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Waypoints currently operates in Ottawa and Kent Counties, and one of our recent blog posts covered some great autism support services in our area. What is the status of access to ABA therapy in Western Michigan, though? In this article, I’d like to review some common barriers to services, and how Waypoints (along with Michigan as a whole!) is working to address those barriers.

First, it’s always worth reiterating that we do not think of our ABA services at Waypoints as “therapy” per se. Therapy can be a very important part of support services, addressing both mental and physical healthcare concerns. At Waypoints, though, we primarily focus on helping clients build skills related to communication, academics, daily living, independence, and anything else that would help them to work toward their goals.

Nonetheless, “ABA therapy” is common terminology amongst behavioral healthcare and insurance providers, so we do reference it. Just know that we strongly believe that autism is not a problem to be fixed!

A child playing with a toy airplane

Potential Barriers, and Overcoming Them

According to the CDC, approximately 1 in 54 children are autistic, and ten years ago (in 2012) the Autism Alliance of Michigan reported that approximately 16,590 children in Michigan public schools were autistic. While this is, of course, based in part on our state’s population as a whole, Michigan had the fifth-largest population of autistic people compared to other states in 2007.

Diagnosis

It’s important to consider that the statistics quoted above are based upon people who have had opportunities to be formally diagnosed. Access to professional diagnostic testing is one of the foremost barriers to obtaining ABA services in Western Michigan right now, as insurance providers require a diagnosis in order to approve coverage. Clinicians who are qualified to diagnose autism are simply in such high demand that they often have waitlists that are months, and sometimes even up to a year, long. Based on the Lakeshore Regional Entity’s internal data, for clients with Medicaid in Western Michigan, the current average wait time from a physician providing a referral for diagnosis to the client beginning ABA services is 222 days.

As I just touched upon, the first step in receiving a diagnosis is to get a referral from a physician. While pediatricians and nurses can be qualified to diagnose autism, many do not have formal training to do so and need to make referrals to another professional – typically a Licensed Professional Counselor (LPC). That credential, though, requires ten years of experience and a PhD to obtain. While Limited Licensed Professional Counselors (LLPCs) with master’s degrees can also conduct diagnostic assessments, they must do so under the supervision of an LPC. You can see why such a professional would be in high demand! And that demand is even greater now due to the ongoing pandemic, where the number of people seeking mental health services has increased, which in turn has led to a nationwide shortage of available psychologists.

Another concern might be whether your physician has the experience or not to recognize signs of autism and provide a referral in the first place. If you believe it would help to advocate for a referral for yourself or a family member, one option is to complete an independent screening at home using a tool like the Modified Checklist for Autism in Toddlers or the Camouflaging Autistic Traits Questionnaire for adults. Just be sure to note that these tools do not diagnose autism in and of themselves; they merely suggest if further assessment could be warranted.

At Waypoints, we are working to be able to provide diagnostic assessments directly through our company to help streamline access to services.

ABA in Schools

However, there are other options that do not necessarily require formal diagnosis! In public schools, all students are entitled to a free and appropriate education (FAPE) due to the Individuals with Disabilities Education Act (IDEA). Depending on assessment results and the agreed-upon individualized education program (IEP), this may include ABA services as part of the school day. While we currently offer primarily in-home services, Waypoints clinicians and technicians are absolutely available to work with clients in school (and other!) settings as well.

The Michigan Department of Education provides a helpful fact sheet which includes guidelines for how to advocate for a student’s needs if they are not yet being met, and this informational website reviews the full process of developing an IEP! In Michigan, adult learners up to the age of 26 are also covered and may still receive access to special education funding.

Michigan provides a variety of helpful free support services in schools. The Early On program covers children from birth to age 3, Build Up Michigan extends through age 5, and there is a comprehensive guide to local school districts available at this link. A variety of other caregiver resources are provided by the Michigan state government here at michigan.gov.

Insurance

While it is an option to pay for services out of pocket, thankfully ABA is covered by most insurance providers. Insurance coverage of autistic children has improved over the years, with 64% covered in 2020 vs. 36% in 2016. At Waypoints, we are currently contracted with Medicaid, Priority Health, and Blue Cross Blue Shield.

Coverage of behavioral health treatment is available through Medicaid as part of the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit. A primary care physician can conduct a screening for autism spectrum disorder (ASD) and refer anyone under the age of 21 for services, after which a more comprehensive diagnostic evaluation must take place in order to confirm the necessity of support services. At that point, the referral is sent out to potential service providers that can meet the individual’s needs, like Waypoints!

If you and your family don’t qualify for Medicaid for any reason, another option is the Healthy Michigan Plan. This program is restricted to families with financial need, but it is definitely worth applying to see if you are eligible.

Regardless of your insurance provider, you can contact your doctor’s office or local Community Mental Health Service Program (CMHSP) for next steps with regard to pursuing ABA services. The Michigan Autism Council even provides a step-by-step guide for talking to insurance representatives!

Next Steps

ABA services can be provided in home, during the typical school day, as a part of community outings and activities, in learning centers or clinics, and even via telehealth or solely through caregiver training. Hopefully, this flexibility in format can help address barriers related to scheduling or location. While our typical “office hours” are from 8:00-5:30 on Monday through Friday, we are committed to accommodating our clients’ needs for evening and weekend sessions as well.

Thankfully, there are many online guides for accessing ABA services, such as this one provided directly by the Michigan Department of Health and Human Services (MDHHS). The process can be undeniably complex and time-consuming, though. If our staff at Waypoints can help to support you in any way, please don’t hesitate to reach out to us at info@waypoints.life.

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Whether you’re looking for diagnostic testing, one-on-one in-home ABA therapy and skill-building resources, or simply want to learn more about our unique approach, please don’t hesitate to reach out! (We love getting mail.)

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What Does an ABA Session Look Like?

As covered in our very first blog post, Applied Behavior Analysis in Simple Terms, ABA can be thought of as a method of making changes to the environment to help promote learning. In yet another post, What Do ABA Therapists Do, some basic procedures that are used during one-on-one ABA sessions were introduced. Discrete Trial Teaching (DTT) and Natural Environment Teaching (NET) are common skill-building techniques used in ABA sessions, but how does that translate to what a session might look like for you or a family member from start to finish? In this post, Waypoints Registered Behavior Technician (RBT) Kiersten Tallant outlines common components of sessions with us.

a child laughing while holding up painted hands

ABA Sessions at Waypoints

The truth is, every ABA session will look different. Sessions are made up of programs (lessons), and each program is individualized to promote daily living skills significant to the client. Sessions can take place in a variety of settings; at-home sessions are common, but other possible settings may include sibling sporting events, the store during errands, afterschool activities, etc. A variety of individuals might be present as well, such as visiting family members or people in community settings.

This flexibility helps to produce new teaching opportunities and further learning. Even though there is no single answer to what exactly a session will look like, there are some elements that you can expect in every session with Waypoints.

Individuality

Each client is their own unique individual, and their programs should be tailored to them. Every session will have several programs to target behaviors that are socially significant to the client themselves.

An example of this could be working on building up tolerance to engage in less-preferred tasks. We all have to do things that we’d rather not sometimes, like homework, chores, or exercising. A program targeting this goal would involve first identifying what the less-preferred tasks are, figuring out why they are less-preferred so that they can be made easier or more pleasant if possible, and then gradually working on tolerating the tasks a few minutes at a time. This would also likely include practice with coping skills and self-advocacy in the form of asking for a break or requesting help.

The point of a program like this is not just tolerating unpleasant things for the sake of it – it would be based on exactly what the client themself wants and needs to learn to work through!

Autonomy

Autonomy means the “right or condition to self-government.” This one is key. The client always has the right to choose to participate in sessions and individual programs, and in no way should the client be forced or pressured to do something that is uncomfortable for them or that they do not value. The Ethics Code for Behavior Analysts specifies that assent is “vocal or nonvocal verbal behavior that can be taken to indicate willingness to participate.” If a client does not assent to a given program, the behavior analyst and other members of the client’s care team are responsible for adjusting procedures to be more acceptable.

At Waypoints, we highly prioritize pairing (see below) to build rapport with clients and maintain open lines of communication about program preferences. In order to help make difficult programs more enjoyable and easier to work on, we almost always utilize reinforcement in the form of favorite snacks, playing together, and praise and feedback to build motivation for participation.

Pairing

Pairing is relationship-building. To establish the relationship between an ABA practitioner and client, we always start out by focusing on things and activities the client enjoys, like playing together and talking about their interests. This gives the practitioner a chance to get to know the client while building rapport with one another.

What we learn about each other during pairing also allows us to individualize programs based on the client’s interests and goals, and also makes it clearer how the client prefers to communicate about their wants and needs.

When a client begins ABA services, several sessions may be spent exclusively on pairing, until good trust and understanding is built up. Afterward, continued pairing will still take place throughout at least part of every session.

Real-Life Goals and Applications

As briefly noted above, Natural Environment Teaching (NET) is making use of the client’s natural environment to implement programs and enhance learning. Using NET, Waypoints practitioners incorporate the client’s likes and interests into clinical programs, making learning something to look forward to.

For example, if a client was working on the daily independent living skill of picking out clothes and getting dressed, we wouldn’t just repeatedly practice putting on different clothes at random. Utilizing NET, we might check the weather together or go outside to figure out the temperature, discuss the activities of the day to determine how casual or fancy an outfit should be, and then talk about anything else that might influence the choice. Real-life motivation for practicing skills like independently tying shoes, zipping up a jacket, or buttoning a shirt might be taking a walk or playing outside without getting too chilly!

Some skills that may start out being learned via Discrete Trial Teaching (DTT) with flashcards in a more traditional learning setting at a desk can also be transferred to NET, which is always our goal at Waypoints. While it might be easiest starting to learn to label colors on simple flash cards or objects, eventually real-life application of simple skills like that are what really matter. NET in that case could involve practicing colors by asking a client, “What color crayon do you want to draw with?” or “Wow, I love your shirt today, what color is it?” or “Did you see that car that just drove by? What color was it?”

What Would ABA Sessions Look Like for You?

Thank you, Kiersten, for this helpful walkthrough of important parts of ABA sessions at Waypoints!

On average, clients at Waypoints participate in ABA sessions for about 15 hours per week, with an average session length of 3 ½ hours. Specific programs are based on initial assessment results and direct input from clients and their family members. Sessions typically involve a high rate of learning opportunities, but with the use of NET in particular, those learning opportunities often don’t look like they would in a traditional school setting!

If you have any questions about how your goals could be pursued in ABA sessions, or would like to talk more about whether ABA services would be right for you or your family member, please don’t hesitate to reach out to us at info@waypoints.life.

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Whether you’re looking for diagnostic testing, one-on-one in-home ABA therapy and skill-building resources, or simply want to learn more about our unique approach, please don’t hesitate to reach out! (We love getting mail.)

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To say that a student is “gifted” typically means that they’ve been found to be above-average intellectually, particularly in comparison with their same-age classmates. Many schools offer classes that meet the special standards of gifted and talented education, often building up to enrollment in Advanced Placement (AP) or International Baccalaureate (IB) courses.

Meanwhile, discussion of autism often centers around social, behavioral, and/or intellectual deficits that are identified in the diagnostic process. Autism is often referred to as a spectrum in terms of how it expresses itself from person to person, and that spectrum in turn is sometimes whittled down to a line from “low-functioning” to “high-functioning.” Strictly in terms of intelligence as assessed by IQ tests (which of course have their own issues), some autistic people also have an intellectual disability (i.e., an IQ lower than 70), while others range from average to gifted just like the rest of the population.

With that being said, for many reasons that continue to be argued to this day, this false dichotomy between low vs. high intelligence, or even more generally low vs. high levels of functioning, can be highly problematic. While not exactly the topic of this blog post, I recommend this recent post by Shannon Des Roches Rosa as just one example of this important discussion. At Waypoints, we strive to celebrate and build upon clients’ strengths rather than eliminate autistic traits. I’ve written about our approach to Applied Behavior Analysis (ABA) services at length in this blog – check out Why You Should View ABA as a Skill-Building Tool—Not “Therapy” and Why We Celebrate Neurodiversity – Not Just Acknowledge It as just a couple of examples!

a gifted and autistic child drawing or writing

Twice-Exceptional

The word “gifted” has positive connotations. It implies fast learning and advanced intelligence, and this in turn seems to suggest that people who learn at a slower pace (or through different methods) have fewer gifts. But when it comes down to it, giftedness is a facet of neurodiversity, just as autism and other developmental disabilities are. Whether someone is gifted vs. autistic, both, or neither, they will experience their own unique challenges in life, and also thrive based on their own unique strengths. As Ilise Feitshans wrote, “everyone has a disability, everyone has a gift.”

So, autistic vs. gifted? These two identities are not mutually exclusive, and indeed aspects of one can sometimes be difficult to differentiate from aspects of the other! Children who are identified to be both gifted and autistic (or otherwise neurodivergent) are sometimes called “twice-exceptional,” which can be abbreviated as 2e.

Gifted students are often identified by the fact that they learn faster and more easily in school, but this can simply mean that traditional instructional methods are the most effective ones for them personally. If children received more individualized education allowing them to learn non-linearly or express themselves non-vocally, it’s quite possible that we’d see more of them as gifted! Indeed, flexible problem-solving and thinking outside the box are oft-celebrated traits of gifted children and are also common to autistic people who perceive things in the environment differently than their neurotypical peers.

On the other hand, gifted children may appear to be rigid or stubborn when required to perform tasks that they find to be repetitive, boring, or unnecessary, something that autistic people are also often criticized for. Both gifted and autistic children can also struggle with sensory issues, feeling either over- or under-stimulated in different environments. As another shared set of traits with a combination of pros and cons, excellent expressive language combined with difficulty determining exactly what to talk about and when can lead to gifted autistic children being judged as simply “too gifted to get along with other kids.”

ABA services are tailored to each individual client’s needs and goals, and that would be just as much the case for a client who was both autistic and gifted. For such a client, goals might focus more so on social skills or independent living rather than academics, but it’s just as possible that they would excel with language arts but request extra support with learning math (or vice versa)!

Avoiding Harmful Expectations

This brings me to my next topic – the importance of avoiding placing expectations upon children strictly because of their being autistic, gifted, or both.

Academic and intellectual success can lead to high-pressure expectations that, when they are not met, can be very stressful. As C.L. Bridge wrote in her blog post Don’t Count on Stereotypes, “please remember that stereotypes about being good at something are still stereotypes.”

For this reason, a more supportive approach can be to celebrate what a child does, rather than what they “accomplish.” As someone who was assigned to gifted and Advanced Placement classes, I deeply struggled with what was expected of me when I no longer easily met those expectations. I failed out of my first semester of college because I had no grasp of basic skills like self-management, studying, or asking for help.

It’s never too late to learn those skills – I took a semester off and then came back swinging to finish my undergraduate and graduate degrees – but I wish there had been more focus in my childhood on what I was actually doing and learning instead of the good grades I was “achieving”! Setting goals based on active responding like studying and practicing, advocating for oneself, or communicating effectively (and praising progress toward those goals regardless of pace or outcomes) can be very helpful.

What Not to Tell Someone Who “Has so Much Potential”

  • “You’re too smart to waste your potential like this”
  • “You must just be bored because the work is too easy”
  • “Your gifts aren’t for you; they’re for the whole world” in response to being unable to function in the ways you expected to function
  • “The kids who are teasing you today are only on top in high school. Once you get into the working world, you’ll be in charge. They’re just jealous because they know that.”
  • “School is hard on smart kids, but college will be much better if you just stick it out so that you can get there.”
  • “You’re not applying yourself”

Source: https://realsocialskills.org/2014/04/28/you-have-so-much-potential-3/

Other Ways of Providing Support

Quoting Ilise Feitshans again, “flaws can actually be converted to assets in the right context.” One great strategy for supporting a twice-exceptional child is to provide options for self-expression outside of traditional academic formats. Someone who struggles in a highly structured classroom environment might thrive when learning a craft or a trade; someone who dislikes writing or speaking might love to keep a scrapbooking journal or sketchbook. Engage with your child about their interests that may not be “productive” or in any way career-oriented in order to celebrate the way that they experience the world, even (and especially) if that experience isn’t always supported in traditional societal structures like college or a “9-5” office job.

Gifted and autistic children can  ; Danielle Voit wrote an excellent analysis of this issue in Autism vs. Giftedness: A Neurobiological Perspective, positing that what many would call poor social skills can simply be the result of “an unforgiving social environment in which social relationships provide little benefit to the child.”

With that in mind, it can be helpful to create opportunities for friendships to blossom on the basis of truly shared interests, not just a shared age, classroom, or neighborhood. This may involve creating opportunities for interaction during extracurricular activities, and/or in safe spaces online. Easier said than done sometimes, I know! (Although, one of our recent blog posts shares some great resources in Ottawa County where that can happen.)

Ultimately, your child may be both gifted and autistic, but it would be an unnecessary process to try to pin down which different traits can or should be ascribed to each identity. These labels can help people find the resources and supports that they need, but they are fluid descriptions, not set-in-stone explanations of how a person should be expected to behave and why. The goal will always be to nurture your child as the unique individual that they are, in pursuit of their own personal hopes and dreams.

At Waypoints, we can help out with the diagnostic process as well as with ABA skills training. Please contact us with any questions at info@waypoints.life!

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When in life can autism be reliably diagnosed? The short answer to that question is generally two years of age or older. Of course, what this means in practice is a bit more complicated.

Autism has been introduced as a spectrum that ranges from “low functioning” to “high functioning.” However, we should not look at autism as a spectrum, and referring to a general “functioning level” can be very overly simplistic.

It is more like a spinning wheel with people falling in different areas of that spinning wheel. There are the foundational behaviors that allow a diagnosis of autism. However, diagnosis (including why and at what age it happens) is different for everyone.

For example, some people are reliably diagnosed with autism at a younger age, then you have people who are diagnosed later in life. At times, such individuals can receive testing even though, based on behaviors, they do not necessarily fall into the autism category.

This article will touch on typical characteristics of autism at any age and dig into the diagnostic process as it relates to age. We’ll also discuss the Waypoints approach to diagnosis and support.

a younger child doing diagnostic testing with a professional

Autism Spectrum Disorder as a Wheel

First, to reiterate, autism spectrum disorder (ASD) is not linear. It is more like a large wheel associated with the following characteristics:

  • Social skills
  • Fixations
  • Routines
  • Sensory issues
  • Stimming
  • Perception
  • Executive functioning
  • Other

Each child can fall anywhere within the wheel experiencing one or more of these characteristics. This might happen when they are a toddler, or it might become apparent later in childhood or into adulthood.

Stages of Autism Diagnosis and a Child’s Development

At times, children display some characteristics or developmental delays prior to the age of two, and screening can help determine if there is a need for an official diagnosis.

Typically, when autism is diagnosed earlier, it helps a child’s development. Being diagnosed by the age of two means the child can move forward with any recommendations to help improve the developmental delays.

According to the CDC, by age two, a diagnosis by an experienced professional can be considered reliable. However, many children do not receive a final diagnosis until much older. Some people are not diagnosed until they are adolescents or adults, thus delay means people with ASD may not get the early help they need.

Let’s look at the stages leading up to an autism diagnosis, specifically developmental monitoring, developmental screening, and developmental diagnosis.

Developmental Monitoring

Before a diagnosis or screening can be determined, you must observe if the child is meeting developmental milestones.

Developmental monitoring is an active process of watching and encouraging conversations between parents and providers about their child’s skills and abilities. Parents, grandparents, early childhood education providers, and other caregivers can participate in developmental monitoring.

Developmental Screening

Next, if family and educators notice some developmental delay, developmental screening takes a closer look. During the phases of life, well-child visits with the child’s pediatrician will also help identify any delay.

If the doctor notices some behaviors, they can recommend testing to determine a reason for delays. The idea is to consider the existence of autistic disorder or any other potential pervasive developmental disorder.

Developmental Diagnosis

The last part leading to an autism diagnosis is a developmental diagnosis. The development diagnosis does not necessarily provide an autism diagnosis, but it can indicate if there is a need for a diagnosis.

A formal evaluation is a more in depth look at the child’s development and uses resources such as the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) and other assessment tools. It may take up to a month to go through the steps to determine if a diagnosis is necessary.

Early Intervention Is Best for Children and Families

It is important to make sure services and supports are received as early as possible to ensure children can reach their full potential.

We never want to force a diagnosis, but careful observation of developmental milestones and early signs can determine if there is a need. The benefits of an early diagnosis can help the child receive all possible resources, which increase their chances of reaching their full potential.

The Waypoints Approach to Initiating Diagnosis

Waypoints Life monitors behaviors and conducts screenings to determine if there is a need for a diagnosis. If a diagnosis is needed, we conduct an assessment and develop a report to reflect the observations. Finally, we provide recommendations for the next steps.

Within this process, we provide the Autism Diagnostic Interview, Revised (ADI-R) to learn what parents are noticing and what teachers (if the child is in school) are reporting. If there is a need to move forward with an assessment, we schedule an ADOS-2 to observe behaviors reported by the family and school.

After the assessment and speaking with family, school, and others, we design a report to develop a comprehensive plan. From there, we provide recommendations to assist the family with the behaviors displayed during observation.

Waypoints Autism Spectrum Disorders

Waypoints’ process of screening and evaluating results in a solid plan that provides families with structured resources to assist in behaviors and skill development. We work with toddlers as well as older children with ASD.

Please, feel free to explore our site, refer to previous blog posts, and get in touch to learn more and how Waypoints is the best choice for supporting your child’s development.

 

References:

Screening and diagnosis of autism spectrum disorder. (2022, March 31). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/ncbddd/autism/screening.html

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Per the American Psychiatric Association, one of the factors by which autism is diagnosed is “persistent deficits in social communication and social interaction across multiple contexts.” This may take the form of, for example, difficulty with sharing interests and feelings with others, limited eye contact and gestural or body language, or trouble with identifying social cues. Overall, aspects of social development often occur differently or at a different pace for autistic people in comparison with their neurotypical peers.

Many “treatments” for autism, including applied behavior analysis (ABA) services offered by some organizations, focus on addressing these differences by teaching clients to conform with social norms and sometimes drastically change their behavior in ways that no longer align with their own interests and desires. This approach is based on the medical model of conceptualizing autism and other forms of neurodivergence: identifying things that are deemed “wrong” with a person and attempting to change or eliminate those things.

At Waypoints, we take a different approach to social skills, and all clients’ goals for that matter. If you’re interested, you can learn more about this in one of our previous blog posts titled “Why You Should View ABA as a Skill-Building Tool—Not ‘Therapy.’”

In this post, I’d like to say more about why it’s so important to celebrate the interests and expressions of all people, regardless of their diagnosis. I will also end with some suggestions for how to teach identification of social cues, with the understanding that how someone then reacts to those social cues is (in most circumstances) up to the individual.

Waypoints CEO David Bergrmark, with his sons following his social cues by imitating him on a walk.
Our CEO David Bergmark, with his sons following his social cues.

A Neurotypical Kid Who Ignored Social Cues

But first, I’d like to share some anecdotes from my own childhood, highlighting why I believe it is so important to respect peoples’ preferences and methods of socialization. Fellow humans who happen to be neurodivergent are more likely to have their behaviors pathologized, even when those behaviors are well within the spectrum of “normal” human experiences.

I was a neurotypical kid and am a neurotypical adult (for whatever extent to which we can call anyone “neurotypical”), but I was nonetheless a deeply strange child from my peers’ perspective. The old-fashioned dresses that my grandma made for me to wear were cute in elementary school but then mocked mercilessly in junior high. I never got into popular music, and got a lot of weird looks for my tapes and CDs ranging from jazz piano to alternative bands like (my favorite to this day) They Might Be Giants. I watched anime and played Dungeons and Dragons at a time when those were DEFINITELY not accepted in the mainstream, especially not for a little girl!

I could go on, but my point is that while I was teased, I was never pressured by my parents or other adults around me into changing my social behavior. One key point is that, even at the time, I recognized the social cues from my peers signaling to me that I didn’t fit in and that my few scattered attempts to do so weren’t quite right. For the most part, though, I didn’t really care. I was sometimes embarrassed or angry, but I never felt motivated to behave differently.

At all stages of my life, I was still able to find wonderful friends with shared interests. To the degree that one does in fact want to make friends, I believe that is the goal around which social skills training should be centered.

The Dangers of Enforcing Conformity

In May of 2021, I attended an eye-opening presentation by Madi Holcomb titled “Make Yourself Uncomfortable: Navigating Autistic and Allistic Social Communication Differences and Encouraging Authenticity.” Madi shared a self-assessment for autism at https://embrace-autism.com/cat-q/#test based on the following common actions on the part of autistic people:

  • Compensation – studying neurotypical social cues and incorporating them.
  • Masking – the daily practice of pretending to be neurotypical, and hiding autistic traits. This often leads to hypervigilance about facial expressions, gestures, etc. because of the impression that one’s own social instincts can’t be trusted.
  • Assimilation – buy-in to social norms with the perspective that one HAS to hide.

High scores on this assessment – that is, tendencies to engage in these actions – are correlated with depression and poor well-being. As such, I again argue that while it can be very helpful to teach people to recognize social cues, enforcing conformity based upon those social cues can be quite harmful. I really can’t say it better than Brian Middleton in his recent Facebook posts (as the Bearded Behaviorist) at both this link and this one. “The concept of appropriateness is difficult because it assumes that there is an agreed upon set of behaviors that everyone follows, yet the very fact that we use that term means that not everyone agrees.”

As a sidenote, though, autistic adults who have learned to mask over their lifetime may feel safer continuing to do so in some circumstances, and that should also be respected. In her Facebook account, Neurodivergent Researcher, one autistic practitioner shares a helpful anecdote to that effect at this link.

Important Social Cues

Autistic people are often stigmatized and teased for a lack of conformity with social expectations, such as repeating phrases from favorite shows or movies, using atypical tones of voice, expressing themselves non-vocally, or focusing the majority of conversations on special interests about which they are often deeply knowledgeable. These behaviors are not harmful or inherently dangerous; in our practice of ABA at Waypoints, we would only intervene based on the explicit request of our clients, with rationale based on their own personal goals.

With that being said, such goals might include making friends, and that is certainly something that an autistic child or teen could struggle with more than a neurotypical peer. In particular, autistic people may have trouble identifying and interpreting subtle cues such as tone of voice, body language, and non-literal language like jokes and metaphors. Learning to recognize these aspects of social interactions can also help one to recognize when others are not being friendly, such as in cases of bullying or lying.

Other important social cues that can directly affect safety and well-being include:

  • Others giving or withdrawing consent for social interactions, especially (but not limited to) those involving physical touch
  • Signs that others are not respecting one’s own consent for social interactions
  • Safety in speaking to family and friends vs. authority figures vs. strangers in different contexts

How to Teach Social Cues

A recent article by Christiana Butera and colleagues provides excellent insight into the fact that while autism is often associated with a harder time with “the ability to imagine how another person is thinking or feeling,” no such deficits appear to exist for “the ability to share and feel emotions others are experiencing.” Difficulty interpreting social cues may arise from difficulty interpreting one’s own physical and emotional states, let alone those of others, based on subtle external signs.

With this in mind, helpful skill-building techniques may revolve around mindfulness in the sense of focusing on the sensations and impulses within one’s own body, as well as learning to attend to external cues such as the location, people present, what those people are doing or paying attention to, and how they appear to be reacting. To that end, taking advantage of learning opportunities in day-to-day settings and interactions while providing very clear and direct explanations can be very helpful. Procedures to formally teach social skills and recognition of social cues can be incredibly complex and should always be individualized for each client, but here are some general suggestions.

Joint Attention and Social Referencing

Joint attention is the coordination of eye contact and other behaviors like pointing that leads to multiple people interacting with the same thing in the environment. Some signs of joint attention are a person shifting their gaze between the thing they’re paying attention to and other people in the room, or engaging in behaviors like pointing specifically to get the attention of the other person.

Social referencing is a similar concept to joint attention, with some additional complexities. Social referencing is based more on reacting to something in the environment in a similar way as another person, rather than simply paying attention to it.

For these behaviors to develop, it’s important for social interactions to actually be reinforcing! This can be accomplished by engaging with things in the environment that the person is actively interested in, not things that you think that they should be interested in.

One common step is to teach a learner to look at the same things that you’re looking at, and then look at your face or body language, with the goal of your behavior in response to those things affecting the behavior of the learner. This can help with giving warnings about safety concerns, but also with relating to peers when they’re excited about something.

Consent

This topic deserves its own blog post at the least, but it’s important enough in the context of social cues that I wanted to mention it here too. These suggestions come directly from my dear friend and colleague Worner Leland, who I trust more than anyone when it comes to teaching and respecting consent.

One important aspect of consent is to learn that someone saying “no” in the moment must be accepted, but furthermore that several repeated “no’s” over time on the same topic means that the request probably shouldn’t be made again.

Adding complexity to this issue, some people may not want to be impolite, or may not feel safe explicitly saying “no.” In such cases, a learner must try to attend to those subtle cues such as tone of voice, body language, and non-literal language. Sometimes, clear rules about this can help. For example, if you’ve asked about the same thing three times and haven’t received an enthusiastic yes, then that person should be left alone about that topic for at least X-amount of time. These scenarios can be practiced through roleplay and in real life with low-risk requests like asking to borrow something!

Learning how to give and withdraw consent is a whole ‘nother issue. Autistic people are often taught “compliance,” with an emphasis on obeying authority figures. I hope that it goes without saying that this can be very dangerous if compliance overgeneralizes. The blog Real Social Skills (which I highly recommend) discusses this topic. My foremost suggestion for teaching this skill is to give opportunities for choice-making throughout day-to-day life, and respect and praise the learner’s choices and boundary-setting.

Social-Emotional Learning Curriculum

There are entire curriculums dedicated to teaching social skills and identification and expression of emotions, both in the classroom setting and for independent or self-guided learning.

One excellent option is the Social-Emotional Acuity Bridge offered by Bridges Learning System, with a free demo available at this link. This isn’t a paid advertisement; this is just the best curriculum I’ve found yet! A wonderful first-hand account review by an autistic parent of an autistic child can be found at this link. As she puts it, “the truth is, adult providers and educators need this more than children do. Adults have had more years of being socialized into harmful perceptions and norms. Even as an autistic, dyslexic, ADHD person, I caused harm as a teacher (to myself and my students) because no one had ever given me permission to regard my differences as anything but something to be ‘overcome’ or to hide in shame. Everything I had learned was coded in shame.”

Another option for learning these skills is neurodiversity-affirming social groups and activities; you can find some suggestions for local Michigan options in our recent blog post here. And as always, you can learn more about the services that Waypoints offers at https://waypoints.life/our-services/aba-skills-training/!

Please feel free to contact us at info@waypoints.life if we can answer any questions.

Related Articles

Get in Touch With Waypoints

Whether you’re looking for diagnostic testing, one-on-one in-home ABA therapy and skill-building resources, or simply want to learn more about our unique approach, please don’t hesitate to reach out! (We love getting mail.)

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Every autistic person is different, and they and their families have unique needs. So, finding the right support services can go a long way toward making life a little easier!

Waypoints offers one-on-one applied behavior analysis (ABA) sessions, which can help with goal setting, education, self-help and -advocacy, and general skill building. You can learn more about our use of ABA at https://waypoints.life/our-services/aba-skills-training/, as well as in previous blog posts such as Applied Behavior Analysis in Simple Terms and What ABA Therapists Do.

However, ABA is not the be-all and end-all. Depending on your and your family’s goals and needs, other therapeutic services and disability-accommodating events and activities can be just as, if not more so, helpful.

a boy with arms outstretched riding on the shoulders of his father

Therapeutic Services

Outside of ABA, other helpful therapeutic and educational services include occupational therapy, speech therapy, clinical child or family therapy, and specialized school settings. You can learn more about various alternatives and supplements to ABA in another one of our blog posts here!

  • Heartstone Guidance Center offers explicitly neurodiversity-affirming therapeutic services to help with “processing difficult life events, reducing life stressors, enhancing your coping strategies, processing grief, reducing anxiety, improving relationships, exploring or discovering your authentic life path, reconnecting with yourself, etc.”
  • For younger children up to age 3, Michigan’s Early On is an excellent resource for referrals to support services. “It’s designed to help families find the social, health, and educational services that will promote the development of their infants and toddlers with special needs.”
  • For children ready to start school, the Michigan Alliance for Families can provide support in accessing high-quality special education.
  • Later in one’s education, Project SEARCH “provides local high school students with disabilities the opportunity to train, gain, and maintain employment through businesses and organization opportunities.”
  • At Waypoints, we are contracted with Ottawa County Community Mental Health (CMH). Scrolling down a bit on their website, you can find a list of mental health supports that offer telehealth and/or online services.
  • The Ottawa County CMH is in turn overseen by the Lakeshore Regional Entity provider network. You can search the entirety of each regional provider network at this link!

Disability-Accommodating Events and Activities

Outside of strictly therapeutic or educational resources, events and activities that actively accommodate diverse needs also offer wonderful support in day-to-day life. Some examples that you might want to keep an eye out for include neurodiverse social groups, sensory-friendly options at museums and parks, and neurodiversity-affirming events.

  • Also on the Ottawa County CMH website, you can find a list of social and recreational programs for adults with disabilities.
  • In 2021, Grand Valley State University began the START Project, which pursues intentional accommodation of neurodiversity and “inclusivity, equality, and acceptance of autistic individuals as part of our society.” Their website provides an incredible wealth of resources including information about peer-to-peer activities, frequently asked questions for families, and much more.
  • As reported by our own Brittany Wick, the Children’s Museum in Grand Rapids does a phenomenal job catering to sensory-sensitive families.
  • Blandford Nature Center provides opportunities for hiking, playing, and learning. It is in general a peaceful area, but they have also been hosting explicitly sensory-friendly evening events and guided hikes.
  • Arts in Motion, in Grand Rapids, “provides opportunities for individuals with disabilities to express themselves, develop peer relationships, and improve motor skills through the creative arts.”
  • In Wayland, Paws with a Cause is a non-profit that helps to train specialized assistance dogs, including service dogs for autistic children.
  • At Legacy Stables, Karin’s Horse Connection specifically accommodates guests of all abilities. An online review states, “Karin’s Horse Connection offers therapeutic riding for those with special needs, both physical and mental. My son goes to Karin’s and LOVES it! It has really helped with his core strength.”
  • The Holland Aquatic Center offers aquatic therapy, specialized swimming lessons, and handicap-accessible pools and splash zones.
  • The Autism Society of Michigan provides a helpful search engine at this link, allowing you to find resources by both county and by service type.
  • Even more sensory-friendly activities in Grand Rapids can be found in this article!

Any Suggestions? Contact Us!

Whatever your needs, support options are available for you. We at Waypoints can be a part of your support team and can also assist you in accessing other services as needed.

As always, you can learn about the services available at Waypoints here on our own website, at https://waypoints.life/our-services/. If you have any suggestions for additional resources that we can list here, or if you would like further assistance seeking out options, please don’t hesitate to contact us at info@waypoints.life!

Related Articles

Get in Touch With Waypoints

Whether you’re looking for diagnostic testing, one-on-one in-home ABA therapy and skill-building resources, or simply want to learn more about our unique approach, please don’t hesitate to reach out! (We love getting mail.)

This field is for validation purposes and should be left unchanged.
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