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Lately, I've been noticing more and more ABA clinics popping up in our area. Every time I see another sign go up, I have the same mix of feelings… disappointed, angry, sad, and so many more that I honestly cannot identify.
There is so much conflicting information out there for families and they are just doing the best they can. Oftentimes they have a lot going on, so they go to specialists and doctors with lots of letters behind their name and degrees on the wall for help. After hearing their loved one is Autistic, they ask what they're supposed to do next, and ABA is usually one of the very first recommendations they hear. However, there is a shift happening currently and many physicians have not yet realized this shift and they continue to make antiquated recommendations. Let’s discuss this shift and also what this means for TCOB families. Before I start, I know that this is a high emotion topic… it is for me too. I have been on the receiving end of behaviorism my entire life. I also practiced in behaviorism, prior to my enlightenment, so this isn't written to make anyone feel guilty…only to help people understand TCOB’s position and why it is our position. After a full day of focused attention, problem-solving and, for many neurodivergent students, the extra effort of masking social expectations, our brains need genuine downtime…what I like to call “recovery time.” Too often, homework barges into that space, turning after-school hours into a marathon of worksheets and projects. Research shows that more than two hours of homework a night doesn’t boost grades but does spike stress, interfere with sleep and chip away at emotional resilience. So when we pile on assignments, especially for ADHD and Autists who commonly learn best void of arbitrary “practice,” we’re actually undermining the very learning we hope to reinforce.
Recovery looks different for everyone. Some kids (and adults while we are at it) need an hour of solo time with a favorite video game or craft project; others find calm in curling up with a book or taking a walk. Isolation isn’t avoidance here; it’s a way to shed the day’s demands and recharge. Parents might worry this looks like withdrawal, avoidance, or even “depression,” but in truth it’s a coping skill…a healthy, necessary one. When homework (or even chores) squeezes into that window, it can push someone already on the edge of a meltdown into a full shutdown, or stretch out burnout. If you’ve ever asked your neurodivergent child to do something, even something they usually enjoy, and been met with resistance, distraction, or complete shutdown, you are not alone. Parents often describe this as defiance or stubbornness, but for many kids, it’s something deeper: demand avoidance. This is where it gets tricky. Demand avoidance can happen for very different reasons, especially in ADHD compared to Pathological Demand Avoidance (PDA). The outward behaviors can look the same, which is why confusion is common. The difference is in why it happens and what's happening within. Demand avoidance is not "stubbornness" or a chance to give adults a "hard time." It is the brain’s way of protecting itself when a task feels overwhelming, threatening, or simply impossible to start. For ADHD, it often comes from the weight of executive functioning needs like initiation, planning, and working memory. For PDA, it is more about the nervous system reacting to a perceived loss of autonomy. Even wanting to do something can trigger avoidance if it turns into a "must." Some people show extreme demand avoidance in one environment, such as a busy, unpredictable home, but far less in another, such as a calmer, more predictable space. If avoidance decreases significantly when distractions are fewer and routines are clear, ADHD is a likely factor. If avoidance stays the same even in calm and consistent settings, PDA may be possible. It feels like everywhere you turn lately, someone is claiming to be “neurodiversity-affirming.” Therapy clinics, schools, even entire districts are adopting the language, but when you look closer, the practices don’t line up. As a parent or caregiver, it can be hard to know who actually gets it and who’s just using the terminology because it’s trendy. There are real, meaningful differences between performative neuro-affirming language and truly affirming support. If you’ve been burned before, you're not alone. Here are some ways to tell whether a therapy clinic, therapist, school, or teacher is genuinely neuro-affirming or just using it as a marketing label. RED FLAGS of Performative “Neuro-Affirming” Practices They say the right things. But what they do tells a different story. 1. They still use compliance-based methods but call them "regulation" or "social skills"
CLICK "Read More" for GREEN FLAGS and for downloadable questions to ask teachers/therapists!
That’s where we can change the game.
One of the most helpful things we can do, for both teachers and kids, is to proactively share the most important information before school starts. Things like sensory needs, communication styles, regulation strategies, or even what truly lights that child up. When teachers aren’t left guessing or learning everything by trial and error, it lowers their stress and sets up the entire year for smoother interactions. At Therapy Center of Buda, we’ve seen how powerful this simple shift can be. That’s why we created personalized info sheets designed to highlight the things that matter most about your child. How they learn. What helps them feel safe. What works when things get hard. We’re offering these sheets to our current families during sessions over the next two weeks. But we didn’t want to stop there. We know so many other families could benefit, so we’re making them available right here too, for anyone who needs them. This school year can start with understanding instead of overwhelm. [Click the image for that version] Alright, I am climbing on my soapbox today... We hold children to higher standards of behavior than we hold adults. We expect them to sit still, follow directions, accept “no” without rational explanation, keep calm in public, and regulate every big emotion, on cue. And yet, most adults struggle to do even half of that. We tune out during meetings. We get cranky when we’re tired. We avoid tasks that don’t interest us. We push back on rules that feel unfair. We complain when someone says no without offering a reason. So why are we demanding more composure, more patience, and more flexibility from children than we expect from ourselves? Children Are Learning. That’s the Whole Point. A lot of the time, what adults label as “bad behavior” is actually just a child doing their best with what they’ve got. Clinical psychologist Mona Delahooke reminds us that when we see behavior as communication, it stops being something we need to “fix” and starts being something we can understand. If a child is melting down, shutting down, or saying no, there’s a reason. They’re not trying to make your life hard. They’re trying to manage something inside them that feels too big, too fast, or just too much. What they need in that moment isn’t punishment or shame. It’s support. Kids Do Well When They Can That phrase, coined by Dr. Ross Greene, should be at the foundation of how we interact with children. If a child could meet the expectation, they would. So when they can’t, we need to shift from blame to curiosity. What’s in the way? What skills or support are missing? Dr. Greene’s work reminds us that collaboration and empathy go a lot further than control and consequence. When we approach kids with understanding instead of demands, we don’t just get better behavior...we build better relationships. They're Not Projects. They're People. We have to stop trying to shape kids into what’s easiest for adults. Alfie Kohn, who’s written extensively about parenting and education, points out that many of our systems reward obedience over authenticity. That’s not preparing kids for adulthood. That’s conditioning them to suppress themselves. Children learn best when they’re trusted. Not when they’re micromanaged. Not when every move is measured and evaluated. And not when we act like their job is to perform for adult approval. Especially for neurodivergent children, the pressure to “comply” can be exhausting. They’re often pulled through endless programs, therapies, and interventions designed to make them appear more socially acceptable. But that’s not the same as meeting their actual needs. We don’t need more kids who can mask their distress. We need kids who are safe enough to be themselves. Being Bored Isn’t a Problem. It’s a Need. Unstructured time is not a waste. It’s where the good stuff happens. When a child is “doing nothing,” they might be regulating. Or processing. Or dreaming. Or coming up with something wildly creative. Or maybe they’re just resting...and that’s more than okay. Most adults fantasize about having a day without obligations. And yet we pack children’s schedules with structured activity, then panic when they say they’re bored. But boredom is healthy. It invites invention. It allows the nervous system to settle. It makes space for autonomy. Letting a child be bored isn’t neglect. It’s a gift. Noncompliance Can Be a Sign of Growth Kristy Forbes, an Autistic advocate and educator, teaches about “radical acceptance”—the idea that children are not broken, and they don’t need to be reshaped to fit into narrow boxes. Noncompliance isn’t always defiance. Sometimes it’s a child protecting their dignity. Sometimes it’s them listening to their body. Sometimes it’s a protest against a system that feels unsafe. We need to stop treating resistance like a red flag. Kids who say no are practicing self-advocacy. Kids who question rules are learning to think critically. Those aren’t flaws. Those are skills they’ll need as adults. The irony is, we often say we want children to grow up to be bold, independent thinkers, but we punish those traits when they show up in childhood. Give Them Compassion. And Give Yourself Some Too. This isn’t just about children. It’s about us. If you, an adult, need rest after a long day, it’s okay. If you check out during something boring, it’s okay. If you say no to things that drain you, that’s healthy. I know I have a very short tolerance for things that don’t interest me. I check out fast. So I don’t expect kids to give their full attention to something that’s boring to them either. Why would they? Let’s normalize rest. Let’s normalize boundaries. Let’s model what it means to listen to your body, to pause, to protect your energy. Children don’t need to earn rest. They don’t need to be fixed. They don’t need to perform for adults in order to be seen as “good.” What they need is freedom to be who they are, support when things are hard, and relationships that are built on trust instead of control. And honestly? We could all use more of that. Lately, there’s been a huge rise in conversations about PDA (Pathological Demand Avoidance aka Pervasive Drive for Autonomy). Some of it has been incredibly validating for people who’ve never had language for what they experience. And some of it… well, some of it has gotten a little muddy. Let’s name it gently: there are a lot of content creators right now framing PDA as a catch-all for any kiddo who resists doing things. And while the visibility is good, the oversimplification isn’t. It’s not that these creators mean harm. Many are trying to support families in real distress. But the result is that many parents are walking away convinced their child is PDA when what they’re actually seeing is demand avoidance…and those are not the same thing. Demand Avoidance Is Common (and Valid) Most neurodivergent people show demand avoidance in some way. Honestly, it’s a reasonable response to a world full of sensory overload, executive functioning challenges, and often inflexible expectations. Avoidance can show up as procrastination, shutdowns, meltdowns, or even hyperfocus on literally anything else but the thing you’re supposed to do. Sound familiar? These responses make sense. But they don’t automatically mean someone is PDA. So, What Makes PDA Different? Pathological Demand Avoidance isn’t just about avoiding things you don’t want to do. It’s a specific Autistic profile where perceived demands trigger a threat response in the body. Not “I won’t.” Not “I don’t like this.” But “I can’t, because my nervous system has gone into literal survival mode.” This is where the autonomic nervous system (ANS) comes in. For people with PDA, requests (even ones that seem minor, friendly, or just expected) can ignite the same kind of physiological response you’d expect from someone in danger. It’s not attitude. It’s not oppositional behavior. It’s the body protecting itself. Why the Distinction Matters When we blur the line between demand avoidance and PDA, we risk giving the wrong support to the wrong kid. Sometimes, what looks like PDA is:
Learning from Lived Experience I also want to acknowledge that some of the most important learning I’ve done around PDA has come from Kristy Forbes. Her work and her lived experience have changed how I show up...not just as a therapist, but as a parent and a person. From Kristy, I learned the concept and practice of radical acceptance...not performative tolerance, but deep, full-body acceptance of another person’s neurobiology and autonomy. That framework has helped me unlearn old patterns, center safety, and offer more meaningful support. I’m so grateful for everything she has shared; it’s made me better in every role I hold. Welcome to the Therapy Center of Buda, where our practice is rooted in affirming and inclusive therapy. Unlike many traditional speech and occupational therapy clinics, we are grounded in the neurodiversity movement and prioritize creating a supportive and positive environment for all our clients. Here are the key features that define our approach:
There are two contrasting views on the effectiveness of exposure to sensorially dysregulating stimuli in children: those who follow the behaviorist approach and those who support neurodiversity.
Behavioralists believe that exposing children to overwhelming stimuli repeatedly can help increase their tolerance and regulation around the trigger. However, this approach can actually be counterproductive and may teach children to suppress their emotions rather than regulate them. This is because the behaviorist approach focuses on changing behavior through conditioning, rather than addressing the underlying emotional and neurological factors that contribute to dysregulation. On the other hand, neurodiversity-affirming supporters understand that exposure to overwhelming stimuli can cause actual harm to a child's developing brain and nervous system. They believe that every child's sensory experience is unique and that it is important to provide individualized support and guidance in regulating their emotions. Effective strategies include identifying and avoiding triggers whenever possible, providing calming activities and sensory experiences, and teaching specific coping skills for managing emotions. Therefore, it is important to take an individualized approach to supporting children with sensory dysregulation. Exposing individuals to potentially harmful stimuli in an attempt to increase tolerance and the overt signs of dysregulation is invalidating to neurodivergent individuals. Learning sensory triggers, dysregulating stimuli, and regulating stimuli is the foundational work that when combined with a support personnel (e.g., parents, teachers, etc) providing support, co-regulation, and self-regulation is affirming of the individual’s neurotype. This approach will promote healthy brain development and long-term well-being. Supporting research:
What is Dyslexia?
The broad definition: Any student who is below grade level in reading and has had sufficient reading instruction. There are disagreements over how far below grade level learners need to be.
The specific definition: Students struggling with reading and writing; often these students have a profile that includes:struggles with phonemic awareness, rapid naming, spelling, decoding, encoding, and fluency despite having typical intelligence. Dyslexia is...
Dyslexia is not...
What are the CORE characteristics of Dyslexia?
Learners with dyslexia will exhibit some of the following components:
Can speech therapy help identify and treat Dyslexia?
YES! Dyslexia is a language based disorder and absolutely can and should be diagnosed and treated by a speech-language pathologist.
Original Source: https://www.slphappyhour.com/
Research Sources: Cabbage, Kathryn L, et al. “Exploring the Overlap Between Dyslexia and Speech Sound ProductionDeficits.” Language, Speech, and Hearing Services in Schools, U.S. National Library of Medicine, 24 Oct. 2018,https://www.ncbi.nlm.nih.gov/pubmed/30458539. Adlof, Suzanne M., et al. “Understanding Dyslexia in the Context of Developmental LanguageDisorders.” ASHA Wire, https://pubs.asha.org/doi/10.1044/2018_LSHSS-DYSLC-18-0049. Otaiba, Stephanie Al, et al. "Elementary Grade Intervention Approaches to Treat Specific Learning Disabilities,Including Dyslexia." Language, Speech, and Hearing Services in Schools, U.S. National Library of Medicine, 24Oct 2018, https://pubs.asha.org/doi/10.1044/2018_LSHSS-DYSLC-18-0022 Farquharson, Kelly. "Why Speech Sounds Matter for Literacy." SLP Summit,7 January 2020, **ANNOUNCEMENT**
If you have been contacted about resuming in-clinic sessions please know that we will be reaching out to you asap to discuss #telehealth options. Please know we are working as quickly and efficiently as possible to reach out to families. The health of all of our families and staff remain our top priority. We do urge our families that have been resistant to telehealth options to reconsider. #tcobuda #hayscounty #budatx #kyletx #covidsurge #Can2020BeCancelled #2020apocolypse #cantstopwontstop Dear families –
TCOB wants to share some important updates regarding the clinic’s phased re-entry over the next 7-8 weeks. We will be contacting all our families individually to discuss scheduling options in the coming weeks. We want to reiterate TCOB continues to take COVID-19 seriously and the health of our families and staff. As many of you are aware, TCOB launched telehealth services shortly after publicly closing in March. For those families who feel they benefit from telehealth, we want to reassure you we will continue to offer these services to families for the foreseeable future and we highly encourage you to minimize exposure and take advantage of this service as long as possible. We recognize not all families benefit from telehealth, and we hope to welcome you back safely to the clinic with necessary precautions in place for the entire wellbeing of our families and staff. I wanted to share changes we will make to the visits and what you can expect when you return to in-person visits. Written By: Emily Swogger, OTR, M.S. Mindfulness refers to paying attention to the present moment while still calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations. Because mindfulness requires you to quiet your mind it can be difficult for children and for adults. The practice is so vitally important because it is through mindfulness that you really get to know your own body and emotions. By simply ignoring these emotions you end up storing them inside but they find a way to make it to the surface anyways through your body. Your body reacts to the stress by causing stomach aches, headaches, and tension in the muscles in your body. Being stuck in your own thoughts prevents you from noticing the joy in every day moments. It can leave you dwelling in the past or worrying about the future. By practicing daily mindfulness it can help you live more in the present which can help reduce stress, anxiety, and depression. I can also help in your social life as well making you more emotionally resilient. Research has confirmed that for children, mindfulness can:
The following content was originally published by: The American Speech-Language Hearing Association (ASHA). https://www.asha.org/stuttering/ This week is National Stuttering Awareness Week! Did you know that stuttering usually starts between 2 and 6 years of age? Many children go through normal periods of disfluency lasting less than 6 months. Stuttering that lasts longer may need treatment. Talking to people can be hard if you stutter. You may get stuck on certain words or sounds. You may feel tense or uncomfortable. You might change words to avoid stuttering. Speech-language pathologists, or SLPs, can help. It seems like we have a new reality for the foreseeable future. One of these realities is wearing face coverings (masks) to protect ourselves and those around us while outside our homes. It is important to recognize that Autistics, those with sensory processing disorder, and other neuodiverse people may have a difficult time wearing masks for a variety of reasons. It is important that we avoid extreme dysregulation/ melt downs as they pertain to wearing masks. When meltdowns happen as a result of mask wearing it is alright to focus on the other avoidance techniques of social distancing and avoiding public places/ gatherings. Don't force mask wearing if that mean a melt down will happen, remember that we want to honor the communication from our littles even if the message is something we don't want to receive. On March 18, 2020 Therapy Center of Buda made the difficult, yet necessary decision to close to the public to ensure we do our part to keep our community safe and avoid the spread of COVID-19 (i.e., Coronavirus). At the time we closed teletherapy was not an approved by the Texas Department of Licensing (TDLR) for speech-language pathologists and assistants. Nor was it reimbursable by Texas Medicaid (and MCOs) or private insurance policies. We relentlessly engaged with Governor Abbott, TDLR and Gov. Abbott in order to obtain approvals and coverage for our families and other Texan children. After a tireless fight, we obtained approval from TDLR and The Governor to allow our therapists to provide our services via teletherapy during the COVID-19 pandemic. We also have obtained approval from all forms of Medicaid and private insurance companies (with the exception of a few self-funded plans). Many of the private insurance companies have also agreed to waive patient portion of teletherapy visits. This was wonderful news for our families and other Texan children that required speech-language and occupational therapies.
You may be wondering…What IS teletherapy? How is it different than the therapy we already get? Is it “right” for my child? Let’s explore these questions together: TCOB families: Due to the apparent longevity of our quarantine, we have been working around the clock to get teletherapy up and running and approved by your insurance companies. Below you will find a consent for treatment via teletherapy (PDF). We will need one of these completed for each patient being treated by our clinicians. I will be emailing families over the next couple of days, but if you want to preemptively complete the document (with signature) and email to us here. It is important for us to note: We have the Occupational Therapy department ready to treat starting next week via teletherapy (We will confirm appointments via text). Speech-language department is a bit tricky at the moment because we are waiting on Governor Abbott to sign an executive order allowing the speech-language pathology assistants we all know and love (Katherine, Katie, Haylee, and Ashley) to be able to provide services via teletherapy with Amy's supervision and guidance. So, until we get this executive order or until we are able to find another solution our hands are tied on speech-language therapy. However, we are still preparing as though he will sign this executive order. If you have connections to Governor Abbott feel free to advocate on our behalf. Please remain safe and quarantined. Kindest Regards, Your TCOB Family
Here is an amazing resource for you! Click below to download and print this social story on the Coronavirus and about the need to quarantine. If you are having trouble explaining school closures, safety precautions, or the need to quarantine to someone you love, this is perfect!
Thank you everyone that came to see us at Boo-da this year! We had a blast! |
AuthorAmy Grant is a licensed Speech-Language Pathologist and Clinic Director of Therapy Center of Buda. Special Focus: Autism/ ADHD Family Corner Blog
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