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BY ASHLEY WILLIAMS, PH.D., LABA, BCBA

During 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

Avoiding behavioral setbacks during COVID-19

How telehealth ABA therapy is helping children with autism

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 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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Flu shot mandate draws praise and ire from parents

All children who attend school this year in Massachusetts will be required to have a flu shot. While medical professionals say it makes sense, some concerned parents are pushing back.

BY JOAN GOODCHILD

Each fall, Anne Gray, a Shrewsbury mom of two, heads to the annual flu shot clinic at her local pediatrician to get her boys, aged 12 and 13, vaccinated.

“I’m aware that the efficacy of the flu shot varies each year, but I also understand that it can reduce the risk of flu illness and hospitalization,” she said. “The potential protection from the vaccine is important for keeping my kids safe and healthy, and therefore it's an annual vaccine for them and our entire family.”

Soon, more parents may be joining Gray and her kids at flu shot clinics. For some, it won’t be by choice.

Massachusetts officials recently announced a new, first-in-the-nation flu shot mandate for students under age 30.

Under the rule, anyone 6 months or older in child care centers, preschool, K-12 schools, and colleges and universities, will be required to receive the flu vaccination this year. And it must be administered before the end of the year.

The rationale for the requirement is that levels of COVID-19 may spike again. A coronavirus surge, coupled with seasonal influenza outbreaks, may overwhelm the healthcare system with an increase in hospitalizations and ER visits.

Officials also note that since the symptoms of coronavirus and the flu are similar, they hope vaccinating children against influenza means it will require less time to discern whether symptoms like a cough or fever are one virus or the other.

“I see this as two-fold,” said Dr. Christina Hermos, a pediatric infectious disease doctor at UMass Memorial Medical Center, and an assistant professor at UMass Medical School. “We need to do everything in our power to limit flu this season. We don't know what will happen with COVID-19 and if numbers start to surge, we need to have available medical personnel and hospital beds available and cutting down in ED and inpatient flu numbers will help. Flu and COVID-19 have similar symptoms. When symptoms develop, children are out of school and adults out of work until a diagnosis can be made. If we limit the number of COVID-19 ‘mimickers’ circulating, it will help children stay in school and limit the number of tests requested for COVID-19-like illnesses.”

Hermos stresses that data confirms the flu vaccine is safe and effective for kids. Last year it was about 60 percent effective in preventing flu in kids, she noted. The vaccine is also effective at preventing severe flu, which can lead to hospitalizations and deaths. Preventing flu in kids also helps limit its spread in the community, she said, and in particular, helps prevent the chances that an older person, who may not respond to the vaccine, becomes infected.

Forced into a decision

But for a variety of reasons, there are parents who simply don’t want their child to get the flu shot. For some of these families, there are ways to opt out.

Students who have a religious or medical exemption are not required to get the vaccine. And those who are homeschooled by parents or family, or are living off campus and learning in remote-only classes, are also not required to receive the flu shot.

But many believe the opt-out options don’t reach far enough. The mandate has drawn backlash from several parents who are concerned about the vaccine and do not want to be forced into having their

child receive it. After the announcement, a group known as Health Choice 4 Action launched a petition calling on the state’s health department and state lawmakers to repeal the flu shot rule. The group also held a rally in August at the State House.

“The decision to abstain from the flu shot is neither uncommon nor irrational. But now, it comes with the life-long consequences of losing access to education,” said Candice Edwards, executive director of Health Choice 4 Action. “Children and young adults in Massachusetts will be barred from daycare, school or college if they make the same reasonable choice a majority of American adults make every year--to decline the influenza vaccine. Keeping kids out of school has enormous costs and real risks. One might assume that the data for influenza vaccine is rock-solid and benefits clearly outweigh costs. Not so.”

Edwards urges parents opposed to the new mandate to start crafting emails and to call their local lawmaker to make their opinion be heard.

“Parents who oppose the mandate must become involved in civil engagement in an effort to rescind the mandate,” said Edwards. “We advise them to respectfully write and call their legislators, the Governor, and the Massachusetts Department of Health to tell them to repeal the order by communicating and sourcing their opposition. Additionally, parents can attend peaceful protests and sign-on to the class action lawsuit against Governor Baker.”

Hermos said, like mask requirements in the wake of coronavirus, just about any mandate always draws some initial protest, but the benefits of the flu vaccine far outweigh any perceived risks.

“One-hundred-eighty-five children died of flu last year and most of these were unvaccinated or under-vaccinated,” she said. “We are learning that children are likely not the main drivers of COVID-19 infection and outbreaks among adults, but children are known to readily infect adults with flu and contribute to community flu rates. Vaccine is the right thing to protect kids and the community at large.”

Joan Goodchild is a veteran writer and editor and mom of two living in Central Massachusetts.

Special Needs, How pets help kids Special Friends with autism, disabilities

BY AMANDA COLLINS BERNIER

Though the pandemic has upturned much of Kimberly Cake’s life — she’s navigating the complexities of raising a child with special needs in the COVIDera, not to mention remote Kindergarten — the Sutton mom has been sleeping more soundly since the world changed in March.

As schools and communities were shutting down, the Cake family was opening their home to a new family member. One with four legs.

Manhattan, or Matti, for short, a two-year-old Golden Retriever/Labrador, has brought

peace, comfort and happiness since she came into the Cakes’ life this spring. A seizure alert, autism assistance and mobility assistance dog, Matti is trained for the specific needs of Cake’s 5-year-old daughter, Kristiana.

Born at 24 weeks, weighing just over 1 pound, Kristiana has had more than her share of obstacles from the very start – a brain bleed, a hole in her heart, a tracheotomy, just to name a few. When she was diagnosed with autism at 2 ½, her parents began the long process of finding a service dog.

“We’d heard dogs can do great things for kids with autism,” said Cake. “We knew a dog could be a social bridge to help her connect with people and help calm her during meltdowns.” Service dogs are being used increasingly to help children who have learning, behavioral, or developmental challenges. They are bred for a calm temperament so they don’t react to even the most extreme behaviors such as screaming, impulsivity, and aggression. First used to guide the blind, service dogs can be trained to perform specific tasks to address a particular disability.

Autism assistance dogs, for instance, can be trained to distract and disrupt repetitive behaviors or meltdowns, to prevent and protect a child from wandering, and in tracking to locate a child who has wandered.

As Kristiana was put on the waitlist for her dog, she was dealt another blow. She was diagnosed with epilepsy just before turning three, then also with a mild case of Cerebral palsy.

“At that point we were so glad we had started the long process for a service dog,” said Cake. “It felt like everytime we thought something leveled off, there was something new.” But

Matti’s trainers kept assuring her, “that’s OK, we can train her for that too,” she said. When Matti and Kristiana first met in March, the bond was instant. “Right away, they were this little dynamic duo,” said Cake. Indeed, they had both been waiting for each other: Matti for the girl she’d trained nearly her whole life to care for, and Kristiana for the dog who would make her feel “safe and brave.”

The changes Matti has brought have been profound, said Cake. Kristiana tolerates doctors appointments better, sleeps better, gets around easier, and has a new way of connecting

Kristiana Cake has more confidence, and her mom, Kimberly more peace of mind, since welcoming service dog Matti into their family this spring. Ashley Green photo socially. “This is my Matti,” she’ll tell anyone she meets. They play dress up, have princess parties, and sleep together every night.

For Cake and her husband, she’s brought peace of mind. Already, Matti has alerted them to four seizures.

“We see her working daily,” said Cake, “but Kristiana just sees her best friend.”

Special needs, special friends

While Matti, trained as an advanced assistance dog by Ohio-based 4 Paws for Ability, is the right companion for Kristiana, experts say service dogs aren't the only animals that help children with special needs.

According to a University of Missouri study, children with autism form attachments to a variety of small pets — dogs, cats, even rabbits and guinea pigs — and those with pets may develop stronger social and communication skills.

But children with a myriad of special needs, not just autism, can benefit from the presence of animals. Reluctant readers may feel more comfortable reading aloud to a patient, nonjudgmental animal, for instance, or children with physical disabilities can find relaxation and improved balance and coordination in the rhythm of horseback riding. And animals with no special training can still offer comfort and affection through qualities like playfulness, soft fur, or a relaxing purr.

While parents can seek out animal therapy and services, Rachel Goclawski found support for her two daughters in an unexpected place – right in her backyard coop. The Millbury mom of girls ages 11 and 9 has been raising chickens since her daughters were toddlers.

“I first noticed chickens helped them with their special needs a couple years later when they would come home from school over-stimulated, anxious or upset and I would see how

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The Goclawski family, of Millbury, has found unexpected therapeutic benefits from raising chickens. Courtesy photos

much the chickens would calm them and the smiles would just come right out,” she said.

Caring for the chickens has provided Goclawski’s younger daughter, who has ADHD, with an opportunity to practice skills she needs to work on like discipline, focus, delayed gratification and impulse control. And in the past few months the birds have been particularly helpful for her older daughter, who is on the spectrum and struggled to adjust to remote learning.

“She has anxiety, had panic attacks and many meltdowns over the first few months (of quarantine),” she said. “Nothing calmed her and gave her joy more than those baby chicks, her favorite full-grown chicken as well.”

According to Modern Farmer, when socialized and supervised properly, specific animals, including chickens, can offer a wide range of therapeutic benefits to children and adolescents with autism as well as conditions including anxiety, depression and attachment issues.

“Nothing is more calming than to watch them scratch and forage, and to listen to the noises they make,” Goclawski said.

Pets help parents, too

The benefits of animals and special needs families extends beyond the children. New research from research from the University of Missouri has found that pets lead to strong bonds and reduced stress for both children with special needs and their parents.

Gretchen Carlisle, a research scientist with the Research Center for Human-Animal Interaction in the MU College of Veterinary Medicine, surveyed more than 700 families from the Interactive Autism Network on the benefits and burdens of having a dog or cat in the family. She found that despite the responsibility of pet care, both children with autism and their parents reported strong bonds with their pets.

Pet ownership was not related to parent stress, and parents with multiple pets reported more benefits.

“Given that the characteristics of autism spectrum disorder are so broad, it can be difficult to identify interventions that are widely beneficial,” Carlisle said. “Some of the core challenges that children with autism face include anxiety and difficulty communicating. As pets can help increase social interaction and decrease anxiety, we found that they are not only helpful in providing comfort and support to children with autism, but to their parents as well.”

For parents considering adding a pet into their family, Carlisle recommends including the child in the decision and making sure the pet’s activity level is a good match with the child’s, as some kids have specific sensitivities.

“A big, loud dog that is highly active might cause sensory overload for a particular child, while a quiet cat may be a better fit,” Carlisle said.

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Pandemic empties pet shelters as families add new four-legged members

BY DEBBIE LAPLACA

The makeshift corner office and kitchen classroom has many quarantined families taking a fresh look at the space they call home and finding it’s the perfect time to add a little something warm and fuzzy.

An uptick in pet adoption requests since March coupled with a limited supply of animals brought on by the novel coronavirus pandemic has emptied shelters and filled homes and hearts with pets.

In case you haven’t heard, pets can make your family healthier. Dogs for instance love to play and are known to move their owners toward a more active lifestyle.

The American Heart Association says dog owners are 54% more likely to get the recommended amount of exercise than non-dog owners. Further, those exposed to pet fur and dander have been shown to have stronger immune systems, which could lead to a decrease in bloodpressure and cholesterol levels.

And if that isn’t enough, pets can also reduce stress, anxiety, depression and the sense of loneliness that many have recently experienced from isolation.

While these are compelling reasons to adopt a pet, training a puppy or acclimating an older dog is a time-consuming, hands-on commitment that typically doesn’t work for every busy family or fast-paced household.

Then came the pandemic.

Work from home and school from home meant more people at home with time to care for a new addition to the family. Add warm weather and quarantine fatigue to the mix and walking a dog becomes an attractive way to get up and out.

Families turned to shelters in unprecedented numbers and soon Fido became the loyal co-worker, recess buddy, and warm shoulder to cry on.

The Sterling Animal Shelter ran out of pets to adopt in March and today, hundreds of people are on its waiting list, while availability remains low.

“It coincided with our shutdown when everything started to get crazy with COVID in March,” Kendel Burdeaux said. “A lot of our pets come from Puerto Rico and unfortunately with the transportation problems and the crazy heat this summer, it’s been too hot to transport. There was a two-month lull where

we had nearly no dogs coming in.”

Yet, the demand for adoptions rapidly increased as did the waiting list.

Sterling has received more than 2,000 applications to adopt since the end of April, which, Burdeaux says is a great problem to have at a shelter.

“I think some of it is the circumstances of the COVID era. The increase is because people are working from home and have the time to train them,” she said. “I also think it’s the product of the culture in New England: people are very good to their pets and make a lifelong commitment.”

The shelter has been scouting for pet transportation partners in the southern states and is presently working with a transporter in Texas.

“Places in the south are drowning with animals and here where we can’t find them. We really don’t have a stray animal problem up here and we don’t see a lot of local surrenders. The requests we get here are from people who have to give up their pets,” Burdeaux said. “We are getting cats, but we are struggling with finding appropriate dogs.” When dogs

arrive, their profile is posted online, and those interested are asked to complete an online application before an appointment will be made to meet at the shelter.

Sterling recently took in 28 cats and kittens from new partners in Texas and Louisiana and they were quickly adopted.

Lindsay Doray, Development Director at Second Chance Animal Services, said the shelter has experienced numerous occasions since March when all their pets were adopted.

“We’ve had so many people waiting to adopt that we when do have pets, we don’t have them very long,” she said. “Animals are going out as fast as they are coming in.”

Doray said they are grateful to the outpouring of adopters who have welcomed new pets into their homes. But this, combined with the limited animal transports across the U.S. at this time, means there are fewer pets available than usual.

Second Chance helps more than 40,000 pets and their families each year through adoption, spay/neuter programs, veterinary care, community outreach, educational outreach, training, and a pet food pantry. It operates an adoption center in East Brookfield and community veterinary hospitals in North Brookfield,

Springfield, and Worcester.

Second Chance receives some cats and dogs from local owner surrenders and animal control officers, but most come from overcrowded shelters that are euthanizing for space from various locations, including the southern states.

“COVID did bring some challenges in bringing in pets, even from the overcrowded shelters for a while. Transports were shut down because nobody really knew what was going to happen with this virus,” Doray said.

Today, animals are posted on the shelter’s website when they are ready for adoption, where people are asked to submit an online adoption survey.

“We had to alter our adoption protocol and limit it to one family in the building at a time so that we could clean between families to reduce any possible risk. There are days we have a line of people waiting to come in and adopt. It has been great,” Doray said.

The Second Chance nonprofit, full-service hospitals that offer subsidized rates for low income households have also been swamped with 2-3 times the normal call volumes for emergencies and vet appointments. Partly, Doray said, due to an increase in families financially impacted by the pandemic and due to the closure of school-based veterinary programs.

“Our pet food pantry is serving additional food pantries to help ensure that no pet goes hungry during this crisis. It has become a vital lifeline for many,” Doray said.

To help limit people entering their buildings due to social distancing restrictions, Second Chance is offering curbside appointments, where clients pull up and staff takes the pet in to be seen. The vet then calls

the client to discuss treatment.

The financial challenges in many households due to the pandemic has also impacted shelters that survive on donations. Second Chance, for instance, has experienced a 40% decline in donations.

“We have had to postpone, limit or cancel all of our major fundraisers, as well as more than 100 mobile adoption events and small community events that we take part in,” Doray said.

Families looking to adopt will find that fees vary.

At Sterling, the cost to adopt a standard adult dog runs from $200 to $500 depending on their circumstance, as the fees for the dogs from other states are typically higher due to transportation costs.

Many shelters have senior dog and cat programs that are less expensive to adopt.

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