Popular Autism Clinical Supports
AIDE Canada
Introduction
About this toolkit
Different approaches to supporting individuals
- Neurodevelopmental Supports
- Naturalistic Developmental Behaviour Interventions (NDBI) and Caregiver Mediated Supports
- Behavioural supports
Modalities of popular clinical supports
Some of the clinical supports discussed in this toolkit are designed to be provided one-on-one, while others can be adapted for individual or group settings. The advantages of individualized support include a more tailored approach to your child’s specific needs. The advantages of group settings include social learning with peers and (usually) lower costs as the specialist’s rates are split between the group.
A common modality of clinical support is Applied Behaviour Analysis (ABA), which uses the science of behaviour to address behaviours deemed ‘problematic’ and/or to teach new skills and behaviours. New skills may include developing functional skills, social skills, and play skills. Problematic behaviours may include behaviours such as aggression, ‘bolting’/running away, or screaming. There has been debate within the autism community about who gets to decide whether a behaviour qualifies as ‘problematic’ and if the skills being taught are in the child’s best interest. Such discussions are beyond the scope of AIDE Canada’s mandate but will be touched upon by our Autistic practitioners and Autistic self-advocates with lived experience of a clinical support in that portion of this resource.
Another modality of clinical support is focused on the intensity of one or more approaches. Some forms of clinical support recommend a certain number of hours per week be devoted to that specific support, while others have multiple clinical supports come together as a program of development. When a child has high support needs, specialists may recommend that they take part in Intensive Behavioural Intervention (IBI), which uses principles of ABA. IBI is individualized for the child and goals will be adjusted depending on the changing needs of the child as they develop. Depending on the model of IBI, this may mean 10 – 20 or more hours per week being spent with one or more clinical support professionals as part of an overall program of clinical support.
One question to be sure to ask when you meet with a specialist is who will be working with your child directly. In some cases, a specialist with advanced training and degrees will both design your child’s program and work with them weekly, while in other cases the specialist will design the program but a practitioner with less education and training will administer the weekly sessions.
Overview of popular clinical supports
Neurodevelopmental supports:
Neurodevelopmental Supports
- Occupational Therapy (OT)
- Sensory Integration Therapy (subtype of Occupational Therapy)
- Speech and Language Pathology (SLP)
- Theoretical approach as described by a practitioner of the intervention
- What might a typical session look like?
- Typical setting for session
- Typical number of hours per week
- Length of typical session
- Practitioner requirements
- Tips for doing your own research
OT is a type of clinical support that seeks to assess and build skills in areas related to everyday functioning. For OTs that specialize in autism, this can include identifying difficulties with self-care, oral/fine/gross motor skills, sensory processing differences, and emotional self-regulation. OTs provide developmentally-appropriate goals and create intervention plans that break down skills into manageable steps. OTs also provide recommendations for modifications and accommodations in school, at home, or in the workplace. For children that are taking longer to pick up certain life skills, an OT can help them by teaching them in a manner that is tailored to their unique learning style.
Depending on the needs of the individual, OTs provide activities and suggest accommodations that help to promote independence. For instance, an OT may work to develop fine motor skills (e.g. buttons or zippers), improve gross motor skills (e.g. using balance beams), expand food repertoire (e.g. try preferred foods in a new way), or develop self-care strategies that minimize sensory discomfort (e.g. brushing their teeth or showering).
May be done in medical facilities, community clinics, school, long term care facilities, private offices, or at the family’s home. School boards may provide an occupational therapist for consultation, or even to do a full assessment. Involvement varies board to board.
Usually once per week but may be more frequent for individuals with higher support needs.
Individual: 0.5 -1 hour typically
Group: 1.5-2 hours
OTs must have at least a master’s degree in Occupational Therapy, supervised field experience, pass a certificate exam, and be a member of their province’s OT council. OTs that work with autistic people may have additional training on sensory processing differences. Parents should expect this additional qualification if they are seeking a sensory assessment.
We know there are many different approaches to clinical supports, if you want to do your own research, please check out this resource: Doing your own research
Use these terms when researching on Google Scholar:
“Occupational Therapy”, “OT”, “autism”, “outcomes”, “intervention”, “hyper-sensitivity”, “hypo-sensitivity”, “sensory seeking”, “randomized”, “meta-analysis”, “effects”, “review”
- Theoretical approach as described by a practitioner of the intervention
- What might a typical session look like?
- Typical setting for session
- Typical number of hours per week
- Length of typical session
- Practitioner requirements
- Tips for doing your own research
Designed for children with sensory processing differences, especially those that have too much or too little stimulation through their senses. The OT will expose a child to sensory stimulation through repetitive activities and will use different techniques to help children feel more comfortable. The OT gradually makes the activities more challenging and complex.
OTs will first observe the child and speak with caregivers before deciding which sensory processing differences to focus on during future sessions. They will provide sensory experiences to help the child’s nervous system respond to different sensations and movement. An OT may also recommend specific sensory equipment or tools to help the child.
Treatment will often take place in a “sensory gym” that is equipped with objects that help provide sensory experiences (e.g. swings). The OT will also provide a “sensory diet” with specific activities to do at home to provide their child with helpful sensory experiences between sessions.
Usually once or twice per week with additional daily activities to do at home.
0.5-1 hour is typical.
Occupational Therapists with additional training in sensory processing differences (e.g. graduate school, professional seminars, mentorship, etc.)
We know there are many different approaches to clinical supports, if you want to do your own research, please check out this resource: Doing your own research
Use these terms when researching on Google Scholar:
“Sensory Integration Therapy”, “Occupational Therapy”, “OT”, “autism”, “outcomes”, “intervention”, “sensory overload”, “sensory processing”, “sensory processing differences”, “gains”, “hyper-sensitivity”, “hypo-sensitivity”, “sensory seeking”
- Theoretical approach as described by a practitioner of the intervention
- What might a typical session look like?
- Typical setting for session
- Typical number of hours per week
- Length of typical session
- Practitioner requirements
- Tips for doing your own research
SLP (Speech and Language Pathology) is a type of clinical support that focuses on improving verbal, nonverbal, and written communication skills. For SLPs that focus on autistic individuals, this can include teaching the use of augmentative and alternative communication (AAC) technology, oral expression and comprehension, social communication skills, improving verbal articulation, and treatments for swallowing or feeding disorders.
Depending on the needs of the individual, an SLP may provide language intervention activities (e.g. playing and talking, using pictures and books, and model correct grammar and vocabulary), articulation therapy (e.g. show the child how to move the tongue to make certain sounds), and oral-motor/feeding and swallowing therapy (e.g. use tongue, lip, and jaw exercises to strengthen the muscles in the mouth). An SLP may also break down nonverbal communication skills into steps to develop confidence in interpreting facial expressions, body language, gestures, etc.
May be done in medical facilities, community clinics, school, long term care facilities, or private offices.
Usually once per week but may be more frequent for individuals with higher support needs.
45 minutes of direct contact typically, with an additional 15 minutes for preparing and/or documenting a session.
SLPs must have at least a master’s degree in speech-language pathology, complete supervised clinical practicum, and be registered with the regulatory body in their province. Those that specialize in developmental disabilities may have additional training.
We know there are many different approaches to clinical supports, if you want to do your own research, please check out this resource: Doing your own research
Use these terms when researching on Google Scholar:
“speech and language pathology”, “SLP”, “Communication”, “augmented and alternative communication”, “AAC”, “minimally-speaking”, “nonverbal”, “minimally verbal”, “outcomes”, “gains”, “intervention”
Voice of the Community
Autistic Clinical Support Provider
Have you provided clinical support? If you would like to share your perspective on the long term impact of this clinical approach, please click below.
Autistic Self-advocate
Daniel Share-Strom, Autistic advocate, writer, speaker, and social worker
As an Autistic child who was heavily impacted in terms of Sensory Integration Dysfunction, OT was massive in terms of helping me with everyday tasks. The idea of stepping from the sidewalk to the pavement felt equivalent to jumping off a building to me, and I had difficulty with everything from swimming to riding a bike due to my bodily systems not communicating properly. When my OT was done with me, I wasn’t just doing those things, but swinging across the room, upside down, on a hot dog swing. Pretty impressive, right? It also helped me understand my limitations, which set me on the path to finding alternatives that could help me be successful in the future. For example, even with extensive work with my OT, my fine motor skills continued to be a challenge, making my writing nearly illegible. Seeing that this couldn’t be helped allowed us to explore alternatives, such as learning to type, which aided tremendously in school and in life.
While Occupational Therapy should not be used to force people to ‘conform’ in ways they’re uncomfortable with, it’s a great tool to help any Autistic person achieve their long-term goals in life. I’m a TV writer and social worker now—occupations which would have been difficult to impossible without the help of OT.
Naturalistic Developmental Behaviour Interventions (NDBI) and Caregiver Mediated Supports:
Types of Naturalistic Developmental Behaviour Interventions (NDBI)
- Early Start Denver Model (ESDM)
- Social ABCs
- Joint Attention, Symbolic Play, Engagement and Regulation (JASPER)
- Pivotal Response Training (PRT)
- Project Improving Parents as Communication Teachers (Project ImPACT)
- Theoretical approach as described by a practitioner of the intervention
- What might a typical session look like?
- Typical setting for session
- Typical number of hours per week
- Length of typical session
- Practitioner requirements
- Tips for doing your own research
ABA-based intervention focused on the individualization of the therapy plan and the importance of parent and family relationships. Designed for use with 18-48-month-old children.
The focus is on active experiential learning, early interaction, and social motivation.
During sessions, the child participates in play and joint activities to encourage communication and social interaction. Sessions include activities that the child is specifically interested in. Eventually these ‘fun’ activities are combined with ordinary activities such as bathing in order to make them more engaging for the child.
Can be done in a variety of settings such as clinics, schools, or at home.
12 – 15 hours is typical
1 hour is typical.
Administered typically by a trained therapist with collaboration of caregivers
We know there are many different approaches to clinical supports, if you want to do your own research, please check out this resource: Doing your own research
Use these terms when researching on Google Scholar:
“ESDM”, “Early Start Denver Model”, “autism”, “outcomes”, “intervention”, “randomized”, “meta-analysis”, “effects”, “review”
- Theoretical approach as described by a practitioner of the intervention
- What might a typical session look like?
- Typical setting for session
- Typical number of hours per week
- Length of typical session
- Practitioner requirements
- Tips for doing your own research
Caregiver-mediated early intervention program designed for toddlers (12-36 months) showing social-communication challenges. Caregivers are trained to learn intervention strategies using play-based activities and daily routines that are motivating for the child.
The Social ABC’s primarily targets:
- Fostering vocal social communication that is intentional, directed, and functional
- Encouraging positive emotion sharing between toddler and caregiver
Standard Social ABC’s: 12 weeks of 1:1 parent coaching and instruction in the home or community
Group Social ABC’s: 6 weeks of instruction in small groups and 1:1 coaching in a clinical setting
For individual parent training: 1.5 hours per week for 12 weeks
For parent working with their own child: Weave strategies taught during coaching into everyday interactions
Incorporated into daily interactions
Social ABC’s parent coaches receive 6 months and 150 hours of training and must be certified with an annual recertification process
We know there are many different approaches to clinical supports, if you want to do your own research, please check out this resource: Doing your own research
Use these terms when researching on Google Scholar:
“Social ABCs”, “autism”, “outcomes”, “intervention”, “communication”, “gains”
- Theoretical approach as described by a practitioner of the intervention
- What might a typical session look like?
- Typical setting for session
- Typical number of hours per week
- Length of typical session
- Practitioner requirements
- Tips for doing your own research
JASPER is a targeted intervention broken into modules that focus on social communication and uses naturalistic strategies to increase the rate and complexity of social communication
The core domains of JASPER are:
- Joint Attention: coordination of attention between objects and people for the purpose of sharing
- Symbolic Play: Encourage diversity in the types of play to increase flexibility and level of play
- Engagement: Increase opportunities for social communication and learning
- Regulation: Teach strategies to address diminished engagement, restricted and repetitive behaviours, and challenges with self-regulation
Training of caregivers can happen in-person or online. Caregivers utilize the training in the home
Two sessions per week per three months, or one session a week over six months
Each session is 30 -60 minutes
Certified JASPER Direct Service Clinicians must go through an intensive workshop to learn the assessment process and how to set targets and implement the core strategies.
We know there are many different approaches to clinical supports, if you want to do your own research, please check out this resource: Doing your own research
Use these terms when researching on Google Scholar:
“JASPER”, “Joint Attention Symbolic Play Engagement and Regulation”, “intervention”, “effect”
- Theoretical approach as described by a practitioner of the intervention
- What might a typical session look like?
- Typical setting for session
- Typical number of hours per week
- Length of typical session
- Practitioner requirements
- Tips for doing your own research
Pivotal Response Training is a variation of ABA with a focus on play-based behavioural intervention that is initiated by the autistic child. This form of training aims to target pivotal skills related to the child’s development. The objectives are to improve the areas of sociability, communication, behaviour and academic skill-building. This training has been suggested to especially lead to improvements in social initiations and turn-taking. It is said to be most effective for children aged 2 to 16 years.
Each session will differ depending on the targeted skill for development. Below are some examples:
- Motivation: Using learner choice by allowing the child to choose their own toys or activities, varying tasks to keep attention, combining new tasks with previously mastered tasks, and rewards.
- Responding to various stimuli: Teaching the learner to respond to various cues, and using schedules of reinforcement to teach them.
- Self-management: Creating independence by slowly increasing independent tasks and reducing direct involvement by the therapist.
- Social initiations: Teaching social and communication skills, turn-taking, encouraging questions.
The training can take place in the child’s natural environment, and it has been noted that this sort of training could be more suited for unstructured settings such as free play at home.
Depends on needs of child, but 25 hours per week is usually recommended
1.5 to 2.5 hours is typical
Various individuals such as psychologists, special education teachers, and speech therapists who use natural positive reinforcements related to the task being worked on
We know there are many different approaches to clinical supports, if you want to do your own research, please check out this resource: Doing your own research
Use these terms when researching on Google Scholar:
“PRT”, “Pivotal Response Training”, “effect”, “intervention”, “randomized”
- Theoretical approach as described by a practitioner of the intervention
- What might a typical session look like?
- Typical setting for session
- Typical number of hours per week
- Length of typical session
- Practitioner requirements
- Tips for doing your own research
Project ImPACT is based on developmental science and applied behaviour analysis (ABA) principles. It is designed to be used with children with social communication differences ages 18 months to 6 years. It teaches parents strategies to help their child develop social, communication, imitations, and play skills during daily routines and activities.
Parents work collaboratively with providers in the first session to set goals for social engagement, language, imitation, and play. Additional sessions involve reviewing the parent’s progress at home since the last session and the provider presenting a new intervention technique. The provider will model the intervention with the child and then will observe while the parent tries the technique with their child. Techniques are taught in a specific order because each technique sets the foundation for later techniques.
The training can take place in the child’s natural environment, and it has been noted that this sort of training could be more suited for unstructured settings such as free play at home.
The parent training usually takes place in the provider’s office or at the family home. This program is designed to be implemented throughout the day and during play or other various activities. This can include time at home or out in the community.
1 hour is typical for parent training, but parents are encouraged to incorporate the techniques of Project ImPACT throughout the day whenever possible.
Project ImPACT intervention providers must attend a workshop, obtain feedback on recorded sessions with parents, and 6 additional one-on-one consultations before they can be certified. Once certified, the provider is able to train and supervise other providers in their organization. Project ImPACT providers must have advanced degrees (e.g., MA, MFT, SLP, OT, etc.) and work regularly with children with social communication differences before they will be accepted into the program.
We know there are many different approaches to clinical supports, if you want to do your own research, please check out this resource: Doing your own research
Use these terms when researching on Google Scholar:
“Project Improving Parents as Communication Teachers”, “Project ImPACT”, “randomized”, “effect”, “intervention”
Voice of the Community
Autistic Clinical Support Provider
Have you provided clinical support? If you would like to share your perspective on the long term impact of this clinical approach, please click below.
Autistic Self-advocate
Did you experience this type of clinical support growing up? If you would like to share your perspective on the long term impact of this clinical approach, please click below.
Caregiver Mediated Supports
- PLAY Project
- Early Social Interaction/ Social Communication Emotional Regulation and Transactional Supports (ESI/SCERTS)
- Treatment and Education of Autistic and Related Communication-Handicapped Children (TEACCH)
- Floortime
- Theoretical approach as described by a practitioner of the intervention
- What might a typical session look like?
- Typical setting for session
- Typical number of hours per week
- Length of typical session
- Practitioner requirements
- Tips for doing your own research
PLAY is a parent-mediated intervention for young children on the autism spectrum. It is designed for use with individuals up to the age of 6.
There are four primary principles to PLAY:
- Fun with People: By focusing on activities that the child enjoys, the child is more likely to interact
- Put in the Time: Unlocking the potential in children takes time and engagement via play sessions and daily activities
- Accurately Profile the Child: Individualized program is focused on each child’s unique abilities, interests, and development.
- Play at the Right Level: Meet the child where they are developmentally
When a PLAY Project Consultant works with families, they will:
- Introduce the principles and methods of PLAY
- Create a unique profile for the child and their needs
- Make a PLAY Plan with individualized techniques and activities
- Guide the family by coaching, modeling, and providing feedback
- Engage with the family and child during PLAY activities
- Review videos of sessions and providing written feedback
- Revise the PLAY Plan as the child develops
Training and parent activities usually happen within the home, but can also take place in the PLAY Project Consultants office.
While the training with a consultant happens monthly, the caregivers are expected to apply the principles in play sessions and daily activities. It is recommended that they engage in these activities at least 10-15 hours per week.
PLAY Project consultants typically come to the family home once per month for 2-3 hours
PLAY Project Consultants must be trained and certified by the PLAY Project team and must have a Master’s degree in a relevant discipline. They often have other professional degrees, including SLP, OT, school teachers, social workers, or psychologists.
We know there are many different approaches to clinical supports, if you want to do your own research, please check out this resource: Doing your own research
Use these terms when researching on Google Scholar:
“PLAY Project”, “parent-mediated”, “intervention”, “caregiver-mediated”, “effect”
- Theoretical approach as described by a practitioner of the intervention
- What might a typical session look like?
- Typical setting for session
- Typical number of hours per week
- Length of typical session
- Practitioner requirements
- Tips for doing your own research
SCERTS is a behavioural education model for infants, toddlers and school-age children that uses guidelines to address challenges frequently encountered by Autistic people. This model uses a team-based approach that views parents as the experts on their child, so parents collaborate with the facilitation team to assess their child and then select a series of strategies that they believe would be most helpful to the child. It can be tailored to the child's needs. SCERTS has similarities to ABA but proponents have suggested it is differentiated from ABA by fostering communication during daily activities that are facilitated by the child.
SCERTS focuses on regulating the child by enabling the child to recognize what is expected of them and what might be the next task. This program helps kids to prepare for school environments by getting them used to following instructions, schedules, and being restricted by a classroom setting.
SCERTS focuses on developing the following skills:
Social Communication: communication, emotional expressiveness, and positive relationships.
Emotional Regulation: cope with positive and negative emotional stressors.
Transactional Support: developing personal and environmental supports that are adapted and modified to fit the child’s needs and personality.
SCERTS can provided in a range of settings, such as home and community environments, although it is typically delivered in a school setting
Depends on setting and skills being developed
During the school day
This model is a team-based approach that requires facilitation by trained therapists, educators, and caregivers. Usually, SCERTS is implemented by trained special education teachers and speech therapists.
We know there are many different approaches to clinical supports, if you want to do your own research, please check out this resource: Doing your own research
Use these terms when researching on Google Scholar:
“Early Social Interaction/Social Communication Emotional Regulation and Transactional Supports”, “ESI/SCERTS”, “SCERTS”, “intervention”, “effect”, “randomized”, “model”, “team-based”
- Theoretical approach as described by a practitioner of the intervention
- What might a typical session look like?
- Typical setting for session
- Typical number of hours per week
- Length of typical session
- Practitioner requirements
- Tips for doing your own research
TEACCH is a clinical and psychoeducation (providing education about mental health issues) framework for supporting the therapeutic and educational goals of autistic individuals. They seek to create and share community-based services, training programs, and research to enhance quality of life.
Five core values of TEACCH:
- Demonstrating a commitment to making a positive difference in the lives of others.
- Creating a culture of collaboration and partnership, where everyone is respected and valued.
- Delivering excellence through innovative and responsive practices.
- Appreciating the unique strengths of every individual.
- Emphasizing the importance of continuous lifelong learning.
This program helps teachers develop skills and techniques to enhance the experience of in-class learning. Visual schedules and guidelines for students are also part of this method. It promotes the use of a generalizable 'structured teaching' approach as it can be modified to accommodate all ages and ability levels.
A visual timetable and work schedule are used to plan out the day’s activities, so the child knows what to expect. Then once a task is completed it would be placed in the completed box so the child knows when it has come to an end. Then a reward such as a sticker is granted to reinforce the routine and promote independence.
Primarily delivered in classroom settings
This intervention can last anywhere from 1 to 36 weeks of sessions that vary between 1.5-30 hours per week, depending on the needs of the child.
During the school day
Provided by trained professionals such as teachers, psychologists, social workers, speech therapists, and residential care providers. Parents are included to allow for consistent support.
We know there are many different approaches to clinical supports, if you want to do your own research, please check out this resource: Doing your own research
Use these terms when researching on Google Scholar:
“Treatment and Education of “Autistic and Related Communication-Handicapped Children”, “TEACCH”, “goals”, “intervention”, “effect”, “randomized”
- Theoretical approach as described by a practitioner of the intervention
- What might a typical session look like?
- Typical setting for session
- Typical number of hours per week
- Length of typical session
- Practitioner requirements
- Tips for doing your own research
Relationship-based and play-focused therapeutic approach that is Developmental, Individual, and Relationship-based. It is an alternative to ABA (but can be used with it). This approach is not exclusive to autism or specific age groups. The goal is to have the parents meet their child at their level and build on their individual interests and strengths while having fun.
The six milestone goals of Floortime include:
- Self-regulation and interest in their surroundings
- Engagement in relationships
- Two-way communication
- Complex communication
- Emotional Ideas
- Emotional Thinking
The sessions with providers include training for parents as well as direct interactions with the child. The provider and/or parent will first join the child and follow their lead on which activities or toys to engage with. Sessions emphasize back-and-forth play to build shared attention and problem solving skills by interacting with the child in more complex tasks.
Training sessions can be done at home, school, or in a professional setting. Families are encouraged to practice Floortime techniques and promote interactions in as many different settings as possible (e.g., home, playground, car, bathtub, etc.)
One professional therapy session or more per week.
Roughly 14 hours per week total (e.g. at least 2 hours per day) to practice the techniques at home for as long as necessary to meet the milestones
Therapy sessions range between 2-5 hours
Child psychologists, OTs, SLPs, and special education teachers can receive specialized training to become certified in Floortime techniques.
*Parents can attend workshops to learn specific techniques to try at home.
We know there are many different approaches to clinical supports, if you want to do your own research, please check out this resource: Doing your own research
Use these terms when researching on Google Scholar:
“Floortime”, “Intervention”, “outcome”, “randomized”, “effect”
Voice of the Community
Autistic Clinical Support Provider
Sarah Harvey, Autistic Independent Speech and Language and Communication Therapist, Autism and Mental Health Specialist
I’m an autistic Speech and Language Therapist. The SCERTS model provides a framework for everyone supporting a young person to adapt and build on what they are doing - to make it more motivating, relevant, predictable and emotionally regulating. The onus is on the supporters to change, not the child. I work neuro-affirmatively - SCERTS helps support teams to think more about the young person’s perspective, rather than trying to “fix deficits”. Teams identify meaningful goals by using SCERTS to assess the young person’s way of communicating, and highlighting the priorities at that stage. There is a clear progression within the model, allowing for goals to naturally increase and shift as the child develops.
When SCERTS is adopted, the child’s team typically become more confident, and start to “get” how they can support the child to thrive. SCERTS emphasises reflection for practitioners, so their skills continually develop individually and as teams. It is very different to a professional telling a team what they need to do, instead it gives them the tools to develop their understanding of what they can do themselves, increasing “buy in” and making it self-sustaining.
Autistic Self-advocate
Did you experience this type of clinical support growing up? If you would like to share your perspective on the long term impact of this clinical approach, please click below.
Behavioural supports:
As previously discussed, AIDE Canada does not endorse or condemn any particular approach to clinical support. Instead, we encourage each person to do their own research and weigh the pros and cons of each specific type of clinical support.
Types of Applied Behaviour Analysis (ABA)
- Applied Behaviour Analysis (standard ABA)
- Positive Behaviour Support (PBS)
- Theoretical approach as described by a practitioner of the intervention
- What might a typical session look like?
- Typical setting for session
- Typical number of hours per week
- Length of typical session
- Practitioner requirements
- Tips for doing your own research
Perceives behaviour as something that can be changed by positively reinforcing the behaviours that are ‘beneficial’ and not reinforcing behaviours that are ‘harmful’. Can be used to alter behaviours at any age, but studies suggest that it is more successful the younger the child is when it begins.
In preparation and throughout an individual ABA program and/or as part of a “functional behaviour assessment” (see PBS below), parents will be asked to track behaviours related to safety concerns or skills that need to be developed throughout the day. Recording where and when the behaviour occurs and describing what proceeded and followed the behaviour will be necessary for setting goals and tracking progress.
Practitioners have differing opinions on whether to include one or both of the following approaches during a session. Ask your specific provider about which option(s) they use:
Discrete Trial Training (DTT): Breaks skills into smaller components that the instructor can teach in a step-by-step manner. Reinforcements are used by the trainer to encourage positive behaviours (e.g. blowing bubbles or getting a sticker).
Natural Environment Training (NET): Focuses on teaching skills in natural settings or environments. Believed to strengthen the ability to generalize and the transition of knowledge to daily situations.
Variety of settings including a practitioner’s office, the classroom, at home, or during play with other children. Sometimes administered in a group setting.
Depends on needs of child, but 10-20 hours is usually recommended
1.5 to 2.5 hours is typical
Board-certified Behaviour Analyst (BCBA), requires a master’s degree or PhD, supervised training hours, and completion of a national certification exam with a license to practice.
ABA providers often have a one-year certificate from a community college and do not usually have advanced degrees. A BCBA may develop the program, but the person working one-on-one with a child may have an undergraduate degree and/or certificate.
We know there are many different approaches to clinical supports, if you want to do your own research, please check out this resource: Doing your own research
Use these terms when researching on Google Scholar:
“ABA”, “Applied behaviour analysis”, “autism”, “intervention”, “outcome”, “randomized”, “effect”, “gains”, “goals”
- Theoretical approach as described by a practitioner of the intervention
- What might a typical session look like?
- Typical setting for session
- Typical number of hours per week
- Length of typical session
- Practitioner requirements
- Tips for doing your own research
PBS is often used to address harmful and interferring behaviours such as self-injury. It can be helpful in understanding why these behaviours are occurring for individuals who are unable to communicate the cause of their distress. This approach is rooted in ABA, but also includes multiple theoretical perspectives and has moved away from a pathology-based model and is instead driven by person-centered values and the normalization/inclusion movement. PBS integrates changes to the environment and lifestyle, building lifelong skills, systems change, stakeholder participation, and multicomponent intervention.
PBS practitioners believe in understanding the big picture before they can make recommendations. The first session(s) will be a “Functional Behaviour Assessment” that focus on exploring quality of life issues that are causing distress for the client. PBS practitioners may meet with caregivers, educators, and therapists to gain a more complete picture of the issue before making any recommendations.
The practitioner will create a “Positive Behaviour Support Plan” and suggest ways to modify the environment, how to respond to the unsafe behaviours, sequences of daily activities, and how to develop the adaptive skills necessary to reduce the behaviour. The goal is to be proactive to reduce future occurrences of unsafe behaviours. Families and educators will be asked to record each instance of a problem behaviour so that patterns can be established and adjustments can be made to the support plan.
May be done in a clinician office or school setting, but can also be done in the home in order to observe the natural environment and make appropriate recommendations.
The entire program can last as long as 9-12 months total, although may be less if things improve quickly.
Month 1-3: meet once per week while developing and testing the plan.
Month 3-9: meet once every two weeks to monitor progress and make adjustments to the plan if necessary.
Month 9-12: meet once per month to continue to monitor progress and discuss transition to other forms of support if needed.
1-2 hours is typical, although some practitioners may choose to observe for longer periods of time in the beginning to gain a better understanding of the issue
A Board Certified Behaviour Analyst (BCBA) will lead the therapy and will work with instructions to caregivers and educators
We know there are many different approaches to clinical supports, if you want to do your own research, please check out this resource: Doing your own research
Use these terms when researching on Google Scholar:
“Positive behaviour support”, “PBS”, “outcome”, “intervention”, “autism”, “effect”, “functional behaviour assessment”, “gains”, “goals”
Voice of the Community
Autistic Clinical Support Provider
Sarah Hart, Autistic BCBA
I originally joined the ABA field without knowing I was autistic. I planned to become a clinical child psychologist, and I was paired with an autistic client when I applied for a job during undergrad. I related to him more than I related to people my own age or non-autistic people. I began a doctoral program for psychology, but I left when I felt it was not touching on enough information to work with nonspeaking autistic children. I instead did my master's in ABA and became a BCBA. Once I found out the Autistic community's response to the field of ABA, I joined the world of autistic advocacy. I was formally diagnosed with ASD in 2020. I don’t think ABA is the only way to support autistic children, nor is it the best field for it; however, the insurance companies pay for it and if we can reshape the field into truly helpful services and support for autistic children, that would be a big win.
I believe that the long-term results of ABA for autistic children can be grim in many cases. Autistic children are often taught to assimilate in ABA programs; to act like neurotypical children. The field of ABA needs to be overhauled completely and rebuilt from the ground up, to include education on autism and ableism, and to make goals WITH clients instead of FOR clients. I hope the long-term results of my own personal work with autistic clients results in a happy, autonomous, autistic adult who is able to self-advocate and live the life they want.
Autistic Self-advocate
Did you experience this type of clinical support growing up? If you would like to share your perspective on the long term impact of this clinical approach, please click below.
Other Behavioural Supports
- Relationship Development Intervention (RDI)
- Cognitive Behavioural Therapy (CBT)
- Dialectical Behavioural Therapy (DBT)
- Acceptance and Commitment Training/Teaching (ACT)
- Theoretical approach as described by a practitioner of the intervention
- What might a typical session look like?
- Typical setting for session
- Typical number of hours per week
- Length of typical session
- Practitioner requirements
- Tips for doing your own research
The focus of RDI is on social and emotional skills by increasing flexible thinking. This is different from Applied Behavior Analysis because it focuses on the parents and relationship building. RDI is a technique that can be adopted into one’s lifestyle and is customizable to the individual child by incorporating their interests. The objectives of this training include:
- Emotional referencing
- Social coordination
- Declarative language
- Flexible thinking
- Relational information processing
- Foresight and hindsight
RDI consultants develop a program plan that is catered to the child’s needs and then trains parents on how to use it on a daily basis. The program tasks may include games that target physical and nonverbal communication. RDI sessions may look different for each family, but parents will learn strategies to connect and relationship build with their children.
Guided release (also known as scaffolding) may include modelling activities to allow the child to feel comfortable before they give the activity a try. As time progresses, each session will include the continuation of working on a goal or the introduction of a new goal. As the child’s abilities increase, so do the complexity of these goals.
This intervention is designed to be used in the home but can also be used in classroom or professional settings.
Once children have developed more skills, they may form a “dyad” with another child or join a small group of children also receiving RDI so they can practice building relationships with different people and in different settings (e.g. park, playground, etc.)
One professional session or more per week, but parents are encouraged to practice the techniques at home for 3-12 hours per week for 16 months.
1 to 2.5 hours is typical
Certified RDI Consultants may work as behavioural therapists or classroom teachers.
*Parents can receive training directly via seminars.
We know there are many different approaches to clinical supports, if you want to do your own research, please check out this resource: Doing your own research
Use these terms when researching on Google Scholar:
“Relationship Development Intervention”, “autism”, “RDI”, “outcomes”, “interventions”, “effects”, “goals”, “gains”
- Theoretical approach as described by a practitioner of the intervention
- What might a typical session look like?
- Typical setting for session
- Typical number of hours per week
- Length of typical session
- Practitioner requirements
- Tips for doing your own research
CBT is a form of talk therapy that seeks to change thinking and certain behaviours that are interfering with a person’s emotional wellbeing. It is problem-focused and goal-oriented to provide strategies and skills. It asks patients to recognize their own thoughts, feelings, and expectations. CBT has shown success in autistic individuals across the lifespan by reducing anxiety, providing strategies for handling stressful situations, and challenging “black and white thinking”.
CBT can be given in both individual and group settings.
Patients are encouraged to describe situations that are causing them difficulty and break them down by identifying the thoughts, feelings, and actions surrounding the issue. Then, a therapist can help patients ‘reframe’ the issue by challenging negative thoughts and beliefs about themselves or others. Strategies for overcoming the issue in the future are also discussed. CBT can be helpful for individuals whose negative self-talk impacts their motivation, self-esteem, and world view.
May be done in a professional office or school setting. Group sessions may also occur in community buildings.
Sessions usually last 30-60 minutes every 1 or 2 weeks.
CBT is usually recommended to be between 6-20 sessions. More sessions may be recommended depending on the patient’s needs.
Psychiatrists, clinical psychologists, registered counsellors and psychotherapists must hold at least a Master’s degree in counselling or related fields. To be certified for CBT, a professional must have additional training and will be listed on the Academy of Cognitive Therapies (academyofct.org) or Association for Behaviour and Cognitive Therapies (abct.org) websites.
We know there are many different approaches to clinical supports, if you want to do your own research, please check out this resource: Doing your own research
Use these terms when researching on Google Scholar:
“Cognitive Behavioural Therapy”, “Cognitive Behavioral Therapy”, “CBT”, “autism”, “intervention”, “outcome”, “gain”, “randomized”
- Theoretical approach as described by a practitioner of the intervention
- What might a typical session look like?
- Typical setting for session
- Typical number of hours per week
- Length of typical session
- Practitioner requirements
- Tips for doing your own research
DBT is a type of CBT originally developed to teach people with Borderline Personality Disorder to better regulate their emotions, but has also been found to be useful for autistic individuals who are not finding success with traditional CBT. The therapy focuses on developing strategies for living in the moment, coping with stress, regulating emotions, and improving relationships with others. DBT teaches skills for combating negative feelings related to anxiety, anger, and sadness.
The 4 pillars of DBT are teaching mindfulness, increasing tolerance for distress, increasing interpersonal effectiveness, and improving emotion regulation skills. DBT is usually provided in a group therapy setting where individuals can support each other as they learn skills to prevent them from lashing out, becoming aggressive, expecting the worst (catastrophizing), or any other negative thought processes or behaviours. This intervention may be helpful for Autistic teens and adults.
Usually provided in professional settings with a small group of peers in addition to individual therapy sessions once per week to help process the skills learned in group and apply it to individual situations and concerns.
Group therapy sessions are held weekly and usually last 1.5-2.5 hours. Weekly individual therapy sessions are usually 1 hour long. Most DBT programs last at least 25 weeks and individuals are encouraged to take part in two cycles of the program (so roughly one year in total). Individuals can be moved to advanced groups to hone the skills they learned if necessary once they have completed two cycles.
Group therapy: 1.5-2.5 hours per week
Individual therapy: 1 hour per week
Psychiatrists or clinical psychologists with training in DBT techniques, usually as part of a DBT team
We know there are many different approaches to clinical supports, if you want to do your own research, please check out this resource: Doing your own research
Use these terms when researching on Google Scholar:
“Dialectical Behavioural Therapy”, “Dialectical Behavioral Therapy”, “CBT”, “autism”, “intervention”, “outcome”, “gain”, “randomized”
- Theoretical approach as described by a practitioner of the intervention
- What might a typical session look like?
- Typical setting for session
- Typical number of hours per week
- Length of typical session
- Practitioner requirements
- Tips for doing your own research
ACT is based in CBT and is a psychotherapy approach used to improve skills and reduce distress in both caregivers and Autistic people themselves. ACT focuses on six major areas to promote psychological flexibility and improved well-being:
- acceptance (of what we cannot control)
- cognitive defusion (observe our thoughts rather than getting stuck in them)
- being present (mindfulness)
- self-as-context (flexible perspective taking)
- values (what is important or motivates us to act)
- committed action (actions that support the overall goal for psychological flexibility and wellbeing and are in line with a person’s values)
ACT can be provided in both group and individual settings.
Usually provided in professional settings with a small group or in a professional office in individual or couple’s sessions.
Weekly group therapy sessions are usually between 1.5-2.5 hours long for 12-14 weeks. Individual or couples sessions are usually 1.5 hours long for between 12-24 weeks.
Group therapy: 1.5-2.5 hours per week
Individual therapy: 1 hour per week
Psychiatrists or Clinical psychologists, BCBA’s, and registered counselors may have additional training in ACT.
We know there are many different approaches to clinical supports, if you want to do your own research, please check out this resource: Doing your own research
Use these terms when researching on Google Scholar:
“Acceptance and Commitment Training”, “ACT”, “autism”, “intervention”, “outcome”, “gain”, “randomized”
Voice of the Community
Autistic Clinical Support Provider
Have you provided clinical support? If you would like to share your perspective on the long term impact of this clinical approach, please click below.
Autistic Self-advocate
Did you experience this type of clinical support growing up? If you would like to share your perspective on the long term impact of this clinical approach, please click below.
What to look for in a therapist
Questions to ask yourself:
Parenting is hard work and interventions are time intensive. The government realizes that parents may need a break for their own self-care. This is why many programs provide funds for respite. Getting a break where you can spend time with your non-Autistic children or other family members is good for the health of the family unit and mental health of the primary caregiver. Respite can also give the child a chance to socialize with someone other than parents or siblings, and to experience new opportunities in the community.
Some forms of respite can also be therapeutic for your child. For instance, many Autistic people enjoy equestrian therapy, music therapy, art therapy, etc. They can build skills and connections with instructors and peers while also providing respite for families.
Questions to ask a specialist to decide if they are the right fit
- Who is your client? The child, the caregiver, the school, none?
- Is the therapy child-centered, do you follow the child’s lead?
- Do you presume competence?
- What is the therapy approach? Is your goal to build skills or “appearing normal”?
- How will my child’s strengths and interests be incorporated into the program?
- What are your thoughts regarding compliance?
- Do you put more emphasis on proactive (antecedent) strategies versus reactive reinforcement-based strategies?
- How do you strive to understand and support a child’s needs and skill development?
- What is the demeanor of the therapist? Does your child respond better to a quiet, calm personality of a loud, enthusiastic and animated person?
- Does the therapist understand that refusal is often rooted in anxiety, and not willful disobedience or oppositional defiance?
- How are goals identified and prioritized?
- What training and experience do you and your staff have?
- How will you tailor this approach to my child?
- How can we work as a team?
- What are your thoughts on my child’s stims?
- Am I locked into staying with this service, or can I leave at any time?
Final Thoughts
It is important to remember that your child has their own agency, with their own interests, perspectives, and goals for the future. The best way to make sure they get what they need is to ask them for their perspective. In cases where they are not able to fully communicate their agency, making support decisions based on their current needs, and not their diagnostic label, can go a long way to making sure that they are getting the support they require and empower them to live their best life.
Other Resources
Websites:
Research Information:
- https://theautismblog.seattlechildrens.org/naturalistic-developmental-behavioral-interventions-for-children-with-autism/
- https://www.autismcrc.com.au/interventions-evidence
- https://www.ontario.ca/page/ontario-autism-program-caregiver-mediated-early-years-programs#section-4
- https://www.ontario.ca/page/ontario-autism-program-guidelines-core-clinical-services-and-supports