Avoiding pandemic setbacks: how telehealth ABA therapy is helping children with autism

Ashley Williams, Ph.D., LABA
BCBA
Baystateparent Magazine

During these uncertain times of social distancing, many parents of children with Autism Spectrum Disorders (ASD) who had been receiving Applied Behavior Analysis (ABA) therapy have asked, “How will we maintain the therapeutic gains that have been made? How do we adhere to the treatment plan and continue to make progress?”

These concerns are certainly justified, as discontinuation or delay in ABA therapy can cause distress in children with ASD. It can also create some real setbacks, including the potential for behavior regression. 

Setbacks

Distress can manifest in different ways. Existing behavior can reemerge and there can be changes in skills acquisition. For example, a child who was previously potty-trained may begin having more accidents. When ABA therapy is consistent, there is instructional rapport. When disrupted, it takes a while to regain or re-teach from the start to re-establish attending skills.

Another concern is the emergence of new behaviors. For example, one child who did not receive ABA services for weeks during the initial phases of COVID-19 returned for therapy and new behaviors had emerged. In particular, spitting, bolting and encroaching on other people’s space. The rates surpassed pre-COVID levels and there was significant difficulty in getting this child to adapt back. 

Virtual ABA treatment during COVID-19

Telehealth ABA therapy allows for the continuation of critical services to help ensure that children and families continue towards their established treatment goals. Typically, these video conference sessions are one to two hours long and held at least three times a week via computer, tablet or smartphone. Some children benefit from shorter, more frequent sessions, up to five days a week. 

This virtual therapy enables families to continue to build upon and reinforce social skills and communication skills. It also addresses personal hygiene and daily living skills, including hand washing, potty training and sleep routines.

Tips for developing routines at home

With children spending so much time at home, developing a routine that fits into the family's schedule is important. Many children with ASD have a hard time knowing what’s expected now that they are home all the time. Cues that would have otherwise indicated what to expect are no longer present. For example, the school building itself is a cue associated with learning and the particular behavior exhibited while at school. Children may get frustrated and upset when previously they had free access to toys or electronics at home and are now asked to do “demands” such as learning virtually at home or in their ABA session. Setting up a routine at home helps establish what is expected and can be predicted. Establish rules around where and what children can access. For example, the kitchen may be designated as the room for virtual learning. The dining room might be designated for meals and snacks.

Setting clear expectations

Rules are important as they provide predictability and routine. There must be a signal for a change in activities. Set up a visual schedule using pictures (preferably) or words, on a whiteboard or Velcro board, so that daily activities are planned out. If the routine or schedule needs to be changed, involve your child in visually changing the schedule to match the day. And, when possible, try to prepare your child for unplanned schedule changes in advance.

Individual reinforcement strategies

Establishing expectations and utilizing reinforcement strategies sets your child up for success. A system of tickets is an excellent way to reinforce behaviors and reward your child. Does your child just want to eat snacks and use electronics seemingly all day? By using a ticket system, there is a visual associated with a limit. The tickets indicate how many times your child can ask for either “want.” For example, three tickets are dedicated to asking for a snack. Additional tickets may be earned for doing planned activities. For example, for practicing skills, your child may earn another ticket to use electronics.

Maintaining social interaction

Social isolation can be extremely difficult. Opportunities for social interaction will help with your child’s self-esteem while also improving their mental health. Seek out related telehealth ABA online groups that your child may attend. For example, a virtual Lunch Bunch group which meets several times a week. Lunch is a commonality, so the children start by talking about what they are eating. Oftentimes, that progresses to follow-up questions to previous discussions such as “How was your visit to Cape Cod last week?” A virtual Lunch Bunch group provides a more relaxed space enabling new skills to emerge and friendships to bloom.

Staying safe

Deficits in social skills are a hallmark symptom of children with ASD. Essentially the skills that we’re trying to teach children with ASD to do -- to be more social, to talk and interact with people -- are now a safety concern due to COVID-19.

From social distancing to mask wearing, parents are worried about going out in public with their children with ASD while adhering to COVID-19 precautions. They are concerned about their child’s overall safety. Some fear judgement and are worried that a community member will think their child is defiant for not wearing a mask or not observing social distancing guidelines. 

For children who are struggling with sensory issues, mask wearing is a problem. Try to put in place a system for tolerating a mask with contact reinforcement. At the outset, parents may expect 10 seconds (or less) of mask wearing. Practice at home by having your child wear a mask for a period of time where your child can be successful (i.e., without complaining, attempting to take it off or other behaviors). After the predetermined period of time, your child would access a reinforcer, or highly preferred item/activity, such as playing a game with a parent. 

As rates of COVID-19 transmission continue to change in each community, it’s difficult to predict future needs and think long-term. Focus on what your child’s and family’s needs are currently. How can we create a model that works now? Telehealth ABA therapy can provide answers and support.