Use of AAC Devices for Individuals with Autism Spectrum Disorder

Augmentative and Alternative Communication (AAC) devices have emerged as crucial tools for enhancing communication and interaction among individuals with Autism Spectrum Disorder (ASD). AAC encompasses a wide array of strategies and technologies designed to facilitate effective communication in individuals who face challenges in speech and language development.

What are AAC Devices?

AAC devices are communication tools that aid individuals with limited or no verbal speech in expressing their thoughts, needs, and desires. These devices serve as alternative means of communication for individuals with ASD, helping them overcome communication barriers and enabling meaningful interaction with their environment and peers.

Why are AAC Devices Used?

The utilization of AAC devices is pivotal for individuals with ASD who struggle with speech and language development. These devices offer a means to bridge the communication gap, reduce frustration, and enhance social interaction. AAC devices empower individuals with ASD to communicate effectively, promote language development, and facilitate engagement in social and educational settings.

Science Behind AAC Devices:

Recent meta-analyses (Aydin & Diken, 2020) have highlighted the effectiveness of AAC interventions for individuals with ASD. A study by Ganz, Davis, Lund, Goodwyn, and Simpson (2012) has demonstrated the positive impact of AAC interventions on communication skills and challenging behaviors. Contrary to concerns, AAC interventions have not impeded speech development; in some cases, they have even improved speech skills (Ganz, Mason, et al., 2014). The research also emphasizes the importance of addressing various communicative functions beyond requesting, including social interactions and joint attention (Ganz, Earles-Vollrath, et al., 2012).

Types of AAC Devices Available:

AAC devices encompass a spectrum of options ranging from low-tech to high-tech solutions.

Low-Tech AAC Devices: These devices include communication boards with pictures, symbols, or words that individuals can point to. For instance, a child with ASD can use a picture board to communicate basic needs like “eat,” “drink,” or “go.”

High-Tech AAC Devices: These devices utilize technology to facilitate communication. Speech-generating devices (SGDs) are an example, allowing users to select symbols or words on a screen, which the device then vocalizes. Another example is mobile AAC apps, such as Proloquo2Go, which offer similar functionality on portable devices like smartphones and tablets.

Considerations for Selecting an AAC Device:

Individual Characteristics: Factors such as age, cognitive abilities, sensory preferences, and motor skills should be considered when selecting an AAC device.

Communication Needs: The specific communication goals of the individual, including the types of messages they need to convey, play a crucial role in device selection.

Context and Environment: The settings in which the AAC device will be used, such as home, school, or community, impact the device’s portability and features.

Multimodal Approach: A combination of AAC modes, including speech approximations, gestures, and facial expressions, may be effective for facilitating communication.

Preference and Choice: Involving the individual with ASD and their family in the selection process helps ensure the device aligns with their preferences and needs.


AAC devices offer a transformative solution for individuals with Autism Spectrum Disorder, empowering them to communicate effectively and engage meaningfully with their surroundings. Supported by scientific research and a range of available options, AAC interventions hold the potential to unlock communication barriers, enhance language development, and promote social interaction for individuals with ASD. By considering individual characteristics, communication needs, and contextual factors, stakeholders can make informed decisions when selecting an appropriate AAC device, ultimately fostering improved communication outcomes and enriching the lives of individuals with ASD.


Aydin, O., & Diken, I. H. (2020). Studies Comparing Augmentative and Alternative Communication Systems (AAC) Applications for Individuals with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Education and Training in Autism and Developmental Disabilities, 55(2), 119-141.

Beukelman, D. & Mirenda, P. (2013). Augmentative and Alternative Communication: Supporting Children & Adults with Complex Communication Needs 4th Edition. Baltimore: Paul H. Brookes Publishing.

Ganz, J. B., Davis, J. L., Lund, E. M., Goodwyn, F. D., & Simpson, R. L. (2012). Meta-analysis of PECS with individuals with ASD: Investigation of targeted versus non-targeted outcomes, participant characteristics, and implementation phase. Research in Developmental Disabilities, 33(2), 406–418.

Ganz, J. B., Mason, R. A., Goodwyn, F. D., Boles, M. B., Heath, A. K., & Davis, J. L. (2014). Interaction of participant characteristics and type of AAC with individuals with ASD: A meta-analysis. American Journal on Intellectual and Developmental Disabilities, 119(6), 516–535.

Ganz, J. B., Earles-Vollrath, T. L., Heath, A. K., Parker, R. I., Rispoli, M. J., & Duran, J. B. (2011a). A meta-analysis of single case research studies on aided augmentative and alternative communication systems with individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(1), 60–74.

Clinic-Based Therapy Versus Home-Based ABA Therapy for Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a complex developmental condition that requires specialized interventions to support individuals in reaching their full potential. Two prominent intervention models are clinic-based and home-based Applied Behavior Analysis (ABA) therapy. In this blog post, we will compare these two approaches. We will explore the benefits and challenges of each model and provide a comprehensive understanding of their differences. These comparisons are drawn from research by Leaf et al. (2017) and Dixon et al. (2016).

Clinic-Based ABA Therapy

Clinic-based ABA therapy involves delivering behavioral interventions within a specialized center or office setting. This model offers several advantages:

Staff Collaboration and Support

One of the primary benefits of clinic-based therapy is the opportunity for staff members to collaborate, learn from each other, and receive continuous support from supervisors. The consistent interaction among staff members fosters skill development and job satisfaction.

Structured Learning Groups

Clinic-based therapy allows for structured learning groups, promoting social interactions and skill development within a group setting. This approach efficiently mirrors real-world environments and prepares individuals for social interactions outside the clinic.

Social Opportunities

Individuals with ASD often struggle with social interactions. Clinic-based therapy provides ample opportunities for peer interactions during breaks, group activities, and therapy sessions. These interactions can lead to the development of meaningful friendships.

Supervised Training and Consistency

Supervisors can provide immediate training and supervision, ensuring treatment fidelity and consistent intervention delivery. This supervision promotes efficient skill acquisition and behavior modification.

Challenges of Clinic-Based ABA Therapy

Limited Generalization

Skills acquired in a clinic setting may not generalize well to other environments, potentially limiting the practical application of learned behaviors in natural contexts.

Parent Involvement

Clinic-based therapy might restrict parental involvement due to logistical challenges such as commuting. This limitation could hinder parents from being actively engaged in the intervention process.

Cost Factors

Running a clinic incurs higher costs for rent, maintenance, and materials, which may indirectly affect the cost of therapy.

Home-Based ABA Therapy

Home-based ABA therapy involves delivering interventions directly within the individual’s home environment. This model has its own set of advantages:

Parental Involvement

Home-based therapy encourages active parental involvement, allowing caregivers to be closely engaged with the therapy process. Parents receive training and support, which can enhance the overall effectiveness of interventions.

Ecological Validity

Assessment and intervention occur within the individual’s natural environment, enhancing the ecological validity of the intervention outcomes. This setting allows for targeting real-life challenges and behaviors.

Generalization to Daily Life

Skills learned in the home environment are more likely to generalize to daily life situations, enabling individuals to apply learned behaviors effectively.

Challenges of Home-Based ABA Therapy

Logistical Pressures

Home-based therapy may require therapists to travel extensively between locations, potentially reducing the variety of experiences for therapists and learners.

Dual Relationships

Continuous presence within the home can lead to the development of dual relationships between therapists and families, which requires clinical skills to maintain objectivity.

Cost and Space Concerns

While home-based therapy avoids clinic-related costs, it may require additional investments in materials and training resources.


Both clinic-based and home-based ABA therapy models offer distinct advantages and challenges. Clinic-based therapy fosters staff collaboration, structured learning groups, and social opportunities, while home-based therapy promotes parental involvement, ecological validity, and generalization of skills. A hybrid approach that combines elements from both models might provide the best of both worlds, capitalizing on the strengths of each while mitigating their respective challenges. At Eastwood Psychologists we attempt to overcome the parental involvement challenges of clinic-based therapy by making parental observation of therapy and parent training a regular part of our programming. We also maximize generalization opportunities by using the community space around our centre such as the library, recreational spaces and retail spaces.  Ultimately, the choice between clinic-based and home-based therapy should be based on the unique needs of the individual with ASD, the preferences of the family, and the guidance of professionals in the field. By understanding the differences between these models, families and professionals can make informed decisions to ensure the most effective and tailored intervention for individuals with ASD.


Dixon, D. R., Burns, C. O., Granpeesheh, D., Amarasinghe, R., Powell, A., & Linstead, E. (2016). A Program Evaluation of Home and Center-Based Treatment for Autism Spectrum Disorder. Behavior analysis in practice10(3), 307–312.

Leaf, J.B., Leaf, R., McEachin, J. et al. Advantages and Challenges of a Home- and Clinic-Based Model of Behavioral Intervention for Individuals Diagnosed with Autism Spectrum Disorder. J Autism Dev Disord 48, 2258–2266 (2018).

The Connection Between Autism and Apraxia

Autism and apraxia are two complex developmental conditions that often intersect, presenting unique challenges for affected individuals and their families. In this blog post, we will delve into the intricate relationship between autism and childhood apraxia of speech, exploring their definitions, connections, and available treatment options.

What is Autism?

Autism, or Autism Spectrum Disorder (ASD), is a neurodevelopmental disorder characterized by difficulties in social communication and interaction, as well as restricted and repetitive behaviors. It affects individuals across a wide spectrum, leading to diverse patterns of behavior, communication, and cognitive abilities. With an estimated prevalence of 1 in 54 children in the United States, autism has garnered significant attention from researchers and clinicians alike.

What is Childhood Apraxia of Speech (CAS)?

Childhood Apraxia of Speech (CAS), also known as apraxia of speech (AOS), is a speech disorder that impacts an individual’s ability to plan and coordinate the precise muscle movements necessary for clear speech. Unlike other speech-related issues caused by physical limitations, individuals with CAS can physically produce speech sounds but struggle to sequence them effectively. This leads to inconsistent speech patterns, making it challenging for others to understand them. CAS exists on a spectrum, ranging from mild to severe and can significantly impact communication abilities. Someone may just struggle with stuttering but someone else may have extreme difficulty with speaking including groping for sounds such that they may have to attempt multiple times to move their articulators correctly to produce a target sound.


How Are Apraxia and Autism Connected?

The connection between apraxia and autism is multifaceted and has been a subject of scientific investigation. Research has shown a notable comorbidity between the two conditions, indicating that a substantial proportion of individuals diagnosed with autism also exhibit symptoms of apraxia. A 2015 study by Tierney et al. examined the potential overlap between autism and CAS. The study found that as much as 65% of children with autism also exhibited speech apraxia. This suggests that children diagnosed with autism should be screened for apraxia, as the two conditions frequently co-occur. The study emphasizes the importance of accurate diagnostic assessments and targeted interventions to address the communication challenges faced by these children.

Echolalia and Autism

Many children with autism initially show signs of echolalia, the repetition of words or phrases, as they learn to navigate language. This repetition serves as an essential step in language development, enabling them to internalize and process linguistic patterns. In children under three years of age, echolalia is a natural part of language development. However, in older children, especially those with autism, echolalia can serve as a communication tool. While they may not fully comprehend the meaning of the repeated words, they associate them with specific contexts and experiences. This allows them to express needs, engage in self-talk, or cope with challenging situations.

The Triad of Interaction:

The interaction between autism, apraxia, and echolalia creates a triad of challenges in communication. Echolalia, often observed in children with autism, can be intertwined with both conditions. While echolalia aids language acquisition, it may also mask underlying apraxia symptoms, making it challenging to diagnose both conditions accurately. This underscores the need for comprehensive evaluations by speech-language pathologists (SLPs) to differentiate echolalia related to language learning from that stemming from apraxia. Intervention strategies for individuals facing this triad of challenges require a multidimensional approach.

Treatment Options for Autism and Apraxia:

Addressing the complex communication needs of individuals with both autism and apraxia requires a comprehensive and personalized approach. Treatment options often involve a combination of therapies and strategies to support language development and communication skills.

  1. Speech Therapy:

Speech-language pathologists (SLPs) play a crucial role in diagnosing and treating apraxia in individuals with autism. SLPs use various techniques to improve speech production, including helping individuals learn to plan and sequence movements for clear speech. Therapy may involve exercises to strengthen oral motor skills and enhance coordination of speech-related muscles. Additionally, visual supports and speech devices, such as picture cues or voice-generating tablets, can aid individuals in communicating their needs.

  1. Behavioural Therapy:

Behavioural therapy is a cornerstone of autism treatment, focusing on improving social skills, communication abilities, and behaviour management. Applied Behaviour Analysis (ABA) is a widely used approach that tailors interventions to an individual’s specific needs and strengths. ABA can be adapted to address both autism-related challenges and the communication difficulties associated with apraxia.

  1. Early Intervention:

Early intervention is key for children with autism and apraxia. Detecting and addressing these conditions in their early stages can lead to improved outcomes. Comprehensive evaluations, conducted by a team of professionals, can help identify the unique communication profile of each child and guide the development of targeted intervention plans.

  1. Visual Supports and Gesture Cuing:

Visual supports, such as picture cards and gesture cuing, are effective tools to aid communication for individuals with both autism and apraxia. These strategies help bridge the gap between understanding language and producing speech. Visual supports provide a visual representation of words or concepts, while gesture cuing involves physical cues that guide speech production.

  1. Core Vocabulary Building:

Focusing on core vocabulary—selecting a set of essential words—can facilitate language development. Practicing these core words through structured activities and incorporating them into daily routines enhances an individual’s ability to communicate effectively.

  1. Parent and Caregiver Involvement:

Parents and caregivers play an integral role in the treatment process. Learning and implementing strategies at home can reinforce progress made during therapy sessions. Activities such as using sound effects, offering choices, and engaging in interactive play can create meaningful opportunities for language practice and communication.


American Speech-Language-Hearing Association. (n.d.). Childhood apraxia of speech. American Speech-Language-Hearing Association.

Tierney, C., Mayes, S., Lohs, S. R., Black, A., Gisin, E., & Veglia, M. (2015). How valid is the checklist for autism spectrum disorder when a child has apraxia of speech? Journal of Developmental & Behavioral Pediatrics, 36(8), 569–574.

What is the connection between apraxia, echolalia and autism?. RDIconnect. (2022, June 27).

Encouraging success in all students

A talk given at the Annual General Meeting for the Learning Disabilities Association of Peel Region, by Dr. Adrienne Eastwood, Psychologist

Good evening everyone, thank you for this opportunity to speak about a topic that I am quite passionate about – the potential for success that lies in each and every student.

As a psychologist, my job involves assessing children, diagnosing learning disabilities, and helping parents to understand what it all means for their child.  Understandably, parents of a child newly diagnosed with a learning disability are often worried and concerned – will my child succeed at school? Go on to post-secondary education? Be successful in life?

It is true that students with a learning disability often have a tough time in school, particularly when teaching approaches and evaluation methods are not adapted in order to meet their needs.  However, parents are often quite surprised when I explain to them that the ultimate barrier to their child’s academic success may not even be their child’s particular learning difficulties.  I let them know that students with all sorts of disabilities are successful when they get the right supports, when they have the motivation to learn, and the persistence to achieve goals that matter to them.  And sometimes, they succeed despite getting less than ideal supports and accommodations.

In my years of practice, I have been impressed by the success achieved by people who some thought did not have the potential to graduate from High School, let alone go on to postsecondary education (which they did!).  Likewise, I have seen how self-defeating attitudes and negative self-perceptions have prevented the most intellectually capable people, without any kind of learning disability at all, from graduating from high school.   Even though research studies confirm that learning disabilities do increase a person’s risk for academic failure, it’s really important to know that it is not the only predictor of important outcomes.

So what is important for parents to know about how to help children succeed?  Tonight I want to share some research results with you that I hope will inspire you to continue your efforts to support the people you know with learning disabilities.   You already know that appropriate accommodations and learning disability-friendly teaching strategies make a big difference in helping children with learning disabilities to achieve academic success.  What I would like to share with you tonight are some research results that are not specific to learning disabilities, but that are relevant for all students.

The research that I am going to tell you about has to do with what people believe about how intelligence works, and how these beliefs impact how they deal with difficult tasks.

Research over the last decade has shown us that a person’s beliefs about how intelligence works actually affect their academic success.  Carol Dweck, a psychology researcher at Stanford University, has published numerous groundbreaking papers about the impact of people’s theories, or beliefs, about intelligence.   She has found that some people believe that intelligence can’t change no matter what – you are just born smart or not-so-smart.  Carol Dweck calls this a fixed mindset.  Other people think that intelligence actually can change, and for the better – she calls this a growth mindset.

People with a fixed mindset behave quite differently than people with a growth mindset.  When someone with a fixed mindset faces a difficult task that they expect they will fail, they are likely to give up.  And when they do fail at tasks, they tend to assume that they were not smart enough to have been successful.  People with fixed mindsets tend to believe that looking smart is more important than how much you learn.

It’s a different story for people with a growth mindset. When someone with a growth mindset is given a task that is too tricky for them, they will increase their effort to conquer the challenge, and they will be pleased when they increase their ability and skills, even if they are still not earning the best marks. When they fail at a task, someone with a growth mindset will assume that the reason is because they did not work hard enough.

These differences in beliefs and behaviour actually translate into different outcomes in academic achievement.  Studies that have followed students over multiple years of schooling have found that when students have a growth mindset, their grades improve over time, while students with a fixed mindset show no improvements in grades.  These patterns hold true whether students are earning high or low marks to begin with.

Now this is a key point… it doesn’t matter whether students were high achieving or low achieving to begin with…. The ones who believe that intelligence can improve tend to perform better over time.

So, why do a person’s beliefs about intelligence impact their achievement? Carol Dweck found out that students who have a growth mindset also hold goals for themselves related to improving their learning, and they are more likely to believe that working hard is both necessary and effective in order to achieve.  With this set of helpful beliefs, students then face setbacks with resilience – they don’t blame their failures on a lack of ability, instead they make plans to invest more time into their work.

Okay, so what the researchers did next was really interesting.  They took a group of kids entering Grade 7, and followed them throughout the year, looking at their beliefs about intelligence, their math marks, and what teachers were saying about them.  This particular group of students was not performing very well; they were overall earning C grades in Math.  What’s more, their grades were dropping as the year progressed.

Then, in the spring term, the researchers had the students participate in an 8-week workshop about the brain and study skills.  Half the students learned that different parts of the brain are responsible for different tasks, and they were taught memory strategies to help them remember new information.

The other half of the students were taught a special growth mindset curriculum, where they also learned about the brain, but instead of learning specific memory strategies, they were taught that their learning can improve through practice.  This was considered the “experimental condition” – the one that the researchers predicted might lead to important outcomes.

I’ll tell you a little more about the growth-mindset curriculum.  The students read and discussed an article called “You Can Grow Your Brain.”  The article teaches them about neurons – those are the cells in the brain that communicate with each other using electrical and chemical signals whenever we think, talk, move or learn.  Students were also taught that the brain is like a muscle that gets stronger with use, and that learning prompts neurons in the brain to grow new connections.  Activities and discussions helped the students to see that they could help their own brains to develop stronger connections, by practicing new skills to mastery.

And what happened to these two groups of students?  Students who received the growth-mindset intervention improved their marks, while students in the control condition continued to have their marks slide.  Kids also began to behave differently after they participated in the growth mindset intervention. Teachers, who had been completely unaware that there were even two different groups, were asked to notice, which students were changing for the better (or worse) with respect to motivation or performance?  When teachers identified a student who had improved, that student was much more likely to have been in a growth mindset workshop than in the control group.

So, what about kids with learning disabilities specifically?  Does this research really apply to them?  Is it really true to say that they can improve their intelligence?  Won’t all this research make kids with learning disabilities feel as though it is their fault they are not getting good marks by trying harder?   Certainly, one can see the possibility for harm when it comes to applying the idea of the growth mindset to students with learning disabilities.  We all know individuals with learning disabilities who try so hard, and yet, still struggle to learn.

In thinking about the answer to these questions, it’s important to consider what a growth mindset is not:

Having a growth mindset is not about becoming skilled at a task simply by believing that one is capable, or believing that one can make a disability go away by just trying harder.  It doesn’t mean that a struggling student will suddenly earn As simply because they understand that the brain can grow new connections.  Having a growth mindset is also not about believing that everyone has the exact same potential.  The truth is that we don’t all have the same potential to learn, and we don’t all improve our skills at the same rate.  But, it is true that anyone can improve skills with practice.  And it is true that all skills must be practiced in order to achieve competence.  Even child prodigies like Mozart, reportedly born with innate talent, spent their whole lives practicing and perfecting their skills.

When it’s used in a helpful way, a growth mindset means telling the truth about a student’s current achievement and then, together, doing something about it, helping them to learn to do something that previously they did not know how to do.  Using a growth mindset also means helping the student to identify what is the next skill they need to learn, in order to achieve their goals.  And when students find themselves stuck on a task, using a growth mindset means encouraging them to sort out what else they can do to find a solution.

So, people with learning disabilities don’t need to hear that they should try harder.  The majority of them are already working so much harder than students without learning disabilities.  What they need to hear is that progress is possible, and that their efforts can pay off.  Students with learning disabilities need to be validated for the progress that they do make as a result of their efforts.  They need to know that you care more about their progress than their grades.

We also need to teach students with learning disabilities that their brains are learning machines, and that they are in charge of those machines.  They need to hear that their brains are constantly developing and improving whenever they practice a skill.

When students with learning disabilities encounter failure, as we all do, we can help them to see it as an opportunity for learning and growth.  When we make mistakes ourselves, we can show our kids that we are interested in figuring out how to do things differently next time.  We can show them that we don’t feel anxious, upset or angry when failures occur – either about our own mistakes, or theirs.

When we give students positive feedback, we need to do so deliberately and specifically.  We can praise them for their persistence or strategies, rather than making general praise statements like “you’re so smart”.  Even when kids are smart, telling them that they are smart may suggest a fixed mindset instead of a growth mindset – that you care more about how smart they are than how much progress they make in their learning.   Kids, and many adults, assume that if they are smart, then things should be easy.  So when things do not come easily, they may feel as though they are not smart.  You can’t go wrong when you let kids know how proud you are of their efforts, their perseverance, and their progress relative to where they were before.  When students learn to care more about their progress than their performance, then they will achieve so much more.

Thank you for your attention, and for all that you do to support students with learning disabilities.


Putting a Canadian Face on Learning Disabilities Study (PACFOLD)

Lisa S. Blackwell Kali H. Trzesniewski and Carol Dweck (2007) Child Development, Volume 78, Number 1, Pages 246 – 263.  Implicit Theories of Intelligence Predict Achievement Across an Adolescent Transition: A Longitudinal Study and an Intervention.

The Secret to Raising Smart Kids by Carol Dweck, January 1, 2015, Scientific American

Online growth mindset training based on Carol Dweck’s research:

Article similar to the one used in Carol Dweck’s 2007 study:

September 22, 2015.  Commentary in Education Week by Carol Dweck

Kyla Haimovitz and Carol S. Dweck (2016) Psychological Science, Vol. 27(6) pages 859–869.   What Predicts Children’s Fixed and Growth Intelligence Mind-Sets? Not Their Parents’ Views of Intelligence but Their Parents’ Views of Failure.

Boredom in the classroom

A talk given at the Annual General Meeting for the Learning Disabilities Association of Peel Region, by Dr. Adrienne Eastwood, Psychologist

Good evening, and thank you for inviting me to speak at your AGM.

Tonight I would like to talk to you about some interesting research about the feeling of boredom, and how it impacts learning in the classroom. I hope my talk won’t bore you!

We have all experienced boredom at one point or another, and no one likes the feeling. Boredom is an unpleasant feeling that happens when we want something interesting to do, but for whatever reason, we can’t find it. When do you feel bored?

When we are bored, we are disengaged with whatever is happening around us, and we wish that we had something to do that would capture our interest.

People who are bored may be kind of agitated or frustrated, or they may appear more sloth-like. Either way, people who are bored have trouble concentrating, and they feel like time is moving slowly.

In contrast, when a person is interested in something, they enjoy that activity, they are focused on it, and it is very likely that they will try to do that activity again.

So, does boredom happen in the classroom? Of course it does.

Boredom can be a big problem in the classroom. Research on boredom in the classroom has shown that kids who report more boredom are less motivated, have poorer study strategies, and lower academic achievement.

And if you are a parent of a child with ADHD or LDs, then perhaps you have heard your child complain about being bored at school.

There actually isn’t much research yet about boredom in people with ADHD/LD, but there is good reason to believe that there is an important relationship there that needs to be investigated. For example, some of the same brain regions are implicated in both boredom and ADHD. One important network of brain structures is called the Default Mode Network or (DMN) . The DMN is active when people’s minds are wandering or when they are “off task”. The DMN is quiet when people are concentrating. Not surprisingly, the DMN is generally more active in people with ADHD than in those who do not have ADHD. And the DMN is also more active when all people are bored compared to when they are not.

So, there is a connection between academic problems and boredom. But what comes first? Are students performing poorly because they are bored? If so, maybe teachers need to jazz it up. Or, are students bored because they are performing poorly? If so, then students may need support for learning so that they can more easily engage with the material. Researchers are only just beginning to untangle this chicken-egg problem.

So far, it looks like the causal direction goes both ways. In other words, students who are initially bored experience a subsequent drop in academic achievement, which then results in their feeling even more bored.

One interesting study cleverly distracted people on purpose, to see whether they would feel bored. How did they distract them? The researchers asked participants to listen to an educational audio recording and rate how bored they felt under three different conditions. In the first condition, there was a loud, clearly noticeable noise in the adjacent room – this was called the conscious distraction condition because the participants knew that they were being distracted. In the second condition, there was a just noticeable noise in the adjacent room – this was called the unconscious distraction condition. The last condition involved no distraction at all. Who felt the most bored? It was actually the people in the unconscious distraction condition. Their distraction resulted in lowered attention, and they reported more boredom because they didn’t realize they were being distracted by the noise. Instead, they figured they were distracted because the recording must have been boring. People in the conscious distraction condition realized they were being distracted, but didn’t report more boredom, because they blamed the loud noise for getting them off track.

A leading boredom researcher, John Eastwood, along with his colleagues, have developed a model of boredom. In a nutshell, they propose that when we fail to become mentally engaged in the world around us, we will feel bored. And when we are bored, we are not learning well.

Psychological research supports the idea that paying attention to things increases our interest and engagement. Consider the following research findings:

• If you ask people to pay attention to objects, then later on they will rate them more positively than objects they have not paid attention to. This is called the “exposure effect”.
• In general, the more often we encounter a particular object, the more we like it.
• Even just gazing or looking at an object will result in our preferring that object over another one.
• When it comes to information and learning, researchers have shown that people prefer information that is processed deeply as opposed to shallowly.
• On the other hand, objects that we actively ignore are subsequently judged more negatively. This is called the ‘distractor devaluation,’ effect.
• stimuli that we struggle to focus our attention on becomes less interesting, and this difficulty in processing appears to give rise to more feelings of boredom.

In summary, research suggests that we: like things we deliberately pay attention to; dislike things we deliberately avoid paying attention to; and find boring things that are difficult for us to pay attention to.

John thinks that teachers and students need to notice when students feel even a little bored, because that likely means that students are disengaged from the learning process, and a change is needed to facilitate learning. If we learn to notice that we are bored, then we can be ready to make a change that will hopefully promote interest and engagement. In this way, boredom can be a helpful feeling, just like anxiety or even pain. Boredom tells us that something is wrong and we need to fix it.

As educators, we need to tackle the problem of boredom head on; otherwise our students will find maladaptive ways of coping with boredom. Because boredom is such a yucky feeling, students tend to look for quickest and easiest way to feel better. Unfortunately, this often results in focusing attention on something other than the task at hand (e.g., acting out in class).

It’s important to remember that the person who is bored is actually highly motivated to be engaged in something, they are just struggling to engage with whatever they are being asked to learn in that moment. It’s not that the bored student doesn’t care, or doesn’t want to learn; in fact it can be quite the opposite.

So what can we do to help students?

If we know that distraction and difficulty engaging with material is the main cause of boredom, then we must ask ourselves what are the possible causes of a student’s distraction, and address those.

There are surely many reasons why students are distracted in the classroom. Today I would just like to touch on one particular issue that is important to me as a psychologist, and that I know will be important to all of you as well.

There are many students out there with undiagnosed learning disabilities and ADHD. As you know, Learning disabilities and ADHD are neurodevelopmental disorders that start in childhood and that are lifelong. They interfere with learning in a variety of ways – these are students who are of average intelligence but they process information differently, and, as a result, end up falling behind academically. Students with both learning disabilities and ADHD have trouble engaging with learning at school, particularly when the approach to teaching or classroom management does not meet their particular needs. For example, kids with ADHD need to move in order to learn. If the classroom teacher does not allow for movement, then a student with ADHD will be more distracted and less engaged. I would predict those students would complain of being bored. Likewise, students with writing disabilities generally find most paper and pencil tasks difficult to complete. Because their learning disability prevents them from engaging with writing tasks, they’re likely to complain of boredom. But what if that same student is given the opportunity to dictate, talk or role-play? Then you’d see that student would be engaged, and would not likely complain of boredom.

These few examples illustrate the importance of understanding every child’s learning profile when trying to find ways to engage them. Psychological assessments are one important way to get a better understanding of child’s learning needs, and to make sure that neurodevelopmental disorders do not go undiagnosed.

As you may know, our healthcare system, as wonderful as it is, lacks equity when it comes to mental health. Not everyone who needs to see a psychologist gets to see one. That is why I’m so excited to partner with your organization to provide psychological assessments to students who need them, but who have not been able to access them. Thanks to your dedicated advocacy efforts on behalf of families, more children will be able to get the help they need to engage in learning. Together, we will help more kids spark an interest in learning that will put boredom in its place!

Enhancing Outcomes with Progress Monitoring

The Globe & Mail published an article highlighting the use of routine progress monitoring to improve the effectiveness of psychotherapy. Given the time and money clients invest in psychotherapy, it is important that clients receive feedback-informed psychotherapy to enhance the effectiveness of treatment. Routine progress monitoring is a practice that clinicians implement at Eastwood Psychologists.  I will be sharing my experience with progress monitoring as a Psychologist (Supervised Practice) at Eastwood Psychologists and how it has benefited my work with clients.

What is Progress Monitoring?

Progress monitoring is a self-report survey completed routinely by a client to assess his or her functioning each week on various areas of concern (e.g. mood and anxiety symptoms). The questionnaire can be completed as a hard copy or electronically prior to each session. This survey is scored immediately and reviewed by the treating psychotherapist at the beginning of each session.

The Globe and Mail published an article on April 7, 2018, titled: “Rethinking therapy: How 45 questions can revolutionize mental health care in Canada.” The benefits and drawbacks of regular progress monitoring were discussed.

Some of the downsides of progress monitoring noted in the article are that the surveys can be lengthy and may distract from the focus of therapy by asking irrelevant questions. Therefore, some clinicians would prefer to rely on a client’s words and presentation, than rely on a self-report measure.  Despite these opinions, the article goes on to identify many benefits of progress monitoring.

The article suggests that routine progress monitoring can enhance the effectiveness of psychotherapy and may transform the healthcare system. Progress monitoring is useful in identifying when a client is improving over the course of therapy, but it can also identify when a client is not progressing in treatment. This information can be used to improve therapy effectiveness and perhaps reduce the risk of early dropout. Other areas of medicine use clinical tests, such as blood tests, to inform and enhance treatment. Similarly, the use of progress monitoring could serve the same purpose in psychotherapy.

Progress Monitoring at Eastwood Psychologists

Eastwood Psychologists have regularly used progress monitoring with their clients since 2011. The tool used at Eastwood Psychologists is a measure called the Outcome Questionnaire-45 (OQ-45). The OQ-45, developed by Psychologist Dr. Michael Lambert, is a 45-item measure that produces an overall distress score and a distress score in three categories:

  1. Symptom Distress – examines mood and anxiety symptoms
  2. Interpersonal Relationships – examines relationship satisfaction
  3. Social Role – assesses difficulties in the workplace, school or at home

The OQ-45 also highlights Critical Items that capture a client’s risk in potentially high-risk areas, including suicide potential, substance abuse, and workplace violence potential. The questionnaire is completed online, takes approximately five minutes to complete, and is automatically scored and reviewed by the clinician prior to session.

My Experience with the OQ-45

 As expressed by many clinicians in the article, I also find that the use of routine progress monitoring augments and enhances the psychotherapy process.  Specifically, the OQ-45 presents a weekly snapshot of a client’s distress, can be a collaborative tool, and can be rewarding to reflect on.

The OQ-45 provides me with a window into a client’s functioning in the past week, even before he or she enters the office. The client’s OQ-45 overall and subcategory scores are compared to a growing database of other groups, such as the general population or an outpatient mental health center. This gives me a context for the severity of a client’s distress.  Moreover, I use this data in conjunction with client presentation, verbal reports, and my clinical judgment. Together, this informs my understanding of a client as whole, allows me to monitor client safety, and helps determine the best use of our time in session.

The OQ-45 is also useful as a collaborative tool with my clients. The completion of the OQ-45 offers another means by which clients can communicate their concerns to me weekly. A discussion of a clients’ OQ-45 score can help them feel heard and understood. I also point out when there is a discrepancy between a clients’ OQ-45 score and what they express in session in body language and their words. These discrepancies helps me and my clients further understand how they cope with their distress, and help us target underlying concerns that may have remained concealed, if not captured by the OQ-45. In addition, tracking OQ-45 scores provides an opportunity to reflect on and revise the treatment plan in consultation with my supervisor, colleagues, and/or my clients.

Reflecting on change over time on the OQ-45 with my client is also a rewarding experience. The OQ-45 plots clients’ weekly data on a graph over the course of psychotherapy. I share progress graphs with my clients at various points over the course of treatment, providing them with evidence of the change they have described. Clients often express surprise, pride and contentment at how much they have changed over the course of treatment. Impressed with their progress, many clients request to take the graph home.

In summary, routine progress monitoring is a valuable addition to psychotherapy. This feedback informed approach not only informs the clinician session-by-session but also informs the treatment plan as a whole for increased therapy effectiveness. As stated in the Globe & Mail article, a brief 5-minute survey can contribute to enhanced treatment outcomes and improve the quality of mental health care.

Working to close the “practice-research gap” in psychotherapy and clinical psychology

The Canadian Psychological Association (CPA) recently published a report prepared by the Task Force on Outcomes and Progress Monitoring in Psychotherapy.  You can find and read the report, entitled Outcomes and Progress Monitoring in Psychotherapy” on the CPA website at the following link:

This important report discusses:

  • The importance of monitoring both client progress and outcomes in psychotherapy, and,
  • The barriers to using progress and outcome measures by Canadian psychologists and psychotherapists.

The report defines outcome and progress monitoring as follows:

Outcome monitoring should involve the assessment, at both intake and at the cessation of treatment, of patient functioning by the therapist, patient, and/or a third party in areas deemed important by the patient and therapist.

Progress monitoring involves repeated assessment of patient progress during therapy, typically conducted from the patient’s perspective at every session or every other session. A key aspect of progress monitoring involves continuous feedback to the therapist on the patient’s status, which facilitates the assessment of treatment progress and may suggest changes to the course of treatment, if necessary.“ (Page 4)

Although considerable research demonstrates that psychotherapy is more effective when clinicians systematically monitor client progress and outcomes, a recent survey found that only 12% of Canadian psychologists routinely track client progress in their clinical practices (Ionita & Fitzpatrick, 2014).  When clinical practice is not well informed by research, we refer to the situation as a “practice-research gap”.  Practice-research gaps are common in all health care fields; it is challenging for busy clinicians to keep up with research findings, and to sort through sometimes conflicting results.  So, it is helpful when professional organizations such as CPA put together reports that help translate key research findings into actionable steps that clinicians can use to improve their practice.

The Outcomes and Progress Monitoring in Psychotherapy” report makes recommendations in the following areas:

  • Implementing outcome and progress monitoring in clinical contexts
  • Ensuring uptake and maintenance of outcome and progress monitoring
  • Training (of psychotherapists and psychologists)
  • Ethics

At Eastwood Psychologists, we are pleased to report that progress and outcome monitoring has been a routine part of our practice since 2011, and that we are already implementing the recommendations put out by the CPA task force.

At Eastwood Psychologists, we also strive to close the “practice-research gap”, by working hard to stay on top of current research in our areas of practice.  We benefit from Dr. John Eastwood’s role as an Associate Professor of clinical psychology at York University, where he participates in research in several areas pertinent to our practice.  Training the next generation of clinical psychologists, Dr. John is well apprised of current psychological science, and he regularly shares his knowledge with the whole team.

All our doctoral-level psychologists come from a strong science-based background and have conducted original research in a variety of domains including:

  • The predictors of early reading skills.
  • Neuropsychological deficits in children with Learning Disabilities and ADHD.
  • Moment-to-moment interactions between clients and therapists in psychotherapy that result in good outcome.
  • Understanding how to help psychotherapy clients tell their stories in new, healthy ways.
  • Development of community-based programs to support immigrant families.
  • Experiences of South-Asian mothers who parent children with Autism.

Some of our clinicians are also actively involved in clinical science – getting involved in relevant clinical trials such as the “Better Days Better Nights” program out of Dalhousie U (see for more information).

Our clinicians also support knowledge translation efforts including and, thereby working hard to decrease that “practice-research gap”.

All clinicians at Eastwood Psychologists also participate regularly in professional development, including workshops and professional training programs, and discussion of research articles during our regular group meetings.  We take pride in being “scientist-practitioners” – relying on the research literature to inform what we do.


Ionita, G., & Fitzpatrick, M. (2014). Bringing science to clinical practice: A Canadian survey of psychological practice and usage of progress monitoring measures. Canadian Psychology/Psychologie canadienne, 55(3), 187-196.

Letter to MPP about the Provincial Advocate for Children and Youth

Dear Prabmeet Singh Sarkaria,

My name is Adrienne Eastwood; I am a psychologist in Brampton, and a resident of your riding. I am writing to express my disbelief and discontent with the Progressive Conservative’s decision to repeal the Provincial Advocate for Children and Youth Act, 2007 and close the Office of Child Advocate (“Advocate’s Office”). As you know, the Advocate’s Office ensures that young people in the care of the government are aware of their rights, and that their voices are heard and considered when decisions are made about their lives. The Advocate’s Office serves the children in child welfare services, youth in the justice system, Indigenous youth, as well as youth with disabilities and mental illness. In the 2016-2017 fiscal year, there were 12 794 children and youth in the care of children aid societies across the province, which reflects only a fraction of the people served by the Advocate’s Office. The closing of the Advocate’s Office leaves these children and youth without an independent body to protect them. It also means that Ontario becomes the only Canadian province without an independent child advocate.

It is appalling that this decision comes less than two months after an investigation by the Ontario Office of the Chief Coroner regarding the suicides of 12 youth in the care of child protective services. This investigation, and countless other examples, confirm the importance of an independent body that oversees and investigates the treatment of children in the child welfare system, and that reviews government policies and practices that impact society’s most vulnerable children and youth. Simply rolling the program into the Ombudsman’s office is not sufficient to ensure that some of the most vulnerable individuals in our society have a voice. The government cannot and should not monitor itself.

Given that the PC government claims to be “working for the people”, I would like to urge you and your fellow MPPs to consult and reconsider this short-sighted and faulty plan. I believe strongly that the provincial government needs to take a lead in putting forth policy initiatives that support children and youth’s rights to individual rights advocacy, systemic advocacy, and independent investigations. In doing this, the government is strongly encouraged to follow principles of the United Nations Convention on the Rights of the Child.


Adrienne Eastwood, Ph.D., C. Psych., BCBA