autism teletherapy

Teletherapy for the Autistic Child Must Include These 3 Principles

Some say that if you have met one child with autism, then you have met only one child with autism. That is because every child who is on the spectrum has an entirely different diagnosis and therefore has a unique set of needs and strengths. Consequently, it's impossible to design a uniform teletherapy plan for the autistic child.


At the same time, there are three fundamental principles that can serve as a general framework and guide an effective treatment plan for the autistic child to whom you are delivering teletherapy.


1. Establish Communication That Is Spontaneous and Functional

You must deal with first things first. Your initial goal in the teletherapy session with an autistic child is to assure that her communication is both functional and spontaneous. In other words, the child must have the capacity to communicate her basic needs and desires to those surrounding her independently, without being prompted regularly.



Sometimes the child's speech is so dysfunctional that introducing some form of augmentative-alternative communication (AAC) is necessary until a more organic method can be found. And even here, you need to be flexible as different forms of AAC work more effectively for different children. Some of the options available are:


  1. Voice-Output AAC Device: When the child hits a switch or pushes a button, the device delivers an auditory message. These devices are often straightforward, easy to use, and quite effective in allowing the child to communicate.

  2. Picture Communication System: For some children, communicating through pictures or object exchange is more concrete, and are therefore the methods of choice. Another phase in the system is introducing a simple communication board and teaching the child to point to the picture that conveys what she wants. A next can be incorporating the board into a voice-output device as mentioned above.

  3. Sign Language: For some autistic children, sign language has proven to be very useful. Using their body to communicate the message has another significant benefit as well. It has been shown that many of these children become verbal quicker than they would have without sign language.


The Importance of Helping Children become Spontaneous

Many autistic children suffer from the deficit of being unable to speak spontaneously. They won't initiate dialogue, even in expressing their own needs, but will merely respond to another's initiation.


This being the case, it is imperative to gradually fade cues that prompt the child to speak, and thereby cultivate the child's facility to speak independently. There are many ways to fade cues for the child. And it is often the synthesis of the particular child's challenges and the SLP's creativity that will yield the most effective approach.


Another approach that has been effective for some therapists is first to teach the autistic child basic requests for those things that will be the most motivating to the child. And then gradually move on to more abstract interactions such as greeting, or commenting. Sometimes just opening that verbal door will lead to unexpected results!


2. Weave Social Communications into Daily Life


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Once the autistic child's communication has become both functional and spontaneous, it is time to move on to the social realm. In this area as well, autistic children require direct instruction; if for no other reason, but the fact that understanding someone else’s behavior is difficult for autistic children.


What most children pick up naturally in their social interactions beginning in playgroups or daycare, and continuing into Elementary School, doesn't often happen for autistic children. These children demonstrate poor understanding of how to behave or act appropriately in social situations. This deficit if not resolved will invariably carry beyond the social dimension of school and negatively impact learning.


Socially Acceptable Behaviors Require Direct Instruction

It is imperative to explicitly teach autistic children what is both appropriate and inappropriate in various social environments. This goes beyond instructing the child as to what can and what cannot be said, but includes how the child should listen and react to others as well.


Regarding younger children, the focus will be on necessary skills such as listening when the teacher is speaking, following directions and answering the teacher's questions. As the children become older, the lessons will focus on communicating with a friend and participating in group conversations.


Social instruction strategies that have proven effective for autistic children include:

  1. Visual Supports: Strategically planting visual reminders in the classroom to assist the child in remembering expectations for different situations.

  2. Social Stories by Carol Gray: Reading stories that will teach the child what behavior is expected in various situations.

  3. Video Modeling: Showing the child videos that demonstrate expected behaviors.


3. Peer Interactions Need to be Targeted

While teaching autistic children the basics of social communication is necessary, it is in no way sufficient. Think about it, just learning what to say on the one hand will help the autistic child to be appropriate. On the other hand, it may leave the conversation with a peer stilted and lifeless. Much more needs to be done to help these children have healthy social interactions and relationships.


The more subtle art of communication can be taught to autistic children. However, it is critical to remember that the skills to impart must be developmentally appropriate.


Peer Interaction Skills for Younger Children

  1. Play skills: Young children need to graduate from parallel play and be taught how to play with others, taking turns and getting along without fighting.

  2. Responding to Name: Show these children how to react when someone says their name.

  3. Developing Attention Skills: Help autistic children to become tuned in to other children's reactions and feelings.


Peer Interaction Skills for Older Children

  1. Targeting Conversational: Observe the autistic child's conversations to determine which social skills are lacking in regular dialogues and interactions with other kids and adults. Focus on these specific skills in the session.

  2. Learning How to See Other Perspectives: An autistic child is often “trapped” inside his world. Consequently, the notion that there is such a thing as another's perspective is entirely beyond his grasp. Therefore the concept of another perspective needs to be introduced and explained, so the autistic child begins to realize that there is an "other."

mindfulness in teletherapy

Need to Transform the Teletherapy Experience? Time for Mindfulness!

Fact: Mindfulness is now the fastest-developing area in mental health. And because of this, more and more SLPs should be integrating mindfulness into their teletherapy sessions. But what is mindfulness? Mindfulness is awareness with intention and without judgment of what’s happening - as it’s happening - in the present moment.

3 Mindfulness Benefits for Teletherapy

1 - Finding a Therapist’s Refuge in Mindfulness

As a teletherapist, mindfulness can enhance your emotional well-being, helping you to develop critical therapeutic qualities such as acceptance, attention, and compassion. When you practice mindfulness, you bring awareness to experience the present moment. You will learn to let go of ruminating about the past or worrying about the future, and return your attention to what is happening with you and the client right now.

You can begin by focusing on the various sounds you hear in the room, the sensations of your breathing, or the feeling you have of sitting in a chair with your feet touching the floor beneath you. As you develop this new skill of openness and acceptance of whatever is emerging at the moment, you will be more present in both your experience and the experience of others.

This will lead to becoming less preoccupied and distracted with your concerns, and more available to what is happening at the moment in the teletherapy session. As a result, you will be able to engage the child and respond more fully and accurately.

Research performed recently shows that therapists who have committed to practicing mindfulness reap a variety of benefits. These include decreased stress and burnout, greater self-compassion and self-acceptance, and an overall sense of well-being.

Which one of you isn’t all in for that?!

What’s more, many of these clinicians have reported significant improvements in relating to their clients, as their capacity to be empathetic has grown.  What often ensues is an enhanced ability to be less reactive or defensive when experiencing the client being angry or frustrated with the therapist.

Not every mindfulness technique is complicated. Some of the simpler interventions take only a minute or so. But they provide the critical benefit of allowing the therapist to return to the present moment and quickly reconnect with the child, sometimes salvaging the session.

Let’s say you feel that the child is very frustrated by her failure to perform to your expectations, and is on the verge of “calling it a day.” Her frustration can easily cause you as the therapist to feel some anxiety about losing the session and possibly having long-term implications on your relationship with the child as a result.

Face it. You don’t know how to react. Mindfulness teaches that, before responding, you could pause momentarily, notice your breathing, become aware of the other sounds in the room, or the sensation of sitting. This self-regulation takes only a minute or two, but it can restore your balance and help you to be less reactive in the heat of a tense moment.

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2 - Mindfulness Deepens Therapeutic Relationships

Studies conducted recently show that most successful therapists, regardless of their arena, are those who are perceived by their clients as understanding, accepting, and warm. It has been shown repeatedly that practicing mindfulness is a very effective way to develop these qualities.

When therapists lack mindfulness training, they invariably attempt to maintain their attention by either becoming more intense or ratcheting up the volume. Alternatively, therapists that perform with the benefits of mindfulness find that their focus and concentration see marked improvement during the session, especially when their minds begin to wander.

Another benefit of mindfulness techniques is that such practices often become powerful tools to raise the threshold of tolerance for painful emotions. Usually, when the child expresses intense emotion, the empathetic clinician will absorb those feelings and be dragged down by them. However, mindfulness provides a natural shock absorber to protect the therapist and keep the session moving in the right direction.

The benefit of this aspect of mindfulness carries far beyond the therapy session. Learning how to absorb the discomfort of powerful emotions by leaning into them instead of running away from them helps the clinician to enhance her ability to tolerate pain of all sorts. This ultimately helps the therapist to become a more balanced person in general.

3 - Sharing The Mindfulness Tool with Children

The best way to introduce mindfulness to children is to present it as an experiment or just another game. Explain to the child that many others have found this experience to be useful, even fun, and encourage him to try it. The child will probably be curious and find it relaxing. Go slowly the first time. You can always add more.

Be sure to elicit feedback so that you can adapt methods and practices to what seems most effective. As is true in many things, there is no “one size fits all” when it comes to mindfulness. Innovations abound, so do your research to find just the right fit. Educate the child that mindfulness is not meant to prevent unpleasant thoughts but rather to become more accepting of them.

Don’t lose sight of your goal. You aren’t trying to turn this child into a mindfulness meditator, but rather help your client to become kinder to herself, more balanced and accepting. The research shows that even a little bit of mindfulness can make a real difference. That being the case, don’t you owe it to your little client to pass it on?

Children can gain these three essential skills through mindfulness:

  1. Self-Regulation - This is the ability to become more aware of the bodily sensations that accompany moments of emotional intensity and the capacity to self-soothe.

  1. Self-State Awareness - This is the ability to identify habitually ingrained coping strategies that effectively imprison the child in those habits, and the corresponding ability to step out of them, creating the potential to cope in healthier ways.

  1. Self-Compassion - this is the practice of reducing self-criticism and shame by developing a deeper form of self-acceptance and self-love.

rural teletherapy

Boundary Challenges for Therapists Serving Rural Communities

What are Boundary Challenges?

When you stop to think about it, it is surprising how often therapists are confronted with boundary issues in the rural communities they serve. And while one might think that this is only true for mental health therapists, the truth is that these challenges exist for occupational and speech therapists as well.

In rural communities across the country, many unanticipated interactions between therapists and their clients are unlikely to pose any significant threat. Take, for example, when therapists and clients encounter one another in the local grocery store. While this brief, unexpected meeting may be awkward, it won't negatively impact the therapy nor the client-therapist relationship.

But at other times, those encounters can be problematic both in the short and long term. So, the question is, "How does a therapist set clear, appropriate boundaries that will maximize the therapy without sacrificing a healthy therapist-client relationship?" The answer lies in understanding that boundaries are invisible lines of demarcation. While creating a sense of separateness, this separateness is an essential requirement of maximizing the therapy, empowering the client, and actually bringing the therapist and client closer together.

Are Boundary Challenges Unique to Rural Areas?

Therapists who provide their services in rural communities aren't the only ones who face the challenges of setting boundaries. As it happens, therapists who work with members of their religious or faith communities face similar problems as well. What happens when the client and therapist attend the same religious services week after week?

What’s more, any therapist could be faced with the dilemma of becoming friends or getting involved in a business deal with a former client. And what about attending social engagements where a current client will be present as well?

However, there are specific boundary issues that exist in rural communities which are unique and demand both sensitivity and skill to navigate successfully if both the client and therapist are to escape unscathed. In a small community, therapists live with the constant awareness and concern that they will be "bumping" into their clients or the client's parents regularly. Or that they will be engaged in an activity together totally unrelated to the therapy being provided.

Liabilities of Dual Relationships

Dual relationships are sometimes unavoidable in rural communities. Sometimes it’s nothing more than the lack of people around that fosters overlapping relationships in any number of ways. This could be the overlap of therapeutic and social relationships, business relationships or even other professional relationships.

Once the higher likelihood that a dual relationship will occur is recognized, it behooves the thinking therapist to anticipate one of these intersections and begin preparing for it. Where appropriate, therapists should speak with their clients or their clients' parents to plan as to how they deal for these potentially awkward situations.

On the other hand, if the therapist allows the practically inevitable to occur without a discussion beforehand, the client may be confused by the therapist's inconsistency.   Today the therapist is so friendly, and tomorrow she comes off as a cold professional keeping her distance.

Client Confidentiality

Perhaps the most crucial reason for the therapist to establish healthy boundaries is to protect the confidentiality of the client. While privacy is essential in any therapeutic relationship, due to the unique dynamics in a rural community, the importance and consequent challenge for the therapist is that much greater.

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Assume you, the therapist, are dining in a local restaurant, and your young client approaches you. Others in the restaurant will interpret the approach itself as an indication that the child is one of your clients. Engaging the child will confirm it, while being standoffish may seriously impair your therapeutic relationship. Checkmate!

In a similar vein, given the size of the rural community, it is likely that some of your clients know each other. This means that even an unintended slip of sharing confidential information regarding one client with another could be damaging. While just an innocent mistake, if the client thinks that his trust has been betrayed, the therapeutic relationship with the client will be imperiled.

What Is The Answer?

In some cases, therapists and their clients can brainstorm together and come up with straightforward ways to solve these potentially thorny boundary issues. Take, for example, if the therapist's client works for the only plumber in town. An easy solution would be to have the client to ask his boss to send someone else to fix the therapist's clogged drain.

Suppose one of the local organizations is sponsoring a trip that needs chaperones. If the young client is attending, it would be advisable for the therapist to refrain from chaperoning the trip, to avoid a potentially uncomfortable boundary conflict.

On the other hand, there are boundary issues, be they actual or potential, that are much more challenging to manage. Take, for example, when the client's father owns the company where the therapist's wife works. This may pose an unavoidable conflict that is going to require loads of respect, sensitivity, and wisdom.

In such a circumstance, where the connection cannot be avoided or severed, it behooves the therapist to broach the boundary issues with the client or the client's parents as early in their relationship as possible. They need to discuss reasonable ways of handling potentially awkward circumstances comfortably and respectfully.

The short answer is that there is no single answer as to the appropriate response to these and other boundary questions. It is very important for therapists, especially in rural communities, to be aware of potential boundary issues. It is only then that they can craft strategies or consult with others who may be helpful in solving these issues.

Be Prepared To Maximize Your Opportunity

The opportunity to serve rural communities is exciting, fulfilling and,  at times, challenging. The same small and tightly-knit community that is at the core of some of these more difficult boundary issues is the reason that many therapists find their work so fulfilling and meaningful. Don't be intimidated by these boundary challenges. They can and will be solved!

Global Teletherapy is Moving to a Bigger and Better Space

To keep pace with its extraordinary growth, Global Teletherapy will relocate to the Commerce Center at 1777 Reisterstown Road in Baltimore, MD in August 2019 where it will triple the size of its office space.

At the core of Global Teletherapy’s business model is their commitment to delivering high-quality service to their clientele. In this vein, the company recently added a Human Relations Business Partner, a Marketing Manager, and a Project Management Supervisor. To maximize the effectiveness of these and their other expanding departments, while simultaneously accommodating the continuous growth of its administrative staff, Global Teletherapy had no choice but to substantially increase its office space. 

Global Teletherapy’s CEO and co-founder Alan Goode had this to say, “To keep up with the rapid influx of new schools and therapists who serve them, we need to expand our highly qualified staff to ensure our renowned customer service, and position the company for further growth. Relocating to a much larger office facilitates this, and allows us to respond to a teletherapy market that is growing at lightning speed.”

Get your free copy of our groundbreaking ebook: Teletherapy Diminishes Client Engagement: Debunking The Myths

Global Teletherapy is Moving to a Bigger and Better Space