How to help children on the spectrum develop friendships

In my high school, a peer known for his social awkwardness greeted me in a monotone voice, “Pratt, do you have anything to say to me?” I replied, “Yes, good morning. How are you doing today?” Satisfied with the exchange, he nodded and walked to class. He did not return the greeting, nor did I expect him to. He also never asked me how I was doing.

There is an expression that “the only way to have a friend is to be one.” But what if you struggle to read facial expressions, body language, and tone of voice? For children on the autism spectrum, making friends can be challenging. From the young child who sits alone on the playground to the high schooler who chooses to stay in the computer lab rather than interacting with their classmates at lunch, it may appear that these children have no interest in pursuing friendships. Unfortunately, this is a common misconception held by neurotypical people (not on the autism spectrum).

The child on the playground and the teenager in the computer lab may be overwhelmed by the noise and chaos of the children around them or the location where social interaction occurs. Other behaviors of children on the spectrum include lack of eye contact, fidgeting, and repetitive movements (arms flapping, rocking, etc.). Many of these actions help limit overstimulation, manage anxiety or help with focus, but they can be perceived as a lack of interest by their neurotypical peers. Neurotypical children may conclude that their counterparts with autism are disinterested. But appearances can be misleading.

Children on the spectrum often long for friendships but do not know how to develop them. The importance of peer relationships is well understood. Friendships can provide opportunities to learn important social and emotional skills, including empathy, cooperation, problem-solving, and similar prosocial skills. Unfortunately, the opposite is also true; negative peer relationships involving bullying, rejection, and manipulation result in feelings of isolation, anxiety, depression, and confusion about relating to others.

Luckily, there are many ways to support children on the spectrum. Here are some steps you can take to support your child in making a new friend:

1. Explain what a friend is:

For young children, keep things simple. For example, explain to them that “a friend is someone who is nice to you and likes to spend time with you.” Understanding abstract concepts can be difficult for young kids on the spectrum. It helps to discuss characters in a movie or tv show that the child enjoys. Ask questions such as, “Is Character X being nice to Character Y? Do they like playing together?”

2. Social Stories

Children with autism often learn better when they are provided with visual support. Social stories lead a child through specific situations using pictures and words. Each story can be tailored to the child. For example, writing a script or drawing out the course of a conversation can help children understand the basics of how to talk to a friend. ***Carol Gray is a good resource.

3. Practice is Key

The best way to try something new is to explore it first in a safe and familiar environment. Have your child practice social skills (greeting others, asking and answering questions, self-advocating, suggesting ideas for play) among people the child already knows and is comfortable with (siblings, cousins, neighbors, and other adults). Through practice and repetition, you and your child can problem solve challenges he might have before encountering them at school or on the playground.

4. Finding Your Tribe

To build friendships, children must first share common interests. Find what your child is good at or enjoys, and then find a community based on that interest. For example, if your child loves board games, find a gaming group. If your child plays an instrument, get them into the band at school. Finding a shared activity is key, and it provides the groundwork for children to further grow friendships by sharing their feelings or by sharing a positive emotional experience.

Sometimes, however, it’s not about what groups children with autism join; it’s about getting other children to join them. Some schools implement a playground ambassadorship program, where neurotypical students are tasked with engaging students who tend to remain on the periphery of the playground. These children look for peers who are not engaged and reach out to them/ask them to play. Parents may want to ask their schools if this program is already in place or can be implemented. You are your child’s best advocate.

SmallTalk wants your children to “find their tribe” and make long-lasting connections with peers. Therefore, SmallTalk offers small social skills group sessions at each clinic location to help teach your children the foundations of social skills and offer guided practice of engaging in different social scenarios with peers. If you are interested, please call us at (619) 647-6157 to schedule an appointment.

Does my child need Occupational Therapy?


What is Occupational Therapy? Does that help my child get a job? No! “Occupations” are daily activities, so that means playing and learning for your child. Children develop daily living and self-care skills through actively exploring their environments and playing with others. Occupational therapy addresses sensory processing, motor delays, and social-emotional components that may be impacting your child’s ability to develop independence at home and school. If any of the following characteristics resonate with you, your child may benefit from occupational therapy!

Sensory Processing

  • Overly sensitive or heightened reactivity to sound, touch, or movement
  • Under-responsive to certain sensations (e.g., high pain tolerance, doesn’t notice cuts/bruises)
  • Constantly moving, jumping, crashing, bumping
  • Easily distracted by visual or auditory stimuli
  • Emotionally reactive
  • Difficulty coping with change
  • Inability to calm self when upset

Social Interaction Skills

  • Difficulty interacting socially and engaging with family and peers
  • Difficulty adapting to new environments
  • Delayed language skills
  • Overly focused on one subject (e.g., space, universe, dinosaurs, trains)
  • Can’t cope in the school environment

Play Skills

  • Needs adult guidance to initiate play
  • Difficulty with imitative play
  • Wanders aimlessly without purposeful play
  • Moves quickly from one activity to the next
  • Does not explore toys appropriately
  • Participates in repetitive play for hours (e.g., lining up toys)
  • Does not join in with peers/siblings when playing
  • Does not understand concepts of sharing and turn taking

Oral Motor/Oral Sensory

  • Excessive drool
  • Chews food in the front of the mouth, rather than on the molars
  • Difficulty using a cup at an age-appropriate time
  • Difficulty with drinking from a straw at an age-appropriate time
  • Lengthy bottle or breast feedings
  • Tiredness after eating
  • Baby loses excessive liquid from their lips when bottle or breastfeeding
  • A child loses excessive liquid or food from his or her mouth when drinking or chewing
  • A child appears to be excessively picky when eating, only eating certain types or textures of food
  • A child excessively mouths toys or objects beyond an age-appropriate time

Fine Motor Skills

  • Manipulating toys and puzzles
  • Holding a pencil
  • Using silverware or straws at an age-appropriate time
  • Using scissors
  • Using zippers, buttons, shoelaces
  • Coloring, drawing, tracing, prewriting shapes
  • Poor handwriting, letter/number formation
  • Not developing a hand dominance at an age-appropriate time
  • Avoiding tasks and games that require fine motor skills

Gross Motor Skills

  • Going up and down stairs at an age appropriate time
  • Coordinating both sides of the body
  • Understanding the concept of right and left
  • Poor ball skills
  • Poor balance
  • Fear of feet leaving the ground
  • Not crossing the midline of their body during play and school tasks
  • Avoiding tasks and games that require gross motor skills

Visual Processing

  • Difficulty with the spacing and sizes of letters
  • Difficulty with recognizing letters
  • Difficulty with copying shapes or letters
  • Difficulty with visual tracking and crossing midline
  • Difficulty finding objects among other objects
  • Difficulty with copying from the board or another paper
  • Difficulty with the concept of right and left

Learning Challenges

  • Unable to concentrate and focus at school
  • Easily distracted
  • Difficulty following instructions and completing work
  • Tires easily with school work
  • Poor impulse control
  • Hyperactivity or low energy
  • Not keeping up with workload at school
  • Difficulty learning new material
  • Makes letter or number reversals after age seven

Do you feel like your child has difficulty in any of the areas as mentioned above? Are you questioning whether an Occupational Therapist should see your child? If so, our SmallTalk therapists are here to help strengthen these skills and answer any questions through structured and unstructured table and gym activities with weekly/bi-weekly therapy sessions. Please call to schedule an evaluation today!

Authors: SmallTalk Occupational Therapists

COVID-19 and your child’s development

SmallTalk is listening to you! In the last year and a half, we’ve heard you express your child’s needs, your own fears and frustrations, and the COVID-19-related obstacles you have encountered.

We empathize with you and understand the difficulties in juggling a little one’s developmental progress as you simultaneously deal with the concerns of a pandemic.

Can you relate to these challenges expressed by some of our clients?

  • We knew our child needed help, but COVID concerns were confusing and worrying, so we stopped seeking services until now.
  • We had a pandemic baby. So, we felt the need to stay safe at home with our child.
  • We didn’t go out much because of COVID.
  • School speech/language or occupational therapy via ZOOM at school did not work for our child, so we discontinued this until the pandemic was over.

If so, keep reading.

The Effects of a Pandemic

Over the past 18 months, the global effects of the COVID-19 pandemic rocked our society. Our country experienced a significant financial and human loss, and, as a result, many of our children suffered considerable speech/language, emotional, physical, or feeding delays. In addition, the temporary suspension of schools, parks, playgrounds, amusement parks, and other outlets limited their ability to embrace a sense of fun and learning. And travel restrictions forced a feeling of stagnation that further added to our children’s loss of opportunity to build important functional communication skills.

On top of all that, as safety concerns and the need to protect family health grew, most playdates, extra-curricular, and family outings were abruptly halted, decreasing our children’s exposure to building critical developmental milestones.

Learning how to develop meaningful in-person interactions with peers, understanding body/facial language and feelings, throwing a ball, balancing on a swing, holding a pencil, or exploring various sensory experiences are all crucial to a child’s development. They learn from experiencing different lights, sounds, smells, and textures that exist throughout our communities. Learning by example is vital. That phenomenon is stifled when, for example, the ability to explore new foods at restaurants is not permitted or the natural mimicking of peers, as they try different foods, is no longer happening.

SmallTalk’s Response

Our therapists have been proactive in working with our current families and addressing specific and individual situations. For the Speech-Language Pathology team, the lockdown caused a significant increase in referrals for children under three years who are experiencing a delay in functional expressive language such as verbalizing basic needs and wants. This team also helps children who have trouble being in groups and sharing. They assist little ones with their ability to play appropriately with toys and other children, as well as understanding age-appropriate language and guiding them to learn to follow directions.

For our school-age children, we are seeing an increase in the need for social groups as children have not had significant opportunities in school or extra-curricular activities to engage and bond with their peers.

Some families seeking extra support for their children found that virtual school therapy was inconsistent, ineffective, or not individualized. Others recognized that due to the severity of their child’s delays, engaging or participating in Zoom school/therapy seemed fruitless, resulting in the cessation of further attempts at treatment until clinics and schools once again provided in-person opportunities.

Our Occupational Therapy team is also providing increasing support to help children with sensory/regulation issues, exploring new foods/textures, attachment/separation anxiety concerns, and lack of core body strength.

At SmallTalk, we have the strong desire and expertise to help children with any speech/language or occupational therapy needs by providing an optimal environment for learning. We are here for you. In addition to working with your child at one of our three locations, we are also passionate about supporting you and your family by sharing ways that you can reinforce and practice the learned skills at home.

Here are some helpful tips that can target missing or delayed skills:

Early Intervention Language

  • Promote child-led play: allow your child to pick their preferred play object and narrate their play. Tell them what they are doing, label objects.
  • Keep the language simple – if your child speaks only in 1-word responses, narrate their play in no more than 2-3 words. Ex: child says “ball,” parent/sibling can say “big ball” or “go ball.”
  • Limit the noisy toys, which limit a child’s ability to be imaginative and/or create their own sounds for the toys.
  • Emphasize using cause/effect toys like blocks, stacking cups, cars, and ramps.
  • Encourage requesting words in play like “more,” “help,” “want,” or “open” to help your child express wants, needs and limit frustrations.
  • Daily routines such as bath time, snack, or mealtimes, are excellent language opportunities. Talk with your child about the activity, the whys, the hows, the sensations, or any related topic that promotes positive communication.

Social Skills

  • Encourage a playdate.
  • Consider enrolling them in daycare/pre-school.
  • Encourage them to participate in a sport.
  • Join a music or story-time class at a local library.
  • Visit a playground/park with other children.


  • Have fun with new foods! Create fun, creative, and colorful displays.
  • Give your child food choices- have them look fun and good.
  • Get messy! Play with your food- kids may want to explore new foods before putting them in their mouths.
  • Give new foods creative and silly names.
  • Use fun books/apps to explore new foods.

Motor Planning, Cognitive and Sensory Skills

  • Use everyday household objects to build a themed obstacle course like pillows, boxes, rolled towels, or packing peanuts.
    • Walk on uneven surfaces –balance and sensory needs.
    • Push/pull heavy items- strengthening.
    • Walk like different animals – coordination.

Smalltalk’s message to our families is that you are not alone. We hear you. We understand. We can help your child reach their greatest potential. Let’s talk. Call us today to learn more at 619–647-6157 ext. 1.

by Pamela “PJ” Baragona, MA CCC-SLP

An open letter to our SmallTalk families

For many of us, last week was one of the most challenging weeks of our lives. Despite this, you have shown such a commitment to your children and support for SmallTalk—which I will be ever grateful for. Thank you for rolling with us through the curveballs we experienced while transitioning to online speech therapy and online occupational therapy. Thank you for reading your emails, answering our phone calls, and most of all—thank you for trusting us to do teletherapy with your children.

It has been a challenging transition for our therapists, as they’ve had to learn an entirely new format and technology. They’ve gone through several training sessions and are excited to interact with your child through teletherapy for the foreseeable future. As always, our top priority is to be there for your child and your family—to help your child maintain the progress they’ve made so far in therapy, to help your family know how to generalize what we’ve been working on to the home environment, and to provide ideas, strategies, and stability to your family in this uncertain time.

From this week until we notify you otherwise, all speech and occupational therapy sessions will be via teletherapy, through our new Teleplatform technology. All of our clients are set up on the platform and you should have received a welcome email. If you haven’t already, follow the link in the email and set up a password (your username will be your email). Then, you will receive an email before each session with a new link to join the online session. If you’d like to change the email address to which these notifications are being sent, please respond to this email and we will update it. Remember, the platform works best if you turn off any other WiFi demands in your house during the session time.

We are able to bill these teletherapy sessions through your health insurance just as in-person sessions. Typical copayments, deductibles, no show fees, etc. will still be applied.

We know that many of you are interested in adding additional sessions to your week. Many of our therapists have open spots in their schedule and this is a great time to accommodate times that are unavailable when school and sports are in session. To add additional sessions, please email: or call 619-647-6157 ext 1. This is also the contact you will use for billing questions or to cancel sessions if your child is sick.

Again, thank you for your confidence in us. We can’t wait to see you online! :)

10 reasons why you’ll love SmallTalk

1. Cozy, intimate and welcoming clinics with personalized service

Our waiting rooms are fun, colorful spaces with train tables, coloring books and other toys for children and magazines and free Wi-Fi for parents. Parents are welcome to join their child in our therapy rooms, or watch through the observation windows in each room.

2. Convenience

Our locations are right off of the freeway, and nearby shopping and restaurants to make it as convenient as possible for you.

3. Speech and occupational therapy in one location

If your child needs both speech and OT, you’ve come to the right place! We’ll try to schedule your child’s speech and OT sessions back-to-back so that you can get them both in one trip.

4. Close collaboration with all members

The secret to our success is our team. Our talented therapists are constantly collaborating and sharing ideas, working together to prepare for each therapy session.

5. Family-oriented focus

Because the person who can make the biggest difference in your child’s life is YOU, parent education and involvement is an essential part of our therapy. Siblings are welcome to play in our waiting room while waiting for their brother or sister.

6. Warm, fun-loving, experienced therapists who LOVE kids

You’ll feel it the moment you walk into our clinic—our therapists are part of this team because they love kids and are passionate about helping them reach their greatest potential.

7. Therapists trained & certified in ABA, DIR/floortime, PROMPT & more

Every therapist attends at least one continuing education program a year, and we share what we’ve learned with the entire team. All our therapists are on the cutting edge of research-based, effective therapy.

8. Parent consultation with each session.

Whether you’re in the room practicing new techniques during your child’s session or following through with homework during the week, we keep you up to date on your child’s progress and how you can help at home.

9. Free weekly parent classes

We offer baby sign and a speech/language workshop for new families or anyone in the community to attend. Please contact for more information.

10. Camp SmallTalk

We offer a week-long summer camp where kids can receive speech therapy, swim, do crafts, sports, play at the sensory table, and go on a nature walk each day. Learn more

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