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Avoiding behavioral setbacks during COVID-19 How telehealth ABA therapy is helping children with autism
BY ASHLEY WILLIAMS, PH.D., LABA, BCBA
D
uring these times of social distancing, many parents of children with autism who had been receiving Applied Behavior Analysis (ABA) therapy have asked, “How will we maintain the therapeutic gains that have been made? How do we adhere to the treatment plan and continue to make progress?” These concerns are justified, as discontinuation or delay in
ABA therapy can cause distress in children with ASD. It can also create some real setbacks, including the potential for behavior regression. Setbacks Distress can manifest in different ways. Existing behavior can reemerge and there can be changes in skills acquisition. For example, a child who was pottytrained may begin having more accidents. Another concern is the emergence of new behaviors. For example, one child who did not receive ABA services for weeks during the initial phases of COVID-19 returned for therapy and new behaviors like spitting and bolting had emerged. The rates surpassed pre-COVID levels and it was difficult to get the child to adapt back. Virtual ABA treatment during COVID-19 Telehealth ABA therapy allows children and families
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to continue services and work towards treatment goals. Typically, these video conferences are one to two hours long and held at least three times a week via computer, tablet or smartphone. Some children benefit from shorter, more frequent sessions, up to five days a week. Virtual therapy enables families to build on and reinforce social and communication skills, and also addresses personal hygiene and daily living skills. Developing routines at home Many children with ASD have a hard time knowing what’s expected now that they are home all the time. Cues that would have otherwise indicated what to expect are no longer present. For example, the school building itself is a cue associated with learning and the particular behavior exhibited while at school. Children may get frustrated when previously they had free access to toys or electronics at home, but are now asked to do “demands” such as learning virtually. At-home routines can help establish what is expected and predicted. Establish rules around where and what children can access. Maybe designate the kitchen as the room for virtual learning, and the dining room for meals and snacks. Rules provide predictability and routine. Set up a visual schedule
using pictures (preferably) or words, on a whiteboard or Velcro board, so that daily activities are planned out. If the routine or schedule changes, involve your child in visually adjusting the schedule to match the day. Individual reinforcement strategies A system of tickets is an excellent way to reinforce behaviors and reward your child. Does your child just want to eat snacks and use electronics seemingly all day? By using a ticket system, there is a visual associated with a limit. The tickets indicate how many times your child can ask for a “want.” For example, three tickets are dedicated to asking for a snack. Additional tickets may be earned. Maintaining social interaction Opportunities for social interaction will help with your child’s self-esteem while also improving their mental health. Seek out online groups that your child may attend. A virtual Lunch Bunch group meets several times a week. Children start by talking about what they are eating, and oftentimes, that progresses to follow-up questions to previous discussions such as “How was your visit to Cape Cod last week?” A virtual Lunch Bunch group provides a more relaxed space enabling new skills to emerge and friendships to bloom.
Staying safe From social distancing to mask wearing, parents are worried about going out in public with their children with ASD while adhering to COVID-19 precautions. Some fear judgement if their child is defiant for not wearing a mask or observing social distancing guidelines. Mask wearing is a problem for children with sensory issues. Try a system for tolerating a mask with contact reinforcement. At the outset, parents may expect 10 seconds (or less) of mask wearing. Practice at home by having your child wear a mask for a period of time where they can be successful (i.e., without complaining, attempting to take it off or other behaviors). After the predetermined period of time, your child gets a highly preferred item or activity. In the COVID era, it’s difficult to predict future needs and think long-term, so focus on your child’s and family’s current needs. How can we create a model that works now? Telehealth ABA therapy can provide answers and support. Dr. Ashley Williams is the Sr. Clinical Director for Behavioral Concept Inc.’s Eastern Massachusetts region. She serves on the state’s licensure board for Allied Health and teaches in Northeastern University’s graduate and undergraduate ABA programs.
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Art by Dominic Killiany, an artist living with autism.
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