Dore Blanchet: Occupational Therapy for Autism & Telehealth

Transcript for Podcast Episode: 073
Occupational Therapy for Autism & Telehealth | Interview with Dore Blanchet
Hosted by : Dr. Mary Barbera

Mary Barbera: You're listening to the Turn Autism Around podcast. I'm your host, Dr. Mary Barbera, and I have been in the autism world for over two decades. And today, I am interviewing one of my friends that I met about two decades ago Dore Blanchet. She is an occupational therapist and she lives near me and we've been friends for like I said, over 20 years, and today she's going to talk to me about the role of occupational therapy. She's also going to talk about how we can use telehealth and tele intervention for children with and without autism.

Mary Barbera: Dore graduated from Columbia University with a master's of science and occupational therapy and has been working with children and families for over 30 years. She founded Step by Step Pediatric Therapy Inc. And she's been working with the Infant and Toddler Early Intervention Program for 20 years. And currently, her Step by Step team includes PTs, OTs, speech therapists and special instruction, and she works throughout Pennsylvania. So I am excited about talking to Dore and her views on the role of occupational therapy. So let's get to that interview now.

Welcome to the Turn Autism Around podcast for both parents and professionals in the autism world who want to turn things around, be less stressed and lead happier lives. And now your host, autism mom, behavior analyst and bestselling author, Dr. Mary Barbera.

Mary Barbera: And now I am so excited to talk to my good friend, Dore Blanchet. Thanks for joining us today. Dore.

Dore Blanchet: Thanks so much for having me, Mary. I'm really happy to be here.

Mary Barbera: Yeah, I know we've been talking about doing a podcast interview for a few months, but the COVID-19 crisis certainly has put us all into a situation where we've got nothing but time, right? We're both still working, but, you know, it's a good time to get our calendars to sync up for this talk. It's going to be about occupational therapy; the role of the occupational therapist; and also because of the COVID crisis and pandemic, we're gonna also talk about telehealth and the opportunities and some of the challenges that go with that, especially for very young children. But before we get to all that, I would like to ask you to describe your fall into the autism world.

Dore Blanchet: Well, I was thinking about this, and I think the first child I ever worked with who had autism was in the late eighties during an internship. And it was actually with a child who... I worked as a student in a locked psychiatric ward for kids. They were 10 and under. And back then, kids weren't given the autism diagnosis as readily. And this little boy was, now I know, very high functioning, loved fans. He learned how to bike ride. And at the time, the diagnosis was OCD or schizophrenia or something like that back in the eighties. But I was so interested in working with him. He was such a unique little kid that when I started practicing as a full time OT, I was very interested in autism, which was really in the early nineties, just starting to kind of explode.

Dore Blanchet: And I worked with a developmental pediatrician and was on an avowed team where we evaluated kids. And she did give them the diagnosis of autism. So I wanted to learn more. I became certified with the CIP first sensory because sensory was kind of such a big area with kids with autism. And the last couple months when I was getting the CIP certification, I was at a luncheon, the hospital that I was working at was catered and had us attend and sat at a table next to Temple Grandin. So that kind of really invigorated me and made me so excited to work with kids with autism way back in the early nineties.

Mary Barbera: Yeah. That's excellent. So for anyone out there that's listening that doesn't know who Temple Grandin is... She is probably the most famous person with autism. She has a PhD. And she wrote several books and her story was featured on an HBO movie that won some awards. And yes, she is still working and living in Colorado. So I also had lunch with Temple Grandin at some point. I was speaking at the Penn State conference, and she was also speaking, and so we sat across from each other and it was very impactful. And she actually told me to write a book, which I did. I wrote my first book.

Mary Barbera: And I also in the eighties had a clinical rotation in a psych ward, and then another rotation when I was a junior in nursing in college in the mid-80s at a residential placement. And there were kids with... I'm not sure if they had a diagnosis of autism or not, but they definitely had the characteristics that I would think was autism back then. So, yeah, it's amazing how we've had parallel lives.

Mary Barbera: So you moved to the area to move to my county shortly after Lucas's diagnosis, we were acquainted by somebody. And you were working at a local university creating their OT program and we became friends. And I came to your class to speak and to try to recruit some OT students to become therapists for Lucas. And right away, I knew that I really... We shared a lot of the same visions in terms of you were very behavioral. You still are and very much into the multi-disciplinary framework that, you know, is really a part of autism. And how did you get so, so accomplished with multi-disciplinary teams and working as an OT with kids with autism?

Dore Blanchet: I think that when I worked my first job, after I worked at Children's Hospital, was at Good Shepherd and Allentown with a developmental pediatrician and working with her on a multi-disciplinary team was really the way that I started to one... You have to rely on other people's expertise and they're relying on you to try to come up with the best plan for the child in the family. And because kids are so varied, it's really helpful to have a whole team input when you're doing evaluations and setting up plans. Back then, my first behavioral experience with a child with autism was a family that had flown out to someone that was associated with Lovaas at the time and had learned, you know, been trained in... back then, I think we called it Lovaas Therapy or ABA. And had recruited members of her church and just all different people to setup a 30 to 40 hour week program. And I went, this was a child that I was seeing for OT, and went to the home and participated in his ABA program, which at the time they were one of the few families in our area, maybe in Pennsylvania, that we're actually doing it. And it was just so interesting to me. And the child did so well and was one of the few types of treatment that had any research behind it that I think that made me very interested in it. And the developmental pediatrician that I worked with. Dr. Karen Senate, she, too, was interested in ABA because there was some research behind it. So we all did a little bit more trying to find more background information on ABA at the time in the early nineties.

Dore Blanchet: So that really spurred me on looking into behavior as part of the areas that I focused on, along with the sensory and sensory integration. And I think your book too, I mean, jumping ahead to when I came to this area and read your book when it first came out, really helped me look at behavior with the verbal behavior approach a little bit broader than I was before. So it was really helpful.

Mary Barbera: Yeah. And for those of you that don't know, I did spur Lucas, I did start out using a Lovaas type ABH approach, having a Lovaas replication site consulted, but that changed a year into it. Around the year of 2000, when my Lovaas replication site consultant moved down south and I needed to switch providers. And so at the time, it was my friend had flown down to see Dr. Vince Carbon speak in Florida. And when she came back, she's like, we have to really switch the way we're doing things. And so we got a verbal behavior type ABH therapy consultant to help us. Back then, in the early 2000s, it was very rough. It was very rudimentary. Nobody really knew what they were doing, including me and my consultant. But we found our way. And years later I wrote my book, which is now many years old. It was published in 2007. And so now I'm working on a new book for the implementation of things parents can do and early intervention providers for very young children with signs of autism or an actual diagnosis.

Mary Barbera: And I know that really is the area you specialize in, Dore. You own a company called Step by Step Pediatrics, still in my county. And you have different providers going in with a contract through birth to three year olds. So for very young children, what is the role of the occupational therapist?

Dore Blanchet: Well, for the clients that we're seeing, they can range in age literally from a couple of months old through age 3. So depending on the age that really helps determine what the focus of the OT intervention is going to be for children who are showing red flags for autism or have some sensory issues. An OT is often called in for sensory based behaviors and different sensory experiences that are impacting the child or the baby's routine. So it can be related to feeding. It can be related to play if there are some hypo or hypersensitivity that are making it difficult for the child to engage in whatever the goal is, the OT might be focusing on that. For older kids closer to 3, we might look more on self-care and some fine motor skills. But for kids with a possible diagnosis of autism, the sensory system is often where I think OTs are kind of automatically put in to help families with those challenges.

Mary Barbera: And what I found, and I did have a contract with the birth to three agency, same birth to three agency that you have a contract with currently, I had a contract from 2010 to 2016 as a behavior analyst. And what I found was that a lot of disciplinary teams, they don't include a behavior analyst or even a behavioral therapist or anybody with real behavior or background. And so I have found that there have been people along the way, like you Dore, who have validated the need for a behavior analyst or behavior specialist, if you will, to look at the functions of behavior and to work with the team so that we're not going in. And one person's giving this advice based on the sensory system. And this other individual is giving advice based on speech like pacifiers, for instance, you know, an OT might say, well, they need the pacifier for comfort and for sensory regulation. And the speech therapist might say take the pacifier away because it's impeding their speech production. And I as a behaviorist have my own opinions about pacifiers. And so how do you deal with that kind of conflict or you know, we know that ABA is proven for young children with signs of autism and with autism. And so do you agree that there's a missing link sometimes with the behavioral approach?

Dore Blanchet: Yeah, I mean, in early intervention there definitely is... They do have some behavior specialists that work with children in our program. But you're right, it's few and far between that there's actually someone who is a behavior analyst or a BCBA that has a strong behavior background and for an OT and on a multi-disciplinary team. My thought is, although we are focusing on sensory, what you're seeing is a behavior that may be caught, may or may not be caused by a sensory issue. So you have to look at the function of the behavior to try to figure out how you're going to approach it. And if part of that is through a sensory model, regardless of what you're doing, you're still having a behavior response. So looking at it through that lens makes it, I think, clear for any discipline that, yeah, it might be a feeding issue or might be a sensory issue. It might be a gross motor issue. But there's typically a behavior response that is causing the problem. So we always have to take behavior into whatever the goal is.

Mary Barbera: Yeah. And I have found problems with people saying, well is that sensory or is it a problem behavior? And it's like, I did a video blog on that, we can link that in the show notes. I did a video blog on sensory rooms, which is for older kids. And we can talk about that in a minute. I want to kind of stick to the little kids for the moment, but how sensory rooms can be used actually in the wrong way and end up spiking behaviors. I also have done a lot of work around feeding because, you know, feeding is such a tricky thing because you can have a behavioral approach to feeding, which is what I would advocate. And then you could have a sensory where you expose kids to different textures or different looks of food or different taste, or you could have like a speech therapist. So it is now multi-disciplinary team or with a child with autism or signs of autism that has feeding issues, you could have three different people who all want to like take the lead, quote unquote, on a feeding goal. And I have found that, especially kids with severe problem behaviors around feeding, sometimes you can really actually not do the child the best service by treating it with just a sensory approach.

Dore Blanchet: I would totally agree. And I think feeding of all the things that I do in that birth to three age range is by far the most challenging for the family because there's such a social context to it. There's such a need for the family to be able to feed their child. There's such a varied behaviors related to what the child will do, what they can't do. Then there are also kids who have motor issues, oral motor issues, along with the sensory. I do think... I'm not convinced that there's only one type of intervention that's going to work for any child. I do think when you blend the sensory with a behavior approach, I think that you get the best outcome in my experience.

Dore Blanchet: I do think that some of the approach, if it is a motor issue that a speech therapist might work on related to chewing or swallowing or something along those lines, that you can still use a behavior approach combined with working on motor.

Mary Barbera: Right. And I do agree that like everybody has sensory issues, that every person will have the sensory needs and sensory differences. And then especially with autism... Kids with autism tend to have really out-of-whack sensory needs and a lot of time... And I have also seen behavioral therapists do feeding programs that involve kids crying and like, I am not about that at all. I use a very child friendly approach. And with feeding, you do not want a child to be crying. So if you have a child crying, they're at high risk for choking. And so even my nursing background and my behavioral background, I am like all about slowly desensitizing children to...

Mary Barbera: Like I have one client who, you know, could chew and swallow fine finger foods and he would eat a decent, you know, string beans and meat and things like that and crackers and so forth with his fingers. But if you presented anything on a spoon or even presented mushy food to look at without a utensil, he would freak out because he didn't want to be fed. Because in the past he was fed with a spoon and he did not like it for some reason. And so a lot of that is oral motor and that sort of thing. But the other thing is this child chewed and swallowed. So it was like, OK, let's desensitize the spoon by putting corn chip on a spoon. And when he was hungry and we slowly got him eating and all that.

Mary Barbera: So, I mean, there are different interventions and we're not here giving medical or behavioral advice. These podcasts, video blogs, even my paid online courses are for information purposes only. But I did do a video blog, we can link in the show notes, to feeding issues and how I would recommend tackling some of those. But I do think that occupational therapists... I remember the first occupational therapist that came to our house to do an evaluation on Lucas' when he was 2 before his diagnosis. And I was really in denial. And I remember asking the OT, you know, do you think it's autism? And I remember her specifically, I can even picture like the room we were in and stuff and her saying, well, you know, some children with autism are, you know, hyper responding or cover their ears like Lucas is doing. And, you know, she was kind of dropping the autism topic a little bit. I was maybe bringing it up, I forget, but I remember her sliding it in in enough of a way to make me think that she's seeing other kids with autism who act like this.

Mary Barbera: So what do we do? And I do cover denial a lot because I was in denial for the first fifteen months of Lucas's life with autism. How do you bring up the subject of autism or help families cope with that one or both parents are in denial.

Mary Barbera: For the population that I see, often the kids are not yet diagnosed because they're birth to 18 months. So we're seeing some red flags. I have to say that usually the family, if they're not bringing it up or in denial, have definitely thought about it before I've ever mentioned it. I've never had a family that was totally shocked when they've gotten an autism diagnosis. But I would never say, oh, I think your child has autism or, you know, term it in something that is kind of a definite. Similar to what your OT team did when Lucas was young, we just talk a lot about red flags and do bring up the autism word, but not in a way that's at all difficult for a parent to hear.

Dore Blanchet: So one of the things that we have, this move and groove group and I found that that's a nice way for a family that is possibly in denial. If I can have them meet another family where the child and the parent has already been diagnosed and the parent is comfortable talking about autism, sometimes that has been helpful to a family where they can actually see another mom or see another child that is similar to their child and then can start to kind of go through the process themselves.

Mary Barbera: What about the move and groove group? What is that? When did you start it? Who comes?

Dore Blanchet: So we started almost five years ago. We started a free group for differently abled kids from age 18 months to about five. That what we noticed with early intervention is it's wonderful that we go to the home and we're in the natural environment. But for some of the families, because you are coming to them, it's a little bit isolating for the parents there. They have a harder time, you know, getting out of the house or they're concerned about their child's behavior in a group setting and don't want to take them out to the library or a playgroup. So we basically kind of created a playgroup for any type of kids with special needs. And we typically have, you know, a bunch of kids that are either diagnosed with autism or probably will get diagnosed with autism. But then we also have other types of disabilities there as well. And it's a very structured group. We have different stations. We start and end with yoga and we have some of the equipment in the exact same spot each week so that the children get used to kind of the routine. But what I noticed the most was that the parents were really talking and making connections and feeling more comfortable.

Mary Barbera: So the parent is partnered with the child, like it's like a mommy and me playgroup structure?

Dore Blanchet: We have mom, dad, older sister. So yeah.

Mary Barbera: Is this once a month or once a week?

Dore Blanchet: It's twice a month. Regroup and running.

Mary Barbera: And how is it funded or is it totally free and just volunteer? Or do you get some funding?

Dore Blanchet: I did initially. We had a small grant and we probably should, you know, work on getting another grant. But it's totally free. It's volunteer. It's run by early intervention therapists that work for Step by Step. So they're really good at adapting whatever the activity is for whoever is coming. We use a visual timer. We use, I mean... if they have an ABA therapist or if they have another speech therapist or someone else that is not part of our team, we encourage them to come with the child and help.

Dore Blanchet: We've had a couple of the BCBAs or wrap-around come to the group to try to work on some of the goals that they're working on.

Mary Barbera: I think it's a great group. I don't think I've ever been there, but I've seen pictures and I know some of my former clients when I was in the birth to three, I recommended it and they went. And the reason I wanted you to talk about it, I kind of forgot about that. But, you know, we have I'm thinking about half and half; half parents half professionals listening to the podcast. And other professionals might want to think about that kind of thing, because I think you're right. I think parents are isolated. With little kids, but also as the kid gets older.

Mary Barbera: And I know our local Autism Society, where I was the founding president back in 2000, they do also fund. The Autism Society funds music groups, music therapy groups. They fund yoga, especially yoga. They fund like sensory-friendly movies. And these are just some ideas for parent advocates out there or for professionals who want to get more involved, because I do... Lucas always goes to yoga and music therapy and it's really increased his quality of life. He loves going to those places where, you know, and not every week was perfect. And in the beginning, you know, there might be kids that have some issues with going in and they need to work through that and having qualified people who are literally volunteering to be there to make that happen, my hat goes off to you for, you know, starting that five years ago and then keeping it where it's motivating enough for your staff to volunteer and motivating for the parents to bring their kids. And I'm sure it was a very big task to undertake. But I applaud you for keeping it going.

Dore Blanchet: Yeah, it's been very rewarding. And what I noticed with the parents is that when a child comes for the first time, you know, some of the kids will just do laps around the room. And the family member is either embarrassed or trying to get them to do an activity, and oftentimes another parent will walk up and say, oh, my son, so-and-so did the same exact thing, they just need to keep coming and get used to the routine and look how well he's doing now. So, I mean, it's gotten to the point where, as a therapist or a special ed teacher, we're not even intervening. A lot of the parents who have been coming are kind of helping to welcome the other parents and really helping them problem solve their child's behavior. So it's really nice. It's really rewarding. It's one of my favorite things that I've done lately.

Mary Barbera: That's great. Yeah, I see that within... I have a toddler preschooler paid online course and a community, a Facebook community that comes with it. And what you're describing is parents, you know, parents might watch a couple modules and then they're trying to implement the table time and they're like it was a complete disaster, a failure. And then we have like reams of people chiming in No, no, don't give up. My first, you know, six sessions were worse than that. And a lot of my really good friends are people that I met early on in my autism journey. And, you know, we've supported each other over the years. So it's great that they can go in a pretty non-threatening environment where they're going to get support not only from professionals who really know what they're doing, but also from parents who have maybe a couple steps ahead. So that's awesome.

Mary Barbera: So let's talk about a little bit older kids; like three to five or even three to eight-year-olds where you are starting to work on things like self-care and fine motor skills. And I remember some of the early OT sessions that, you know, once Lucas gets to school, then I don't really know what happens in OT. But when he was young and when he was three to five, when he had OT weekly, I would go in with him. And I would totally encourage if your child is getting OT and you are driving him there or having somebody come to your home, that you're in the room, you're watching, you're learning, you're also telling the therapist, you know, what you're worried about, what the child struggling with. I have seen examples posted where, you know, a parent is driving a child to OT or speech therapy and they're being mandated to stay in the waiting room. And that is really not doing anybody any favors, especially when you have a non-vocal, nonverbal child, or at least a nonconversational child. You know, I would want to be right there. And, you know... So let's discuss like older child, you know, older meaning whatever age, but where you are working on those fine mode or self-care skills

Dore Blanchet: Yes, the self-care skills with the older kids. If you don't have the caretaker or parent with you, or at least in constant communication, it's going to be much harder to make any gains as an OT. If you're with a child for a half an hour, an hour a week and the parent or caretaker is there, all the other times that if you can coach them similar to your courses coaching, you know, coaching parents vs. you actually doing or helping the child. It's so much more impactful for the family. It's you know, when you talk about behavior, it's also a positive reinforcer for the parent when they're doing something and they're seeing a positive result that their child is doing. So I really think even with the older kids, as we do with the younger kids, that you really need to be able to demonstrate and support the family in carrying out whatever it is that you're trying to help the child do.

Dore Blanchet: And if you have a BCBA or you have a behavior program in place, that is so helpful for an OT to know, especially with self-care, because it's much easier if you're working on whatever the self-care issue is with all the team on the same page. If you're doing, you know, three different ways that you're telling somebody how to take off their pants or put on their shoes, it's confusing for anyone but someone who has more difficulties it�s just going to be very frustrating and you're going to see more negative behavior. So if everybody is on the same page, including the caretaker, it just makes it much more positive for everybody.

Mary Barbera: Yeah. That reminds me of a story when we were teaching Lucas to use a fork and a knife to cut his food. The behavior analyst and I were like, OK, let's break down how... You know, he's right handed. I'm right handed, you know, and we just said to like, me, the behavior analyst, the therapist, my husband, OK. Show me how you would cut a chicken tender with a fork and a knife.

Mary Barbera: And it was amazing just for a silly little skill like that. Some people turn their fork over. Some people cut through the tongs, some people cut them the back and the front. I was like, wow. So when in doubt, I always say, pick the one of the primary caregiver, pick the way the primary caregiver does something.

Mary Barbera: So if it's tying shoes or cutting with a fork and a knife, you know, or, you know, even have a sibling putting on a coat, how does the sibling put on a coat? Break down those tasks. Where does the child or the adult pick the coat up? What arm goes first? And I think that is a really good example of making sure you're on the same page with how you're going to teach. I'm also realizing that a lot of self-care can be done in a behavioral approach. And I have blogs, podcasts, guides on sleep, feeding, potty. I have it within my paid verbal behavior bundle. I have videos on how to teach showering to a child and with actual videos, of course, discrete videos of how to teach dressing and a lot of these ways to teach, I got from occupational therapists who really do specialize in that. And then if we work together where the OT has the knowledge of how to do it, and I have the knowledge of how to reinforce it and how to break it down more, we work together and then we have a great result. And like you said, it's positive reinforcement for the parent to get that result right.

Dore Blanchet: And as OTs, I mean, part of the education process is task analysis and breaking down tasks. So we have a pretty strong background in that. So when you're talking about breaking down a task, the way an OT and behavior analysts might break down a task might look a little bit different. Because as far as what the reinforcers are and the OT looking at not only the reinforcers and the outcome, but also the mechanics that go behind it, or if you need adaptive equipment or if you need to change the environment at all. But when you blend the two, it's just such a complete package that they really complement each other I feel like. And you're right, in the end, it's the caretaker who's going to really determine what is the best way that they're able to help their child. But when you do blend those two together, I think it makes it a little bit easier.

Mary Barbera: Yeah, I think it's great. OK. So because of the COVID-19 situation, your company and all the therapists that work under you have moved to telehealth. And so that was kind of an abrupt move. Before that, it was all in person in the homes or in daycares with the parent in the same room. That's kind of the model. So tell us about how your move to telehealth has gone and some of the challenges and opportunities that you're facing?

Dore Blanchet: Yeah. It happened in about two days where we went from hearing that we were no longer doing face to face to being approved by the state to be able to use a large group of different platforms. As far as what we were able to use to be able to provide teleintervention, the early intervention program in Pennsylvania and definitely in Berks County where we are really uses a coaching model. So they stressed, we stressed for the past couple of years, just different ways to engage the family and coach them on different ways to interact with their child, to meet whatever the outcomes and the goals are. When we switch to telehealth, it was not that different because you're still coaching. It actually forces the coaching a little bit more because you're not in the room. And what I have found is that when I first get on the computer, the family is showing me all the things they did this week and how it worked and what didn't work there. I don't know if it's because everybody's quarantined and you don't really have anywhere to go, but it has been wonderful. The enthusiasm and the different creative things that different family members have come up with has been really fun.

Dore Blanchet: The challenges are a lot of technology. Not everybody has Internet. Not everybody has good Internet. Not everyone has a semi quiet environment because everybody's home. So the house sometimes is a little chaotic and we just try to support the family and see where they are at that moment and how we can kind of coach them into working with overcoming whatever behavior or issue it is at the time. But overall, it's been really positive. Really positive.

Mary Barbera: Yeah, I think maybe, you know, what you're describing is that they seem to have really good follow through from one week to the next and maybe this has forced the therapist to really work with their arms tied to around their back. Like you can't physically prompt, you can't show them. So you're going to have to talk them through it more. And then at the end of the session, you're probably going to have to be like, these are the three things you should do for next time if you can. But you know, when you're an early intervention professional and you only have half hour or so sessions, or one hour sessions, you know, the child might need a diaper change in there. And then they have a tantrum. And you're trying to like, be Houdini with the whole thing. And then at the end you're flying out the door for the next appointment. And where telehealth is, like, you know, I think more structured, more like, OK, we're going to talk about the two things from last week. OK, you did one of them. One of them didn't go so well. Let's go on. Let me show you things. So sounds like it really could have a lot of advantages. Plus, it saves on travel time and saves on money for gas.

Dore Blanchet: So I think it's awesome, too, the timing. So it's easier to do later appointments. So you might have the opportunity to work with the parent that you normally would not because they're working or they're not home at that time. It's easier to do it around meals if feeding is an issue, too. What's also really helpful, I think, to the therapist by having a coaching model is that you can't... Like today, for example, I was working with someone on feeding, and all of a sudden I realize, well, let's try this. So the parent then has to go like search for this different food. And whereas normally if I was there, I might have whatever it is, or let's try this type of spoon, or I had my spoon and my little baby doll and I was demonstrating. And the parents have been really creative in what they've kind of come up with. Whereas if I was in the home that they might have relied more on me. And now they're really relying on what they have in their environment. And coming up with some great ideas. So it's been some really wonderful.

Mary Barbera: Yeah. I know in addition to in the past when I had the contract with birth to three, you would call me in on some cases that were particularly challenging. In addition, I've done some workshops with your employees and some training. Can you tell people that aren't local... And I don't really do any real one to one local work anymore or any live trainings, but I do a lot of video blogs and podcasts and that sort of thing. So can you share how you are utilizing my resources to help train your staff or families to direct them to certain parts of what I'm presenting?

Dore Blanchet: Sure. So I myself, I've done a couple of your courses. The first one and then part of the infant-toddler one. Some other members of my staff have also done some of your online courses. And each year for early intervention we have 24 hours of continuing ed, so each year part of your blogs or some of your other trainings are part of my staff's training. The one just recently I just sent out to everybody was on pointing and requesting and how that often is a red flag for kids if they're, you know, 15 months and they're not pointing or reaching. And how you give some really nice suggestions on different ways you can start working on those skills with your 15, 18 month old child and early intervention. And it's because you're also training parents, it's easy for my staff to then take those suggestions and explain it to parents in the family friendly way that you do. So we use lots of your blogs.

Dore Blanchet: I mean, my staff is fortunate that you've a couple time come in and talk to us, but I think it's really helpful because you focus on that age group that we're in. And a lot of the kids have not been diagnosed yet with autism, they more often are diagnosed towards the end of our program or once they're out. So it's just nice to refer families to your website as well if they're interested in learning a little bit more.

Dore Blanchet: I think because although you obviously work with kids with autism, you often say that a lot of your suggestions are for kids with any type of developmental disability. So it's helpful in that respect because then we can, you know, send lots of different parents to the website to check things out.

Mary Barbera: And probably out of the toddler preschool online course that I have now, probably about 50 percent of the people that introduce themselves on the Facebook group do not have a diagnosis yet. They're waiting for a diagnosis. And that's really why I started that course, and why I'm writing my new book. It's because the early signs of autism are the time to treat. And I want to empower parents and early intervention providers to empower their parents to really do the right things for kids, because the same strategies. It's working on engagement. It's working on looking at the whole picture and not working on something like potty training when you don't have, you know, they're not even three yet and they have all these other issues. And, you know, just working on things that make sense and that are positive and child friendly and because families want reinforcement, too, and they want to know that what they're doing is actually helping.

Mary Barbera: So I do think that you are really one of the best OTs I worked with. So thank you for always being so open to behavioral intervention and working as a team, because that's, you know, there's no point to... It's not anybody's one idea. It's working as a team. But also, really, if this was your child or your grandchild, you would want the most efficient, effective way. And whether that's my way or somebody else's idea or a combination of our ideas, we want to get them to the next point as quickly as possible, because time is of the essence. Right?

Dore Blanchet: Right. Right. And really, when you're starting so young, it just makes the journey, I think, a little bit easier because you really are starting to make changes before they reach to a point where there are some real negative behaviors. So the younger kids are really primed to try some of these interventions that are so helpful and have much more research to back up, you know, what works and what doesn't work.

Mary Barbera: I did attend a lecture by Omni Clinton, he's down at Emory. And I attended a lecture he did at the Penn State National Autism Conference this past summer. He has lots of research on the diagnosis and treatment of very young children. And I asked a question, do you think autism can be prevented? And he gave me a very thoughtful answer.

Mary Barbera: He said, based on his eye gaze research, he was thinking that he didn't think autism itself could be prevented, but he was pretty sure that intellectual disability as a co-morbid condition could be prevented. And the severe problem behaviors could be prevented. And it doesn't matter. Nobody has a crystal ball to say like, what would've been? You know, what would be down the line. But we all know the earlier you treat anything, the more engaged you are with the child. You know, even my toddler preschooler course could be great for parents who just want to learn how to engage your toddler more effectively, how to deal with normal toddler tantrums, how to teach sleep and eating and potty training in a positive way.

Mary Barbera: And so it really is encouraging if we could just have the child just reach their fullest potential. That's kind of what my whole thing is about. And we don't know where it's going to end up. But treating early and working as a team, I think this whole podcast has certainly illustrated the importance of that. So thank you.

Mary Barbera: So last question. Part of my podcast goal is for parents and professionals listening to be less stressed and lead happier lives. So any parting advice on self-care tips or stress reduction skills that you've managed to gain over the years?

Dore Blanchet: I guess the one would be yoga that's really been helping me. We do yoga with the kids in our group, but also the special instructor who does our yoga with our special needs kids is also my person, my yogi that I've been going to for fifteen years. In this COVID-19 quarantine situation, I found that trying to do even like fifteen minutes of yoga day and some breathing and meditation has been really helpful. And if you can take a walk outside, that's helpful. So that's been my saving grace for me.

Mary Barbera: Yeah, that's great. Alright. Well, thank you so much again for your time. I think this was very helpful. We'll have lots of those resources in the show notes. If you are listening to this podcast and you're working out or you're driving and you don't have a pen and you don't know how to look for the show notes, anything we say here, if you just want to search 'Mary' 'autism', plus the topic like 'stimming' or 'sensory rooms' or 'feeding' or 'potty' or anything we talked about, just search it and my free resources will shortly pop up.

Mary Barbera: So I appreciate your time today. I think it's always an important thing that we look at the different roles that might make our kids lives better and also our lives better. So thanks so much for your time and stay safe in this COVID situation and I look forward to hearing about all the progress you're making with the teleintervention. I think it is an exciting opportunity to get better and better at parent coaching. So thanks so much for your time.

Dore Blanchet: Thanks so much for having me, Mary. It was really wonderful. Take care

If you're a parent or an autism professional and enjoy listening to this podcast, you have to come check out my online course and community where we take all of this material and we apply it. You'll learn life-changing strategies to get your child or clients to reach their fullest potential. Join me for a free online workshop at MaryBarbera.com/workshop, where you can learn how to avoid common mistakes. You can see videos of me working with kids with and without autism. And you can learn more about joining my online course and community at a very special discount. Once again, go to MaryBarbera.com/workshop for all the details. I hope to see you there.