Total Occupational Therapy

26/11/2025

18/10/2024

The difference between a compliance approach and an approach that supports and honours individual differences is very clear to see in these visuals.

11/10/2024

Why is “Is it sensory or is it behavior?” the wrong question to ask? Oct 11 Written By Amy Lewis The question “How do you know if it is sensory or behavior?” comes up over and over again in the world of occupational therapy practitioners (OTPs) and I have addressed it on a surface level in t...

10/08/2024

This says it all.

There's a whole lot of things that I 'just need to learn how to do.'

The truth is- I can do a whole lot. Until I'm dysregulated. Until I'm maxed out. Until I'm overcome with emotions.

Then I can't do a damn thing.
Logic or no.

If I want to get back to my logic, I need help coregulating first.

It has to happen first.
It doesn't work in reverse.

If you want good stuff from me, you need to take some stuff out of my hands.

Yes?

Em

18/05/2024

There’s a lot to more consider than the ability to read early.

WHAT IS HYPERLEXIA AND HOW CAN IT AFFECT THE AUTISTIC CHILD'S SCHOOL EXPERIENCE?

A child is considered hyperlexic when they develop a precocious ability to decode words and read well beyond what is expected for their age. Hyperlexia is common in autism (between 6-20% of Autistic children are hyperlexic), and 84% of all hyperlexics are Autistics, according to McGill University. DOI: https://doi.org/10.1007/s10803-021-05057-x

Hyperlexic children often show an intense interest in numbers and letters, and their favourite toys may be magnetic letters they can play with on the fridge door, or felt letters they can arrange on a felt board. They prefer books and these alphabet play letters to more common types of toys.

Parents can be forgiven for thinking their little miracle is gifted when their child starts decoding words and reading fluently at the age of two, three, or four, or five years of age. Well, sometimes they are gifted, but other times--many times—the hyperlexic Autistic student struggles with learning disabilities and executive functioning skills needed for learning.

Let’s take a deeper look at some areas of struggle for hyperlexia Autistic children may experience at school. Keep in mind that not all hyperlexic Autistic children will be reflected in these examples:

COMPREHENSION: Their precocious reading skills may mask the fact that they do not understand what they are reading. They may not understand the meaning of individual words, or comprehend the entirety of the information they are able to read aloud so beautifully. The huge gap between their fluent reading/decoding skills and comprehension can cause problems. It can affect their self-confidence. After all, everyone says they are so smart, but they are not able to pass tests or answer questions related to the reading material. The child may struggle to mask their difficulties as they try to maintain the pride they feel from praise for their reading ability. As well, advanced reading skills can mean the child falls through the cracks. As teachers focus support on children who are learning or struggling to read, the Autistic hyperlexic child struggles alone with their lack of comprehension of the reading material.

LITERAL INTERPRETATION OF LANGUAGE Autistic hyperlexia children, like most Autistic children, understand language in very literal terms. This can mean nuance, humour, metaphors, inference, idioms and turns of phrase used in books are often misunderstood. This can lead to frustration and anxiety. A child may feel they understood the text perfectly well, only to find that are way off the mark when it comes to understanding what happened in a story. This can contribute to them misunderstanding the characters, and not catching on to the themes or plots in the text.

WRITING SKILLS While they demonstrate excellent reading/decoding skills based on their age, the hyperlexic Autistic child can struggle to produce written work. The challenges can be related to retrieving words to express their thoughts, and in organizing their thoughts on paper. Like many Autistic people, they may also have struggles with fine motor skills, where the requirement to print or write by hand is onerous, uncomfortable, and even painful.

CONCRETE THINKING While the hyperlexic Autistic child may be a skilled reader, they may only be motivated to read fact-based, non-fiction books, or books based on their areas of high interest. When asked to read a novel, it may be impossible to sustain attention on a book where nothing is real—it is all made up. Similarly, when required to read three pages of a history book, it may be difficult or impossible to initiate and follow through with that task.

MATH WORD PROBLEMS Just as they may struggle to understand the text they are reading, the hyperlexic Autistic child may have difficulty with word problems in math. While they can read the question beautifully, understanding what the question is asking can be a real challenge.

When the child cannot do the work, the emotional brain may take over (the amygdala/emotional brain from the thinking brain/pre-frontal cortex where executive functioning skills are located (i.e. task initiation, self-regulation, attention, organization, time management). At this point, the child who actually can’t do the work appears to be refusing to do the work.

Their appearance of academic competency leads teachers to believe the student is choosing not to do the work. They miss the reality that the student needs help and attribute it to work refusal, laziness, or inattention.

SOCIAL COMMUNICATION DIFFICULTIES: Many autistic children, including those with hyperlexia, have challenges with social communication and interaction. This can affect their ability to engage in group work, follow social cues, and participate in class discussions, leading to social isolation or misunderstandings with peers and teachers.

SOCIAL-EMOTIONAL IMMATURITY Teaching staff may have difficulty reconciling the advanced reading ability with the child’s everyday struggle to manage their emotions. As expected for their age. When they don’t understand instructions, the hyperlexic Autistic student may be unable to ask for help. Instead, responses such as protracted crying, eloping from the classroom, hiding under their desk to cope or other behaviours that are disruptive to the classroom. These emotional responses are in stark contrast to their age and precocious reading abilities.

Hyperlexic Autistic children benefit from teachers who understand the unique learning needs that can accompany Autism and contrasting strengths and needs of hyperlexia. They must have staff who understand the challenges they may have in expressing their struggles, and who know their reading skills may not reflect comprehension of writing abilities.

Were you hyperlexic? Do you have a hyperlexic Autistic child? Let us know what struggles you have experienced, and what approaches you found helpful.

18/05/2024

Great information

One challenge in neurodiversity-affirming and strengths-based practice is supporting the stims of autistic children while ensuring a functional learning environment for other children.

Autistic stims are regulating to autstic kids, but at times these stims may get loud. In order to shift stims or support autstic and all kids better, we must understand how vocal stims benefit autistic kids.

This visual shares some of the reasons why autistic people embrace vocal stims. But remember, these are always only best guesses! Autistic people are unique, so we can never make assumptions. We can ask and explore and try our best to understand.

How can we support all students in a classroom?

Try these ideas to embrace strategies to support all kids!

What ideas am I missing?

How do you support all children when some kids tend toward noisy stims?

14/02/2024

WHAT KIND OF COMMUNICATION EXPERIENCES CAN SPEAKING AUTISTICS HAVE?

Edited Jan. 30, 2024.
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This we know for certain.

Very few professionals understand what it means to be Autistic. Nowhere is that more apparent than in the lack of knowledge around communication challenges in verbal Autistics without an intellectual delay.

They call us 'high-functioning', but we know high-functioning does not mean low needs. Functioning labels do harm by denying support to those who need it.

Take the very real communication challenges that many speaking Autistics may experience:

** we may not be able to communicate with spoken words in some situations. When we are anxious, overwhelmed, or face a new or unexpected situation, we may experience ‘situational mutism’. (We don’t like the term ‘selective mutism' because it suggests we are making a choice to remain silent. Selective mutism can be misinterpreted as rudeness, inattention, disinterest, or an intellectual delay.

** we may not be able to say what we need. It may feel like asking for help is a weakness, we may struggle to approach you, or we may just not know what words to use to make the request.

** we often have great difficulty asking for help, whether it's related to our emotional state, a school or work problem, or something related to social understanding. This is often because we have too much anxiety around the process, but it can also be because we don’t know what words to use to make the request.

** we can become fawning people-pleasers because we struggle to stand up for ourselves. We don’t want others to become angry or disappointed with us, so we go along with what they want with no attention given to our own preferences or needs.

** It is hard for us to say "No" when we need to—like when we have no more capacity to take on more tasks. As well, we may say we agree with someone’s position on a topic when we don’t because it is very difficult for many of us to have interactions that may cause or involve conflict. We might struggle to say, “Yes” if it means we have to reverse a previous, “No”. We just want the conversation to end so we may say whatever makes you stop talking.

** We may communicate very effectively in written form but struggle to communicate our thoughts in spoken language.

** we are commonly rule-bound and may unintentionally alienate others by 'policing' them'--pointing out their mistakes and trying to enforce rules. This makes others not want to hang out or make friends with us. Apparently, our love of rules doesn't jibe with NT social communication expectations.

** we may love to share information on our favourite topic, and our communication partner may be unable to get a word in to contribute to the conversation. It is less an exchange of information and more like a lecture. We might be unaware of your boredom, and as you back away from us, we may follow and keep talking. We don’t always pick up on the intent of your body language.

Info-dumping, as it is often called in the Autistic community, is not a problem for us—we love talking about our interests, but NT culture does not appreciate what they describe as our ‘monologuing’ and lack of awareness of their disinterest.

** we may not understand the social expectations of different environments and situations. This can cause us to do or say things in a way that makes others (re: NTs) misjudge our character and intention. Again, we can be labelled rude, lacking empathy, inconsiderate, indifferent, or out of line.

** we can misinterpret what NTs are communicating to us. Literal interpretation of language, difficulty with focus and attention, auditory processing, poor understanding of body language, tone of voice, and gestures can all contribute to this.

** we may not respond in a timely way because we take several seconds or more to process what you just said. The gap in response time can again be interpreted inaccurately. People assume we have zoned out and are not paying attention, that we are intellectually challenged, or that we are hearing impaired.

These are just a few of the things that can contribute to communication challenges for verbal Autistics.

It is important to remember that Autistic culture has a different experience of communication than non-Autistic culture. From a very young age, we are expected to adapt and defer to the NT majority when it comes to interacting with others.

That consideration doesn’t go both ways, as the NT majority does not accept our way as valid and does not seem to care about understanding our motivations.

This is the Double Empathy problem (“…when people with very different experiences of the world interact with each other, they struggle to empathize with each other’…(It’s) likely to be exacerbated through differences in language and comprehension.” *—autism.org.uk*

You'd think all professionals would be aware of how social communication can be expressed in verbal Autistics, but…not so much.

This needs to change in order to improve the quality of life for many Autistic people. A good first step would be for professionals to realize that it takes more than memorizing diagnostic criteria to understand autism.

They need to know what they don’t know, and much of that learning can come from engaging with those who are Autistic and can share lived experience rather than relying solely on memorizing textbook content.

In 2018, my son Daniel and I delivered a 90-minute session at the Toronto Geneva Centre for Autism symposium called, "I Didn't Say There Is Anything Wrong with Me, I Said I'm Autistic: A Discussion of Communication Challenges in Bright, Verbal Autistic People."

Sigh. Most who attended were parents and Autistic individuals.

Professionals---the ones who are paid to improve the well-being of Autistic people, who can help to translate the NT culture for those Autistics who choose to learn more, were conspicuously in short supply.

Communication is a two-way street. This means it is an act requiring both sides to contribute equally. Seems to me that the onus is entirely on Autistics to adapt to the rigid expectations of the NT majority. The justice warrior in me wants to shout it from the rooftops: this is unfair and needs to stop.

Let the conversations begin.

14/02/2024

Here's some great ideas on how to help autistic children who experience slow processing speed.

This is another slow-processing speed post about children and written primarily for parents, caregivers or teachers of Autistic learners.

For an overview of slow processing speed, look at our Nov. 24, 2023 post: http://tinyurl.com/4sjej84t

This post is a more comprehensive list of tips that we believe will help your child compensate for slow processing speed and be better able to manage the speed and volume of the school curriculum. If you have any ideas that we haven’t thought of, we’d love to hear them.

In the meantime, a reminder that processing speed refers to the time a person needs to take in the (verbal, visual or other information they’ve received), interpret its significance, and then respond to it. Kids with slow processing speed can take several seconds or longer to react/respond. This may mean they struggle to get through times tests, get dressed on time at home or for recess, or respond to jokes in a timely manner. In school, it can mean even academically capable students fall behind their peers because they cannot keep up.

This is a reminder that many Autistic students have been identified with slow processing speed, so you will have less pushback when you request accommodations for this. Other Autistic students have processing speed that may measure average or higher on assessments, yet they take a long time to get through their schoolwork and chores. Why might this be?

Anxiety and emotional distress can also impact processing speed, and may not have been present at the time of the assessment. For example, if a child is bullied at school, they may always be in a state of fight, flight, or freeze when attending. This child’s ‘emotional brain’—the limbic system—then takes over the prefrontal cortex—the thinking brain--and the child may no longer be able to manage time, get started, or prioritize tasks. The anxiety and distress slow them down. If you can get these experiences documented, you can use them to back up your requests for relevant accommodations.

Here are some accommodations you can request or use at home if your child is struggling to keep up with expectations:

• Pair all visual learning with visual support. These would be the important points, such as providing a step-by-step example for solving a math formula or providing definitions for parts of speech along with examples.

• Provide a scribe or allow the lesson to be recorded.

• Give time-and-a-half or double time for tests, and example. Provide extra time to complete projects and assignments.

• Give the child/student advance warning when you will be calling upon them. “I’m going to ask Jonny and Jane for provincial capitals, and then I’ll be asking you, Taylor.”

• Give the student less work to allow them to demonstrate they’ve mastered a lesson. Give a test with seven long-division questions rather than 15. The results will show if a teacher has been successful in teaching the lesson.

• Chunk work into small, chunks. Explain each section clearly, and give defined dates for each section. Check in to know if the student truly understands each section as assigned. Ask them to take their time and explain what is expected of them. Take responsibility when they don’t understand: I’m not sure I explained that well enough. Let me try again.” This can guard their self-esteem.

• Assignments and projects should be provided with rubrics. This allows the student to understand, in detail, what is expected in the finished product.

• Allow the student a choice of assignments. If they are doing a book report, allow them to choose a book of high interest. If they are learning to write an essay, allow them to pick a topic they find engaging. After all, the point of the lesson is to teach them how to write an essay, so the topic should not be a barrier.

• Allow the use of technology, such as a keyboard, calculator, or
a text-to-speech app. Prompt the student to use the technology, as high anxiety can cause the student to forget to access technology.

• Check in for comprehension whenever work is assigned, a new lesson is taught, or a test or exam is given. Do not ask if the student needs help. Have them explain to you how they are going to answer the short and long essay questions and redirect if they are misunderstanding.

• Oral testing or providing a scribe can also speed things up.

• Provide the student with a copy of class notes. This will not only help the student keep up with the class but will also benefit those who can either take notes or listen for comprehension—but not both.

• For quizzes, tests, and exams, vary the types of questions to speed things up. Include short written answers, fill-in-the-blank, true/false, match the columns, and circle the response to see if they have mastered the lessons. Consider allowing a student to create a graphic novel rather than a short novella for a culminating assignment if art or anime is a strength. Use the students' strengths to help them demonstrate their capabilities.

• Allow the student to begin packing up to transition to the next classroom five minutes before their peers. For younger students, provide hands-on help so they can get out to play at recess or after lunch at the same time as their peers. Autistic students don’t like to be late or enter social situations after they have begun.

23/11/2023

Forget rewards and stickers. Focus on the relationship.

29/10/2023

It’s more supportive to look at what the person’s needs are rather that trying to fit them into a diagnostic box.

02/09/2023

I've been rereading a lot of Calvin & Hobbes lately...

There are a lot of takeaways from Bill Watterson's continually brilliant mind. And all the strips about Calvin in school have a tendency to break my heart.

Here's just one takeaway: Calming coping strategies (like drinking water or taking deep breaths) aren't going to help when the underlying problem is societally inappropriate developmental expectations of our six-year-olds...
..or three-year-olds, or five-year-olds, or ten-year-olds, or eighteen-year-olds...

[Image description: A four-panel Calvin & Hobbes strip. In the first panel, Calvin is sitting at a desk, bored. In the second, he is screaming with a wild expression, "What on earth are we doing in here in this beautiful day? This is the only life I've got!" In the third panel, he is running away from his desk screaming. In the fourth, his teacher has hold of him and says, "Next time, try a drink of water and a few deep breaths."]