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Bloom Blog

A play-based program helps parents connect with toddlers with early signs of autism

By Louise Kinross

A parent-led intervention co-developed at Holland Bloorview for toddlers awaiting an autism assessment is attracting attention from around the world.

The Social ABCs is a program where parents are coached on strategies to enhance their child's social and communication skills through play at home.

This week Prince Edward Island announced it would offer the Social ABCs to Island families of children aged one to three who are waiting for an autism assessment. Last year, staff from Holland Bloorview's Autism Research Centre began training clinicians in India and researchers in Israel to run the program. 

Jessica Brian is a psychologist and scientist at Holland Bloorview who co-developed the program. We spoke about how it works.

BLOOM: How would you describe the Social ABCs?

Jessica Brian: We use a positive, coaching approach to provide families with specific strategies that will enhance their toddler's social communication and connectedness. One model is a 12-week program that originally took place in family's homes and one is a six-week program that combines group learning, where parents learn together, as well as individual coaching.

When COVID hit we quickly shifted gears and have been providing the group sessions and individual coaching over Zoom. So where we would normally be standing with the parent in their home, providing real-time strategies and encouragement as they interact with their child, we now coach them as they play with their child over Zoom.

BLOOM: What is the goal?

Jessica Brian: We talk about two main goals. One is enhancing a child's communication skills so they can pass messages to their parent about what they want and like and need, and learn how communication works. The second is building these positive social relationships with your primary caregiver, so you learn that mom or dad is fun to play with and understands me when I deliver a message.

BLOOM: What's an example of a strategy you might teach parents?

Jessica Brian: We help them to carefully observe their child and notice every activity they engage in and figure out what it is about the activity that the child really likes. One child might like a pop-up toy because of the sound, whereas another child may like it because of the feeling of the buttons. Once a family has identified what the child really likes and why, they're coached to play in that way and, every now and then, to provide a language opportunity to keep that interaction going. 

So if the child really likes the sound the pop-up makes, the parent might block the door from opening and say "pop," and if the child is looking at the toy or the parent and makes a vocal attempt, the moment they make the attempt, the parent is coached to open the door. Parents learn creative ways to be part of a game and to be really fun and playful.

BLOOM: What changes in kids have you seen in your research?

Jessica Brian: We had a randomized control trial published in Autism Research in 2017 that describes the study and the main findings. We saw gains in vocal responses, which is the child verbally responding to a language opportunity provided by the parent; child vocal initiations; and shared smiling between parent and child. We want parents and kids to be enjoying each other's company and playing together positively.

BLOOM: Why might the Social ABCs be more appropriate for some toddlers than traditional applied behaviour analysis (ABA)?

Jessica Brian: The Social ABCs uses some principles of ABA in it. ABA is a well-understood way that anyone can learn, and can be especially helpful for children with autism. Where the Social ABCs differs is that the focus is on play and on fostering the positive relationship parents and toddlers have with each other, as that sets an important foundation for all future relationships.

Toddlers spend a lot of time with their primary caregiver, and it's a really important way for children to learn how to interact and connect and play and relate to that parent. We focus on noticing what the child is motivated to do. What does the child really like and enjoy and want to do? We teach the parent to read those cues and follow the child's lead so they can interact in ways that are most appealing to the child and help the child feel motivated and engaged and connected.  

When these things are in place the parent is coached to build in natural playful opportunities for the child to communicate and interact with them.

BLOOM: Do kids who receive the Social ABCs later move on to ABA?

Jessica Brian: Many do. Part of the reason why we were so motivated to develop early intervention is because many kids wait a long time to get into more intensive ABA programs. The average age that a child receives an autism diagnosis in Canada is four. We want to build on the natural development that is starting to unfold in the toddler, and help families learn skills and build their confidence. 

BLOOM: Do some parents come into the program hoping it will change their child, so they don't receive an autism diagnosis?

Jessica Brian: Some families may come in asking that question, but that's not the objective of the program. We don't try to eliminate autism and we don't try to change a child fundamentally. We are focused on enhancing skills. 

BLOOM: Is PEI the first province to offer the Social ABCs?

Jessica Brian: It's the first to take it up as a province-wide offering. Children's hospitals like McMaster Children's and CHEO in Ontario offer it, and we're training colleagues in Alberta. We have researchers in Halifax and Edmonton who have been doing the research with us. And we also run the program at Holland Bloorview. 

We're so excited to be partnering with PEI to provide the intervention across that province. They plan to focus on very young children who are waiting to be seen for a diagnostic assessment. This means toddlers can start learning really early, with lots of great potential for their families to benefit in meaningful ways.

The Social ABCs research programs have been funded by Kids Brain Health Network, Azrieli Foundation, Brain Canada, Autism Speaks Canada, Holland Bloorview’s Centres for Leadership, and the Holland Bloorview Foundation (with donations from CIBC and Alva Foundation).