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Trellis provides ABA therapy to help children with autism.

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5 Steps to Swim Safety for Your Child with Autism

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As the summer heat settles in, many families head to pools, beaches grow crowded, and our time spent near water becomes part of our routines. What seems like a standard summer activity for most can be challenging for children with autism spectrum disorder (ASD) and their families.

Sadly, drowning after elopement, a term used to describe the tendency for some individuals with autism to wander from caregivers and secure locations, is a leading cause in death in children and adults on the autism spectrum. In fact, a 2017 analysis from Columbia University found that children with ASD are 160 times more likely to die from drowning than the general population. Other studies report similar findings—and highlight a dire need for more awareness and preventive measures.

Given the impairment in cognitive functioning and language associated with ASD, several experts have hypothesized that children with autism tend not to see water as a danger. Rather, their impulsivity and therapeutic love for the sensations of water can take over. While this may seem like ominous news, on the plus side, a study from the Journal of Autism and Developmental Disorders provides an initial indication that children with ASD can develop skills to avoid drowning.

What does that mean for you, as a parent or caregiver of a child or young adult with autism? Fortunately, you can take steps now to keep your loved-one safe and secure this summer—and beyond. Here’s what to do:

1. Exposure

The earlier you expose your child to water, the better. Sign up for local swim lessons, offered at most recreational centers in surrounding areas. Some specialize in adaptive programs geared toward children with special needs, which can provide an individualized approach to learning to swim, while building confidence and safety near the water.

2. Precautionary Measures

If you own a pool or live near water, make sure you use locks, gates, and other barriers around these areas. After using any small kiddie pools, large tubs, or water play areas, take a few minutes to empty these when done.

3. Strategies

Establish rules for your loved one with ASD. Practice and review these rules before going near water and throughout a visit or trip to a pool, lake, river, or ocean. Present these rules and other strategies in a way that can easily be understood and reviewed often. Consider, for instance, developing a social story that outlines the expectations of what it means to be safe near water. You can also provide replacement behaviors, such as how to enter water and when it is safe to be in water; teach children to identify and respond to common safety signs related to water; and model appropriate behavior when swimming or near water.

4. Discussion

Talk to neighbors who own pools about your child’s increased risk of roaming and drowning. Discuss the issue, too, with all lifeguards at your pool, babysitters, extended family—and even your local police department. As a parent or caregiver, you are your child’s best advocate, especially when it comes to safety. Some police departments provide a safety plan or alert form that allows for your child’s likes, fears, and behaviors to be documented, all of which can help immensely in the event of an emergency.

With these five proactive steps and clear directives, a successful trip involving swimming isn’t out of question—and is actually encouraged. Go enjoy the beach and plan to visit the local pool, but don’t forget the power of preparing and communicating with your local support systems.

Help your child stay safe this summer with the National Autism Association’s Big Red Safety Box. You can apply to receive the box of tools and resources for free, or download the NAA’s Be REDy Booklet for Caregivers at no cost.

Transitioning to Summer: 5 Tips to Make It a Success

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by Elizabeth Jeffrey-Arceneaux, M.S., BCBA
Autism Spectrum Therapies (AST), Louisiana

With summer fast approaching, the increased time for preferred activities may be a point for joy and satisfaction, but this can also challenge parents as they attempt to transition kids from necessary tasks and activities. Most children, particularly those with autism, benefit from structure and routine in their schedule.

One of the reasons summer can create a challenge is that routines shift dramatically—or disappear altogether. This is further exasperated by the changing protocols of the pandemic, where we wear masks and stand six feet apart one day, only to loosen the mask mandate and stand three feet apart the next.

There are things you can do, however, to ease this transition and keep your child engaged this summer. Consider these five tips:

Only Take On What You Can Manage

For starters, understand what will allow your child to thrive and what you, as a parent or caregiver, can manage. Professionally, I’ve spoken to many parents who feel tired and frustrated—mostly due to their tendency to take on more than they have the time and energy to manage.

While it’s important to provide opportunities for your child, be careful of overdoing it and creating stress for yourself—and the whole family. Strategize and play to your child’s strengths.

Prioritize Activities

To avoid taking on more than your family can handle, you first need to realize that you can’t do everything—and need to prioritize. Decide the three most important things to you, as a parent or caregiver who knows your child and family well, and plan around those goals. For example, your goals might be to increase education, family fun, and time outside.

With your top three priorities identified, seek out resources to meet those goals. For example, many states offer an extended school year (ESY) option for children with disabilities. This program varies across the United States but provides a way to maintain educational activities at no cost to parents and caregivers in the same school system your child normally attends. Another option might be increased therapy time.

Often, you can find fun things to do with your family by attending events in your city. Many cities, in fact, host particular days in which children with autism or sensory sensitivity are given priority. In Louisiana, where I live, zoos, libraries, and other places host sensory days. These can be a great introduction to new activities. It might take research and planning, but doing so can help your child and family cultivate a wider array of interests.

Spend Time Outdoors

As my colleague, Genevieve Marshall, recently discussed on our blog, time in nature is good for all of us, particularly kids with autism. In fact, many children with autism enjoy water play, which you can set up outdoors, even without access to a pool. Simply fill up bowls or an inflatable pool, and give your child a mix of cups and utensils to interact with water in various ways.

Kids Playing On Beach. Children Play At Sea.

I keep a running list of outdoor sensory activities for my own children that includes:

  • tinting water with food coloring
  • mixing water with sand
  • making mud pies
  • drawing with sidewalk chalk
  • collecting and painting rocks (or simply setting up an easel and paints outdoors)
  • blowing bubbles (and making homemade bubbles)
  • picking flowers or weeds

The list goes on. These activities engage children on a sensory level, while allowing kids to spend essential time outside.

Plan—But Plan Flexibly

Although it’s critical to plan as much as possible for summer, it’s also important to accept and expect that you will need to be flexible. Often, programs like ESY and accessible summer camps don’t last the entire day. You can fill in unstructured time by having a loose schedule in place anchored by sleep, snack, and highly preferred break activities. Consider, too, using a visual aid and timer as you transition between activities, and do your best to stay consistent (and flexible!) across days.

Acknowledge Differences

If you have more than one child, realize and expect that your children are different, and prepare accordingly. For example, I have two toddlers. My youngest, at age two, typically is a wild and reckless toddler who loves new things, fireworks, and getting dirty. At the beach, he holds his father’s hand and loves hearing the ocean and feeling it cover his feet. He doesn’t mind varied environments with different sounds and senses.

My oldest, now three, hates fireworks and covers her ears. All loud noises cause her distress, particularly when unexpected. She loves playing in the sand at the beach but cries that the ocean is too loud. She also hates and refuses to walk across reflective floors. Instead of forcing her to fall in line and like the same things her brother likes, I give her earphones and encourage her to enjoy things from afar. I accept and honor their differences.

As you gear up for what we anticipate will be a more relaxed, open summer than last year, due to the pandemic, keep in mind that planning, prioritizing, and concentrating on what matters most to you and your family are key. Remember, too, that your time and energy are limited. Resist the urge to overschedule your family, and know that downtime is good for us all.

For more tips on helping your child with transitions, read “Easing Your Child Back Into Life Post-Pandemic.”

Easing Your Child Back Into Life Post-Pandemic

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by Ronit Molko, Ph.D., BCBA-D
Strategic Advisor, LEARN Behavioral

If the last 16 months have taught us anything, it’s that the only constant in life with COVID-19 is change. And while the persistent evolution of information and safety protocols has left many with a severe case of whiplash, its impact on children has been even more profound—particularly for those with autism. Now, as more Americans receive their vaccinations, and more of the country begins gradually reopening, our children are set to face yet another daunting upheaval: returning to normal life, or adapting to a “new normal.”

This will be easier said than done, however. Depression and anxiety among children have skyrocketed since the beginning of the pandemic, and the prospect of reentering a “normal” society will do little in the way of alleviating that anguish. For children with autism, the sudden reentry into everyday socialization may seem downright terrifying. Children are incredibly resilient by nature, but as we begin to take these first baby steps back toward the lives we used to know, it’s imperative to remember that when it comes to our children’s mental well-being, they’re not out of the woods just yet.

What follows are some strategies you can use to help ease your child into a post-pandemic life.

Structure, Schedules, and Routines

It’s not an overstatement to say that COVID-19 took a wrecking ball to the structure, routines, and cues children had spent a lifetime developing. Activities like school, sports, and outdoor playtime were forced to take a back seat, in favor of safer but more sedentary options like TV, gaming, and, hopefully, reading. And while many parents will feel a natural urge to thrust their children back into the recreational activities they enjoyed pre-pandemic, it will be important not to throw them into the deep end before they feel ready. This is especially true for children on the autism spectrum, who can feel overwhelmed by sudden, unexpected change.

How, then, can you help your child adjust to our sudden “new normal”? Start small. Try reestablishing daily and weekly household routines, such as mealtimes, cleaning schedules, and, of course, play time. Planning small outings to places like a local park will not only help get kids out of the house but also help refamiliarize them with learned social concepts in a comfortable, low-stress environment.

Communicate with Your Kids

Some children will initially feel reticent to exit the cozy, slower-paced lifestyles they’d grown accustomed to over the last 16 months. Others may feel anxious to reengage with high-stress social environments after a year of isolation. Understanding what your child is feeling will be crucial. For children living with depression, anxiety, or autism, too much, too fast, too soon may only worsen their anxiety.

Make it a point to have regular conversations with your child about their mental health space, and what activities they might feel comfortable, or uncomfortable, participating in. This will help foster a relationship of mutual trust and understanding, and provide your child with a sense of agency they may have been lacking over the previous year.

Be Aware of Emotional Cues

No matter your child’s age, it’s possible the pandemic has left traumatic effects on their mental well-being. Recognizing your child’s emotional cues will help you better understand what is causing their distress.

It’s natural to feel stress when adapting to a new environment, and some children may show common signs, including changes in appetite and sleep, or increases in behavioral issues. However, if you believe these sustained symptoms are beginning to affect your child’s mental health, it’s essential you contact a health professional. This is particularly crucial for children with autism, who can struggle to effectively communicate their feelings. If you find it difficult to understand the emotional cues of your child, it’s better to consult a psychologist or other professional to help find ways you and your child can overcome this stressful time.

For more on helping kids with autism manage stress, read “How to Support Kids with Anxiety or Depression.”

How Parents and Caregivers of Kids with Autism Cope with Stress

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by Katherine Johnson, M.S., BCBA
Senior Director of Partnerships, LEARN Behavioral

Parenting can be stressful, and research shows that parents of autistic children consistently score higher on stress indicators than other groups of parents. While stress can be good for us—in manageable doses, it can energize and motivate—prolonged bouts of stress can lead to health problems. In fact, parents of autistic children report that they experience more depression, anxiety, and stress-related health problems than other parents. Parental stress has also been associated with marital distress, less effective parenting, and dropping out of treatment.

Why is this? Although no causal relationships have been definitively shown to exist between parental stress and kids with autism, several factors likely play a role. Some families cite pressure to get treatment early on, amplified by stories of “recovery.” A lack of sleep, financial burdens magnified by the need to pay for treatments, a greater necessity for parental vigilance and advocacy, and the presence of challenging behavior can also contribute to more parental stress.

If parents of kids with autism do, as research indicates, experience higher stress, what, then, does the research say can help parents and caregivers cope? Here are three research-backed suggestions:

1. Effective treatment for children

It stands to reason that effective treatment can mitigate some of the parental stress experienced by families with autistic children, particularly those whose children struggle with communication and challenging behavior. As numerous studies suggest, the effects of challenging behavior (aggression, defiance) on the family system are a major factor in parenting stress.

What, then, triggers or leads to challenging behavior? Often, challenging behavior is precipitated by communication difficulties or unexpressed/untreated pain—and, as you likely know, autistic children have more health problems than typical children. Intervention that supports your child’s communication, assists them in accessing medical services, and arms you with behavior management tools can lower distress in both child and parents. Likewise, reducing challenging behavior can also help you avoid the social stigma and feelings of exclusion and isolation that many parents report.

2. Coping strategies

Some research suggests that how parents direct their focus has an impact: those who concentrate on getting help, solving problems, and finding meaning in their experiences have better outcomes than those who avoid their emotions and stressors. It’s also clear that social supports can ease parent stress; this may be in the form of emotional support (family, friends, other ASD families), informational support (schools, professionals), or online communities. Other coping strategies found to be important in reducing stress include:

Optimism – Your family can cultivate optimism by shifting thoughts about why things are happening to what we can do to change them. For example, say a favorite service provider is leaving. A pessimistic parent might think they are partially to blame for the provider leaving (perhaps: she doesn’t care about us enough to stay), while a parent shifting to optimistic thinking may chalk up the loss of a provider to simply bad luck, and something that everyone experiences from time to time. The pessimistic parent may feel helpless in the face of changing providers, while a parent shifting to optimistic thinking will focus on what they can do to help the next provider be successful.

Emotional acceptance – Some parents report acceptance as a coping strategy that tempers stress. Continuously comparing an autistic child and their development to that of a non-autistic child can perpetuate anxiety. Accepting that an autistic child has unique needs, such as additional educational services and a parenting approach that is quite different from the approach used with siblings, can help ease some parental distress.

Cognitive reframing – Cognitive reframing is a coping strategy that can help families who have a child with differences adjust. For instance, parents might reframe their situation to see difficult events, rather than a difficult child, and view those difficulties as manageable—i.e., as problems that have a solution.

3. Mindfulness

A growing number of studies reveal that mindfulness programs can help reduce the additional stress experienced by parents of autistic children. Generally, programs consist of meditation, focusing on physical sensations, and letting go of thoughts. Some also include a discussion of stressors or light stretching. Parents participating in mindfulness programs report decreases in stress and depression, improvements in sleep and health, and increased self-compassion and feelings of well-being. In a study that paired mindfulness practice with training in positive behavior supports, the mothers experienced stress relief, while simultaneously learning strategies that significantly reduced their children’s aggressive and disruptive behaviors.

Raising a child with communication and behavior challenges is incredibly stressful, but it doesn’t have to sentence you to a life defined by stress. Do your best to recognize when the pressures of your life are creating a chronic stress situation, and take steps toward relieving the strain. This will not only improve your own health and happiness but also benefit your autistic child and the entire family system.

To read one mom’s account of the stress of parenting, see “To All the Other Parents of Children with Special Needs: I Feel You.” To dive into the research on coping strategies for parents and caregivers of kids with autism, see these studies:

Bazzano, A., Wolfe, C., Zylowska, L., Wang, S., Schuster, E., Barrett, C., & Lehrer, D. (2015). Mindfulness based stress reduction (MBSR) for parents and caregivers of individuals with developmental disabilities: A community-based approach. Journal of Child and Family Studies, 24(2), 298–308. https://doi.org/10.1007/s10826-013-9836-9

Da Paz, N. S., Siegel, B., Coccia, M. A., & Epel, E. S. (2018). Acceptance or Despair? Maternal Adjustment to Having a Child Diagnosed with Autism. Journal of autism and developmental disorders, 48(6), 1971–1981. https://doi.org/10.1007/s10803-017-3450-4

Ekas, N.V., Lickenbrock, D.M. & Whitman, T.L. Optimism, Social Support, and Well-Being in Mothers of Children with Autism Spectrum Disorder. J Autism Dev Disord 40, 1274–1284 (2010). https://doi.org/10.1007/s10803-010-0986-y

Fox, L., Dunlap, G., & Powell, D. (2002). Young children with challenging behavior: Issues and consideration for behavior support. Journal of Positive Behavior Interventions, 4, 208–217.

Lucyshyn, J. M., Dunlap, G., & Albin, R. W. (Eds.). (2002). Families and positive behavior support. Baltimore, MD: Brookes.

Siah, P. C., and Tan, S. H. (2016). Relationships between sense of coherence, coping strategies and quality of life of parents of children with autism in Malaysia: a case study among chinese parents. Disabil. CBR Inclus. Dev. 27, 78–91.

Singh, N. N., Lancioni, G. E., Karazsia, B. T., Myers, R. E., Hwang, Y. S., & Anālayo, B. (2019). Effects of Mindfulness-Based Positive Behavior Support (MBPBS) Training Are Equally Beneficial for Mothers and Their Children With Autism Spectrum Disorder or With Intellectual Disabilities. Frontiers in psychology, 10, 385. https://doi.org/10.3389/fpsyg.2019.00385

Walsh, C. E., Mulder, E., Tudor, M. E. (2013). Predictors of parent stress in a sample of children with ASD: Pain, problem behavior, and parental coping. Research in Autism Spectrum Disorders, 7, 256-264.

Christian Tsetsos Shares Stories from His Life on the Spectrum

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Christian Tsetsos works as an insurance authorization coordinator for the head office of LEARN’s Behavioral Concepts (BCI) in Worcester, Massachusetts, while serving, on the side, as a neurodiversity advocate and Asperger’s/autism speaker. He joined us recently to share stories from his professional and personal life with autism, delving into everything from his life growing up and struggling to make friends to his experience using dating apps and revealing autism to suitors. Here, we offer a recap of the conversation.

Q: You’ve worked for BCI now for 14 years. Tell us about your job there? What aspects of your work do you enjoy?

A: I started working part-time for BCI my last year of high school and continued as an administrative assistant at the main office, while attending college at Worcester State University. I majored in urban studies and realized I liked the human and social services side of the field. Urban studies is an interdisciplinary major that weaves in government, city systems, sociology, and even art, engineering, and psychology. So, my job at BCI involves interacting with and helping people get the services they need.

I liked my work at BCI and the safe space it gave me to develop my social and professional skills, so I stayed on to take a full-time position in 2014, after graduating from college. This was around the time that insurance policies started covering more ABA services. The company was expanding and transitioning from only providing services through school contracts to offering services in client’s homes and in clinics. To this day, I work in BCI’s first clinic.

Over the years, I’ve worked in a number of jobs at BCI—answering phone calls as a receptionist at the front desk, screening candidates for behavior techs as a human resources assistant, supporting recruiting and talking to prospective applicants at career fairs, and coordinating the intake and insurance authorization processes. I like what I do now, in the insurance side of the business, because I’m detail-oriented. Authorizations involve a ton of rules and policies and limits. Remembering and tracking endless details isn’t for everyone, but it’s something I’m good at and enjoy.

What I like most about my role, though, is the human interaction—for instance, I like helping behavior analysts when they don’t remember a particular insurance code. I like feeling needed and being part of a collaborative team.

Q: You also go to colleges and other places to talk about autism and ABA. Tell us about that experience—and how you developed the skills and confidence to put yourself out there and speak in front of crowds.

A: The man who founded BCI, Dr. Jeff Robinson, had been my mentor for many years. In fact, he’s the one who hired me at age 17 and opened the door to my career path. He worked in schools and wanted someone to speak at community colleges about the differences between high school and college—and the kinds of support available for kids with autism and other special needs. I ended up taking part in that event, which led to the Asperger/Autism Network inviting me to do a 45-minute stand-up talk in front of 50 or so K-12 educators. This was a big deal for me, and I felt both open to it and anxious.

I remember, as I stood in front of that crowd, hearing myself talking without really seeing the audience. I focused on delivering the information and probably looked frozen and stiff. Over time, I became more comfortable and got invited back to talk about my own experiences in the K-12 education system as an individual on the spectrum. I talked about various challenges, interventions that made a difference—that sort of thing. Recently, I gave a talk to a group of grandparents about what they might do to support their grandkids on the spectrum.

Q: Public speaking can be a scary experience, but you overcame your fear. What are some of the things you share, in your talks, about growing up on the spectrum?

A: I talk a lot about the social aspects of school, and how, in elementary school, my teachers knew me and understood how to support me. They even helped me make friends. But my middle school was much larger, and I didn’t know my teachers or classmates as well. I felt disconnected. My differences became more obvious to my peers, and I eventually fell into a deep depression, partly because I didn’t have friends and started struggling academically—everything was overwhelming.

Some teachers treated me like the problems were my fault. They didn’t understand that someone with autism could be smart but still have certain challenges. I have a normal IQ, which meant I didn’t qualify for many services. At the time, people tended to look at the issue in black and white terms, without understanding that someone could have a normal IQ but still have anxiety and problems with executive functioning. It was really a lack of understanding and awareness about autism. My mom advocated for me but often ran into the school saying things like, “Well, according to the law, we don’t have to accommodate that.”

As my depression worsened, my mom kicked into full advocacy mode and started figuring out how to navigate the system. She created a system of supports that helped me get through school. She also hired Dr. Robinson as a consultant to help teachers realize I wasn’t making stuff up—that autism is a real condition that creates real challenges.

One of the big things Dr. Robinson did for me was to help my teachers become more compassionate. Of course, there are always people who can see that there is a need and intervene on their own. These people are naturally compassionate. But others need help getting there.

It’s sad, looking back, that I didn’t have a single friend when I graduated from high school. It’s also disturbing that the school was OK with that.

Q: Yes, that’s really sad and disturbing, and remarkable that you found your way to a far healthier, happier place. In your own words, why do you think you struggled to make friends, and how did you eventually start making friends?

A: I didn’t learn social skills in a class. I taught myself, but not until around age 20, when I enrolled in community college. I was lightyears behind my peers but started, around that time, to open my mind to the possibility of having friends. It dawned on me, however, that I had no idea how to go about it. This was a hard realization to make because, in general, society can be judgmental if people aren’t acting a certain way, especially a grown man who looks typical.

I started trying, on my own, to work on learning social skills by putting myself in different situations. I joined various college groups and had small conversations with people to see if the conversations went anywhere. But it took trial and error. For instance, I realized I was insulting people when I said things like, “If you want to do anything with your psych major, you’ll need to go to grad school.” I learned to take a step back and think through how that might come across as offensive.

Q: With your friends today—and even on the dating scene—do you come right out and tell people you have autism?

A: I don’t think a lot of people understand autism if they’re not affected by it. Sometimes, I’m hesitant to come out with it, though I know that telling might open the door to more understanding and compassion. At the same time, I know there’s a lot of misunderstanding about being on the spectrum. People tend to think of it as an intellectual disability, which automatically means I have a lower IQ, I can’t live on my own, I don’t have a job, and I don’t have a partner. That’s just not true.

I have most of those things, in fact. I’m single at the moment but have been on a long quest to find a partner. I went on a lot of dates last summer—really put myself out there. I’m gay and stay active, on and off, on some dating sites. I tend not to mention autism on the first date but do mention it later, and gauge the reaction. As a side note, I encounter plenty of people who are likely on the spectrum but don’t realize they’re on the spectrum—not necessarily on dates but just in general. It’s interesting.

Q: That is interesting. You’ve developed a heightened self-awareness that plenty of people lack. Aside from that, what are some advantages of being on the spectrum that most people don’t realize?

A: One positive is being able to remember certain facts and figures, like I can do in my job now, with the details of insurance rules and policies. As a kid, I would memorize what states border other states, and what towns border other towns. That’s a unique skill.

Q: What do you wish more people understood about autism?

A: People tend to think of autism as something far removed from their lives or something they only encounter on TV. In reality, autism is part of our society. I wish people could understand that there are many people out there in the world on the spectrum, in our everyday lives at work, college, everywhere. It helps to be aware of that and open-minded and accepting of those who come across as different.

I also think some people don’t want to be friends with someone with autism, and I wish that wasn’t the case. At one point in college, I was struggling academically and socially—it was obvious to the rest of the class, so I came out with my diagnosis. Instead of lending a hand, they didn’t know what to do and ended up avoiding me. I’ve had positive experiences, but it was disappointing that my classmates and my professor treated me like a nuisance. Having a teacher or classmate say, “We’re going to help you succeed,” could have done so much.

So, I would say that I wish people felt more comfortable talking about autism, instead of shying away or feeling afraid. What I really wanted, in that instance, is for people to open up and lend a hand.

Q: It really comes down to what you mentioned earlier about natural compassion, versus trained compassion. Is that fair to say?

A: Yes, it’s really about educating people in compassion. That’s what I try to do with my talks. Whether people have it naturally or need to be taught, compassion can go a long way.

Understanding the Evolution of ABA

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by Ronit Molko, Ph.D., BCBA-D
Strategic Advisor, LEARN Behavioral

Applied behavior analysis (ABA) is widely considered by many professionals and families to be the “gold standard” in intervention for children on the autism spectrum. With decades of empirical evidence to support its efficacy at teaching necessary skills and reducing maladaptive behaviors, ABA is broadly funded by private and government insurance plans and typically supported as the premiere teaching tool for autism.ABA is used more extensively than many people realize. In general terms, ABA refers to the science of teaching and learning or, more specifically, the idea that, over time and through repetition, we can increase behavior that is reinforced, while decreasing behavior that is not reinforced. Corporations and marketing companies use the principles of ABA to affect buyer behavior, just as teachers use ABA to manage students in classrooms. Likewise, ABA is used to train and modify behavior in athletes, musicians, employees, and even animals.

Liltle Preschooler Kid Playing With Wood Blocks And Teacher Educ

In the autism field, the services market has evolved and expanded, leading to significant variety among ABA providers. Consequently, the term “ABA” has become associated with a broad spectrum of services, some of which do not meet the standards and definitions of true applied behavior analysis.

Additionally, there is growing criticism from self-advocates and autistic adults who received ABA services and now share stories of experiencing PTSD (post-traumatic stress disorder) and trauma from the ABA they received. Stories like these are sad and heartbreaking to hear—and call upon all of us in our field to listen to and learn from the conversations, instead of plowing onward in an obstinate disregard for lived experiences. As a profession, we need to use these conversations to reconsider how we approach intervention, and ask ourselves: are we changing specific behaviors because we determine them to be appropriate or inappropriate or because making this change actually serves the person with autism?

We also need to understand the evolution of ABA over the past 70 years. To understand the evolution, one needs to understand the history, and how we reached the point where some individuals and groups find fault in ABA. In my opinion, we cannot simply declare that old ABA was harmful and bad, while current ABA is helpful and good. If our treatment harms even a single individual, that is one individual too many.

The origins of ABA
B.F._Skinner
Dr. B.F. Skinner (Msanders nti, CC BY-SA 4.0 via Wikimedia Commons)

Up through the early 1900s, the predominant theories and schools of psychology focused on thoughts and feelings. Dr. John B. Watson, a pioneering psychologist, popularized the theory of behaviorism in 1913. Watson believed that instead of focusing on internal and mental states, the practice of psychology should focus on observable behavior. Dr. B. F. Skinner further developed the theories of behaviorism to describe how we learn—essentially, by describing and researching how our behavior is changed based on antecedents (what precedes a behavior) and consequences (what follows a behavior—i.e., the rewards and punishments we receive).

The principles of teaching using ABA were further defined by multiple researchers in the 1960s, forming the basis of ABA. In the mid-1960s, Dr. Ivar Lovaas developed a program designed to teach language to children with autism, using the principles of applied behavior analysis, with the goal of preventing children from being institutionalized. Lovaas’s program included 40 hours a week of intensive and rigid clinic-based ABA, with the findings of his research demonstrating the efficacy of intensive ABA on teaching language and other skills to children with autism. As a result of this research, early intervention programs were launched, and ABA became more popularized as the best form of intervention.

Nevertheless, at this time, the application of ABA was rigid and unnatural. Children were required to sit through multiple, repetitive drills to learn skills and sequences, and the number of hours of intervention were exhausting. The popularization of his methodology created a mindset among some parents and providers that intervention must be highly structured, rigid, adult-driven, and sometimes, aversive, meaning treatment could involve unpleasant techniques to alter maladaptive behavior.

Mother And Young Son Playing With Wooden Toy At Home
Evolving practices

Since the early 1970s, however, the world of ABA and the application of the principles of ABA have evolved enormously. Just like in other areas of healthcare, the field has progressed as more research has been conducted and newer strategies developed. ABA has evolved into a much more naturalistic, engaging, play-based, and child-directed form of intervention. In natural environment teaching (NET), for instance, treatment takes place within the ordinary routines of daily living, occurring during mealtimes, playtime, bath time, community outings (like a trip to the grocery store), and other natural parts of a child’s day. This sort of real-life teaching differs extensively from the overly formal, clinical settings of the past.

Today’s ABA programs should be tailored and customized to the needs, values, and culture of each child and family. ABA services need to involve choice-making and person-centered planning, in which each client and family steer and help make decisions about their target goals and treatment, and what fits within their family’s culture. Ultimately, every client and family need to decide what goals to target in therapy, with guidance from the behavior analyst. As in other areas of healthcare, research and best practice standards guide the strategies, techniques, and intensity of intervention. It is the combination of professional expertise and family input that aligns to create the most effective program for each child.

Consider, for instance, a conversation I had recently with the mother of a non-verbal child with autism who communicates regularly with noises one might describe as grunts. A behavior analyst wanted to use ABA to reduce that particular behavior, but the child’s mother did not agree. “Those noises are my child’s language,” she explained. The mother explained further that with each goal presented by her ABA team, she asked these questions:

  • Does the goal respect my son’s privacy?
  • Does it foster his independence?
  • Does it cultivate his voice and self-expression?

The mother, in this scenario, knew what she wanted for her son—and advocated effectively for him.

Other parents I’ve talked to celebrate the skills and capabilities their children gained through ABA services, attributing their children’s gains to the dedication of their ABA providers. Many of these parents stress the importance of making sure the goals and strategies they were advised to use fit with the culture and parenting philosophy of their family. Not every parent or caregiver will advocate in this way or have the time and capacity to manage their children’s program. It’s up to us, as a profession, to honor and respect each client and family’s wishes and values, and to discuss issues related to things like dignity, individuality, and self-expression. It’s up to us to honor self-hood.

As the population of individuals with autism is aging, we now have a group of adults who received ABA services and wants to articulate and share their ABA experiences. I urge my colleagues to stop and listen—and use what we learn to inform the future of services. For example, some adults have articulated that making eye contact is physically unbearable, and, yet, this is one of the core skills ABA practitioners teach as a foundational part of learning.

Given what we’ve learned, it’s time to examine the degree to which each of the skills we teach benefits and serves individuals with autism, despite the fact that we may consider them appropriate social and communicative behaviors. In other words, we need to weigh our own self-interest as a society against what we’re learning from the individuals to whom we’ve devoted our careers.

Stay tuned for Dr. Molko’s upcoming story, where she offers advice on what to look for in a quality provider.

A Special Mother’s Day Interview with Becky Schoenfeldt

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Becky Schoenfeldt, a registered behavior technician (RBT) for LEARN’s Behavioral Concepts (BCI) clinic in Worcester, Massachusetts, spends her days helping kids with autism attain goals on their behavioral health treatment plans. At the end of the day, she goes home to do more of the same, only this time with her 18-year-old son, Dougie, who was diagnosed with autism at age three and needs round-the-clock care.

In a recent interview, Becky talked about her journey with autism, the pitfalls and triumphs along the way, and the lessons learned as both a parent and practitioner in the field. In honor of Mother’s Day, she gives advice to other moms—and all parents and caregivers of kids with autism—about the challenges and rewards.

Q: Let’s start from the beginning, Becky. You were working as a case worker for the Housing Authority, helping families from homeless shelters find work and become self-sufficient, when you noticed developmental delays in Dougie. Tell us about that time period.

A: That’s right. At the time, I spent my days—and nights—helping families get back on their feet after setbacks. I also worked for the Department of Youth Services, the juvenile justice agency in Massachusetts that serves kids and teens who were arrested or charged with an offense. The work wasn’t easy and required late shifts. When I became a parent, I knew I couldn’t keep working there because of safety issues related to the challenging behaviors of some of the kids. I had three little children close in age—technically, Irish triplets. Dougie and Stevie, my twins, have a sister Alli who is only 11 months older. I had my hands full.

Stevie and Alli are neurotypical, so I noticed certain things were different with Dougie. Instead of crawling, he would scoot on his butt. He wouldn’t respond to his name or loud noises. We would bang pots and pans and get no response. He also didn’t make eye contact or speak. But he was sweet and adorable. Once he started walking, he would take us quietly by the hand and lead us along. He was a happy boy.

Often, I brought up my concerns to family and friends, and they would say, “Don’t worry—he’ll eat [or walk or talk] when he’s ready.” The pediatrician kept saying, too, that twins do things at their own speed, that I shouldn’t worry. But I knew in my heart something wasn’t right.

Q: What was it like getting the diagnosis?

A: We were prepared and knew it was coming, but it still felt like a kick in the gut to hear those words. I worried about his future, his present—everything. And then I realized: parents of newly diagnosed kids can either wallow in self-pity or start supporting their child so he or she can live the best life possible. That’s what we did—we were proactive and started supporting Dougie.

We lived in Connecticut at the time and enrolled Dougie in preschool, thinking it would be a good opportunity. When I picked him up from school one day, they told me he had eaten rocks—as though that was normal behavior for a child. “What do you mean, he ate rocks?” I asked them. They said it wasn’t so unusual, but I didn’t believe them. I worried about his safety.

We decided to move to Massachusetts, where my mother-in-law worked as a teacher in a local school district. We had high hopes for Doug’s first school in Massachusetts but came to realize our son needed more support than the school could provide, despite their best intentions. Sometime after kindergarten, Dougie spotted a red jeep in the parking lot that looked like his grandmother’s car. Thinking it was, in fact, his grandmother’s car, he bolted out the door, somehow getting past several staff members—six of them, I was told. How could a kid bolt past six staff members? Why couldn’t they protect my son?

For a long time, Dougie has had an issue with bolting. Even today, if he sees something as ordinary as a squirrel across the street or a holiday decoration nearby, he might take off. He doesn’t have the safety skills.

Q: Did you end up keeping Dougie at that particular school? What was your relationship like with the school staff?

A: We realized the regular public school wasn’t right for him. They wouldn’t allow him to use noise cancellation headphones or other coping mechanisms, like a weighted scarf or blanket. Their attitude seemed to be: if you can’t change the environment, you change the kid. But it was more the environment that needed changing, with so many noises and the constant bells ringing and beeping, the harsh lights, smells, and crowds. These things really bother kids on the spectrum.

We tried to get Dougie placed out of the school and put into a more supportive set up, but that would have cost the school district money they didn’t want to pay. Plus, they would have had to admit that they couldn’t manage Dougie, which they didn’t want to do. So, it was an all-round bad situation.

Growing up, Dougie had severe self-injurious behaviors (SIBs) like head-banging or hitting his head. He often did this on the school bus, and the bus monitors weren’t trained to handle it. I had to leave work several times to pick up Dougie from school, especially in 6th grade—that year was horrible. But the school principal was great, and knew we needed something different. We ended up hiring a lawyer to help us get the school district to “outplace” Dougie, meaning they paid for him to attend another school. It worked, and that was the best $350 we ever spent.

Q: That sounds like an incredibly rough year. What happened next? How did you get Dougie the help he needed?

A: Around the time, I had retrained in my career and worked as a behavior technician for BCI. It was stressful because I kept having to call out of work to take care of Dougie. I finally went to Dr. Robinson, the founder, and asked if Dougie could get a spot in a social skills group at BCI. We worked out an arrangement, and Dougie started ABA therapy.

Eventually, with the help of Dr. Robinson and the lawyer, we secured a spot for Dougie at a school for kids with autism, the Center for Applied Behavioral Instruction (CABI), in Worcester, and that has made all the difference. He has one-to-one attention, a highly-structured routine, and only six or so students in the classroom. He’s a happy kid now—a completely different kid now. He’s doing geometry. He works as a cashier in the school store. Best of all, he actually seeks interaction and even physical contact, like a hug, from people he trusts.

He also discovered he likes art. Just like his dad, Dougie is a talented artist. He loves to draw on whiteboards, and loves to draw Sonic characters.

Q: CABI seems like a great place. Have you thought about life after CABI? How long can Dougie stay there?

He can stay at CABI for four more years, until he ages out at 22. It’s gone by so fast. My husband and I both have to work, and we’re not sure what we’re going to do. We’re looking at day programs because Dougie will still need structure. But I want him to do more than bag groceries at Shaw’s. I hope he can find a job and do something related to art, something he’s passionate about, though I wonder how he can hold down a job if there’s a loud noise, like a baby crying. He would need an understanding, supportive work environment.

I worry about Dougie getting older—and me getting older. I don’t want him to end up in a residential program. For many people who work at those facilities, it’s just a babysitting job. But it’s far more than a job. It’s someone’s life you’re molding.

Q: Yes, it’s an opportunity to really influence and mold, as you say, an individual’s character—a person’s whole life, really. What has it been like for you, as a mom and an RBT?

A: Helping kids and families with autism is who I am and what I do. I’ve finally found something I enjoy, and it’s nice working with families. I never dread going to work because when I open that door, I know I’m a positive reinforcer. The other week, one of my kids fell asleep during a session, so we had to reschedule. Then I didn’t see her the next week because of Dougie’s spring break. When I finally got to see her, she gave me an enormous hug. That’s pretty rewarding.

When we had to go full remote with COVID, life was a rollercoaster. Dougie adjusted well because I set up his environment and work area similarly to school, with his visuals and sensory objects in place. We followed his treatment plan and kept making progress.

Q: What advice do you have for other moms or caregivers raising kids with autism?

A: I see a lot of single-parent families, mostly where it’s just the mother. That’s not easy, especially if there are other kids in the family she has to care for. When parents have their own personal problems they’re dealing with, that can make it difficult to support the goals of therapy at home. But that part of therapy is so critical—learning has to continue in the home environment.

The advice I can give other moms and parents is to build your support network. It might take work, but the effort is worth it. Also remember that no challenge is too big, and no victory too small. I like a challenge and decided to rise to the challenge of raising Dougie and two other kids, while helping kids in my job. It’s not easy, but it’s my life, and I wouldn’t trade it for anything.

Q: With your busy schedule, how do you practice the important art of self-care? What will you do for fun this Mother’s Day?

A: For self-care, I make every moment count, even when I’m at the grocery store. Sometimes, I just enjoy the quiet of walking down an aisle alone, getting to think or move at a slower pace for a moment. This summer, I’ll go to the zoo and water park with my family. We’ll get outdoors and do some of the things we couldn’t do last summer because of COVID.

On Mother’s Day, I’ll be with my family, but the weekend before, my daughter, Alli, will be home from college—she goes to Roger Williams University in Rhode Island. On Sunday, I’m taking the two of us to get our nails done. It’s an early Mother’s Day present before she has to go back to school.

Create a Calm-Down Kit for Your Child with Autism

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As parents and caregivers, we’re hard-wired to respond to our children’s cries with efforts to comfort and soothe. Nothing is more frustrating, however, than when our efforts fall short—and our child spirals into a meltdown. What can help? In a few words: a calm-down kit.

A calm down kit is simply a collection of objects and items to help children cope with their emotions in a positive and safe manner. Also known as sensory integration boxes or toolkits, each calm-down kit can look a little different, depending on the needs and interests of your child. Of course, you can buy preassembled calm-down kits online, but your kit won’t have the magical ingredients that can comfort your child (aka, the objects and items your child loves), and often, these kits don’t take into account things like ages and sensory needs.

How, then, can you create your own calm-down kit to soothe your child’s sensory system during a meltdown? Here’s a breakdown of what to include—and how and when to use the kit.

What to include in your kit

As a parent or caregiver, you know your child best. Ask yourself these helpful questions:

  • What soothes your child when restless?
  • What usually calms your child down?
  • What does your child like to do?
  • What are your child‘s favorite items?

Gather together an assortment of items generated from the questions above, along with objects that cater to various senses, such as sight, sound, touch, and taste. For instance, you might include:

  • A weighted or soft blanket, which can help kids who respond well to deep pressure receptors.
  • Fidget toys that can occupy the mind and fingers by giving kids something on which to focus.
  • Noise cancelling headphones, which can provide the peace and quiet kids need during a sensory meltdown or outburst to calm their bodies.
  • Bubbles, which can help kids take deep breaths for relaxation, without realizing it.
  • Chew toys to provide oral sensory support and help some children focus and manage feelings of anxiety and sensory overload.
  • A stress ball to squeeze and release anger and overwhelming feelings.
  • Plastic baggies full of various materials like kinetic sand, oatmeal, pasta, pine nuts, or rice, which can satisfy cravings for tactile stimulation.
How to use the calm-down kit

Once you have the items, place them in a backpack or cloth bag, and take the kit with you in your car or on the go. Then, once a sensory meltdown starts, use the items either to refocus your child’s attention and lessen the magnitude of the meltdown after it begins. Keep in mind, too, that  you can use the kit anytime, even during typical downtime. Using the calm-down kit during downtime will serve as practice and enable your child to figure out what items help in times of distress.

Again, the goal of the calm-down kit is to give kids the tools they need to transform their inner state from upset to calm. These kits can make all the difference, not only for your child but also for  you, as a parent or caregiver.

Want to learn more about sensory issues? Listen to our podcast, “How Lighting Can Affect Your Circadian Rhythm,“ on All Autism Talk.

Spotlight on Black Professionals in ABA: Maia Jackson

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Our new series, “Spotlight on Black Professionals in ABA,” continues with an interview with Maia Jackson, the clinical development manager of LEARN Behavioral’s Autism Spectrum Therapies (AST) office in Oakland, California, in the East Bay region of the San Francisco Bay Area.

The series comes on the heels of an analysis conducted by the Behavior Analyst Certification Board (BACB), which found that Black behavior analysts make up only 3.6 percent of the total board certified behavior analysts, a number that lags behind the 13.4 percent of Black people living in the United States, according to 2019 U.S. Census data.

Here, Maia talks about her experience and the critical need for mentorship in the ABA field.

Q: Thanks, Maia, for taking time to chat with us. Let’s start with the beginning: how did you get into ABA? What attracted you to the field?

A: My senior year in college at Sacramento State University, I still didn’t know what I was going to do. I majored in psychology, which is kind of general. As I got closer to graduating, I went on Craigslist—that’s a sign of my age—and saw a job posting that said, “Work with kids!” I really enjoyed kids and thought, Why not? I ended up taking the job and doing direct intervention with four- and five-year-old kids with autism spectrum disorder (ASD). They were adorable.

After a few months of that, I knew I wanted to continue but in a way that allowed me to grow in the field. I started Googling and looking at various options for graduate school, ultimately enrolling in National University’s master’s program in education, which offered a specialization in ABA.

Q: What was graduate school like for you?

A: It was an interesting, though busy, experience. I kept my job with Bridges, an ABA provider in Sacramento, and juggled work with studying. It helped that most of my courses were online, but that also made it harder to make connections and interact with my peers and professors. My studies lasted about a year and a half, and when I graduated, in 2009, I needed a board certified behavior analyst (BCBA) to observe and supervise me in the clinic for a set number of hours, in order to earn my own credentials as a BCBA. But ABA was still a relatively new field, at least in regard to autism, and I couldn’t find anyone to supervise me. There just weren’t that many BCBAs around at that time.

In 2011, I ended up taking a job with AST, which had recently opened a new office in the Bay area. The office caseload grew quickly, which was exciting but also challenging—I was thrown into the mix. There was a learning curve, but I got the supervision and support I needed to earn my BCBA certification and ultimately help kids and succeed in the position.

Q: What was the supervisory experience like for you? What kind of feedback did you receive on your work in the clinic?  

Someone from one of AST’s more established offices in southern California drove up to supervise me, and that was a real game-changer. I came to think of her as my mentor. In fact, I didn’t know what I had been missing until I had someone come in and provide that level of support. Mostly, what she gave me was time—time to sit and listen as I talked about my cases, time to answer my questions, time to trouble shoot. I hadn’t had that level of support before. She gave me her input and clinical guidance and expertise. Plus, she was a woman of color, like me, and I hadn’t worked with a woman of color in ABA until that time, even in grad school. She gave me the confidence to express my thoughts and concerns about the job, and advice on how to balance my professional and personal lives. We still keep in touch and call each other to troubleshoot or even just catch up.

Q: It sounds like the relationship with your mentor was a game changer, indeed. How has that experience influenced your continued work in behavior analysis?

A: Well, right now I work as the clinical development manager, supporting newly hired trainers and providing training to new supervisors, so my job, essentially, is to help guide and support new employees in clinical positions. This is important because the better trained we are, and the more we feel supported in our positions, the better the outcomes for our clients and the higher retention rates for our team.

I’m also part of a team of five professionals at LEARN launching a mentorship program for employees taking part in our organization’s Future Leaders Diversity Advancement Program Cohort, designed to increase the number of Black BCBAs at LEARN. The program provides financial assistance to employees attending National University’s master’s program in ABA. As I mentor, much of what I’ll do is what my mentor did for me—listen, guide, and help troubleshoot any problems that come along, whether related to the field or to things like work-life balance.

Mentoring is something I truly love doing. It differs from a supervisory role, where people might be guarded and careful with what they say. In a strong mentor relationship, people can pick up the phone and call anytime without worrying how they’ll be perceived. The focus is on building confidence, happiness, support, and growth.

Q: In your own words, why do you think it’s important to increase the number of Black professionals in ABA—and to increase diversity across the field, in general?

A: At LEARN and AST, we have a diverse clientele, though I’d like to see an even more diverse clientele—to see a broader range of children accessing services. Systemic issues prevent some children from getting the care they need. It often starts with well-baby checks, for instance, where a pediatrician might not refer patients who are Brown or Black to the appropriate resources in a timely manner or might not diagnose them early enough. Difficulties with transportation, work schedules (with parents working multiple shifts), and funding also prevent some children from getting the care they need. Plus, not everyone can afford services. Even with insurance, a $40 to $45 co-pay several days a week adds up quickly.

Early diagnosis and intervention are also critical. Studies show that Black and Hispanic children are diagnosed later than white children. We need to do more to make sure all children are diagnosed as early as possible so they can take advantage of the benefits of early invention. Increasing diversity among BCBAs, who can go out in the community and conduct parent and caregiver workshops, while raising awareness to pediatricians and other people in the community, are key to better serving the broad range of children in need. LEARN’s partnerships and community liaison team are doing that important work, and I would love to join and support their effort going forward.

Read the first interview in this series, “Spotlight on Black Professionals in ABA: Brandon Whitfield,” and find out more about our Diversity, Equity, and Inclusion Plan.

This Earth Day and Beyond, Spend More Time in Nature

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by Genevieve Marshall, Ph.D., BCBA-D, LBA
Clinical Director, SPARKS

Years ago, in an undergraduate social psychology class, I recall my professor focusing an entire lecture on how the industrial revolution affected our relationship with nature. Specifically, the professor talked about the migration to cities and the increasing amount of time children spent inside, whether working or at school. Coupled with an increase in pollution and limited urban green space, doctors started seeing a rise in depression, anxiety, and general malaise. Their prescription? A fresh air retreat—time away from the city, time spent in nature.

I remember thinking how obvious and ridiculous the lecture came across at that time—of course, deprivation from nature is a bummer. Who doesn’t know that? When our visual environment is made of overly designed spaces and straight lines, it messes with our perception and psychology. A lack of Vitamin D from sunlight makes people sad; how strange it was to me that people needed to see a physician for medical advice, when nature was free and plentiful.

In my reaction, twenty-some years ago now, I recognize my privilege in being able to spend leisure time outdoors. As a child, I spent every day of every summer outside camping and canoeing or cavorting around my grandmother’s cottage. I built tree forts and caught frogs. In the winter, we skied and went sledding. I see now that access to abundant nature was a privilege. My parents could facilitate access; it aligned with their ‘crunchy’ conservation mindset, and they were afforded time away from work or caregiving. We also lived in a place close to nature—it was accessible, and, so, I took for granted that access was not always free.

Fast forward to the present day, and I no longer consider the lecture ridiculous. After all, we are navigating a pandemic that has increased our screen time and, for many of us, our sedentary behavior. We are worn out and ground down from restrictions, global illness, and death. For me, the monotony of quarantine, especially through the cold winter months, brewed an apathy that made the idea of time outside seem too effortful or uncomfortable.

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As an adult this past winter—a parent and an employee one year into the pandemic—my enthusiasm for the outdoors froze. My boys, too, started to fight me on going outside. Their curiosity and energy dulled. Too tired to stand firm, I would sit with them and watch The Never Ending Story or Captain Underpants for the umpteenth time. The greyness of winter pandemic life started to feel like a never-ending cycle of work, chores, and screen time.

Then spring hit. The days stretched longer and felt brighter. The trees started to come alive, and I felt like wearing pants with buttons for the first time in a while. My boys, not so much. They were still trapped in the brain fog of remote learning and social isolation. They were suffering from Nature-Deficit Disorder. The only prescription? More cowbell. Apologies, that’s not right. The only prescription? More time outside.

Richard Louv coined the term nature deficit disorder in his international bestseller from 2005, Last Child In the Woods, where he writes that “the child in nature is an endangered species, and the health of children and the health of the Earth are inseparable.” In his more recent book, Vitamin N: 500 ways to Enrich the Health & Happiness of Your Family & Community, Louv suggests that pediatricians across the country are now writing park prescriptions. The science is clear: time in nature is as important as eating a balanced diet and sleeping well. As Louv explains, experiences in the natural world boost the immune system, stimulate learning and creativity, and serve as a buffer to depression and anxiety. Confirmed by our optometrist at a recent eye exam, time in nature can even improve myopia.

So my family took a page from Louv’s book: we set up a rule that we had to spend 30 minutes engaged in movement outside every day, rain or shine. I would be a liar if I told you we accomplished this goal every day. In fact, I resorted to peppering in a few behavior analytic interventions (see: Premack Principle) to buoy the effort and enthusiasm. But it has gotten easier, and we are all feeling less ‘blah.’ We plan one big activity every weekend—a hike, a long bike ride, or a yard project. Pokémon Go city hikes are a favorite. We also use an app that identifies trees, and we dusted off our bug vacuum just in time for the Brood X cicada season.

On this Earth Day, start to think about how much time you spend outside, and how much time your kids spend outside. I would be a hypocrite to stand on this organic fair-trade soap box and tell you to limit your environmental impact by removing meat from your diet or to stop purchasing single use plastic. A conservation mindset is important, but you have to take care of yourself to take care of others (and the world). You can skip the Birkenstocks and tree hugging—and just spend some time outside. Get some Vitamin N (nature). It is rough out there, but I promise, sunshine and fresh air will make you feel better.

Want to know how nature can help your child or teen with autism? Browse these stories and studies:

“Exposure to Nature for Children with Autism Spectrum Disorder: Benefits, Caveats, and Barriers,” Health & Place, v. 55, 2019

“Nature as a Healer for Autistic Children,” Alexandria Engineering Journal, v. 58, 2019

“Vitality from Experiences in Nature and Contact with Animals—A Way to Develop Joint Attention and Social Engagement in Children with Autism?” International Journal of Environmental Research and Public Health, 2019

“Kids with Autism Benefit from Outdoor Classroom,” Toronto Star, 2013

Looking for tips on integrating nature into your autistic child or teen’s life? Consider these ideas:

“Time Outside: Ideas for Families,” LEARN Behavioral, 2020

“Tips for Playing Outside, and Why Children with Autism Benefit from Outdoor Play,” Marcus Autism Center

“Learning Opportunities in Nature: How Discovering Nature Benefits Children with Autism,” Marcus Autism Center

“Playing Outdoors: Building Skills, Exploring and Creating Memories for Those with ASD,” Autism Awareness Centre Inc., 2020.