Blog

There has been a lot discussed since the debut of the “Skinny Budget” proposal for 2026. I have had a lot of administrators and teachers reach out to try to get some clarification on what it means for our classrooms. Let me try to break it down for you as best I can to give you some insights in handling your budgets and things you may expect to see down the road.

First, let me share with you a qualification of this budget proposal. Anytime that educational funding is discussed on a federal level for a given calendar year, that budget actually takes effect July 1, 2026, at the beginning of the new academic year (2026-27). I have had a lot of groups concerned that if this is passed, it would directly affect buildings beginning on January 1. While that is not the case, we still want to be aware that cuts could still be made to the academic year of 2025-26. So, we want to make sure that we are planning our budgets with protections for more cuts. We will have a better idea of potential cuts by October 1, 2025, for the upcoming academic year when the budget funds are formally released to the schools.

Many of the readers of this blog are focused on what will happen with IDEA funding. At this point, IDEA funding is to remain at current levels. While that sounds positive, and is to a degree, right now, there is something that we definitely want to keep our eyes on moving forward.

One of the discussions in the background of this budget is how federal funds will be distributed out to the states. There is a proposal that would change the structure of how all federal funds are distributed. This would effectively be a “grant program” going out to the states as part of what is being referred to as a “single funding stream.” That would allow the states to then determine how the funding would be allocated. There is a concern that some states might choose to decline IDEA funds and look to use the funds from the stream to support special education under their own guidelines. We will want to keep on top of that discussion for certain.

For the moment, it appears that Head Start funding will also not be changing. The concern with Head Start, as some of you are already aware, is that 5 out of the 10 regional support offices were closed when the government did their cuts. This has caused a disruption in having questions answered as well as causing some delays in funding being processed. We hope to see the funding maintained and have a return to timely support for our programs.

Title I funding has brought a significant amount of questions to me. As it is written, it appears that Title I funds will remain intact. This bodes well for our students and school communities that utilize those funds for a variety of purposes. The concern lies in the fact that in a separate area of the budget, there is a proposal to eliminate two grants that support migrant students. There is also no mention of the state grant for literacy instruction. These will be areas that might reduce some of the funding we are seeing in Title I.

So where are the current cuts hitting if those areas are as stable as possible? Title III funding is on the block to be cut. The Teacher Quality Partnership grant is also in that same boat. Title II is in limbo as the specifics within that grant are being reviewed. There are many other programs that are being reviewed to be either combined into a single funding lane or eliminated entirely. There is one area where the recommended budget actually sees an increase and that is with our Charter Schools.

What does this all mean for education? I wish I had a specific answer for you. One thing that I can share is that it will take some time to see how things begin to move. Much of what we have heard over the last few months does tie into the suggestions for this budget. We will probably begin to see a streamlining of the funding as it is sent to the States for distribution. Within this streamlined model, the States would have significant say in how the funding is to be used and who can actually receive it. Overall, it could mean a reduction in funding for some districts over the next few years.

How can we better prepare for these adjustments? My first suggestion is for districts to work on identifying how they are using their federal funds and look at alternatives moving forward. We know that some districts use that funding as a critical support for their students. Are there any other avenues to replace some of the funding which might be lost? I recently spoke with a district CFO who shared that he was working with his administration across all buildings to see how they could take state and local funding and use those funds for more. He shared that they were looking at how some of his Title I classrooms were looking at stocking up on supplies and materials now. They were also taking a hard look at class sizes as well. None of these are easy decisions or choices we wish to make. He left me with an interesting thought in saying, “We learned so much about how we could change the educational environment during COVID. Now, can we apply some of the positive things we learned to continue to provide solid educational programming in the face of budget reductions.”

As you start taking a look at what you can do, think about ideas around getting the devices and materials which will benefit the most students and the greatest number of environments. As you wrap up this academic year, plan out the first quarter and how that might flow for yourself and your students.

I have had some administrators ask what they should be doing over the summer. The first suggestion is the most important one. In my work on mental health, almost all of the professionals are telling educators and administrators alike to take at least one week of staying away from anything that deals with school. Whether it be taking a vacation, doing a project around the house, or staying busy with family events, do not think or address anything from school. Administrators, I know that is not as easy as it sounds. However, we have to take that time to recharge. We are surrounded by continued uncertainty. Unless we have given ourselves a break, we cannot be our most effective in supporting those students and staff in our school community. Take that time for yourself as we will all need to be ready for what is coming in education.

 Here are three reasons why the Cuddle Ball is a favorite:

1. This pillow is 10 inches in diameter, weighs 1.5 lbs., is extremely soft 100% plush tactile fabric, and has gaps to fit your hands inside for comfort and warmth.
2. Designed to support sensory regulation. Hugging a Cuddle Ball tightly brings deep pressure to the sensory system, reducing anxiety and increasing a feeling of calmness. Helpful for calming children and adults with anxiety, stress, hyperactivity, or other sensory needs.
3. It can be used at home, in classrooms, sensory spaces, and even while traveling. It’s a simple way to create a soothing and supportive environment for emotional and sensory well-being and doesn’t look like a medical or therapy item at all. It looks like a really neat pillow.

My colleague, Dr. Ray Heipp, shares examples of what this Cuddle Ball looks like and how it might be used in this School Health Presents Talkin’ Tech with Dr. Ray video.

Interested in learning more? You can find the Cuddle Ball on the School Health website at www.schoolhealth.com. Do you have any experiences to share using the Cuddle Ball with students, family, or for yourself? We would love to hear from you.

Enjoying reading Access Angle- share your feedback on this article. I’m always delighted to highlight and explore new products or topics. Don’t hesitate to reach out; let’s connect via email at gryan@schoolhealth.com.

School nurses are the heart of every school community — providing care, comfort, and compassion to students, staff, and families alike. This School Nurse Day, we asked principals to share why they love and appreciate the incredible nurses in their schools. Their words are a powerful reminder of the lasting impact school nurses make each and every day. Today, we celebrate you — the heroes who bring healing and hope to every hallway.

"Nurse England is extremely responsive and goes above and beyond for all students as well as community members. She is often split between two schools to ensure that adequate coverage is available. She is a great asset to our school no matter the need big or small she provides customer service at the highest level."

Candace Nixon at Tench Tilghman Elementary & Middle School |  School Nurse Lisa England 

"Our school nurse not only cares for our students but for the entire staff. She attends to all needs and make each person feel comfortable and 'seen.' She goes beyond addressing all health concerns to caring for our overall wellness. She motivates the staff to be healthy through fun challenges and initiates. Our school nurse of not just part of the FCS team but an essential member that makes us all BETTER. We love and appreciate Mrs. Cruz greatly!"

Patricia Perez at Florida Christian School  |  School Nurse Eva Cruz

"She gives her all each and everyday.  She sees about 70 students a day in the nurses office.  She is kind, compassionate, and treats every student as if they were her own. She is flexible and a forward thinker.  Always positive and a definite asset to our team."

Tara Peacock at Winston Churchill School  |  School Nurse Megan Brackin

"Nurse Tate came to us this year after a horrible experience with out previous school nurse.  She is totally Outstanding.  She is here early everyday, stands up front and greets all the students, takes care of us all and does her duties exceptionally. She has also taken on the charge of buying gifts for all our special days. She is The BEST!"

Michaela Granger at Shadow Oaks Elementary  |  School Nurse Kayla Tate

"Krystal Little is an extraordinary professional whose impact on students, families, and staff at East Dover Elementary and throughout the Capital School District cannot be overstated. With over a decade of service as a school nurse and currently serving as the Lead Nurse for the district, Krystal redefines what it means to care for the whole child. She seamlessly blends her clinical expertise with compassion, using a trauma-informed approach to support students‚ physical, emotional, and mental well-being. Her ability to deescalate crises, mentor students, and connect families to essential resources has made her a lifeline in the community. Krystal's leadership has advanced equitable access to health services and helped normalize conversations around mental health in schools. She is not only a trusted healthcare provider but also a tireless advocate, confidante, and a foundational force in creating a nurturing, responsive school environment. Quite simply, Krystal Little is awesome because she leads with heart, integrity, and an unwavering commitment to making every child feel safe, seen, and supported."

Nicole Ickes at East Dover Elementary  |  School Nurse Krystal Little

"Nurse Ury is awesome because she is a part of our school community during and beyond the school day. In addition to being a fantastic school nurse that cares for our students, she works as our Dance Team coach and volunteers for various after-school events such as Battle of the Classes and the proms!"

Adam Brusotti at Manalapan High School  |  School Nurse Kristie Ury

"Nurse Shaikh is a phenomenal school nurse who is dedicated to ensuring the well-being of our students. Nurse Shaikh is innovative and consistently works to bring new ideas that will benefit our school from a health and safety perspective."

Adam Brusotti at Manalapan High School  |  School Nurse Shafqat Shaikh

"Nurse Smith is awesome for her unwavering dedication to the Carnegie School community. Nurse Smith takes care of our students with the utmost compassion, as if they were her very own. Her commitment to supporting students goes beyond just medical care; she continually explores new ways to ensure our students are safe, healthy, and supported. In addition to her dedication to our students, Nurse Smith works tirelessly to maintain a well-organized and efficient nurse's office, ensuring all necessary structures are in place for a smooth operation. She collaborates closely with Nurse Goldman on some days, and together, they keep our school running smoothly and in compliance with health standards. We are incredibly grateful for Nurse Smith's hard work, care, and commitment to the well-being of our students and staff."

Shirley Roberson at Carnegie School  |  School Nurse Iris Smith

"Ms. Duru is an invaluable member of our school community‚ compassionate, dependable, and always there when we need her most. Whether she's caring for a student with a sudden illness, offering a calm presence during stressful moments, or checking in just to make sure someone is okay, she brings empathy and professionalism to everything she does. Her ability to support our students' physical health while also caring for their emotional well-being is truly remarkable. What makes Ms. Duru amazing isn't just her medical knowledge‚ it's the way she makes every student feel seen, safe, and supported. She goes above and beyond every single day, partnering with families, collaborating with staff, and advocating for what's best for our kids. She is a steady, reassuring presence in our building, and her impact reaches far beyond the walls of the nurse's office. We are lucky to have her as part of our team!"

Luis Lima at Coppin Academy High School

"Nurse Christy works super hard everyday to take care of our students and staff. She is always smiling and willing to help. We love her so much and Helen could not function without her."

Crissy Burley at Helen Edwards Early Childhood Center  |  School Nurse Christy Roberts

"Our School Nurse is amazing due to her kindness and calm. She is also a graduate of the school district. She is warm and welcoming. She offers support snd healthy advice to all school community members. We are extremely grateful for her!"

Paula Bethea at Joyce Kilmer Intermediate School  |  School Nurse Melodie Flores

"Mrs. Lorie Simos is a new school nurse with CCSD and has already demonstrated a strong commitment to her role. She consistently goes above and beyond by staying beyond her contracted hours to ensure she is aligned with district protocols and procedures. Her warm and compassionate demeanor has helped establish a more welcoming and supportive environment in the health office. Mrs. Simos treats every student interaction‚ no matter how minor‚ with genuine care and attention, fostering a sense of importance and respect. In a short time, she has built meaningful relationships with students and families alike. Mrs. Simos is just who we want representing Gibson to our community. Thank you Lorie, for all you do."

Jill Keith at James Gibson Elementary  |  School Nurse Lorie Simos

"Cindy Peterson is a true gift to our school community. As a compassionate and loving presence, she brings calm and comfort to every student she serves. Her warm and personable nature makes her approachable to students, staff, and parents alike, while her deep sense of loyalty ensures she is a constant and reliable support in every situation. Cindy's trustworthy care reflects not just her professional excellence but also her deeply rooted, grace-filled faith that shines through in every interaction. We are incredibly blessed to have such a devoted and nurturing nurse caring for our students each day."

Carrie Smith at Rockford Lutheran School  |  School Nurse Cindy Peterson 

"Nurse Daidone is one of the most caring, diligent nurses I have had the pleasure of working with. She puts children first and addresses the whole child when they are in her office. She gets to know them, builds relationships with them, and their families. If they need ice, a hug, a water bottle, change of clothes, she has got that all covered! We are lucky to have her!"

Lorie Beard at Academy Street Elementary School   |  School Nurse Angela Daidone 

"She is kind, student-focused, friendly, helpful, forward-thinking, flexible, and just all-around awesome to students, families, and staff."

Bill Knittle at Rowe Elementary School  |  School Nurse Lydia Brisson

"Nurse Powell is the utmost nurse professional; she is caring and proficient when ensuring the safety and wellbeing of our students. I am grateful to her for her unwavering devotion to our students at Rosemont!"

Dr. Dorie Banks  |  School Nurse Shakera Powell 

"We have two school nurses who have each served our school for more than 20 years. They know all of our students and families, and provide daily tender loving care.  The nurse's office is 'home base' for many students -- a place to find a listening ear and caring assistance for so many different needs.  We love both of our school nurses and truly hope to celebrate them on this special day and all year through!"

Catherine Butel at Faithful Shepherd Catholic School  |  School Nurse Carolyn and School Nurse Cheryl

"Our school nurses are the best! They help keep our kids in class learning and have gone above and beyond in training our staff to handle medical emergencies. They also created a 'care closet' for students that need help accessing basic supplies needed to have a healthy life without having to be embarrassed by asking for things like toothepaste."

Matthew Raper at Ivy Academy

"My nurse is awesome for so many reasons! She is a true community nurse! She not only follows up on immunizations and physicals as any nurse would do, but she also does home visits to provide health and hygiene support, support to families to encourage consistent attendance at school, provides packages to families to prevent lice and to address lice when it happens. She serves on our Attendance Committee so that she is sharing who is struggling with major health situations and who is struggling with just getting to school. I cannot say enough about our elementary school nurse! She is outstanding!"

Lauriel McCoy at Deposit Elementary School  |  School Nurse Kaeli Rutledge

"Ms. Katelyn Carusso is Northwest's amazing school nurse! Katelyn is truly the heart of our Northwest nurse's office, and she does SO much more than just take care of scrapes and sniffles. She makes our students feel safe, loved, and heard every single day. Whether she's bandaging up a knee, listening to a student who needs a safe space, or handling a challenging situation, she approaches everything with genuine kindness, compassion, and professionalism. Katelyn has a naturally caring demeanor, always ready to jump in and assist wherever she's needed. She supports not only our students but our staff as well, meeting everyone's needs with a calm, reassuring presence. She is incredibly friendly, always greeting others with a smile, and is constantly looking on the bright side, even on the toughest days. Her positive attitude is contagious, and her ability to balance care with professionalism makes her an irreplaceable part of our school family. Northwest is beyond lucky to have Katelyn!"

Jennifer Nordall at Northwest Elementary School  |  School Nurse Katelyn Carusso

Thank you to all the principals who took the time to recognize their school nurses and help make School Nurse Day special!

April and May are known as the time we review IEPs and create those transition plans for the following academic year. Here in 2025, those Transition Plans should also include our schools and our teachers as a cloud of uncertainty hangs over public education. We must not neglect the regular transition plans we do for our students. We may need to look at them a little differently than we have in the past. Along with that, we also want to make sure that we prepare ourselves for the questions which may arise going into the 2025-26 academic year.

Let’s start with our students and their plans. As we go through our IEP meetings each year, we look at the progress of our students and initiate the plan we would like to see them utilize the following year. When we have students moving from one building to another, those transition plans also include setting up meetings with the new team and reviewing the activities which have worked. This year, we want to be cognizant of the fact that the way things were done in the past may not be consistent with what we see starting the next academic year. What if programs or classrooms are moved to another building and we just are not aware that may occur? What if we prepare a student for that movement only to learn that they will remain in the same building with different support team members? These are the questions which are hanging over the head of districts right now.

In speaking with administrators throughout the country, concerns about how their programs will be structured come to the forefront of our conversations. One Special Education Director shared with me that if cuts were made over the summer, most of her classrooms would be allocated in one building. To her, almost 50% of the transition plans would need to be updated. Work that has been done to prepare students to move to a different building would have to be redone as they could be going somewhere else. There would also be a few students who were supposed to move to another building but now would be staying in the same one. She has significant concerns about how those students might react; would they think that they had done something wrong or were not good enough to move on?

A Director of Pupil Services shared with me his concerns about how any reduction in funds could create issues with services along with class sizes potentially growing larger.  His frustration carried into a discussion we were having about the need for proper AT support for his students. “How can I make sure we have the right AT, when I don’t even know where those students will be or who their teacher will be with any certainty?!” His frustration was borne out of his care for his students.

So how should we go about our Transition Plans for next year? I just finished a call a little earlier today with a Special Education Director who had called with questions about a specific young lady who is transitioning from middle to high school. I asked her how she was approaching her IEP meetings and it was a great response. “I am focusing on my kids and their needs first. Instead of looking ahead to meeting teams or doing walk-throughs, I am looking at the tools to help them succeed no matter where they are doing their work. The particular child who we were discussing had visual impairments. By focusing on the student’s strengths and academic needs, we were able to put together ideas of products to bring to the IEP meeting. If approved, these products will be ordered. As she said to me afterwards, “Everything else will fall into place once she can do her work.”

As we look at ourselves, are we able to focus on the students and their specific AT needs first? There may be already some fiscal restrictions. How can you evaluate what alternative devices might work? Calling those groups, you trust can help with that for sure. Why do I suggest that? What if you are able to find a text-to-speech device that can work for a few years and addresses that student with dyslexia or some other reading issues? We can get so focused on finding one thing that we might miss the obvious. My example here came from a Reading Specialist who wanted to know the cheapest text-to-speech software programs. When I asked why, her response shocked me. “I want the cheapest because I am going to have to also find someone or some company to digitize the older texts and documents we are using. When I suggested a reader pen as a tool to both support the text-to-speech side of things as well as the scanning abilities to “digitize” texts, she seemed flabbergasted. “Why am I looking at software then? Good question which could probably be answered by the fact that someone said find a text-to-speech software. Uncertainty, like what surrounds us both inside and outside the walls of education, creates a diminished ability to think “outside the box.”

Hence, if we begin our Transition by looking at the students and their AT needs, don’t forget to think through what alternatives might be there for the first “solution.” This was made quite obvious in a discussion I was having with a former colleague who reached out more to vent about the times than to ask any specific question. When I slowed down the venting and asked for examples, she shared a case where the AT Evaluation came from a certified evaluator who also works for a sales company. She was frustrated that the evaluation stated that the student needed a very specific product that was also very expensive. When we spoke more about the student and the need, we realized that other manufacturers had less expensive products that might actually work as well if not better than the recommended device. Make it a part of your transition plan to talk through all alternative devices that your students might need.

The next part of your Transition Plan should begin to look at “what if” scenarios. If your budget got cut, what would happen for classes to go on as smoothly as possible? In the previous examples, we heard the potential disaster situations which could occur. How do we prepare for disasters if we are not sure they are going to happen? We actually do this every year. As an administrator, I had to make sure that we had fire drills every month. One of the things we would do is create scenarios where certain stairwells might be blocked to simulate a fire being there. I have also been through tornado drills as well as active shooter drills. We can’t be ready for everything, but we can have a general plan which allows us to pivot if one of these events occurs. You want to create the same structure, so that if something drastic does happen, you are not starting from scratch.

Finally, there is one other thing that you must build into your Transition Plan and that is you! What are you going to be doing after the school year for yourself and your mental health? Plan that vacation or staycation. Have time for yourself where you are able to refocus and recenter yourself. Even a weekend of recharging can have you more energized and thinking clearly in the event that one of these drastic scenarios takes place. You are not alone in this as well! Reach out to your network and those you trust so that you can be at your best to do your best for your students!

TextAid by ReadSpeaker: Product Spotlight 

By: Gabriel Ryan, School Health Blog Writer and Contributor

Having the ability to access content online can be difficult for many users if the material is too hard to see or the user is not able to read very well. Modern devices have better built-in text to speech features and technology, but these don’t always work across all material a user is trying to access online. I recently learned more about a product called TextAid by ReadSpeaker which was developed to address these challenges and help individuals increase access to text and documents online. I’d like to share a brief overview from ReadSpeaker and highlight some of this products helpful features.

TextAid is a web-based personal literacy support tool that makes it possible for the user to listen to texts and documents using text-to-speech technology in a standard web browser. This software is helpful for individuals with learning disabilities and particularly those with vision impairments or other visual challenges. TextAid works on just about any device, even an old  Mac/PC/Chromebook. The latest version of Google Chrome is recommended for best results. 

Here are 10 key features about the TextAid:

• Text to Speech – Read text out loud,  listen to the whole text or section of text, choose reading speed and add pause between words. Create a downloadable audio file.
• Personalized Text Appearance and Synchronized Highlighting Options – Choose from 5 colors for the text color, 5 background colors, 6 text sizes, 6 fonts, and three line spacing settings for page options. Words and sentences are highlighted as they are read. Seven background colors available for highlighting sentences and/or words.
• Text Editor – Author texts in the text editor which provides text formatting features from the toolbar such as heading levels, bold/italic/underline, text formatting, etc. includes writing assistance such as read back, spellcheck, and word prediction. A user can also use dictation to enter text.
• Save and Reload Texts – Text or HTML content in the text editor can be named, saved to the TextAid library and loaded again in the text editor at a later time. 
• Personal Library – Upload documents of various formats from the user’s device, Google Drive, or OneDrive, or from the user’s Book share account.
• Document Navigation and Annotations/Highlighter – User can choose a specific page or go to next or previous page, they can also make notes and add highlights in a document.
• Multiple Languages – User licenses available to support text to speech in over 20+ languages.  Content that has been typed or pasted can be translated in the text editor.
• Web Reading – Add a web reading tool to the browser’s bookmarks or favorites to listen to any page on the web. The text will be read out loud and highlighted in the same manner as in TextAid.
• Optical Character Recognition (OCR) – Using third party technology scanned images containing text can be converted to text, which can be read in the same way as other library documents in the text editor or the document viewer (PDF).
• Calculator – Embedded calculator for simple calculations (addition, subtraction, multiplication, and division) the digits, symbols, and calculations are read out loud. 

There are also several administrator features such as assigning user roles, licenses to users, grouping users, sharing documents, creating exams, and more.

Tools like ReadSpeaker TextAid help students improve comprehension, increase self-confidence and motivate readers. I have a visual impairment and primarily use text to speech technology. I enjoyed the opportunity to learn more about and try TextAid. Getting started took some time for me to learn the features that would support my reading and writing style the best, but once I learned where to find those tools, the features became easier to navigate. I especially like autosave feature when writing and the ability to have the tool read content from a variety of webpages was impressive. I look forward to continuing to learn more ways I can effectively incorporate this tool as part of accessing content online.

Visit the schoolhealth.com website to learn more information about the ReadSpeaker TextAid.

What are your thoughts about this topic? Have you used this product? What other topics are of interest for consideration for Access Angle? Contact me through email at gryan@scoolhealth.com. I’d love to know how you’ve used information from the School Health Access Angle segments.

From the moment a parent learns of their child's autism diagnosis, their journey toward providing the best care and support begins. Driven by an unwavering commitment to enhance their child’s opportunities and quality of life, they leave no stone unturned in exploring every avenue for their child's well-being. Yet, amidst this tireless pursuit, one vital intervention often remains overlooked: exercise. 

Surprisingly, it's a topic rarely discussed by doctors or the early intervention team. While many parents assume their child is getting physical activity through occupational or physical therapy, the reality is that these therapies are not tailored to meet the daily physical activity needs of children and adults with autism. Statistics from the U.S. Centers for Disease Control reveal that nearly a third of children with autism are severely obese, underlining the urgent need for a holistic approach to physical activity. 

Compounding their children’s lack of physical activity is the lack of awareness among parents about the mandate for physical education (PE) services according to IDEA Law in the United States.Exercise interventions are not frequently discussed or included in Individualized Education Plans (IEPs). This lack of emphasis on exercise as part of comprehensive support for individuals with ASD can result in missed opportunities for promoting physical health, social interaction, and overall well-being.Even with all the dedicated and tireless research that has shown exercise has a positive impact beyond the health-related benefits, it's a shock (no, it's actually sad and frustrating) that exercise is not getting the attention it deserves by more schools. 

There is a lack of understanding of how to effectively deliver exercise for those with autism in communities worldwide but that is changing. Successfully engaging a person with autism in any new activity - especially exercise - is achievable. To do so, it will take patience, creativity, and the use of evidence-based teaching practices (EBPs). 

Exercise is an Evidence-Based Practice

Exercise & Movement is one of 28 defined evidence-based practices (EBPs) that support those with autism. In addition to the health-related benefits, Exercise & Movement has been shown to produce positive outcomes in academics, communication, school readiness, behavior, motor and cognitive development.

However, parents and professionals cannot just put their children, clients or students in a physical activity program or environment and immediately expect those results. They need to apply a combination of the remaining 27 EBPs to start making the exercise connection. For example, visual supports, social narratives, video-modeling, and reinforcement are commonly used EBPs in a special education classroom, therapeutic environment and home. These familiar practices promote success for those with autism and should be applied in exercise settings as well. Parents know what strategies have been used to motivate their children, so start by applying those in an exercise program to get your child engaged!

10-Minutes to Exercise Success

I had just completed a successful exercise session with a 10-year old autistic boy. He was engaged the entire session and was making progress in his exercises and his time on-task. When the session ended I walked him to his mother who was waiting in the foyer. Excited to share the news, I noticed a bit of concern on the mother’s face. She then said to me, “What did I just pay for?”

Taken aback, I replied with genuine curiosity, "What do you mean?"

With a hint of frustration, mom elaborated, "He's not sweating."

At that moment, I came to understand the urgency of narrowing the gap between mainstream notions of exercise and the subtle - but critical - requirements of autistic individuals success with exercise.

What we have seen on reality fitness shows like “The Biggest Loser” with individuals dripping in sweat does not signify a successful workout, let alone for most people. This approach will likely lead to pulling children further away from exercise.

When you embark on this mission, your goal should be to get your child through the first session in an enjoyable way. If you get them through the first session and willing to try again, you’ve won! When starting, you (and your child) need to be like a tortoise, not the hare.

Making the Exercise Connection
The American College of Sports Medicine and the World Health Organization recommend that every person do at least 60 minutes of moderate to vigorous-intensity physical activity every day. Resistance and strength training exercises should be done at least 3 times a week.

For families and individuals with motor challenges, sensory differences or busy lives, this can be a huge undertaking. Below are some tips and strategies to getting started and working towards your exercise goals:

Start with 10 minutes a day
Although the recommendations from ACSM are optimal goals, I want parents to know that the most important thing is to get started. Don’t let the recommendations deter you from exercising at all. In fact, a 2017 study from Rutgers University showed that just 10 minutes of low to moderate-intensity exercise each day was able to make a significant difference in the lives of autistic individuals.³ Whether you have never exercised before, or have exercised intermittently throughout your life, 10 minutes a day is an achievable and realistic place to start, with the eventual goal of adding more time.

Start with low-intensity exercises
Much research states that adequate exercise requires high-intensity exercises, including high-intensity cardio. However, for many autistic individuals, these high-intensity exercises should not be the initial focus as they require underlying lying skills such as core stability, balance, and motor planning to efficiently complete. Low-intensity exercises are a great place to start to slowly build a routine of engaging exercises, to build confidence, and to improve core muscles.

Use Evidence-based Strategies in your exercise program
Rarely are evidence-based practices used in the physical education environment. Work with your child’s school, sports team and personal trainers to help them implement an exercise program with visual supports, structured routines, sensory considerations, individualized goal-setting, positive reinforcement, adapted equipment, and progress monitoring. By incorporating these approaches, instructors can create a supportive and inclusive environment that caters to the unique needs and abilities of autistic individuals.

Provide Structure and Routine
We know that autistic individuals typically thrive on structure and routine. It is important to have the same application and methodology in exercise. Choose the same day and time every week to schedule exercise. Provide the same exercises each week in the same order and then slowly build on that foundation.

Consider a gym membership and/or a personal trainer
Autistic individuals often benefit from one-on-one instruction. This type of instruction is especially effective for motivation and using a customized exercise routine. Participating in exercise in a gym setting also allows for increased community engagement and the opportunity to improve social skills. Seek out qualified professionals within your community to assist in developing a healthy relationship with physical activity.

Low-intensity At-home Exercises
The exercises below are an excellent place to start because they require limited to no equipment and although they are low-intensity, they provide significant benefits. These are also excellent exercises for parents to join in with their child.

(1) HIP EXTENSIONS
As mentioned above, many autistic individuals have gross motor movement challenges. Having strong glutes and hamstrings can help improve this area while also helping to reduce any lower back pain. This is a low-impact exercise that can help build confidence and most individuals should be able to perform safely.

What to do
- Have your child lie on their backs with their knees bent, feet flat and neck relaxed.
- Have your child lift their butt or tummy up so the knee, hip and shoulder are in a straight line.
- Control the movement on the way down and repeat.
- Parents or coaches can stand by their feet and show the visual support card.

How much, how often
- Perform 2–4 sets of 6–12 repetitions each. (Focus on proper form)

Coaching Tips
- Try to not let the butt hit the ground, so as to help reduce the risk of injury while also challenging the muscles.

- If your child begins doing this exercise fast, that’s okay: They’re moving! In future workouts coach them and demonstrate how to make it a more controlled movement

(2) DOWNWARD DOG
The yoga position called downward-facing dog offers full-body benefits including stretching the lower body, strengthening the upper body, improving blood flow and improving posture.

What to do
- Have your child start on their hands and knees then lift their butt in the air.
- Place the visual support card on the ground in their line of vision. 

How much, how often
- Have your child do 1–4 sets of 10–20 seconds each.

Coaching Tips
- If your child’s hands are not pointed straight ahead, don’t adjust in the first attempt. Just have them try to complete the duration.
- Make sure your child is breathing through the exercise and not holding their breath.

(3) LOG STRETCH
This exercise, which uses a foam roller, has many benefits without placing too many demands on a person new to exercise. It calms the nervous system, engages the abdominal muscles, and reduces stress and tension in the neck, all while building a positive relationship with exercise.

What to do
- Show your child the visual support card.
- Model how to get onto the foam roller.
- Be prepared to spot your child, staying close beside them.
- Make sure your child’s head is always in a neutral position on the “log.” 

How much, how often
- Begin with 30–60 seconds. If your child wants to stay on longer, that’s okay as long as they are in a safe postural position.

Coaching Tips
- Palms should face up.
- If the hands are not on the ground, that is okay. Don’t force them down, as this means that the muscles of the neck and shoulder girdle are tight. This will improve over time.
- As your child becomes independent and confident in this position, you can add various arm movements to work on muscle tension reduction and motor planning.
- Practice, practice, practice.

Even basic exercises can be complex for autistic individuals, so it is essential to recognize that perfection isn't the immediate goal. I acknowledge the importance of biomechanics and correct body positioning, but initially, the priority should be to simply to engage in 10 minutes of physical activity every day. As the relationship between the child and their support system, whether it's a parent, OT, or trainer, strengthens and trust develops, there will be opportunities to refine body movements and strive for perfection. Most importantly, provide your child with an exercise program that is as accommodating and enjoyable as possible, so they can continue a life-long routine of regular physical activity.

References
1. Toscano, C. V. A., Ferreira, J. P., Quinaud, R. T., Silva, K. M. N., Carvalho, H. M., & Gaspar, J. M. (2022). Exercise improves the social and behavioral skills of children and adolescent with autism spectrum disorders. Frontiers in psychiatry, 13, 1027799.

2. Rafie, F., Ghasemi, A., Zamani Jam, A., & Jalali, S. (2017). Effect of exercise intervention on the perceptual-motor skills in adolescents with autism. The Journal of sports medicine and physical fitness, 57(1-2), 53–59.

3. Schmitz Olin, S., McFadden, B. A., Golem, D. L., Pellegrino, J. K., Walker, A. J., Sanders, D. J., & Arent, S. M. (2017). The Effects of Exercise Dose on Stereotypical Behavior in Children with Autism. Medicine and science in sports and exercise, 49(5), 983–990.

Across the country, legislation is driving the conversation on access to period products in schools, with many states passing laws requiring them to be provided for free. Studies show that nearly 1 in 4 students struggle to access period products  (State of the Period 2023), which can negatively impact their education, health, and well-being. These initiatives acknowledge that period products are essential, not a luxury.

That’s where Aunt Flow comes in. As a certified woman-owned business, Aunt Flow is on a mission to ensure high-quality period products are freely accessible, championing the belief that “Toilet paper is offered for free. Why aren't pads and tampons?” Today, Aunt Flow products are stocked in over 600 schools nationwide—helping school districts prioritize student health, dignity, and academic success.

As of January 1, 2025, 28 states and the District of Columbia have enacted legislation requiring schools to provide free period products to students. However, the specifics of these laws vary, with differences in funding provisions and the grade levels affected. 

Beyond passing legislation, where these products are placed within schools plays a crucial role in accessibility. Some schools debate whether to stock them in bathrooms or the nurse’s office, often citing concerns about restocking, vandalism, or theft. But to truly support students, period products should be available where they’re needed most—inside school bathrooms—ensuring easy, immediate, and stigma-free access.

The Benefits of Offering Free Period Products in Schools

Providing free period products in schools comes with several important benefits:

• Supports student health, dignity, and attendance: 84% of teens have missed class or know someone who has missed it because they didn’t have access to menstrual products (State of the Period 2023). Ensuring students have access to necessary products helps them stay in school without unnecessary disruptions. 

• Reduces stigma around menstruation: Normalizing period products as everyday essentials helps eliminate shame and discomfort around the topic.

• Aligns with similar initiatives like free toilet paper and soap in restrooms: Schools already provide other essential hygiene items—period products should be no different.

Why Location Matters: Bathroom Access vs. Nurse’s Office:

Even in schools that do provide period products, where those products are located matters. Many schools only offer menstrual products in the nurse’s office. The reality? Requiring students to visit the nurse’s office for period products can create unnecessary obstacles.

As Jennifer Christensen, Principal of Olympus High School in Salt Lake City, Utah, explains, 'Students in the past would have to come to the office or the counseling center, and they would have to come in and ask if they had any kind of period products. It would be scary and nerve-racking for a lot of students to come in and ask for anything they might need. I would say every school needs to have something easily, readily available for students.'

Barriers to access: Students may feel embarrassed asking for products, lose valuable class time, or face limitations on availability. In fact, 44% of teens report stress and embarrassment due to a lack of access to period products (State of the Period 2023). 

Not to mention, sending students to the nurse’s office takes them out of class. If a student has to leave to get a pad or tampon, that’s time lost from valuable learning opportunities—just for something as simple as managing a period.

A more effective solution: Placing products in bathrooms allows for immediate, discreet, and equitable access, empowering students to manage their periods without disruption.

Addressing Concerns: Dispenser Maintenance, Restocking, and Respectful Usage

Some schools hesitate to place period products in bathrooms due to concerns about maintenance and misuse. Let’s dive into some proactive strategies that can help give schools some peace of mind!

Dispenser Maintenance and Restocking

Launching a free period program is a great first step—but long-term success depends on consistent upkeep. That’s where your maintenance and facilities teams come in—they’re the real MVPs! 

Set them up for success by putting the right systems in place:

• Set clear procedures and schedules for restocking, dispenser maintenance, and reordering.

• Provide training for staff and establish protocols for responding to feedback.

• Maintain open communication about supply levels and streamline access to reordering information.

Once you’ve completed staff training, keep your period program running smoothly:

• Monitor usage patterns and adjust stocking levels accordingly.

• Gather feedback from users (anonymous surveys work great!) and document any issues or complaints.

• Track costs and optimize ordering to minimize waste.

Pro tip: Create a map of all dispenser locations to share with your facilities team—it makes restocking and maintenance much more efficient!

Encouraging Respectful Use

While overuse and vandalism are uncommon, they can occasionally occur in adolescent-heavy environments like K–12 schools—often simply because students are adjusting to something new in their bathrooms. 

When period products are introduced, there may be initial curiosity or concern about scarcity. But once students trust that products will be consistently available, misuse tends to decrease. Educating students about the program and involving them in its rollout helps foster respect, reduce waste, and create a shared sense of responsibility.

Here are a few effective solutions:

• Educational Signage: It’s vital to educate people on the importance of such products' accessibility and the importance of ensuring that they are not misused. Download Aunt Flow's signage to place next to your dispenser!

• Education and Awareness: Language is power! Understanding and talking about the experiences of menstruators and the challenges associated with period poverty and menstrual equity can help form empathy and positive attitudes toward free-vend dispensers. 

• Bathroom Tours: Quite a few schools have led “school bathroom tours” once their Aunt Flow dispensers are implemented. That way, students can see the dispensers, learn how to use them, and dispose of products properly. Students love the “field trip” they get out of it and respect the products!

From Legislation to Implementation: Building a Sustainable Period Program

If your school is looking to comply with or implement policies regarding providing free period products, the first step is to understand the legislation in your state and then work with School Health to stock your bathrooms with Aunt Flow products. 

Schools can take steps to implement sustainable programs by:

• Leverage funding and community support: Many schools don’t realize they can tap into existing federal and state funding—like Title I, Title IV, and McKinney-Vento—to cover the cost of period products. Beyond that, districts can apply for grants or partner with local organizations and education foundations to strengthen their programs.
• Create a consistent restocking plan: A sustainable program isn’t just about launching—it’s about keeping it running smoothly. That starts with building a plan for regular restocking, aligning with your facilities team, and budgeting for ongoing supply needs.
• Use plug-and-play implementation tools: Aunt Flow and School Health offer ready-to-use education kits, signage, and staff training materials that simplify rollout and help students access products without confusion or stigma.
• Track usage and measure impact: We provide tools to help schools track product usage, gather student feedback, and evaluate the program’s success—so you can report on impact and keep the program thriving.

Ready to get started? Aunt Flow and School Health are here to help you feel equipped and empowered for a period program at your school! 

Written by: Alexandrea Wiegand, MBA, MS, BCBA, IBA

 I've been an athlete since I was a child, and once my collegiate years ended, fitness became my go-to for managing stress and staying healthy (as well as supporting my love for food). I've been a behavior analyst since 2010, and I’m thrilled to combine my passion for fitness with my professional practice. My Autism Exercise Specialist certification has allowed me to incorporate exercise into my clinical practice, positively impacting my clients' lives more than ever before.

 It's no secret that ABA (Applied Behavior Analysis) therapy has faced criticism, especially from autistic adults who received services in the past. Critics often point out that ABA methods can be rigid, focusing on compliance and behavior change through extrinsic reinforcement, sometimes leading to individuals feeling like they are being forced to conform to neurotypical standards. Concerns about ableism, punishment, and encouraging masking behaviors (i.e., consciously or unconsciously) are valid and must be addressed. The perception of ABA creating "robots" instead of celebrating individual differences and promoting neuroaffirming practices has been a significant issue.

 However, I believe society has created a difference between ABA therapy and the science of behavior analysis that isn’t really there. The principles of behavior analysis—understanding how environment, motivation, punishment, and reinforcement history shape behavior—are present in everyone's daily life. There is no denouncing the science of human behavior.

 Let’s look at how behavior analysis is present in everyday life. Imagine a child finishing their homework more often because they know they can play their favorite game afterward. This would be an example of positive reinforcement. The behavior (completing homework) is reinforced by the reward (playing the game). Simple, right? Now, think about when we avoid speeding in the presence of a police car or speed cameras to avoid getting a ticket. Here, the behavior (driving the speed limit) is reinforced by avoiding the consequence (ticket). Unless, of course, you have millions of dollars, in which case, the fine might be more annoying than an actual deterrent.

 In the workplace, we complete tasks on time to avoid nagging, reprimands, or poor performance evaluations from our boss. The behavior (completing assignments on time) is reinforced by avoiding negative consequences (nagging, reprimands, poor evaluation). Or some of us may complete work tasks simply because we enjoy crossing items off our to-do list. The behavior (completing tasks) is reinforced by the satisfaction of crossing off items on our list (some can equate this example of intrinsic reward as automatic reinforcement).

 Ever wondered why we help each other? Well, it is likely because the behavior (kind/helpful actions) is reinforced by positive attention (compliments). And it’s not just in personal interactions; governments also use behavior analysis! For example, they use incentives to promote environmentally friendly practices. By offering reduced fares to frequent users, the government reinforces the behavior of using public transit. The reduced fare is a positive reinforcer, increasing the likelihood that individuals will choose public transportation over other modes. Similarly, providing monetary rewards for recycling increases the frequency of recycling. In both cases, the incentives reinforce and encourage behaviors that contribute to environmental sustainability.

 And how many of you have kids who fake being sick? Maybe it’s because, in the past, when they complained of a stomachache, you allowed them to stay home, and they got extra time to study for an exam. The behavior (complaining) is reinforced by escaping the aversive situation (going to school) and accessing more study time. Now consider why we don’t open doors with a large "closed" sign. The "closed" sign signals that opening the door will not be allowed, discouraging the behavior. And the list goes on! These are simple examples of the science of human behavior, or ABA, in everyday life. ABA is everywhere, all the time. There is no escaping it!

 ABA therapy became popular with the results it produced with the autistic population because it aims to use the principles of human behavior in a structured, individualized manner to help individuals improve their quality of life and bridge developmental gaps by increasing learning opportunities. Despite some misconceptions and criticisms, the field of ABA therapy is continuously evolving to better understand and support neurodiverse individuals. One way behavior analysts can continue strengthening the field’s reputation is to embed other evidence-based practices, such as exercise and the tools provided within Exercise Connections coursework, into their clinical practice to continue to improve outcomes.

 Exercise offers numerous benefits that align perfectly with the typical goals of ABA therapy for neurodiverse individuals. It supports physical health, mental well-being, cognitive function, and development (Toscana et al., 2022). Embedding exercise supports the release of natural hormones and chemicals that can lead to the possible development of intrinsic reinforcement (i.e., automatic reinforcement), such as endorphins, dopamine, norepinephrine, cortisol, adrenaline, testosterone, and growth hormone.

 Did you know that dopamine, norepinephrine, and endorphins are released during exercise? And they act as natural painkillers and mood enhancers and even boost energy levels? They’re like nature’s way of saying, 'Here, have some happy juice!' This can be especially beneficial for individuals with autism who may experience sensory sensitivities, depression, and anxiety. Regular exercise can reduce symptoms of depression and anxiety, which affect 10-54% of autistic individuals and 1-12% of the neurotypical population (Spencer, 2024 & Stewart, 2022).

 Dopamine and norepinephrine also improve mental focus and concentration. This is crucial for individuals with autism and ADHD, as it can enhance their executive functioning skills (e.g., planning, organizing, time management, self-monitoring, task initiation, and problem-solving; Liang et al., 2022; Lang et al., 2022). It’s like giving a child a magical brain boost. Next time they struggle with focus, consider a quick exercise break—it’s like hitting the reset button without the screen time.

 Exercise also helps regulate cortisol levels, reduces stress, and improves behavior regulation—all the same outcomes ABA therapy typically desires to achieve (Best et al., 2010; Tomporowski et al., 2008). And guess what? Structured exercise routines mirror common antecedent interventions used in ABA, such as visual or text schedules, a first-next board, task analysis (breaking down skills into smaller steps), and clear expectations, further supporting behavior regulation.

 We all know that exercise has many health benefits, including cardiovascular health and muscle strength. But have you ever thought about how this can lead to greater independence and participation in other daily activities? Improved strength and coordination help with tasks like brushing teeth and dressing, while increased stamina supports participation in chores and community activities like cleaning, cooking, organizing, sports, volunteering, after-school clubs, concerts, shopping, and more. This fosters a sense of responsibility, belonging, and dignity and provides more opportunities for building meaningful relationships and targeting essential life skills. ABA therapy often targets life skills such as dressing, showering, brushing teeth, and social development. Combining the two is like giving individuals a backstage pass to the world of social skills. Through sports and group activities, they learn teamwork, communication, and how to handle winning and losing gracefully—useful life skills beyond the playground.

 So, why not support strength and coordination while teaching life skills? I would also imagine if we incorporated exercise within our sessions, the rate of skill acquisition would also likely improve… What do you think? Could behavior analysts use exercise to improve outcomes and the reputation of ABA therapy?

 Did you know that 50- 80% of children and adolescents with ASD suffer from sleep problems (Zavier, 2021)? And guess what? Regular exercise improves sleep quality and regulates sleep cycles (Tse, 2023), which leads to better sleep, mood, and cognitive abilities!

 And then what about weight!?!?! The prevalence of obesity is on the rise in general. However, it is even higher in autistic children and presents between ages 2 to 5. Studies show that 42.4% of children with autism are overweight and 21.4% are obese, compared to 26.1% and 12.0% in typically developing children. This is caused by a multitude of factors, including selective eating habits, preferences for energy-dense foods, and side effects of medications like antipsychotics. These eating patterns and lower physical activity levels make autistic children more vulnerable to obesity (Iverson & Perry, 2015). With exercise embedded into daily lives and ABA sessions, the prevalence of obesity and other related health issues can be reduced. This could even lead to lowering the number of traumatic experiences in one’s life related to medical care!

 Research indicates that regular exercise can significantly reduce rates of stereotypy—repetitive, non-functional behaviors often seen in individuals with varying abilities (Lang et al., 2010). Although I believe the community should embrace these differences, we aren't yet there as a society, especially in regions outside the Western world. Physical activity can provide a constructive outlet for energy and improve overall well-being, decreasing the frequency and intensity of stereotypic behaviors. In some cases, ABA therapy may focus on reducing stereotypic behaviors, particularly when their rate or form becomes dangerous or significantly hinders learning and the development of meaningful relationships. For example, suppose a child engages in repetitive hand-flapping to the extent that it interferes with their ability to participate in classroom activities or social interactions. Similarly, if an individual engages in head-banging that poses a risk of injury, ABA will likely target this behavior to ensure safety and well-being.

 By incorporating regular exercise into ABA therapy, behavior analysts can reduce stereotypic behaviors in less intrusive and more natural ways than traditional methods. This approach not only effectively addresses the behaviors but also enhances the overall quality of life for neurodiverse individuals. As society gradually learns to accept and embrace differences, integrating exercise can help move toward a more inclusive society.

 Exercise indirectly targets many of the goals of a typical ABA program for diverse individuals. Integrating exercise into ABA therapy not only improves the overall quality of life for neurodiverse individuals but also helps rebrand the field of behavior analysis. Combining the evidence-based practices of exercise and behavior analysis shows the commitment of behavior analysts to holistic, neuro-affirming practices that celebrate individual strengths and promote long-term well-being. Let's embrace this approach and work towards a future where ABA therapy is a supportive, inclusive practice that genuinely enhances lives.

References

Best, J. R., & Miller, P. H. (2010). A developmental perspective on executive function: The importance of biological and environmental influences. Child Development, 81(6), 1641-1660. https://doi.org/10.1111/j.1467-8624.2010.01499.x

Iverson, K. S., & Perry, A. (2015). Obesity and autism. Pediatrics, 136(6), 1051-1061. https://doi.org/10.1542/peds.2015-3497

Lang, R., Koegel, L. K., Ashbaugh, K., Regester, A., Ence, W., & Smith, W. (2010). Physical exercise and individuals with autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders, 4(4), 565-576. https://doi.org/10.1016/j.rasd.2010.01.006

Liang, X., Li, R., Wong, S. H. S., et al. (2022). The effects of exercise interventions on executive functions in children and adolescents with autism spectrum disorder: A systematic review and meta-analysis. Sports Med, 52, 75–88. https://doi.org/10.1007/s40279-021-01545-3

Spencer, S. D., Pinciotti, C. M., Murphy, C., et al. (2024). Concurrent validity of the anxiety disorders section of the anxiety disorder interview schedule- Autism Spectrum Addendum (ADIS-ASA) in autistic youth. J Autism Dev Disord. https://doi.org/10.1007/s10803-024-06496-y

Stewart, T. M., Martin, K., Fazi, M., Oldridge, J., Piper, A., & Rhodes, S. M. (2022). A systematic review of the rates of depression in autistic children and adolescents without intellectual disability. Psychol Psychother, 95(1), 313-344. https://doi.org/10.1111/papt.12366

Tomporowski, P. D., Lambourne, K., & Okumura, M. S. (2008). Physical activity interventions and children's mental function: An introduction and overview. Preventive Medicine, 52(Suppl), S3-S9. https://doi.org/10.1016/j.ypmed.2011.01.028

Toscano, C. V. A., Ferreira, J. P., Quinaud, R. T., Silva, K. M. N., Carvalho, H. M., & Gaspar, J. M. (2022). Exercise improves the social and behavioral skills of children and adolescent with autism spectrum disorders. Front Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.1027799

Tse, A. C., Lee, P. H., Sit, C. H., et al. (2023). Comparing the effectiveness of physical exercise intervention and melatonin supplement.

Zaivier. (2021). The relationship between autism spectrum disorder and sleep. Sleep Sci, 2021 Jul-Sep; 14(3), 193-195. https://doi.org/10.5935/1984-0063.20210050

Written By: Dr. Emilee Moore, OTD

Occupational therapy (OT) continues to play a pivotal role in enhancing individuals' quality of life. The Occupational Therapy Practice Framework (OTPF) 4th Edition, highlights physical activity as a key area of intervention that occupational therapists (OTs) are uniquely qualified to address. By focusing on a client-centered approach, OTs can help clients integrate physical activity into their daily routines, ensuring long-term success and satisfaction.