to go way deeper so that you can feel like a true expert and become much more confident in your behavior problem solving for kids with autism. See you in the live webinar! (Don't worry if you can't make it live, there's a recorded replay for everyone who registers!)
Somewhere along the line, many of us got the idea that our goal as therapists is to get our kids to reach their therapy goals. With that in mind, many of us dive in and do what it takes. Do we need to tell them what to do? Show them? Move their bodies for them? With the mission to overcome barriers and teach our kids new skills, many dedicated therapists will do any number of these things, for as long as it takes, to help our clients meet their goals.
I’ve personally used hand-over-hand (using my hands to move a child’s hands) to teach kids how to do something they’re not yet coordinated enough to do by themselves. I’ve used it to teach them something when they aren’t able to learn from the other types of instructions I know how to give. And, somewhat reluctantly, I’ve used it when they just won’t get started with trying the activity.
Have you done these things too? Is there a little voice in the back of your head that sometimes suggests that this might not be the most effective approach? That it might not even be the most ethical?
If you don’t have a toolbox full of autism-specific strategies, letting go of hand-over-hand can feel scary. After all, when your client can’t or won’t follow the instructions you’re giving, what exactly do you do?
Keep reading to learn three reasons why it’s worth letting go of hand-over-hand assistance in most circumstances, and how to figure out what new strategies you need to learn to use instead to keep therapy moving forward.
3 Reasons Not to Use Hand-Over-Hand Assistance for Kids with Autism
Kids with autism learn from routines.
One thing we know about the learning style of kids with autism is this: they form routines quickly, and once those routines are formed, they can be hard to break. When you teach a child a new skill with hand-over-hand, they are learning how to do that skill with someone moving their hands. This is a much harder type of prompt to fade out than other types of prompts, because most likely the child isn’t really learning, they are simply having their hands moved. If we are teaching a new skill for independence, this is not where we want to start.
Kids with autism often struggle with initiation. Executive functioning skills are often impaired for kids with autism. This means that it can be hard for them to see where an activity starts, what the steps are, and when the activity will be finished. Additionally, they often have difficulty with taking the first step to initiate and activity. If you are helping them initiate by moving their bodies, you aren’t helping them to see the steps, you are jumping right past that skill by doing it for them. The problem is, if you want the child to be truly independent with whatever you’re trying to teach, using hand-over-hand isn’t going to help them get there. And it’s not going to help you learn what they really need from so that they can eventually complete the activity independently.
People have the right to control their own bodies,
unless they are threatening themselves or others. This is just my personal opinion…but maybe you agree? Let me put you in their shoes for a moment. Let’s imagine it’s your night to do the dishes. But you are really tired, and you just don’t feel like it. So you tell yourself, “It doesn’t really matter if I leave these until tomorrow,” and you decide not to do them.
But your partner does not agree. They try every tactic they know to get you to wash the dishes: they beg, threaten, offer you rewards. Nothing works. So they come and take your hands and start using them to wash the dishes. Not cool, right? You get to choose to say no, even if someone more well rested than you might tell you it’s not a very good choice.
If our kids aren’t doing an activity because they don’t find it interesting, aren’t motivated, or can’t see why it’s important, moving their hands for them is not just lazy on our part, it violates our clients’ rights to autonomy.
There Are Some Exceptions!
Now if you have a client who is actively working on a motor skill that they want to accomplish but don’t quite have the skills yet, it’s fine to jump in and carefully help them. I like to do this with the feeling of permission from them, or even with their explicit permission when possible. In these cases, I try to hold the object with them rather than holding their hand. Say I’ll grab the puzzle piece together with them (not their hand) and help them position it in the puzzle.
Or if a child wants more bubbles and doesn’t yet understand that they should give the bubble wand to their mom to request more, I may hand them the bubble wand and nudge them at the elbow to help them pass it to mom. In both of these instances, I’m helping the child meet their own goal, not forcing them to work towards a goal I’ve set for them that they don’t want to try.
There are also plenty of moments that parents just have to move their kids’ bodies. The kid has to get in the car. They have to have their diapers changed. They have to fasten their seatbelts. Teeth must get brushed. Parents must get out the door to work. There are some real non-negotiables in their lives that their kids may not understand or be on board with. I try to leave these actions to the parents while I support them in strategizing how to minimize the struggle and increase the child’s understanding and cooperation when possible.
If Not Physical Assistance, What Can You Do Instead?
Knowing what strategies to use instead of hand-over-hand assistance depends on what the problem is that you’re trying to solve. Here are a few examples of common reasons therapists use hand-over-hand assistance, and some ideas about what you can try instead.
Problem: The child is not initiating the activity.
Possible solution: Try handing the child the material they need to begin (their pencil, the crayon, a ball, a puzzle piece, their jacket, etc.). Make the task and the instructions as simple and clear as possible so that once the material is in their hand it is easy for them to use it successfully. Sometimes just handing our kids something can give them a clear cue to initiate, and it’s easy to fade this out over time.
Problem: The child doesn’t understand the instructions.
Possible solution: Use visual instruction and structure to clarify the instructions within the activity. We know that visual learning is a relative strength for our kids with autism. But relative strength doesn’t mean that they all understand symbolic pictures or written instructions. You should be sure that you know how to use visual instructions at every level: materials, objects, photographs, symbolic picture, picture with words, and written instructions. That way you can choose a type of instruction that will make sense to the child even if they are frustrated or having a bad day.
We also know that part of the autism learning style is difficulty with central coherence, or trouble seeing the main point versus the details. This means that you’ll want to set up your activity using appropriate structure so that it is obvious to them what they are supposed to do with the materials you are providing.
You’ll also want to have a very clear prompt hierarchy for yourself for teaching that involves demonstration, visual prompting, tailored language, and careful prompt fading. And you’ll want to have a clear understanding of why and how to use error-free learning.
Problem: The child isn’t motivated to try the activity
Possible solutions: Try incorporating the child’s interests. If the activity is a put-in activity and the child loves sounds, try doing the activity using a coffee tin where they can hear the material “ding” at the bottom. If it’s math and the child loves Minecraft, have the child work out a math problem related to something they’d like to build in Minecraft. Be clear with yourself about what the goal is, and be open to adjusting the details of the activity so that the child will willingly work towards the goal.
Another possible solution is showing the child that the activity will, eventually, be finished. Because kids with autism have trouble looking at an activity and seeing when it will be finished, they often don’t want to get started. I mean, would you want to go to a hard job if no one would tell you when you’d get off or exactly how much work you had to do that day?
Sometimes showing finished means reducing the materials, like, say, only having 5 beads on the table for the child to string. And sometimes this just means making it more visually clear how and when the child will be finished with the activity.
You Can Do It!
When you learn to teach using visual instructions, structure, and thoughtful prompting, you’ll find that you are more effective and confident in your work. If engaging in power struggles and moving a child’s body when they clearly aren’t on board leaves you feeling not-so-ethical, you’ll also be happier when you leave that strategy behind.
If this highlighted some blank spots in your tool box, I’ve got you covered there too. In my online course, The Learn Play Thrive Approach to Autism, I teach therapists exactly how to use informal assessment to develop the right goals and intervention strategies; how to prompt and teach for initiation, engagement, independence, and flexibility; how to use structure and visual instructions at every level; and so much more. Check it out and make sure you don’t miss your spot when registration opens April 1st! Or you can join me in Durham, NC for a live training on April 12th!
Meg Proctor is an autism specialist and occupational therapist. She trains therapists in the latest evidence-based interventions so that they can show up to work feeling more confident and effective in their skills.
Many parents and therapists have heard by now that visual supports can help kids make sense of their instructions. We know that receptive language, or making sense of what they hear, is difficult for our kids with autism, and that visual learning is something they're relatively good at. The problem is, when we start making visual supports things can get really complicated very quickly!
Maybe this sounds familiar to you: You start making a schedule for a child with autism. And suddenly you’ve put everything on it. You’ve put where the child needs to go, what they need to do when they get there, and how they need to do each activity. The schedule is long and complicated. Not even you want to look at it! You feel certain your child will be overwhelmed, but you can't figure out what information you could leave out to make it simpler.
Not only is making complicated schedules a waste of our time, it’s confusing and frustrating for our kids. Kids with autism struggle with what’s called “central coherence,” meaning that it can be hard for them to separate out the big picture from the details. When we try to give too much information in one place, even if it's visual information, our kids can get lost and totally miss the point.
The good news is, there is a very simple way to sort all of this out and make visuals that will get our kids where they need to go and help them know what to do when they get there. Keep reading to learn what three types of visual supports your kids may need and how to make them clear, simple, and to the point.
Sorting It All Out
Imagine this: You give your child a schedule. It tells them that it’s time to brush their teeth, and that they need to brush the top and bottom for 30 seconds each. But by the time they get to the bathroom, they’ve forgotten about the 30 second instructions. They quickly brush, and then aren’t sure what to do next. Now they have to go back and get the schedule to see what’s next….It says “wash face,” so they head back to the bathroom. But they forgot to look at the schedule where they would find the steps of washing their face. So they do it, but they don’t do a very good job. After that, they totally forget about the schedule and just go to their room. You find them using the ipad and say “What did your schedule tell you to do??” They shrug and say, “Wash my face.”
Now imagine this: You give your child a schedule. They look at it and see that it’s time for “bathroom routine” and they head to the bathroom. Once they are there, a to-do list shows them the sequence of activities: brush teeth, wash face, toilet. The child picks up the toothbrush. Right by the toothbrush they have a post-it note reminding them how to brush their teeth well. Then they check their bathroom to-do list, posted right in the bathroom and they mark off "toothbrushing" and see that next it says “wash face.” They find the instructions for face washing right next to the wash cloth. And then they check their to-do list and see that they should use the toilet. After that’s done, their to-do lists reminds them to head back to the schedule to see where to go next.
That sounds much better, right? This is what we do for ourselves. We use a schedule to guide our overall day. We use to-do lists to sequence individual activities within our schedule. And we use instructions to understand the steps of each activity.
My schedule may tell me that I have time set aside to do some deep cleaning (okay that’s wholly unrealistic…what working parent has time to deep clean!?). Once I am ready to get started, I’ll have a to-do list showing me the activities involved in deep cleaning (clean the toilets, wash the baseboards, whatever else tidy people actually do) so that I can see what all I have to do and see that I’m making progress through the tasks. If there are any activities that I’m unfamiliar with, like say I have a new vacuum cleaner I don't know how to use, I’ll reference a set of instructions to see how to complete that individual activity. If I wrote all of this in my planner it would be a huge mess! But when I break it down in this way I know exactly where to turn for all of my instructions.
When we can give our kids meaningful schedules, to do lists, and instructions, they can begin to make more sense of their visuals and develop more independence in their daily routines. And this process works whether your child understands writing, pictures, or even just objects.
3 Types of Visuals to Get Them There and Help Them Take Action
1. Schedule: The schedule gives the big picture of the flow of the day (or part of the day). In a school, the schedule may say “Math, Science, Recess, Lunch.” At home, it may say “Dinner, Play time, Bathroom.” It should help the child get their body where they need to go, but not tell them exactly what to do when they get there.
Schedules come in all different forms. You can make a schedule using objects for your child who doesn’t understand pictures. You can use photographs or clipart. You can pair pictures with words for your emerging reader. Or you can use a written schedule for your strong reader. You’ll want to use what makes the most sense to your particular child.
2. To-Do List: The to-do list tells them what to do when they get where they are going. In school, the schedule may get them to math, but then the to-do list may say “Turn in homework, Get out pencil, Start activities written on board.”
Or at home, a to-do list may say “Put away shoes, Feed the cat, Free time.” For a young child coming to the table for OT, their to-do list may be “Shape sorter, Puzzle, String beads, Playdoh.”
To do lists should also be in the form that makes sense to your child. For kids who can read, a simple list often works well. But for more concrete thinkers, they may need to see the actual activities themselves laid out in a “list.” So for that child coming to OT, the shape sorter, puzzle, beads, and playdoh could be sequenced on a low shelf where the child can see that they are making progress as the activities move off of the shelf. No one likes to make a to-do list and not be able to check things off!
3. Instructions: The instructions tell the child how to complete a particular activity. Instructions on a worksheet may say, “Answer questions 1-7 and show your work.” Instructions in a shoe-tying activity may show each step of how to tie your shoes. Instructions in a stringing beads activity may show the child how many beads they should string and in what order.
Instructions can also come in many forms. For our kids who can’t read and don’t understand pictures, sometimes all we need to do is lay the activity out in a way that is clear and shows the steps in a way the child can understand. Others may be able to use picture instructions or written instructions to complete an activity.
Do What Works!
Our kids let us know what kind of help they need to be successful. Not every child needs every thing in their day on a schedule. They probably don't need every schedule item to have a to-do list. And they certainly don't need every activity to have instructions. It’s best to let their needs guide your visual supports. Use visuals for the transitions and activities that you find they always need your help with, but you’d like them to be able to do more independently. You should also try using them for the activities that they resist if you suspect part of the resistance could be about them not understanding what’s expected. (Since kids with autism think differently than we do, this is the case more often than we realize!)
Visual supports don’t have to take a long time to make. They don’t have to be beautiful or perfect, printed in color, laminated, or Velcroed. What matters is that they make sense to your child, and help them move through their day with greater ease and success.
So try breaking it down! Where does your child need a schedule? Where could they benefit from a to-do list? And how might some instructions help them? When you make visuals that are clear and meaningful, your child will show you how much it really helps them!
Therapists: If you want to know exactly how to make schedules, visual to-do lists, and instructions at every level to promote independence and flexibility, watch out for the next enrollment period in my online class, The Learn Play Thrive Approach to Autism! Or check out my upcoming live trainings.
As the new rolls in, many of us begin to take stock: What will stay the same? What could be new and different? How do I want to change?
When I hold this lens of change and possibility to my own OT practice, here’s what I see: a lot of the same-old stuff......tinted with a glimmer of the new. But that glimmer didn’t just appear. I though about what I wanted a lot. Then I searched for it. And finally I picked out my particular shade of OT glimmer and stuck it right smack into my work.
If your OT practice feels stale, I know how it drains your enthusiasm. It makes you feel dull and boring, and your work days aren’t inspired like you imagined they would be, but rather like factory work doing the same old thing day in and day out, waiting for the days to pass.
Here’s the thing: it really doesn’t have to be this way. As the year winds down, we all have the opportunity to make the choice to bring new life into our work as OTs. We can reestablish our enthusiasm, skill, and expertise, and, most importantly, bringing joy back into our daily work.
What My Practice Looks like as 2019 Begins
THE SAME OLD: For a while now, I’ve felt really strong in my work with young kids with autism. I remember how exciting it was as I was getting here. Every new intervention and unexpected success was a spark that kept me going.
Now, I still enjoy it, but it’s all very familiar. Sensory social routines. Play skills. Object schedules. Communication exchange. Self-care routines. Parent coaching. Etc, etc. I’ll keep going into homes and working with young kids because I enjoy doing it and families need help. But this isn’t an area I’m having an easy time finding opportunities for growth and newness.
THE BORING: I do a little school-based teletherapy. It is predictable and steady. My work isn’t inspired but it’s also not uninspired. It’s my factory work. And it lets me spend time with my kid in the afternoons.
THE SMOOTH ROAD: My work coaching and training OTs is past the initial giddy build-up phase and into the smooth road. It feels good. I’m constantly learning and growing as I go. I feel successful and proud of my work, and I can't wait to see where it takes me.
THE NEW: For several years I’ve been inching my way over into working with more adolescents with autism. In my last job I dipped in my toes and I loved it. Working with more concrete adolescents was an easy transition. But when I get kids who are more conventionally bright, I realize I have so much to learn. For years that made me want to stick with my young kids and my concrete learners. And at that time, it was the right move. But now, the chance to grow is calling to me.
In 2019 I have a new opportunity working with high schoolers with level 1 autism, and I'm so ready for growth. I’m buying new assessments and reference books, taking new trainings and learning new interventions. I feel that spark of the new! And it feels so good.
Where Is Your Spark?
As you peer into the new year and take stock of your work, where is your opportunity to strike a new flame?
Where is that part of your practice that feels stale even though you know you could be doing so much more?
Who is that client you are excited about but feel like you just need some different skills?
Or even, who’s that child that you could imagine being excited about if you just knew what to do?
If we don’t nurture these opportunities, they simply fade away. But we always have a choice we can make to cultivate new energy, enthusiasm, and excitement in our work.
Learn Play Thrive Training Opportunities in 2018
One of the great joys in my work is watching the therapists who I coach and train build their confidence and begin to excel in their work with kids with autism. It’s not that I made up some brilliant intervention. I’ve simply gotten the right trainings and mentorship from the right people at the right moments in my career.
And I love figuring out how I can effectively pass this along to other therapists so they can feel confident and inspired in their work with kids with autism too. Therapists email me after trainings and say "I absolutely cannot wait to try all of this on Monday!" And my coaching clients write to say, "I just spoke up in a team meeting for the first time and totally felt like I knew what I was talking about!" The spark is contagious.
Want to Catch It?
If you just want to dip your toes in and start with a small but powerful practical training, I have two 2-hour trainings just for you. (If you want way more, keep scrolling!)
PLAY SKILLS MINI-TRAINING.
In this live online training, I'll teach therapists the very best of what I know about assessing and teaching play skills and social play skills to kids with autism. This is the type of training where you walk away armed with tons of concrete skills you cannot wait to try when you head back to work. I've taken a huge amount of the latest research-based interventions, put them into practice, and re-packaged it all for you so it's easy to pick up and use right away. Join me on January 8th at 4:00 CST.
BEHAVIOR PROBLEM SOLVING – Last month I taught a live course where I shared my exact behavior problem solving process (complete with a workbook and a fillable PDF) to help therapists develop true expertise in using an autism lens in developing hypotheses and interventions for behaviors with their clients with autism. We went super deep and therapists walked away with with so much new knowledge. I couldn't believe the incredible ideas they came up with after just two hours of training. You can still catch the replay!
EFFECTIVE AUTISM INTERVENTIONS FOR OT -If you really want to go deep into working with kids with autism, cultivate new expertise, and transform your OT practice, I’ll be opening up my full six-hour autism interventions course for enrollment in January. This course is online and self-paced. If you take either mini-course above and then decide to take the full training, you’ll get a coupon for the full mini-course enrollment fee off of Effective Autism Interventions for OT, so the mini-course is like a freebie!
I’ve also got live trainings coming up in Charlotte, Atlanta, and Durham (and I'll be honest, the live trainings are my very favorite).
Let's Do This
If you want to improve your work with kids with autism, I can’t wait to help put a new spark in your OT work in 2019. Make a resolution: go sign up now, mark it on your calendar, and let's build a fire.
IT'S GOING TO BE A HAPPY NEW YEAR!
For those of you who have already taken my autism interventions course and are knocking down my door for advanced topics, I hear you too! I've got a training on functional communication and one on parent coaching coming down the pipeline for you in early 2019. Stay tuned!
As a parent of a child with special needs, you count on therapists and teachers to help your child meet their potential. Becoming a parent of a child with a disability doesn’t instantly make you into an expert in developmental therapies. And knowing that you don’t have to be the expert is a relief. You can rest assured that there’s a whole team of people standing by to show you the ropes and to teach your child the skills they need to thrive.
The problem is, not all therapists understand your family’s needs or your child’s strengths and challenges. Many OTs are kind and thoughtful and invested, but simply aren’t the right fit for what your family is looking for. Others are great with your child, but they don’t help you, the parents, learn the new skills that you need to learn to support your child day in and day out.
Many kids with developmental disabilities think differently, and when your OT has a deep understanding of your child’s learning style, they’ll be able to more effectively help you tackle your goals for your child and to suggest truly meaningful next steps. Having a therapist who understands how your child thinks and learns means you won’t get generic interventions that just don’t matter in your child’s real life. You’ll get help with the things that are truly important like helping your child connect to others, participate in family routines, and find joy in play and leisure time.
But if I’m being honest, just having a therapist trained in a specific disability isn’t always enough. Having a therapist work with your child one hour per week doesn’t matter if the therapist isn’t teaching you what you can do during your real daily life. If you sit in the waiting room wondering what’s happening while your child is in therapy sessions, or if your therapist comes to your house with a bag of tricks, works with your child, and then leaves, you may be wondering what on earth you should be doing to help your child learn new skills during all of those hours that the therapist isn’t there.
There are so many factors that have to fall into place for you to get the best therapy for your child. However, you don’t have to sit back and just hope for the best. There are questions you can ask to ensure that you are getting the most out of therapy from your child’s OT sessions. Keep reading to learn what 4 questions you should ask to maximize your child’s success in occupational therapy.
Asking for What You Need Is Totally Worth It
When working with professionals, it can be really hard to speak up and ask for what you want and need out of your work together. But there are so many downsides to not asking questions.
If the lines of communication between your family and your OT aren’t open, your child may miss out on a real opportunity to learn and grow. Or your therapist may have the strategies your family needs tucked away somewhere, but she doesn’t ever help you with the things you want help with because they are simply not on her radar. Or there may be a therapist out there who really gets your child and could help them meet their goal so much sooner, but you’ll never find that therapist if you don’t ask the right questions.
Similarly, you may live with mom guilt or dad guilt every day, wondering if you’re doing everything you should to help your child. You may watch your therapist conduct these beautiful sessions with your child and wonder why you can’t teach them in the same way the therapist does. Every week that you don’t step up to ask for help, you may be missing the opportunity to gain the skills you need to help your child in their daily life.
But when you become more involved and start asking for what you want in your child’s occupational therapy, you may find that your therapist really begins to understand your child and your family. Your child will start to show more and more new skills as you practice them together during your daily routines. You’ll feel more confident as a parent, and your family life can become happier and more relaxed.
Your therapist will learn your top priorities for OT sessions and will tackle them one by one together with you. They will include you as an essential member of the therapy team and will give you time to practice the new strategies together with your child. While you try out your new skills, your therapist will watch, guide, and coach you along the way. You’ll feel confident that you don’t just know what to do, you also know how to do it.
At the end of the sessions, you’ll never again wonder what the point of the activities was because you will be right there with the therapist every step, working together to help your child meet their goal. When the therapist leaves your house or when you leave the OT clinic, you’ll know exactly what the next steps are and how to do them.
4 Questions to Ask Your Child’s Therapist
If you are read to stop standing by hoping for more and to start getting the most out of your child’s occupational therapy, here are four questions to consider asking.
QUESTION #1: “Can you show me how to do that?”
REASON: Most likely, your therapist sees your child for just one or two hours a week. While your child might do great working on their goals with the therapist, if you also learn how to do the intervention the impact can be so much larger.
When I work with families, it looks like this:
I ask the family to show me what they are doing now and we talk about what all they’ve tried. I never want to jump in and start suggesting new strategies without learning about all of the things parents have already tried. I don’t want to waste parents’ time by suggesting things they’ve already done, and I also I learn so much from just listening to families’ inventive, creative, and insightful ideas.I introduce the intervention to the parents and ask permission to try it with the child.After I work with the child, the parents and I discuss what worked and what didn’t, and how we might need to change things to make it work better for the child and for the family’s real daily routines.I offer to let the parents try the intervention while I watch and help them.We discuss what the family can do during the week to keep practicing the new skill before the next session.
If your therapist isn't already teaching you new things, you can ask them to! For example, if your OT is helping your child put on her shirt by herself, you can say, “Can you show me how to do that?” or even, “Can I try while you help me?” Most of us don’t learn by watching. We need to try something while a skilled person helps us and walks us through. It may feel uncomfortable at first, but it will be worth it! After practicing your new skills with the therapist helping, you’ll feel much more confident moving into the rest of the week to help your child meet their goals.
QUESTION #2: “What are we are working on with this activity?”
REASON: Some therapists are great about keeping parents in the loop during a therapy session. But sometimes you may be observing a therapist work with your child and feel like you have no idea what is going on. It is okay (and even good!) to ask. Most likely, after they explain you will be able to follow along and make much more sense of the therapy session. You may be missing the intervention all together—and missing a valuable opportunity to learn—because you didn’t know what to look for.
Let’s say you are watching your child’s OT reading a picture book with your child. You may feel like they are working on the skill of reading books, but you aren’t totally sure, so you ask. Your therapist tells you that she is, in fact, working on helping your child learn to point to pictures! You watch more closely and learn a new skill you can use when you read together with your child.
Sometimes the therapist may say, “I’m just playing with him to help him relax and get comfortable,” and that is okay too. A good therapist will balance working on the goals with building good relationships with both your child and with you.
When I work with families, we spend a few minutes at the beginning and end of the session discussing the reasons behind the intervention, and we also reflect on our progress after each activity.
I develop a comfortable and open relationship with families so that they always feel safe stopping me to ask a question. Sometimes families will ask, “Can you explain what we’re doing again” And families even feel comfortable enough to tell me “No, I don’t think that idea is practical for us. Can we do something different?” I love the feedback I get from families because it helps me understand what they need to learn and thrive together with their child.
QUESTION #3: “Could I tell you some of my goals for my child?”
REASON: When your therapist first does the evaluation, or anytime that you want to revisit the goals, make sure the therapist knows what your top priorities are for your child. When I work with families, I always find out what the parents’ main priorities are for therapy. Then I use my specific training to discuss other goals I see and find out if they are also important to the parents.
Sometimes parents tell me things like, “I don’t want to work on play skills right now” and so I don’t write that goal. Goal writing is a team effort, and both the family and the therapist have to be on board for it to really be effective.
If your therapist doesn't ask you what you want to work on, you can chime in and say, "Could I tell you some of my goals for my child?" They might agree to work on the goal together, suggest a slightly different goal, or tell you that it would be best to work on that with a different type of therapist. Any of this will be good information and ensure the best possible plan of care for your child.
Here’s an example of how this could look. Let’s say your son’s OT has been helping him stack blocks week after week. At first you felt that it was great seeing your son master this new skill. But eventually, it started to feel like the same thing over and over again. Secretly, you want your child to learn to look at things when you point to them, to play better on the playground, and to eat with a spoon and fork. One day you ask the therapist, “Could I tell you some of my goals for my child?” The two of you sit down and talk. Within weeks, the therapist has written new goals, and you and the OT are tackling the new goals together.
QUESTION #4: “Could you refer me to a therapist who can help me with X?”
REASON: Sometimes you may want to add additional types of therapy to work on different types of goals. But sometimes you may want to stop working with a particular therapist all together. If your therapist just doesn’t understand your child’s disability or doesn’t have the skills to help your child meet their goals, it may be time to keep searching.
When I work with families, I usually take between 12 and 24 sessions to teach the skills they need to learn. After that, the parents have learned exactly how to support their child, and they don’t need me there with them each week to continue progressing. Some will get other types of therapists to see what other new skills they can learn. Others will practice what they’ve learned for a while and come back to me when they get stuck. Most families come back to me after several months or several years with a new set of needs and we start up again.
But sometimes I start working with a family and realize that I am not the best therapist for the goals they have for their child. And other times families tell me that they want a different approach from what I have to offer. When this happens, I do my best to refer families to the right place to get exactly what they are looking for.
Even the best therapist is not a good fit for every child. This is normal, and therapists know and expect this. If you feel like you’ve given it a good shot and your therapist isn’t connecting with your child’s learning style, it’s okay to ask for a referral to a different therapist or to simply tell the therapist that you want to stop services. This can feel stressful or nerve wracking for many parents, but rest assured is totally normal and expected. It is better for the child, the parent, and the therapist for there to be a good fit. You don’t have to compromise your child’s learning to spare potentially hurting a therapist’s feelings; we want what’s best for your family too.
You Can Do This!
As a parent of a child with a disability, it can be hard to know when to push for more and when to sit back and accept what you get. But getting more out of your child’s OT is totally possible when you start with these four simple questions.
If you are ready to feel truly empowered in the OT process,send me an email to schedule a free 45 minute consultation to discuss how I can help your child thrive.
Meg Proctor is an occupational therapist and autism specialist. She was formerly a faculty member for UNC-Chapel Hill's TEACCH Autism program. Meg will be working with children with developmental disabilities in their homes in Asheville, NC beginning in January, 2019.
As OTs, we have an incredible opportunity to help our clients with autism improve their play and leisure skills. We know how important play is for all kids, and many of us feel the immense responsibility of teaching play to our clients with autism when play just doesn’t come easily for them.
That pressure only intensified recently with the American Academy of Pediatrics’ new statement that highlighted the endless importance of play for the development of kids. The authors highlighted that even though play is incredibly relaxing and balancing for almost all children, kids with autism actually experience a spike in their stress hormones when it’s time to play. Yikes.
The problem is, knowing how important teaching play is for our clients with autism doesn’t mean we feel competent and confident when we sit down to try to write our goals, plan our treatments, and actually teach new play skills to our young clients with autism.
Feeling Stuck on Teaching Play? I’ve So Been There
When I started out as an OT in early intervention, I remember getting my first client with autism. He was an adorable two-year-old boy with a very involved mother. I’d worked with tons of two year olds in my career before becoming an OT, so I was feeling pretty excited. Mom wanted me to help her child learn some new play skills, and I confidently dove right in.
And then I quickly hit a wall. I realized that the child did not imitate, and that the only way I knew how to teach play (or really anything) was through modeling and imitation. I dug deep into the tool box in my head. There was nothing there that didn’t involve imitation. I was stumped. And mortified.
This wasn’t my only struggle with teaching play, but it was the first one. And it stuck with me.
I’ve since learned that many OTs struggle to teach our clients with autism how to play. The lectures from grad school are hard to apply, and their content quickly fades from our memories. We try to piece together continuing education trainings, but we often feel like we are missing an important piece (or two, or five) of the picture.
We dive in and teach the things we know, but we still have this slightly icky feeling that we could be doing something more relevant, more meaningful, and more effective for our clients with autism.
The thing is, so many OTs feel this way. Kids with autism think and learn differently, and we need a truly robust and specific set of tools in our OT tool box to really be able to teach our young clients with autism how to fill their play time without spiking their stress levels.
It’s totally possible to become effective at teaching kids with autism how to play. Keep reading for the three most important strategies you need to know to start saying “yes” with confidence to teaching your clients with autism how to play in a way that will be meaningful, stress-free, and effective.
Why You Should Learn to Teach Play
As I learned the hard way, trying to teach kids with autism how to play without really good training can leave you feeling so discouraged. You might consider switching settings to avoid the challenge and hope that a more qualified therapist comes along to help your former clients learn to play. Or you might keep trucking along, nursing that icky feeling that you really aren’t equipped to teach this skill even though you know how important playing is for your young clients with autism.
You may find yourself focusing on the things you are good at teaching like fine motor skills and simply calling it “play” while hoping no one notices. Deep down you know that there is more to play than stacking and coloring, but it’s so hard to sort out where to start with writing a play goal and impossible to figure out what to do to teach play effectively. There seems to be no guidebook, so you simply turn away from being the one to teach your clients with autism to play.
Although many OTs fall into the routine of doing what they are good at and finding reasons not to do the rest, you can become excited about teaching play again by learning concrete, effective, autism-specific strategies.
For me, this took months (even years) of training and mentorship. But now when I write play goals, I write them with clarity and confidence. I teach parents the strategies they need to learn without hesitation. I teach therapists in my course, Effective Autism Interventions for OT, how they can obtain this confidence in teaching play. And I coach therapists one-on-one about how to overcome their play skills roadblocks.
In my own practice, I’ve come along way since that awkward day in early intervention. Now, I teach play to kids who imitate and to kids who don’t. I teach pretend play and toy play, acting out play scenarios, symbolic play, and, for my older clients, leisure skills. I teach play at home and at school and at the park.
Now that I have relevant strategies in my toolbox, I absolutely love teaching kids with autism how to play.
Tip #1: Select the Right Play Goal
One reason therapists often feel unsuccessful teaching play is that their goal is way off target. Many therapists fall into the trap of teaching too many things at once or of making too big of a leap.
Imagine that you were learning a new language, but you weren’t very good at it yet. Now imagine that a teacher came along with the brilliant idea to teach you a new skill like playing an instrument or doing advanced calculus in that language you’re learning! Terrible idea, right? Recipe for stress and failure.
That’s exactly what we often do to our kids with autism when we write our play goals. I’ll explain. Writing the right goal is three-fold:
1) If you are teaching a new play skill, teach it using a mastered social play skill. That means that if you are teaching a child to use a simple toy (that's the play skill), you should not also be teaching turn taking (that’s the social play skill). Asking a child to learn a new play skill while using a social skill they haven't mastered is the equivalent of asking you to learn calculus in French!
If that child’s level of mastery for social play is playing side-by-side but not sharing materials, that’s where you want to be when you teach the new play skill.
If you don’t know the levels of play skills and social play skill, take some time to learn them. (If you get stuck, I teach them in Effective Autism Interventions for OT and to my one-on-one consultation clients.)
If you are teaching a new social play skill (like imitation, sharing materials, turn taking), use a mastered play skill. That child who's learning imitation? Make sure you are teaching him using a play skill he already has, like cause and effect toys or sensory exploration.
The child who is learning to take turns? Use a simple activity he already knows how to do; don’t teach turn taking right along side a new complicated game. Again, that’s teaching your piano lesson in Arabic.
Choose an emerging skill to work on and avoid trying to make big leaps.It’s so tempting to teach every child turn taking because….well, it’s something we feel like we know how to teach. But if a child isn’t already sharing their materials, they aren’t ready to learn turn taking. I teach therapists five concrete mini-goals (with specific teaching strategies) they can work on to slowly travel from solitary play to sharing materials and eventually working on turn taking.
Similarly, for play skills, if your child isn't yet using toys functionally they are probably not ready for pretend play or games with rules. It's best to shoot for very small leaps to make sure you are working at a level that is developmentally appropriate and meaningful for your client.
Tip #2: Use Structure
One thing we know about the learning style of kids with autism is that they learn better from what they see than from what they hear. If you’ve read my ebook, 5 Essential Autism Strategies, you know that it’s important to use visual instructions at a level that the child can understand. Sometimes this means that our play activities need to contain object-level instructions for our kids who don’t understand pictures. Some kids understand pictures and benefit from picture instructions (photographs or symbolic pictures, depending on the child) in their play activities. And some kids can use written instructions.
Beyond how we embed visual instructions in our play activities, we can also structure the activities so that our kids can focus on the play goal. For a child who gets distracted by the materials, we may need to segment out each piece so that they are only picking up one at a time. Or maybe at the end-point in the activity, the materials need to disappear into the structure of the activity.
Let’s say I’m teaching symbolic pretend play to a child. She feeds a puppet little craft balls pretending they are cookies, but then she pulls the craft balls back out and gets distracted by playing with them. Cutting a hole in the puppets mouth so the craft balls disappear can eliminate this problem and help the child focus on the play activity. The same can be done using a container with a hole in it for a variety of play activities.
There are lots of other ways to use structure. In Effective Autism Interventions for OT, I teach therapists how to use informal assessment to think through exactly what structure they need in a play activity, and I give concrete examples of all of the different specific ways you can structure an activity.
Tip #3: Use Naturalistic Strategies
Let’s go back to that two year old who didn’t imitate. What I didn’t know then was that I had two options for how to teach him new play skills: 1) Embed visual instructions and structure in the play activities, and 2) Teach him how to imitate.
Since we teach new play skills using mastered social skills, this child needed to learn the social play skill of imitation before I could really dive into teaching new play skills.
Fortunately, folks wayyyyyy more clever than me have already figured out how to teach kids with autism to imitate using what’s called naturalistic strategies. If you already have training in an approach like Floortime, naturalistic strategies will be familiar to you. I learned how to do this from an autism specialist trained in the Early Start Denver Model.
Playing using naturalistic strategies comes naturally to basically no one, but we all need to know it to teach play to kids with autism with greater success.
If you aren’t familiar with naturalistic play, I lay out the steps for you in this blog post. (If you’re reading in the Facebook app, links in this post may not work so head over to a new browser!)
The short version is, start by imitating the child and narrating what they are doing. When that gets their attention, try something new with the toy without telling them to copy you. You can use words or sound effects to describe what you are doing and capture their attention. Then go back to imitating them. It’s a bit of a back and forth dance. But the challenge is to try not to ask questions or tell them what to do.
This sounds so simple, but it’s a huge change from how we usually play. When I teach therapists and OT students how to do this, we work together over the course of many sessions (or videos for those in the course) to nail down these skills.
And it’s amazing because this way of playing really truly works. I’ve taught dozens of kids with autism to imitate using naturalistic strategies.
Naturalistic strategies aren't only useful for teaching kids how to imitate, they are also important for teaching new play skills to kids who already to imitate. I’ve used these same strategies to teach dozens of kids how to do all kinds of play without ever having to give them instructions like “do this!” or “make the plane fly!” They simply watch me and copy.
Teaching play skills using naturalistic strategies allows our kids to learn to play in new ways without requiring someone to prompt them verbally. Since our kids learn routines quickly, we want to be careful not to teach them the routine of getting a prompt before imitating. Teaching play in this way will go so much farther in helping them play in their real daily routines.
You Can Teach Play with Confidence
It’s so tempting to take the easy road and simply skip getting good at teaching play. But the research and our own experience tells us that learning to effectively teach our young clients with autism to play could not be more important.
When you learn autism-specific strategies for teaching play, you can feel confident that you are making the greatest impact on your clients with autism.
To gain the skills you need to help your clients thrive during down time, join the waiting list to enroll in Effective Autism Interventions for OT or schedule a free consultation to discuss one-on-one clinical mentorship.
Many parents struggle to help their kids with autism focus on learning activities. It can feel frustrating to not know how to get your child's attention and help them engage in the things you've picked out. In this video, I share three strategies that will help you feel more successful at teaching your child new things.
Also an exciting announcement: I'm not accepting families in Asheville, NC for in-home OT! Reach out for details!
Most OTs want so badly to make a real impact in the lives of the people we work with. We want to feel like what we are doing matters for our kids and their families, that it is effective, and that our time has been well spent.
When I first started out as an OT in early intervention working with kids with autism, I felt immense pressure to really help the families I was seeing. The parents were exhausted, confused, and out of other options. They were counting on me to help. I did the best I could, but every day I felt awful. I felt ineffective, confused, and terribly stressed. I worked all the time and felt like I accomplished nothing.
The thing is, we don’t come out of school ready to be successful with kids with autism. Sure, there are a few lectures on autism in our pediatrics classes. And we get some experience on fieldwork. But when we really dive into the work, whether we are new therapists or have been doing this for years, eventually we begin to feel that we don’t really know how to be effective with our kids with autism.
The insecurities creep in. We may start to think, “Do I know what I’m doing?” We may feel like imposters and dread going to work. We stay up late trying to look at research (even though we no longer have a research database logins, so we are reading abstracts and clicking on links that won’t actually load).
We eventually settle in and start to do the same uninspired interventions over and over again. They don’t really feel individualized or effective. They often don’t even feel like skilled interventions. But we really don’t know what else to do, so we keep plugging along and try not to think about it.
We take continuing education courses, and they feed us more theory and superficial ideas. We are taught to consider the environment, to use a new theoretical framework, or to use more visuals. But we still don’t really know what that means or how to do it in a way that will really make a difference for our young clients with autism.
Have You Been There?
It’s easy to get caught in an uninspired rut, and to feel like no continuing education could get you out of it. However it’s not so complicated to become truly effective therapist for your clients with autism. When we begin to deeply understand autism learning styles, it’s entirely possible to feel skilled, competent, successful, and inspired in our work once again.
Doing Something Different
If we never deeply learn about how kids with autism think and learn, we try to get by on what we think we know. We use clipart in our instructions because, “They’re visual learners, right?” The clip-art picture schedules and visual instructions get ripped up, ignored, and thrown on the floor. We aren’t sure what we are doing wrong, but we keep plugging along, spending hours putting pictures onto pages.
We try to teach social skills, because we know that kids with autism have social differences. And somehow we wind up teaching new, rigid routines that don’t help our kids at all. We try to teach our kids to play, and they won’t imitate us. So we just keep trying, feeling ineffective once again.
We teach fine motor activities, even though we aren’t sure that it will ever make any real difference in daily activities. And we teach tons of handwriting, because after all of this time we’ve gotten good at teaching handwriting, while we still feel uncertain working on other daily routines and activities.
When we do behavior problem solving, we continually write, “The purpose of the behavior is to gain attention or to get out of something” even though this generic hypothesis isn’t really helping us generate effective interventions for our kids with autism.
Working like this eats away at our confidence. It leaves us numb or even dreading our work, and it makes us question our abilities as therapists.
If you are dragging yourself along in your therapy without a true, deep understanding of autism learning styles, you have the opportunity to do something different. You can become a more skilled therapist and begin creating interventions that really speak to your clients. You can clarify your therapy process from start to finish so that you show up knowing exactly where to start each day with your clients with autism. And you can rekindle your excitement about your work and your confidence in yourself knowing that you are truly an expert with deep knowledge of autism that guides your work.
Using Autism Learning Styles to Guide Your Work
When I work with OTs in one-on-one consultation or in my continuing education courses and workshops, I start with a deep and thorough exploration of how kids with autism think and learn. Then, we practice going through each part of the autism learning style and using it to problem solve a behavior and develop an intervention plan.
Here’s an example of how this process took one therapist from stuck to totally rocking it.
The therapist’s client, Kyle was a five year old with autism who dumped out all of the toys during free play. Kyle’s behaviorist hypothesized that this behavior was to gain attention. But the OT wasn’t so sure. She suspected that the behavior related to poor play skills. But she didn’t know how to make the leap from her suspicion to a full intervention plan.
After working together to problem solve using autism learning styles, here is what we came up with.
Our first hypothesis was that Kyle’s dumping toys may be related to his difficulty with social relationships and social communication. We hypothesized:
He may not pay attention to how others play and therefore does not imitate others.His peers’ social play may not capture his attention, so he doesn’t look around and join in with the other kids.He is not motived by his parents’ and teacher social responses to how he does or doesn’t play, so traditional behavioral strategies like praising desired behaviors and ignoring challenging behaviors aren’t effective.
To address this, we decide we may need to:
Teach him imitation in a way he understands, using naturalistic strategies to capture his attention.Consider that behavioral strategies requiring perspective taking (e.g. “Kyle I don’t like it when you throw blocks!”) are unlikely to be effective since Kyle has difficulty with taking others’ perspectives.
Our second hypothesis was that Kyle’s throwing blocks may be related to his restricted and repetitive behaviors. We hypothesized:
He may have a very strong interest in how toys look when they are falling.He may have a very limited set of play interests, and the toys present during free play may not capture his attention.Throwing and dumping toys may be a rigid play routine, and routines are very difficult for him to change once established.
To address this hypothesis, we determined that we may need to:
Teach Kyle how to play with the available toys in a one-on-one setting using clear, visual instructions, autism-specific teaching strategies, and structure.Provide him with appropriate play activities that involve watching things fall.Bring in new toys that we have taught him how to use rather than trying to teach him to stop dumping the current toys, since breaking the current strong routine of dumping toys will be difficult.Incorporate his strong interests into the available play activities.
Our third hypothesis was that Kyle’s dumping toys may be related to his learning profile and executive function. We hypothesized:
He may have difficulty understanding how he “should” play because of his challenges with receptive language.He may not know how to play with new toys because implicit learning is not a strength for him, and he has never been taught to play in a way he understands.He may have trouble seeing where the play activities start and where they finish, so he can’t pick up a toy and know how to get started with a play routine.Dumping toys does not have a clear end point, so once he starts he continues dumping everything.
To address this, we realized that Kyle likely needs the following:
Explicit instruction in how to play, using a blend of naturalistic strategies and structure.His play activities in free play should have a clear beginning and end (e.g. start with the puzzle pieces in a container next to the puzzle for him to put into the puzzle, so he can get started right away and also see that he’s finished when the container is empty).A visual to-do list of play activities that he can do during free time. If he doesn’t understand pictures, his visual to-do list will need to be at the object level.If we create an activity that involves appropriate dumping, we’ll need to make sure it has a very clear and concrete end point.
What a Difference it Makes!
What a difference it made when we applied autism learning styles to this therapist’s behavior problem solving process! This OT certainly didn’t need all of these interventions, but she was finally able to approach her team confidently with a relevant list of hypotheses and interventions that related directly to how this child thinks and learns. From there, together they could figure out where exactly to start. She went from “Maybe it’s his play skills?” to this rich, relevant, concrete list of behavioral hypotheses and interventions.
From Confused to Confident
Being an OT can leave you feeling totally alone and confused. But becoming a competent and confident therapist for kids with autism is totally possible. When you commit to deeply understanding autism learning styles and applying this to your practice, you can reinvigorate your work and rediscover that hopefulness that you felt when you first decided to work with kids with disabilities. To start becoming more confident and competent in your work with kids with autism right away, check out my free 30 minute masterclass,
Autism Learning Styles & Behavior Problem Solving .
The masterclass link will be gone after October 4th, so head over right away and start transforming your work.