Dating and relationships bring joys – and potential challenges – for autistic and neurotypical people alike. This list of resources and expert advice from ARI and around the web that can help.

Building Social Skills to Support Autistic Teens and Young Adults

Conversation Skills for Teens with ASD

This free webinar recording offers practical suggestions and support for teens and their adult supporters.

Watch Now

Social Skills and ASD

Watch Now

Evidence Basis for Teaching Social Skills

In this free webinar, Aarti Nair, Ph.D. explains why teaching social skills can be beneficial for autistic youth.

Watch Now

Social Skills, Social Networking, and Adolescents with ASD: What Every Parent and Professional Should Know

The Johnson Center for Child Health and Development webinar with advice for parents and professionals supporting autistic adolescents.

Watch Now

Utilizing Students’ Interests to Teach Social Skills

This Johnson Center webinar describes how to identify and utilize a student’s interests to help them learn social skills in a natural environment. Doing activities and sharing information that interests your student provides opportunities for spontaneous and successful social interaction in an environment where the student is ready to learn and where you can be a meaningful and successful social coach.

Watch Now

Understanding Social Development in ASD

In this webinar, Dr. Matthew D. Lerner, Ph.D., discusses social development in individuals with autism. He emphasizes understanding theoretical mechanisms that underly processes generally accepted as social “skills.” The presenter outlines recent findings and discusses their implication in treatments and personal understanding.

Watch Now

Dating and Sexuality

Autism Support: The Ins and Outs of Dating

Dr. Aarti Nair discusses the ins and outs of dating as it specifically applies to individuals with autism. She considers the need for teaching such skills to autistic adults and answers common questions she receives in her work. The presenter uses the UCLA PEERS program to discuss sources for potential partners, how to give compliments, digital communication, and more. Nair shares positive and negative role-playing videos for dating steps and uses a perspective-taking exercise to point out non-verbal social cues and outcomes. She underscores dating safety and comfort before the question-and-answer session.

Watch Webinar

Aide Canada: Sexuality and the Spectrum: Lessons on Sex, Dating, and Love, Autism Style with Amy Gravino

This free AIDE Canada webinar, which features a woman on the autism spectrum sharing her firsthand perspective, will dispel some of the myths and misconceptions surrounding autism and dating, discuss the potential for using ABA to teach dating skills and the challenges involved with teaching these skills, and offer strategies and resources to help parents and clinicians begin conversations about relationships and sexuality with their family members and clients

Watch Webinar

Aide Canada: Healthy Relationships, Sexuality & Autism – Dating

Autism Nova Scotia, discusses their toolkit of resources for healthy relationships, sexuality and dating support for autistic individuals.

Watch Webinar

LGBTQIA+ and Autism – Autism Research Institute

Research, resources and information on the intersection of LGBTQIA+ and Autism.

Learn More

Safety and Sexual Education

Social/Sexual Awareness

This article, written by Geri Newton, talks about how parents and caregivers can support autistic individuals’ sexual development. “Sexual awareness is normal. Sexual feelings are normal, and there are many ways of expressing them. If a person has a disability, it does not change any of this. What often changes is the socialization that provides the foundation for sexual identity.”

Read More

Sexuality & Autism: How to Address Sex Education for People with Autism

In this free Johnson Center webinar, Amanda Tami, LPC, BCBA and Claire Schutte, Psy-D, BCBA-D share insights and information to help parents and educators teach sexual education.

Watch Webinar

Social Media Use and Autism – Teens and Adults

Pamela Wisniewski, PhD, presents new research about the online and social media experiences of autistic teens and young adults. Her research findings emphasize teaching teens how to leverage technology to their advantage, stay safe while doing so, and cope with online risks when they are encountered.

Watch Webinar

Sexual Victimization in Autism

Sexual victimization of autistic youth is of particular concern. Current research on the prevalence of sexual victimization clearly shows that autistic individuals, especially those with profound disabilities, are at greater risk for unwanted sexual contact, violence, and victimization. This resource page shares research, describes risk factors, and provides links to support.

Learn More

The prevalence of mental health conditions like anxiety, depression, AD/HD, OCD, and suicidality is significantly higher among autistic individuals than in the non-autistic population. Co-occurring mental issues in autism have been associated with imbalances in the gut microbiome, sensory processing difficulties, chronic inflammation, and autonomic nervous system dysregulation. Our list of resources covers contemporary research on drivers of mental illness and advice for navigating mental health difficulties in autism.

Articles on Mental Health & Autism

Gastrointestinal and internalizing behaviors may be “bidirectional” in autistic children, teens

This article originally appeared in Autism Research Review International, Vol. 36, No. 2, 2022, and discusses the relationship between gastrointestinal (GI) issues and internalizing behaviors in autistic individuals. It notes that many autistic people experience GI issues such as constipation, diarrhea, and abdominal pain which may contribute to internalizing behaviors such as anxiety and depression. The authors highlight the importance of identifying and treating GI issues in autistic patients, as this may improve their overall well-being and reduce the severity of internalizing behaviors. The article also emphasizes the need for continued research to understand further the relationship between GI issues and internalizing behaviors in individuals with ASD.

Read Summary

Meltdowns & Calming Techniques in Autism

Many autistic individuals experience meltdowns due to various triggers, such as difficulties with sensory processing, mental health issues, or physical discomfort. This article discusses several strategies for calming individuals during a meltdown, such as using sensory input or distraction techniques. The author emphasizes the importance of understanding individual needs and triggers in treatment planning and highlights proactive measures for preventing meltdowns, such as creating a sensory-friendly environment. Overall, the article provides practical guidance for autistic individuals and caregivers in managing meltdowns and promoting a sense of calm. All information presented in this article was gathered from ARI resources listed within the text.

Read Article

Webinars from ARI on Mental Health & Autism

How the Autonomic Nervous System May Govern Anxiety in Autism

Amanda Tami, LPC, BCBA, discusses the importance of self-care for adult caregivers supporting people with special needs, including autism. She provides context for mental health in the US and highlights the importance of self-care in the modern world. The speaker outlines factors that affect mental health, discusses burnout compared to depression, and describes issues with the way society views and idealizes self-care. Tami reframes self-care using five key aspects to create more accessible and realistic expectations for adult caregivers. She emphasizes short personalized self-care routines that can be done alongside other responsibilities and notes the trial and error of discovering what works. Throughout the presentation, Tami highlights community support and socialization. She provides references and resources before the Q & A.

Watch Webinar

Parents and Caregivers: The Importance of Self-Care

Amanda Tami, LPC, BCBA, discusses the importance of self-care for adult caregivers supporting people with special needs, including autism. She provides context for mental health in the US and highlights the importance of self-care in the modern world. The speaker outlines factors that affect mental health, discusses burnout compared to depression, and describes issues with the way society views and idealizes self-care. Tami reframes self-care using five key aspects to create more accessible and realistic expectations for adult caregivers. She emphasizes short personalized self-care routines that can be done alongside other responsibilities and notes the trial and error of discovering what works. Throughout the presentation, Tami highlights community support and socialization.

Watch Webinar

Nutritional Strategies for Regulating Mood in ASD – Q&A

Vicky Kobliner answers questions about nutritional strategies for regulating mood in autism. She covers constipation, hydration, food sensitivities, inflammation, vitamin D, food-chaining, and much more. The speaker discusses general information on these topics and asserts that her suggestions do not replace individualized professional medical advice.

Watch Webinar

Prenatal stress and Neurodevelopment

Dr. Beversdorf discusses prenatal stress and its implication in autism etiology. He provides a brief history of autism heredity, epigenetics, and the role of serotonin. The speaker details current understandings of the association between prenatal stress and autism. Beversdorf discusses recent research on the impact of SERT, prenatal stress, and other epigenetic factors. Clinical studies are provided alongside rodent models. 

Watch Webinar

Children, Anxiety, and ASD in the Pandemic Era – Live Q&A

Dr. Moskowitz discusses coping with anxiety related to COVID. She briefly overviews anxiety and how cognitive behavioral therapy (CBT) can be used to treat it. The speaker outlines five major aspects of CBT and how they can be modified for autism. Moskowitz reiterates the importance of understanding anxiety instead of fearing it. During the live Q&A, she discusses how to talk to kids about COVID anxieties and provides tips for tackling medical phobias and readjusting after COVID.

Watch Webinar

Stress & Anxiety Reduction

Dr. Amy Keefer dives into common co-occurring psychiatric conditions in autism. Previous projects, she explains, have investigated correlates of anxiety and predictors of response to anxiety treatment in autistic youth. Keefer outlines contemporary collaborations and research on the mechanisms underlying anxiety in autism. She asserts the potential and need for developing novel, empirically validated treatments for emotional dysregulation. This page also includes an interview with Dr. June Groden on anxiety and autism.

Watch Webinar

Immune system dysregulation is linked to various conditions that co-occur with autism. These include chronic inflammation, GI problems, autoimmune diseases, and mental health issues. For many autistic individuals, immune dysregulation can impact daily living, well-being, and overall quality of life. This list of resources covers contemporary research on the drivers of immune dysregulation and nutritional treatment strategies for immune dysfunction in autism.

Immune Function & Autism

This information page outlines the connection between the immune system and autism. It details antibody classes and health problems associated with immune system dysregulation in autism. Conclusions about when to evaluate autistic patients for immunodeficiency and food allergies are presented. Resources on the page include a recorded symposium on biomarkers and autism and a list of published studies on the immune system and autism.

Visit page

Webinars Related to Immune Function in Autism

Immunological Issues in ASD – Gestational Influences

Judy Van de Water, Ph.D., discusses immunological dysregulation during gestation. She examines the etiology of autism and explores the interplay of genetic markers and environmental factors by examining correlations in infections, gestational immune system dysregulation, and autoimmune and autism diagnosis. Van de Water outlines studies on early markers in autism (EMA), maternal autoantibody-related autism (MAR), and intracellular MAR staining, demonstrating the significance of maternal antibodies both as biomarkers and developmental contributors. She highlights the findings and emphasizes their value in future research, screening, treatments, and prevention before opening to questions.

Watch Webinar

Gluten-free/casein-free diets – research updates

Director of the Nutrition Clinic at the Johnson Center for Child Health and Development, Kelly Barnhill, MBA, CN, CCN, discusses gluten-free and casein-free diets (GFCF) in autism. She details research history, present findings, and future exploration pathways. Barnhill outlines multiple case studies and discusses what we do and do not know about GFCF diets. She presents nutrition concerns and practicalities associated with GFCF diets and advises listeners to seek medical support for such changes.

Watch Webinar

Systemic Inflammatory & Autoimmune Diseases—PANS

Jennifer Frankovich MD MS, clinical professor at Stanford University/Lucile Packard Children’s Hospital, discusses the co-occurrence of systemic inflammatory and autoimmune diseases – including the overlap between pediatric acute-onset neuropsychiatric syndrome (PANS) and autism. She outlines the presentation of classic rheumatologic diseases noting the prevalence of mental health symptoms and provides clinical criteria for PANS. Frankovich discusses PANS as a relapsing/remitting condition and explores the clinical management options, citing recent studies on steroid use. She concludes by reemphasizing the association of psychiatric symptoms with autoimmune and rheumatologic diseases and states the importance of post-flare rehabilitation before opening the floor to questions.

Watch Webinar

Eating Well for Immune Health

Alan Gutierrez, MS, RD, LD, presents on optimizing immunity with nutrition and lifestyle. The speaker outlines the dangers of flu season and provides a brief overview of the immune system and its functions. He describes the GI tract as an extension of our external environment, underscoring its significance in immune response and stability. Gutierrez advises on nutrient-rich foods, their benefits to the immune system, and how to prepare them for optimal nutrient intake. He discusses critical vitamins and urges viewers to use caution and consult a practitioner before adding supplements to one’s diet. The speaker touches on the importance of lifestyle in long-term immune health, especially sleep, hygiene, physical activity, and stress. Gutierrez provides suggestions for stress management and summarizes the presentation in five action items.

Watch Webinar

Evidence Supporting a Nutritional Approach for ASD and Comorbid Conditions

Dr. Viki Koblinor dives into evidence-based approaches for nutrition in autism, PANS/PANDAS, and POTS. She describes nutritional biochemistry and which nutrients are vital to proper gut and overall body function. The speaker discusses a 2018 study that employed holistic nutrition-based treatment strategies over 12 months. Koblinor underscores the gut-brain communication pathway and outlines what a nutrient-rich, healing diet looks like. She touches on PANS/PANDAS and POTS, noting that nutritional treatments and strategies greatly resemble those she discussed for autism. The presenter highlights inflammation as a driver for many behaviors and presentations of autism, PANS/PANDAS, and POTS. Koblinor underscores the importance of balance in a healthy diet before the Q & A session.

Watch Webinar

Ehlers-Danlos Syndrome and Other Hypermobility Spectrum Disorders in Families with Autism

Dr. Casanova dives into Ehlers-Danlos (EDS) and related hypermobility syndromes in this webinar. She describes EDS with a focus on the joint hypermobility spectrum. The presenter highlights that this field of study is in its infancy and that much more research is needed. She outlines recent findings that have shed light on the roles collagen fibers play within the body and the brain. Casanova discusses the co-occurrence of EDS and autism and other hypermobility syndrome disorders and wonders what other roles collagens play in the body. She outlines future research aims and closes with a question-and-answer session.

Watch Webinar

PANS/PANDAS – Research Updates

Susan Swedo, M.D. discusses research findings on causes, symptoms, and treatments for PANS/PANDAS. She highlights the differences in syndromes and diseases and discusses the diagnosis and clinical presentation of PANS/PANDAS, asserting that comorbidities are the rule, not the exception. Dr. Swedo also details the disease pathway and historical links of OCD and Sydenham Chorea to PANDAS and affirms its recognition as a form of autoimmune encephalitis.

Watch Webinar

Research Updates on Maternal Autoantibodies and ASD

Judy Van de Water, Ph.D., discusses current machine learning research used to identify several patterns of maternal autoantibodies associated with the diagnosis and severity of autism. She outlines the history of autoantibody research related to autism, defines a new subtype, and details animal model development. Van de Water discusses commonalities across presented models and findings, highlighting the potential for biomarkers and preclinical studies. She summarizes significant findings and research themes before opening the question and answer session.

Watch Webinar

Sensory processing issues are a common challenge for autistic individuals. These difficulties can include heightened sensitivity to certain stimuli, such as sounds or textures, and difficulty processing and integrating sensory information from different sources. For many autistic people, sensory processing issues can significantly impact daily life. This resource list provides a selection of helpful webinars and articles that can provide support strategies for individuals with sensory processing issues.

Sensory Processing Articles

Sensory Integration in Autism Spectrum Disorders

This article provides a detailed overview of sensory processing issues in autistic individuals. It explores different ways the brain processes sensory information and how those processes can be disrupted in autistic individuals. Information on the signs and symptoms of sensory processing issues and strategies for managing these challenges are discussed. The author emphasizes the importance of early intervention and provides resources for families and professionals to help support individuals with sensory processing issues.

Read Article

Auditory Processing Problems in ASD

Read Article

Aide Canada: Sensory & Motor Strategies Collection

AIDE Canada and its partners have collaborated on this collection regarding sensory and motor strategies. It includes a toolkit, articles, library resources, and webinars.

See the Resources

Sensory Processing Expert Webinars

The majority of the webinars listed below have been time-stamped and transcribed into concise written summaries, which can be easily accessed on the same page.

Pain, Sensory Issues, and Autism

Register now for our free upcoming webinar on August 30, 2023, where Dr. Tami Bar-Shalita, Dr. Yelena Granovsky, and Dr. Eynat Gal will delve into the topics of sensory issues, pain behavior, and neurophysiology related to autism. The presenters will provide a comprehensive review of both quantitative and qualitative studies in this field.

Watch Webinar

Brain & Sensory Processing Differences Across the Lifespan (Series Part 1)

In part one of this webinar series, Fakhri Shafai, Ph.D., M.Ed., discusses sensory differences experienced by individuals with autism across the lifespan. She describes atypical neuronal migration and synaptic pruning and outlines how such differences in brain development lead to sensory issues in autism. Dr. Shafai uses relatable analogies to discuss complex topics and highlights the lack of adult sensory symptom studies across the field. She defines crucial brain regions, the eight sensory systems, and current limitations to the discourse. Before opening the floor to questions, Shafai touches on future directions for research and resources and provides practical examples of sensory toolkits and programs.

Watch Webinar

Sensory-Friendly Strategies for Home (Series Part 2)

In part two of this webinar series, Moira Peña, BScOT, MOT, OT Reg (Ont.), discusses sensory processing strategies for home. She describes how atypical sensory processing affects lived experiences of autistic individuals and outlines three sensory profiles. Peña dives into the sensory diet approach noting short- and long-term goals and the importance of the “power senses.” She provides examples of strategic sensory schedules and environmental adaptations and emphasizes the importance of co-regulating and leisure activities. Peña celebrates individual differences in autism and suggests that productive failures are part of the process. She provides more resources and tools before opening the question-and-answer session.

Watch Webinar

Live Q&A: Sensory Strategies at Home (Series Part 3)

Moira Peña, BScOT, MOT, OT, Reg. (Ont.), answers questions about sensory strategies for home. This recorded live question and answer session was a follow-up to our two-part series on brain and sensory processing differences and sensory strategies for home.

Watch Q&A Session

Autismo y el Procesamiento Sensorial: Estrategias Prácticas para Usar en Casa

Our talk Sensory-Friendly Strategies for Home by Moira Peña, BScOT, MOT, OT Reg (Ont.), is available fully in Spanish.

Moira Peña, BScOT, MOT, OT Reg (Ont.), habla de estrategias de procesamiento sensorial para casa. Describe cómo el procesamiento sensorial atípico afecta a las experiencias vividas por las personas con autismo y esboza tres perfiles sensoriales. Peña se sumerge en el enfoque de la dieta sensorial señalando los objetivos a corto y largo plazo y la importancia de los “sentidos de poder”. Proporciona ejemplos de horarios sensoriales estratégicos y adaptaciones ambientales y hace hincapié en la importancia de la corregulación y las actividades de ocio. Peña celebra las diferencias individuales en el autismo y sugiere que los fracasos productivos forman parte del proceso. Proporciona más recursos y herramientas antes de abrir la sesión de preguntas y respuestas.

Ver el seminario web

Auditory Processing and Autism Spectrum Disorders

Sophie Schwartz, Ph.D., discusses auditory processing disorders (ADPs) in autistic individuals. She defines ADPs and highlights their impact on language acquisition and quality of life. Schwartz outlines her recent research at Boston University and affirms that atypical responses to sound correspond with biological differences in the brain and are not behavioral problems. She discusses current diagnosis and treatment options and outlines future research avenues before closing with a question and answer session.

Watch Webinar

Autism and Eating-Related Behaviors

Gregory Wallace, Ph.D., discusses eating-related behaviors in autism. He examines potential drivers of food neophobia and presents novel studies on the cognitive/behavioral correlates of eating in the absence of hunger (EAH). Wallace defines selective overeating as a new subtype of autism and details recent studies on taste perception and cortical taste pathways in ASD compared to typically developing groups. The presenter highlights limitations to current research and the need for longitudinal studies. Wallace closes with a Q&A discussing picky eating, GI difficulties, ASD and anorexia, and more.

Watch Webinar

Hippotherapy for Autism Spectrum Disorders

Founder and COO of Taking the Lead, Chelsea Whitaker, OTR/L, discusses hippotherapy and how this distinct practice can help autistic individuals and other disabilities. She describes how working with the natural movement of horses enables clients to build self-confidence, gain independence and reach their goals. Whitaker provides video examples of therapy exercises and outlines how they can improve communication, physical strength, and focus. She closes with a question & answer session where she discusses training, extant research, and more.

Watch Webinar

Sensory Features: Research and Evidence

Dr. Roseann Schaaf discusses the sensory challenges commonly experienced by autistic individuals, as well as evidence-based strategies for addressing these challenges.

Watch Webinar

Supporting Sensory Needs

Lindsey Biel, MA, OTR/L, describes the complexities of sensory systems, how they impact daily activities and learning, and the importance of positive sensory support. She outlines the sensory systems, noting differences in lived experiences for autistic persons, and discusses support techniques based on sensory understanding. Biel emphasizes the nature of stimming and sensory meltdowns and prescribes sensory diets/programming techniques. She concludes with ideas and links for supportive sensory activities, clothing, resources, and more.

Watch Webinar

Sensory Processing Research Funded by ARI

Gastrointestinal conditions like constipation, abdominal pain, and GERD often co-occur with autism and can significantly impact daily living and quality of life for autistic people. Contemporary research suggests the gut-brain communication pathway is integral in the development and presentation of autism and GI conditions. The following articles and webinars provide information on current research and theories explaining the interplay of GI conditions and autism and offer suggestions for supporting a healthy gut.

Gut-Brain Connection Articles

Nutrition and the Gut-Brain Connection

This article discusses the importance of nutrition and outlines research on the gut-brain connection in autism. It considers how imbalances in gut microbiota can affect brain function and behavior and how nutritional interventions can help address these disproportions. The article also highlights the importance of a balanced diet with essential nutrients such as vitamins, minerals, and amino acids. It emphasizes the need for individualized treatment plans that consider each person’s unique nutritional needs and challenges.

Read Article

Gastrointestinal Problems Common in Autism Linked to Gene Mutation that Affects Behavior

This article outlines a study conducted by Dr. Kara Gross Margolis and colleagues that found a link between gastrointestinal problems in autism and a specific gene mutation that affects behavior. The study, conducted at Baylor College of Medicine, found that the RERE gene mutation is associated with an increased risk of gastrointestinal problems in individuals with autism. The article explains that the RERE gene plays a role in the development of the nervous system and can affect behavior, including social interaction and communication. The researchers suggest that the link between gene mutation and gastrointestinal problems may be due to disruptions in the communication between the gut and the brain. Overall, the study provides valuable insights into the complex relationship between genetics, behavior, and gastrointestinal problems in autism.

Read Article

Continuing Medical Education

Gastrointestinal Issues in Autism Spectrum Disorders

This CME video was co-produced with the Cleveland Clinic.

1. Recognize the varied manifestations and diagnostic evaluation of diverse gastrointestinal conditions commonly co-occur in autistic individuals.
2. Identify barriers to the assessment and adequate clinical care of GI concerns for autistic people.
3. Recognize critical gaps in our clinical understanding and practices pertaining to GI issues and autism.

Watch CME Webcast

Gut-Brain Webinars from ARI

Autism and Pica

Dean Alexander, Ph.D., discusses pica, the ingestion of non-food substances, which has received insufficient attention as a common, sometimes lethal, form of self-injurious behavior. Behavioral approaches to treatment, more often than not, fall short. Biological intervention, if supported, may hold out new promise.

This is a joint presentation by ARI and the World Autism Organisation.

Watch Webinar

Gastrointestinal Issues and Autism Spectrum Disorders: Serotonin as a Potential Brain-Gut Link

In this webinar, Dr. Kara Gross Margolis discusses research on the association between gastrointestinal problems and challenging behaviors in children with autism. Her basic and translational research focuses on the relationship between intestinal serotonin, gut dysfunction, and the potential role of serotonin as a gut-brain link in autism.

Watch Webinar

Cross Talk Between Gut & Brain in ASD: Do They Understand Each Other?

Dr. Fasano considers the interplay of environmental factors and the gut microbiome in autism presentation and pathogenesis. He explains intestinal permeability and highlights the role that environmental factors like gluten play in the leaky gut theory. The speaker considers the complexity of the microbiome genome compared to the human genome and describes contemporary theories explaining the co-occurrence of GI conditions in autism. Fasano underscores the need for personalized medical care and cross-discipline investigation before the Q&A.

Watch Webinar

The Role of Neurotransmitters in GI Disorders Related to Autism

Kara Gross Margolis, MD, explores recent studies surrounding the role of serotonin and the more extensive gut microbiome in gastrointestinal (GI) and inflammatory conditions related to autism. She presents case studies highlighting the different presentations of GI issues in individuals with autism and how those behaviors relate to the gut-brain links. Margolis outlines research on fecal transplant, multi-omics of brain-gut-microbiome disease, correlated bacterial communities, serotonin reuptake transporters (SERT), and new longitudinal pilot studies. She notes limitations and key findings for each study and discusses their impact on current and future research avenues. She concludes by recognizing ongoing serotonin drug development before the question and answer session.

Watch Webinar

Co-occurring Medical Conditions in Autism

In this brief overview, neurologist Margaret Bauman, MD, summarizes symptoms and signs of medical comorbidities that frequently occur but may go unrecognized in patients diagnosed with ASD, including seizures, sleep issues, hormonal issues, urinary problems, and gastrointestinal disorders. While the underlying cause of autism spectrum disorder (ASD) is generally unknown, scientists suspect that it is a multifactorial condition affecting multiple body systems.

Watch Webinar

Research finds GI issues coincide with challenging behaviors in ASD

Dr. Ferguson discusses current research indicating that GI issues coincide with behavior problems in autism. He explains how the autonomic nervous system drives stress response and details its relationship with GI functionality. The speaker describes five studies investigating different aspects of Gi issues, anxiety, stress, and problem behaviors in autism. Ferguson touches on pharmacological, vagal, and behavioral treatment strategies before the Q&A.

Watch Webinar

Interview with June Groden, Ph.D.

Dr. June Groden is considered one of the pioneers in the field of autism and developmental disabilities. Her primary areas of interest are stress and anxiety and procedures to reduce stress. She has focused on the development of relaxation and imagery-based procedures for a population with autism and developmental disabilities. Dr. Groden is the Director of the Groden Center in Providence, Rhode Island.

The Groden Center provides community-based evaluative, therapeutic, educational, and vocational programs for children and adults who have or are at risk for moderate to severe behavioral/emotional problems, including autism. Dr. Stephen M. Edelson (SE) interviewed Dr. June Groden (JG) on November 13, 1996.

SE: Could you tell us a little bit about your background?

JG: I have a bachelor’s degree in business administration, a master of education and a master of arts in psychology and a Ph.D. in psychology. The combination of education and psychology is helpful in combining both the academic and behavioral programs since behavioral problems are often affected by the appropriate curriculum or vocational programs. My interest in stress reduction arose from the work I had done earlier in self-management and self-control, and I felt that it was important to look at inner behavior in addition to overt behavior. I had studied the work of Joseph Cautela, Ph.D. at Boston College and went to study with him for the specific purpose of adapting the procedures he developed which he labeled as Covert Conditioning to use with the population with autism and developmental disabilities. We are still working together to continually refine and expand these procedures. He is the co-author of the Relaxation Manual and has been part of developing the videos, Breaking the Barriers: I and II which feature the relaxation and imagery procedures.

SE: Since you are considered an expert in the areas of relaxation and visual imagery, could you describe your work so our readers will have a better idea of what is involved and what they might expect?

JG: The relaxation program that we use involves progressive relaxation developed by Edmund Jacobson. Basically, this program involves teaching consumers how to discriminate between tense muscles and relaxed muscles. Children and adults are taught the relaxation procedure, usually in a one-to-one teaching session lasting for as long as the participant can maintain attention. This usually ranges from a few minutes to twenty minutes. The practice session is a regularly scheduled event built into the person’s schedule. The person learns to tighten and relax the arms, hands, and legs, and to do deep breathing in a sitting position. The child or adult is then taught relaxing without tensing. Finally, the person is taught to tighten and relax all remaining muscle groups of the body.

After the person has mastered the relaxation procedure, we administer a stress survey which I have developed and which helps to identify stressful situations. Once these stressful situations have been pinpointed, the client can then use coping strategies, such as relaxation or imagery to reduce their stress. The relaxation program can also be used to develop self-control by the individual learning to make a relaxation response in place of the typical maladaptive behavior he or she exhibits during stressful situations.

The imagery programs utilize visual imagery and/or a procedure we call picture rehearsal. After conducting a functional analyses of behavior (this is described in our book Understanding Challenging Behavior), a script is written which utilizes the information from the analyses. For procedure rehearsal programs, line drawings or photographs depict the antecedent event, the targeted behavior and the consequences. For visual imagery alone, just the script is read without the pictures. Often relaxation is incorporated into the scene. An example of a scene which targets bedtime behavior might be: “You are watching TV and mother says, It’s time to go to bed. You take a deep breath and relax and say okay, I will get into my pajamas. You feel proud you were so cooperative. Now imagine your mother reading your favorite book before you get in bed.” The mother, therapist or teacher describes the scene first and then the child or adolescent repeats it either verbally or by pointing to each picture.

SE: During a recent lecture of yours, you mentioned that imagining a reward could be as effective as actually receiving the reward. I thought this was a very interesting concept, and it could be an extremely important behavioral tool.

JG: There is some evidence to suggest that at times the effects of observable behavior and imagined behavior can be similar. Studies by K.D. Brownell, D. H. Barlow and A.E. Kazdin support this. We have also observed our children and adults smiling when they imagine a reinforcer or swallowing when they imagine eating a favorite food. It has a great impact on the use of imagining for therapy since it is possible to create many different situations, places and reinforcers without actually being there.

SE: Could you describe a couple of individuals who benefited from your program?

JG: There is a person in our adult program who had lived in a state hospital where he had a two-on-one staff ratio around the clock. He was also receiving a very heavy dosage of medication. When he arrived at our program, he could not even be in a room with other people. He had to be placed alone because he was extremely aggressive. We started working with him, one-on-one or two-on-one; and we started teaching him relaxation as a way to control himself. At first, he did not want to use relaxation with a staff person, so we recorded the relaxation procedure on an audiotape. He would listen to the tape but he would often break the tape. Over time, he started using the tapes and doing the relaxation procedure. We then started to identify situations for him in which he was anxious so he could learn to relax himself using the relaxation procedure.

We also identified situations that were antecedent to some of his tantrums. We did a thorough functional analysis of his behavior, and we were able to determine precursors to situations in which he would become aggressive. We then developed several imagery scenes which we put on index cards. It is the procedure I just described called picture rehearsal. We used the cards to rehearse more appropriate behavior. We were also able to get him involved in a vocational training program and an academic program. In about six months he reduced his aggressive behaviors, and we then transferred him to the adult vocational program. Now, seven years later, he is in a group home where he has a separate apartment. He has a job and uses public transportation independently. Although he is doing very well, he still has a few episodes where he may break items, usually his own; but his aggression has not been towards other people or himself. He has changed dramatically and people who knew him at the institution and meet him now cannot believe the difference. This case is more fully described in the Covert Conditioning Casebook (Cautela & Kearney, 1993). Reprints are available from me.

In another case, we worked with a 3-year old boy who was diagnosed as having autism. He did not interact with other children, and he had very little language at that time. We started working with him in a regular nursery school. I was the consultant on this case, and he had a teacher aide who worked with him one-on-one in addition to the other teaching staff. The main part of the program was teaching him the relaxation procedure and using picture rehearsal. We also taught his parents the relaxation procedure, and they were able to use this procedure with him at home. After a short time, every time he became anxious, the staff member cued him and he was able to relax immediately. We also identified situations which caused him to become anxious and incorporated these events into the picture rehearsal program. The picture rehearsal scenes identified events that made him uncomfortable and illustrated how to behave and act more appropriately. We worked with him from preschool through kindergarten and first grade. When he got into first grade, the teacher thought the relaxation procedure was very helpful and requested it be taught to the entire class. When he continued into the second grade, that class also performed the relaxation procedure everyday. Eventually, he started developing his own imagery scenes; and by the third grade, he was doing so well that we began reducing the amount of time he spent with his aide. By fifth grade he did not need special services any more. He is now in a regular high school, and he is the junior class president. This is a real success story, and I do not think anybody would be able to pick him out as having autism.

Let me describe another case. We had a person in our program who was very disruptive. She would yell out in class, and she would throw things and get very upset. When she came into our program, we started using imagery to reduce her disruptive behavior. She would rehearse scenes on how to wait and how to act more appropriately. She also practiced relaxation. Within one year, we were able to reduce her aggression and her tantrums. In the second year, we started working on additional appropriate social behavior, such as learning how to interact with other people and how to be more assertive in her responses instead of screaming or yelling. Within a short time, she was able to handle these situations in a more appropriate manner. We then started teaching her how to go into stores and learn what to say to strangers so that her mother could feel safe when taking her into the community. Overall, she did very nicely; and now she is back in a public school.

SE: Often people cannot imagine how a relaxation or an imagery program can be used to teach individuals who are very low functioning. What are your experiences with these issues?

JG: It is assumed that because of their cognitive deficits, this population is not able to benefit from procedures that are used frequently with a non-handicapped population. This misconception is particularly the case concerning the use of relaxation and imagery-based procedures. Some people with intellectual disabilities are able to learn the relaxation response, and we have been very successful for over 20 years in teaching relaxation and using picture rehearsal with these individuals. We had one boy, who comes to mind, who spoke with just a few words and could point to a few pictures. It took many years to teach him independent living skills, such as shoe tying and dressing, but he was able to participate in the relaxation program. If you cue him to relax, he knows exactly what to do. The training took about five or six years, until he was able to do the breathing correctly and to relax all parts of his body.

SE: Could one assume that the best candidates for your program are those who suffer from anxiety and stress?

JG: I feel that everybody, to some extent, has stress or anxiety in their life. It is the way that we cope with the stress and anxiety that makes the difference. We focus on teaching coping strategies that are beneficial and increase the well-being of the individuals we serve.

SE: Since autistic individuals typically have communication problems, I would assume that they are more likely to experience stress in their life than those individuals with good communication skills.

JG: Yes. In the literature, stress is often associated with not being able to assert oneself and not being able to say what one wants. This, of course, applies particularly to people with autism.

SE: Can you describe the relaxation procedure in more detail?

JG: When working with individuals with autism using progressive relaxation, I suggest starting with gross motor areas because it is easier for them to learn to tense and relax these muscle groups rather then starting at the head and working down the body. First, we tighten and we relax each arm individually, and then the same for each leg individually. Because many people with autism exhibit stereotypic behavior, I have them concentrate on tightening and relaxing each hand because we want them to know what if feels like to have their hands relaxed. Then, when they are engaging in stereotypic behaviors, we can say “relax your hand,” and they understand what that means. After the arms, legs and hands, we start deep breathing exercises. We teach them to inhale and exhale. Also, I teach them to associate a meaningful calming word, such as peace or a religious word or the word “relax” as they exhale. The word then becomes associated with a relaxed feeling.

SE: Changing the topic slightly, and this is a question I often ask during my interviews, ‘when you come across a family with a newly diagnosed child, what recommendations do you give them?’

JG: I usually tell them to get involved in a program. If the child is young, they should be in an early intervention program. If they are older, the family should find a consultant with expertise in the field of autism to go into the classroom and set up a program that is appropriate for the child and act as an interpreter to the teacher and staff. I also feel that parents should receive counseling and education on how to handle a child or adult with autism, what to look for, what kinds of problems might occur, and what they should do about them. We emphasize parent teaching at our program, so that parents learn how to handle some of the problems when their children are young. We also inform them of resources available to them, and we tell them about the kinds of assessments they should have for their children. This is all very individualized because there is such a wide variation of problems since autism is a spectrum disorder. We try then to determine what is appropriate for that particular person.

SE: What do you think about teaching a child in a home situation?

JG: I feel that it is very good for parents to learn what to do and to work with their children at home and for the children to have home services. I also think that children should be part of a school program. These children should have the opportunity to be with other children, to be with their peers and to learn to have social relationships. For very young children, Lovaas has found it effective to do intensive applied behavioral analysis for 40 hours per week at home. We provide this type of home program but also supplement the discrete trial format with self-control procedures using relaxation and imagery. We introduce academics at an early age, using direct instruction, incidental teaching and communication training. We also have these services provided in preschools and classrooms with typical peers.

SE: You mentioned that you developed a stress survey. Can you describe this survey in more detail?

JG: Yes. We felt that there was a need for a good assessment tool to measure stress with people with special needs. I first used an open-ended questionnaire and asked a number of people within our system and other staff, parents, and persons with autism to tell us what they felt were significant stressors for people with autism. We then placed these responses into a number of categories. By a statistical analysis, called principal component analysis, we divided the stressors into categories. This questionnaire also provides us with a stress profile, and this information helps us to develop imagery scenes and other programs to reduce stress. People can obtain a copy of the stress survey by writing to our Center.

SE: Could you tell us a little bit about your Center?

JG: We have a very large continuum of services that are flexible and personalized. They were developed in response to the needs in our area. We first started with a 6-day extended hour school-based program. Since some parents could no longer keep the children in their own homes, or some parents were not able to care for their children because of other issues, we started residential programs which include apartments, group homes, as well as what we call ‘professional family living arrangements’ (PFLA). Basically, we want young children to be part of a family, so we train foster families and call them ‘professional families.’ We give them the extra training on how to handle children with special needs, and place some children with these families for a period of time. Sometimes the children need only a short period of time and then they return to their natural families while others remain at their PFLA for extended periods. We also have home-based services for early intervention, in which we send therapists and supervisors to work up to 40 hours in homes; and we also set up programs for children in their own home schools. Using an applied behavioral analysis approach, they receive intensive services but they are still part of a regular classroom. We also serve individuals with special needs through adulthood. We have vocational programs, and all of our vocational services are located in the natural community, such as hospitals, food banks, etc. Our supported employment program has job coaches or natural supports. In addition, we have parent programs, offer consultation services to schools and to other programs. We provide training workshops to disseminate our procedures.

SE: Do you offer workshops at your Center?

JG: We do workshops outside of our Center like the one you attended in Portland. However, we are thinking about establishing a training center at our institute where people can come for a week or two to receive training. We have had many requests from people who want this type of training and are interested in our relaxation and imagery procedures and our assessment procedures, which include the functional analysis of behavior.

To learn more about the Groden Center, visit their website.