The Complete Guide to Online Therapy for Autism

Fact-checked by Vincenza De Falco, Autism & Learning Disabilities Specialist Coach.

In today’s hectic world, it can often be difficult to find time to take your Autistic child to in-person therapy, but you know they would benefit from outside help. Therapy and other services have moved online in recent years, including therapy services for people with Autism. How can you find online Autism therapy, and what types of therapy can be done online?

While in-person therapy for Autism works at a deeper level, online therapy can help provide maintenance levels once a therapy relationship has been established. There are several types of online therapy for Autism, including speech therapy, relationship development, and even play therapy. 

For a complete guide to online Autism therapy, let’s dig in!

What Are the Signs of Autism?

Autism Spectrum Disorder (ASD) often shows up by the time a child is three years old. A child with ASD might be observed walking on their toes frequently or have an unusual sensitivity to light compared with other children. While a 3-year old doesn’t have excellent communication, to begin with, a child with ASD might not be able to talk at all or might have difficulty communicating in general.

Although Autism is a lifelong condition, various therapeutic modes can help them live fulfilling lives. Some children may need more work, while others require less work due to their signs. 

The most common signs include:

• Sensory variations, where a child cannot touch certain items because of how it makes them feel.
• Impaired social abilities that keep them from making friends or saying the right thing.
• Mental health issues like anxiety or obsessive behavior might also be present. 
• Unable to change or be flexible through life’s little changes. 
• Constant repetition of a particular behavior or word or word phrases might signal ASD.

Children with ASD don’t always show the same signs or the same level that other children do. There are also several differences in how it shows up between boys and girls. Plus, children with ASD often have other issues that complicate Autism.

There Are Varying Levels of Autism

One child with Autism will have different signs than another child with Autism due to the varying levels that ASD presents itself in other people. 

• On the mild end of the spectrum, otherwise known as “high-functioning,” children have difficulty initiating social interaction. Still, they can get along with their peers if another person has initiated the interaction. These children need support with planning, but they can usually figure many things out for themselves. 
• Children with moderate Autism will interact with other children if they do something within that child’s interests. But if they are not, the Autistic child will do their own thing elsewhere by themselves. They also have very focused interests and will need more support in many areas of their lives.
• But when a child is on the severe end of the spectrum, they might be unable to communicate or have severe verbal difficulties that impact creating friendships. They also have more issues with changing focus or staying on task. 

An example of a person being on the extreme end of the spectrum involves an adult male who received job coaching while working as a dishwasher at a Dairy Queen. While he was verbal and could express his words, so he was understood, he often got stuck on a topic and stopped working to discuss that topic. 

It was a fast-paced environment, and the boss often came back to try getting him to focus and hurry. But he went at his pace. He did well and got things done, but it was difficult for the job coach to keep him focused on his tasks. He also misunderstood many of the socially accepted teasing ways, of which the coach had to reassure him that those things meant nothing. 

As you might guess, he needed full-time support to keep his job in the community and could not live alone.

Another example of mild Autism is another adult male who worked at a gas station and needed about an hour per week of coaching support. He knew what he needed to do, could stay on task most of the time, and did his job well. The issue was that he could be very aggressive and needed someone there to keep him at a calm level.

He also kept asking the same questions over and over to the supervisor. They gave him a task list to follow, which helped somewhat, but he kept finding excuses to ask the supervisor repetitive questions. The job coaches he had needed to field many of those questions and reassure him that he was doing the right thing as long as it was on his list.

His social skills were limited, so the coaches would often reassure him that he said or did the right thing and that no one was upset with him. He needs minimal support with his job, and he lives alone, with community support.

The ASD Symptom Differences Between Boys and Girls

Much of the reason that more boys are diagnosed with Autism than girls is that they appear different in boys than girls. While many boys with Autism have behaviors that include hand flapping, rocking, or being loud and disruptive, girls with Autism tend to shy away from groups and could be called a “loner” among her peers. 

Because the louder behaviors get attention, many girls with quiet behaviors or signs often go overlooked. Since they get overlooked, many girls grow up thinking something is wrong with them only to be told that it’s all in their heads, and they are “drama queens.” As they don’t get treatment, they might go through life falling into negative habits or go from one job to the next, never knowing why they can’t get their lives together.

Why don’t teachers and counselors recognize these different signs? Some do, but many accept the cultural stereotype that women are to be quiet and reserved, so the signs in a girl are mistaken as them being “good girls.” In the future, as professionals become more aware of these differences, girls might receive testing and therapy earlier in life. 

Multiple Diagnoses Are Present With ASD

Many people with Autism often have coexisting conditions that complicate things, which may require specialized therapy methods. Conditions such as depression, anxiety, ADHD, and disruptive behavior disorder can create more problems. Find an online therapist that can work with your child’s multiple diagnoses.

What Is the Difference Between Online and In-Person Therapy?

Children and adults with Autism tend to do better in life when they get support and treatment for different parts of their lives through therapy. Typically, in-person therapy was the only way therapy would be administered. However, with many prior in-person services going online, including therapy, parents and caregivers can choose online or in-person therapy.

The difference between online and in-person therapy for Autism besides the way it is delivered is that when a therapist is face-to-face with the child, they have an opportunity to address any concerns that they would miss online. But when a therapeutic relationship has been established, and the therapist knows what is normal for the child and what is not, online therapy can be a great booster between in-person sessions.

Let’s take a deeper look at the differences. 

In-Person Therapy Provides a Deeper Therapy Level

When a child or adult with Autism enters into therapy, the main goal is to help them live and function in the world more fully than they would otherwise. During the first few therapy sessions for people with Autism, the goal is to establish trust and workability and determine the norm for that person. Initial therapy sessions conducted online might prove difficult for reaching these goals.

One situation that may require in-person therapy might be when a child has severe physical limitations. A hands-on approach is necessary to help the child overcome these limitations. Another situation that in-person therapy is preferable over online therapy is during occupational therapy.

Occupational therapy focuses on teaching children and adults with Autism the skills they need to go through life. Children are taught fine motor skills, writing, and how to take care of themselves. Adults are taught life skills like cooking, handling money, and how to clean their house. Trying to teach these skills online would not go as well as in-person would.

Deeper therapy levels can help those with Autism achieve much more than with online therapy. However, there is a place for online therapy, as it can be used for maintaining strides made with in-person therapy between sessions. 

Online Therapy Provides Maintenance Levels

Online therapy for Autism has become a viable alternative to in-person therapy when used properly and in conjunction with a caregiver’s support. If therapists use online therapy for maintaining the gains they made with in-person sessions, they can make sure that their clients and caregivers continue doing the exercises learned while in person.

During a pandemic like the current COVID crisis, more therapists and other service providers move their practice online to protect themselves and others from contracting the virus. While this is usually fine for most people, children and adults with Autism might find it challenging using technology for something that works better for them in person.

For Autism therapy, some types of therapy work just as well online as it does face-to-face. Speech therapy is one of these types that work especially well online because some of the challenges families face in their daily lives are present during virtual therapy sessions. A family can work with a skilled speech therapist at home.

Online therapy can also help counselors keep up with their clients and caregivers for simple things that might not need a full session. Children who have aggressive behavior, who are learning how to control that through therapy, might have a particularly frustrating episode that wouldn’t normally warrant a visit to the counselor’s office. 

However, a quick chat online with the counselor might be enough to help both the child and the parent deal with what happened and make a plan for what to do differently in the future. Online therapy is convenient and quick, making it a decent substitute for in-person therapy.

What Type of Therapy Is Best for Online?

For some people, however, online therapy is the better option due to other coexisting conditions. Some with Autism have Disruptive Behavior Disorder, which could create problems for other clients in an office setting. Online therapy might work better for them, as they would be at home and away from others, creating other problems that could be avoided.

What types of Autism therapy work best online? Therapies that don’t necessarily need a hands-on approach would be best. Also, a therapy that involves caregivers like play therapy can be guided through online methods. 

Applied Behavior Analysis

Applied Behavior Analysis (ABA) is the preferred method that therapists often use with Autistic children. It teaches specific, measurable goals that the child needs to make before moving on to the next therapy phase. ABA’s basis is to take a skill down to its most simple steps and teach those steps to the child. 

For example, say you want to teach your child with Autism how to make their bed. Here are the steps you would teach:

1. Pull the covers and pillows off the bed and put them on the floor.
2. Straighten the fitted sheet by pulling each corner and make sure it goes slightly under the mattress.
3. Put the pillows back on the bed where the head goes. 
4. Put the first blanket on the bed and spread over the bed to cover it completely. Let part of the blanket hanging on either side and at the foot of the bed.
5. Put the second blanket, if any, over the first blanket and repeat the process.
6. Smooth out any wrinkles on the bed.
7. Pull the blankets off the pillows and smooth down. 
8. Set the pillows on top neatly.

As you can see from the example above, breaking down a simple task into several simple steps can help children with Autism learn how to do something that most people take for granted, knowing how to do. With ABA, each task (or step) must be mastered before moving to the next step. 

The therapist can choose to give a small reward at the mastery of each step, and a larger reward when the child masters the entire task or chooses to save a reward when the larger goal is accomplished.

This works with online therapy because the therapist will show the child and the caregiver how to complete a task. The therapist will then communicate with the parent how to work with the child in learning the basic steps. In later sessions, the therapist could ask the child and parent to show how they are progressing. If there are issues, the therapist can intervene and offer new suggestions. 

Sensory Integration Therapy

Sensory integration therapy involves a therapist working on the senses with an Autistic child who might be overly sensitive to light or sound. This type of therapy works on the classical conditioning model, where a person is exposed to an overwhelming sensation in small doses of time. The longer the person can tolerate the overwhelming sense, like light or sound, the more they can integrate it into their life. 

The therapist will encourage the child to push slightly past their limits. When completing this online, a light can be shown into the camera, or sound can be turned up for short periods. A parent or caregiver can be nearby to monitor the child’s reaction and do what might be needed to assist the therapist in this therapy type. 

Speech Therapy

As mentioned before, speech therapy works well with online delivery methods. Parents can find materials online that show them how to work with their children in speech therapy. Then, they can seek a skilled speech therapist online that offers online therapy solutions. When combined with parent resources, a speech therapist can take a back seat once the initial lesson is complete. 

A speech therapist can detect what is wrong and help the child and parent correct it without needing to be in an office. 

Relationship Development

Relationship development therapy is a fancy term for “having a conversation” with someone else. Since children and adults with Autism are somewhat socially impaired, relational and social therapy is usually added to help them learn how to get along with others. Much of this work can be done online since a therapist can have a conversation with the child. 

A therapist will outline certain social goals for your child, show you how to implement them, then let you practice them with your child. All of this can be done online.

Play Therapy

Playing is the main way that children learn how to get along with others. But children with Autism have impaired social skills that hinder them from making friends through play. Play therapy is exactly what it sounds like–it teaches a child how to get along with others through playing with a parent or therapist. 

You and the therapist will work together online to develop games to play with your child to help them reach the goals you and the therapist will set up together. Hide and seek is a favorite game of therapists because it allows your child to learn how to take turns and works with others for the game’s good.

Cognitive Behavior Therapy

Another therapy that works well online is cognitive behavior therapy or CBT. CBT works through talking about feelings, emotions, and behaviors, and what can be done differently. It can be done completely online if that method works for your schedule and your child’s communication skills. 

This method aims to help your child learn how to recognize emotions in themselves and others and help them begin to learn how to recognize visual cues in how others are feeling–something that people with Autism have a difficult time with. 

How Does Online Autism Therapy Work?

Much like telemedicine, online autism therapy can be conducted through Zoom or other video meeting software in a virtual “room.” The therapist sets up the room, then emails the room link to you to click on and join the meeting. Provided your computer has the appropriate software and hardware, like a camera, you will be able to join relatively quickly and easily. 

Once you’re in the meeting room, the therapist will begin the meeting just as they would if you were in their office. You, and your child, will need to be sitting in a chair and not reclining in bed or anywhere else. Since this is a therapy session, all parties need to act as if they were meeting in person. 

A virtual therapy session can be more affordable than in person, and it is more convenient, especially if you have a busy schedule. As for payment, you and the therapist will either work that out before the session or after the session. They may even take Paypal, but be sure to ask first. 

Expected Outcomes of Online Therapy

The expected outcomes of online therapy are usually the same as in-person therapy. While the delivery methods are different, online therapy has the same goals as working with clients in a face-to-face format. 

Therefore, depending on the type of therapy used, the outcomes should be the same. In ABA therapy, the outcome would be that the child learns various tasks or behaviors set out by the parent and therapist. 

In speech therapy, the child would meet specific measures consistent with their educational plan. In cognitive behavior therapy, the child would learn how to recognize emotions in others or themselves and find effective ways to cope or deal with them. 

Individualized outcomes are up to the parent, the child, and the therapist to determine, and can be achieved through online therapy just as well as through in-person therapy.

Alternatives to Autism Therapy Include Medication and Diet

In addition to Autism therapy, parents often try alternatives like diet, medication, and weighted blankets to calm their children and help them create stability in their lives. While there is little scientific evidence that these treatments are as effective as therapy, many parents try them anyway. What works for one child might not work for another child, so a bit of trial and error might go well.

The different alternatives that parents try include:

• A gluten or casein-free diet
• CBD Oil
• Weighted blankets
• Vitamin C
• Omega-3 fatty acids
• B-6 and magnesium
• Melatonin
• Stimulants
• Antidepressants
• Anti-psychotics
• Anticonvulsants

A doctor must prescribe the last five items, and your child needs to be monitored for any side effects or negative reactions. 

Talk with your therapist and doctor before trying any of these methods, as they might have an adverse reaction for your child. Autism therapy is not meant to cure your child but helps them learn how to function in life. Therapy can be used in conjunction with the above methods if that is what your child needs. 

Remember that you are the expert at what your child needs or can tolerate. If you have questions, be sure to ask your doctor or therapist.

Parents Can Help Their Child Between Sessions

Parents are instrumental in their child’s progress. Between therapy sessions, whether online or in-person, you will be given homework exercises to work on with your child. Or, if your child is older, they will have the homework. Your job is to work with your child on practicing what you both went over in the previous session. 

For example, if you’re working on play therapy, and the goal is for your child to ask another child to play with a certain toy, then your homework between sessions would be you and your child sitting on the floor with their favorite toy. You could pick up the toy, hold it for a bit, and then encourage your child to ask for it.

If they don’t ask according to the rules, then you wouldn’t give it to them. But you would remind them how to ask, and then they could try again.

Parent interaction between online therapy sessions helps children learn better and get to their goal quicker. 

Conclusion

Online therapy methods have come a long way since the beginning of the modern internet, and it has changed the world in many ways for the better. Several therapists and doctors are taking their services to the internet to reach more people and create a convenient and affordable option that busy people can take advantage of and use on their time table.

It is much like the world of the Jetsons, where everyone just got on their video-phones and called whoever they liked. A doctor made house calls, while others phoned in to work in their pajamas. Online therapy for Autism works in the same way, so why not take advantage of it?

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References

• SLP Tele: Is Online Speech Therapy Appropriate For a Child With Autism?
• Healthline: Autism Treatment Guide
• Psychology Help: Online Therapy for Autism
• RDIConnect: Online Therapy to Help Autism
• Medium: Online Therapy for Autism for Your Child
• Very Well Health: 6 Autism Therapies Parents Can Provide in Their Own Home
• Very Well Health: Autism Overview
• Very Well Health: Signs and Symptoms of Autism
• Applied Behavior Analysis Programs Guide: 5 Types of Behavior Therapy For Individuals With Autism