Autism Telehealth: Engaging Autistic Children through Telehealth

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HERE IS HOW

Getting a child to sit down for anything but their favorite television show or YouTube unboxing video for more than an hour can be challenging. Navigating a full autism telehealth or autism teletherapy session can be more than challenging for both the therapist and parents when trying to engage the child. Even pulling out all the stops when it comes to activities for autistic children does not guarantee maintained attention.

What can behavioral analysts and other behavioral professionals do to maximize effectiveness when delivering autism telehealth services? Thankfully, Doctors like Dr. Kristin Sohl of Missouri Health Care have devoted time and effort to identifying answers to this important question. While there are no guaranteed approaches when it comes to autism teletherapy, the collection of tips and approaches below will likely contain at least one or two items that will prove helpful and effective for your autism teletherapy sessions.

An Ounce of Preparation Can Help The Autism Telehealth

While telehealth sessions are the “main event,” there’s much that happens in advance to help increase the possibility of a child maintaining some amount of focus and participation throughout a session.

First, clinicians should talk with the parents to explain the process and what they might expect. Engaging the parent is the first step to engaging the autistic child. During this pre-teletherapy meeting, therapists can offer parents several key pieces of information, including:

How to arrange the room where autism telehealth service will be delivered, including, if possible, the use and placement of several cameras for the therapist to be able to see the client and what they are doing even if they do not stay directly at the computer. For example, if the parents(s) have a smartphone, iPad, or other digital devices with access to the Internet, these devices can be positioned strategically to allow the therapist to use a multi-point video platform to see all three cameras on their single screen when interacting with the child. This also allows the therapist to utilize a wider range of activities for autistic children.

Cameras are optimally placed with stationary holders such as a wide-mouthed cup or glass to prevent the camera from being dislodged and falling over. It is best to encourage parents to prop devices into stationery holders. Pillows are not the best choice, as phones can flop over. Autistic children are not often able to redress the device prior to carrying on with the session. Having access to the parent can be challenging as well if the child is using their phone. 

Cameras would optimally be positioned to show the child’s face, with another one on the child’s desktop where games can be seen and one in the corner of the room.

• The primary camera is likely to be already positioned on a desktop.
• The second device can be positioned to allow the therapist to see the child’s hands as well as much of the desktop. The goal of showing the child’s hands is to allow the professional to work more closely with the child and to thereby increase engagement.
• The third camera would optimally be positioned in a far corner of the room, to allow the therapist the ability to maintain visual contact with the child if they get up from their seat and move to another location in the room. Every situation will demand adaptations, but this type of camera configuration has been shown to be optimal.

Below, detailed instructions for parents will be provided.

Involving Parents Yet More in Autism Telehealth

Record the session for parents to use as a resource in the future if that fits your autism teletherapy treatment model. If recordings are shared with parents, be sure to advise them regarding how to protect privacy when storing these files in their own technology. A suggestion and video explaining how and where to upload such recordings to a HIPAA-compliant service are crucial. Having one of these videos pop up five years down the road by another family member, friend or intruder could be harmful to the child and or family system. See HIPAA Compliant Cloud Storage: Is Your Practice at Risk?

Encourage a parent to be either present or close by during each session for client and clinician support, and particularly if their telephone rings with a call from you, the therapist. If a parent is using their phone to help with the session, the video platform that you select for autism telehealth would need for all incoming calls to be heard.

Parents can also be asked to routinely provide insight to you before a session that can help things go more smoothly. Again, the clearer an idea of the client the therapist has, the more effective they can be at selecting activities for autistic children that provide the best fit. Some questions to consider:

• What are the child’s interests? See this specialty autism website for more suggestions: RaisingChildren.net 
• If the child has a favorite toy or other objects that they use for comfort, what are their name? Which words to use to ask the child to access it, and where you can direct the child to find it if the parent is unavailable when it is needed.
• Ask for any and all relevant medical information at every session. In essence, you will want to know if the child is well, and if not, what is happening and what you need to watch for as you proceed with your work that day.
• Which strategies are currently being used by the parent(s), and how effective have these strategies been for them. Parents may also be open to strategies that you can teach them to expand existing attempts at soothing, educating, rule enforcement.

The parent should also take the time to prepare the child as best possible. This should include describing the purpose of the session, how long it will last, and what your role is. You might offer them suggestions for showing your picture to the child prior to your first meeting, as well as how to introduce you at the first meeting. You may want to know where the parent will be while the session takes place.

Parents should consider helping with the transition into session by accompanying the child at the start of the session by:

• Introducing or reminding the child of who you are and your role
• Describing any recent milestones, achievements, or setbacks
• Reporting how the child’s mood was just before the start of a session 

These considerations should, of course, be customized to the parent’s as well as the child’s level of understanding.

While The Autism Teletherapy Session Is Underway

You may want to set the tone and tempo of the session. If the child usually struggles with transitioning away from previous activities, incorporating what they’re already doing into the work can be tremendously helpful. If the child has shown more of an ability to shift focus, using familiar objects such as flashcards, Legos or familiar games such as Simon Says can be useful tools to gain and maintain their attention when delivering autism teletherapy services. Mixing and matching the clients’ interests with activities for autistic children that have been demonstrated effective can be a great way to serve the client while keeping them interested.

The Post-Game To Reinforce the Autism Telehealth Experience

When an autism telehealth session ends, it again falls to the parents to provide effective reinforcement to hopefully inspire participation going forward. Parents may consider any of the following to help the child integrate the autism teletherapy experience:

• A token economy in which session participation earns a symbolic item (stars, checks, plastic coins) that will allow them to “buy” a physical reward or a sought-after experience when the client has gained enough of them.
• Video game time
• Other screen time
• Praise
• Time engaging in a favorite activity or with a favorite person

Parents can also set the table for the next session by asking the client what he or she enjoyed in the session. Again, the better idea a clinician has about what activities for autistic children hold the most appeal, the more effective future sessions can be.

Again, none of these will guarantee a child will pay attention and focus through an entire autism telehealth session. Nor will they always work as well as they did the week before or two weeks later. However, by considering each stage of the telehealth session as a separate component with its own strategies—before, during, and after—and by trying several if not all the techniques described, your chances of success rise significantly. Additionally, the more the child and parents succeed, the more likely they will maintain that momentum.

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