WEBVTT

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Carrie Alvarado, PhD, OTR: Good morning!

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Carrie Alvarado, PhD, OTR: Good morning, welcome!

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Carrie Alvarado, PhD, OTR: Hello, hello!

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Carrie Alvarado, PhD, OTR: Welcome, everyone. Good morning, good afternoon, I should say.

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Carrie Alvarado, PhD, OTR: Give it a few more minutes for a few more people to trickle in.

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Carrie Alvarado, PhD, OTR: So lovely to be with all of you today.

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Carrie Alvarado, PhD, OTR: I'm gonna make you a co-host, Claire, just in case I need a little background help as I'm presenting.

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Carrie Alvarado, PhD, OTR: Okay, wonderful. Welcome, everyone.

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Carrie Alvarado, PhD, OTR: And we'll go ahead and get started. I want to make sure that we're respectful of your time. Thank you so much for spending your morning, or your afternoon, or your evening with us, depending on where you're coming from.

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Carrie Alvarado, PhD, OTR: My name is Carrie Alvarado. I am an occupational therapist in, San Antonio, Texas, in the United States, and I am really, really happy to be kicking off our PACT webinar series of 2026.

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Carrie Alvarado, PhD, OTR: And today I'll be talking about a neuroaffirming approach to supporting autistic children and families, and certainly PACT is very neuro-affirming. I have been practicing PACT now since 2019. I was the first in the United States to train to Fidelity in this approach.

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Carrie Alvarado, PhD, OTR: And I'm using it widely with a wide variety of families. I work in a non-profit autism diagnostic center.

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Carrie Alvarado, PhD, OTR: And so, I generally support families with PACT, either pre-diagnostically or post-diagnostically, and then sometimes, perhaps, I'm working with them a little bit later in their journey with their child, when they finally discover that there is this beautiful, new, and innovative intervention called PACT. So today, we'll be talking a lot about

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Carrie Alvarado, PhD, OTR: how PACT is a neuroaffirming approach for supporting children and families. So, just a few reminders about today's webinar.

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Carrie Alvarado, PhD, OTR: We know that we have a variety of professionals here. I think we have some speech-language pathologists, some educators, perhaps some OTs, some psychologists, so please, if you'd love to share what your background is and you weren't able to do that on your intake documentation, feel free to put that in the chat for us.

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Carrie Alvarado, PhD, OTR: I think we also have some parents amongst us today, so welcome, parents. I'm really, really excited to have all of you joining us today. I do want to remind you that the session today is being recorded, and we will have it available in the PACT UK website after the webinar, so if you miss any part of today, or if you just want to share this.

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Carrie Alvarado, PhD, OTR: with other, families that you know, please do feel free to let them know about that.

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Carrie Alvarado, PhD, OTR: We'll have about 15 minutes at the end for questions, and feel free to enter any questions that you have into the chat as we go along. I will try to aim… I will aim to answer a few of these at the end today, but if we have a lot of questions, they may be emailed to me at the end, and then I will respond to you individually.

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Carrie Alvarado, PhD, OTR: We also wanted to let you know that we'll be sending a short feedback survey after the session, and we would really appreciate your input on this. It helps us to shape and make sure that we are tailoring our future presentations to your interests and your needs.

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Carrie Alvarado, PhD, OTR: We want to make sure that the content that we're producing is really relevant and important and useful for you. So please do take the time to respond to that survey at the end of today.

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Carrie Alvarado, PhD, OTR: Alright, so I know that some of you joining us have a bit of a background in PACT, and for some of you, this might be the first time that you're really being introduced to it, so what a joy for me to be able to introduce you to this model, if that's the case.

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Carrie Alvarado, PhD, OTR: But I do want to just kind of do a real quick primer overview of how the model works, for those of you who are newer to it.

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Carrie Alvarado, PhD, OTR: So, pediatric Autism Communication Therapy is a really innovative, parent-mediated approach to supporting children on the spectrum, in addition to their families.

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Carrie Alvarado, PhD, OTR: It is a program that is about 12 to 18 sessions, and so this typically takes about 6 to 12 months to complete the full program. So it's not like your traditional approaches where you're kind of longitudinally seeing children for a really long time if you're a clinician.

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Carrie Alvarado, PhD, OTR: or a family who's seeing the same therapist for years, it is really intended to be a dip-in, help and strengthen and embolden that family system as much as possible, and then to step back and to afford the family to take the child's journey from there.

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Carrie Alvarado, PhD, OTR: PACT is, focusing on supporting developmental processes for the child. These include things like shared attention, emotional engagement, communicative intent, initiation, understanding the balance between a back-and-forth serve-and-return interaction.

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Carrie Alvarado, PhD, OTR: And there are also benefits for parents. Parents who participate in PACT really, feed back to us that they feel very much more engaged with their child, they have a greater degree of confidence when they're interacting with their children, and they really do report back to us that there are collateral benefits for how the entire family system is functioning.

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Carrie Alvarado, PhD, OTR: As a professional using PACT, it's a very efficient use of my time. I, you know, like I said, it's a short-term intervention, 18 sessions when used fully. Sometimes it's 6, sometimes it's 12, and sometimes it's 18, depending on where you're finding PACT. But it is a very efficient way to support families.

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Carrie Alvarado, PhD, OTR: And to empower them as quickly as possible with the tools that they need to be able to support interactions with their children more efficiently.

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Carrie Alvarado, PhD, OTR: And because we're empowering families, PACT, and many parent-mediated approaches like it, really have a 24-7 therapeutic effect. You know, I always tell parents, when I'm working with you during PACT, and I'm empowering you, and I'm giving you the skills, and really benefiting from your expertise and your child.

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Carrie Alvarado, PhD, OTR: Your child, it's like having a gym membership 24-7, right? Your child is able to interact with you in these more optimized ways across different settings, across different contexts.

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Carrie Alvarado, PhD, OTR: And if you're seeing me as a clinician in my therapy clinic, and you're coming to me 30 minutes a couple times a week, well, that's like going to the gym just a couple of times a week, or maybe not making it both times to the gym, right? Which one is going to really enhance your strength?

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Carrie Alvarado, PhD, OTR: and your sense of agency and competency. So, the 24-7 therapeutic effect is really important for PACT, because that is really what affords this approach to support dynamics between parents and children that sustain and generalize over time.

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Carrie Alvarado, PhD, OTR: PACT uses video feedback to produce the intervention effect, so this is probably one of the most unique features of PACT. I'm not ever, as a PACT clinician, working directly with your child.

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Carrie Alvarado, PhD, OTR: I am working with you, and perhaps you and your partner, in order to help you see your relationship with your child through different and new eyes. So through use of video feedback, you are zoomed out of that moment with your child where you may be experiencing some anxiety, you may be, you know, it's coming at you really fast, you're having to make decisions on your feet.

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Carrie Alvarado, PhD, OTR: And the video analysis really allows us to step back into a regulated space, and for you to become very comfortable in seeing the really nuanced social cues that your child might be seeing you that you might miss in real time, and seeing how you are successfully responding to your child. PACT is all strengths-based.

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Carrie Alvarado, PhD, OTR: So you, as a parent, my job as a facilitator is to help you as the parent to identify those moments in the video where you're feeling connected with your child, where you see your child make a communicative initiation, or you see yourself doing something nicely that allowed something new to surprise you in your interaction with your child.

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Carrie Alvarado, PhD, OTR: And what we do is we zoom in on those moments, and we peel them apart, and we say, okay, mom, okay, dad.

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Carrie Alvarado, PhD, OTR: What are the strategies that you used in these moments that afforded your child that opportunity?

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Carrie Alvarado, PhD, OTR: well, hmm, I slowed down my pace, or, oh, I positioned myself a little differently, or, oh, instead of me coming up with the activity, I really followed to see what he was interested in. And that seemed to make a really large difference in his motivation and his engagement with me.

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Carrie Alvarado, PhD, OTR: So we take this time, it's about an hour session, and we take this time to really peel back the.

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Chidiogo Irene Oraelosi: the layers.

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Carrie Alvarado, PhD, OTR: And.

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Chidiogo Irene Oraelosi: to support…

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Carrie Alvarado, PhD, OTR: your ability… sorry, I'm getting feedback from someone real quick. Let me just see… if everybody could mute… thank you very much, very appreciated. So, it really supports you in the moment to be able to notice

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Carrie Alvarado, PhD, OTR: those communicative bids or signals that your child might be sending you, and for you to also notice that you've got some strengths, you've got definite expertise in your child, and sometimes you just need a therapist to really shine the light on those strengths for you. So that's our role as a packed clinician or educator.

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Carrie Alvarado, PhD, OTR: So, this is kind of the chain of reaction that occurs in PACT intervention. I work with you directly, parents, and my job, again, is to facilitate

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Carrie Alvarado, PhD, OTR: Changes in your responsivity patterns, to notice those responsivity patterns that you're already using that are really benefiting your child, and shine the light on those.

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Carrie Alvarado, PhD, OTR: But to also really highlight those moments where you paused a little longer, where you reduced the load of your language, and where you followed your child's lead and afforded your child to communicate with you in a bit of a different way. And we're trying to grow those moments of opportunity.

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Carrie Alvarado, PhD, OTR: Through use of our sessions together.

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Carrie Alvarado, PhD, OTR: once I support those parental responsivity patterns shifting just a little bit, what we see are there are changes in the parental-child synchrony.

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Carrie Alvarado, PhD, OTR: And this really affords the child more space, more time, more of a sense of agency to make an initiation, and to really practice being the driver of an interaction versus kind of being ushered through or prompted through the interaction by the adult.

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Carrie Alvarado, PhD, OTR: And as the child practices being the driver with you, and being the one who's initiating the communication, this really helps to

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Carrie Alvarado, PhD, OTR: strengthen those capacities in their child across contexts, and so what we're hoping to see after PACT, and really those last six sessions of PACT, are really centered around, is the child starting to generalize their social communication initiations with other people outside of just mom and dad?

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Carrie Alvarado, PhD, OTR: Right? Are they starting to pull Grandma in? Are they starting to pull Grandpa in? If they go to the park, are they starting to play with other children differently?

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Carrie Alvarado, PhD, OTR: Are they beginning to develop a sense of agency as a person, as a communicator, a sense of confidence? And what they saw in the PACT research is that these changes in child initiation impacted children even in as kind of funky as a situation as working with a researcher who's using an ADOS.

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Carrie Alvarado, PhD, OTR: To assess the child. So this is a novel person using a novel context, and the child was able to demonstrate changes in their communicative initiations, which is really, really exciting to see.

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Carrie Alvarado, PhD, OTR: Okay, so let's talk about how PACT is a neuroaffirming approach, because this is really, really important.

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Carrie Alvarado, PhD, OTR: First I'd like to go over a little bit of terminology you might hear me using throughout today's lecture, and for some of you, you might be really, well-versed in neurodivergence or neurodiversity-affirming care. For some of you, where you are in the world, it might not be as large of a construct, and so it is a developing, evolving.

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Carrie Alvarado, PhD, OTR: movement of neurodiversity-affirming care, and so I wanted to kind of define everything, you know, in the way that I understand it currently. So neurodiversity today, I'm going to define this, as encompassing everyone on the planet.

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Carrie Alvarado, PhD, OTR: as a spectrum of neurodiversity, right? We all have different brains.

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Carrie Alvarado, PhD, OTR: our brains are a map of our experiences, right? A combination of our experiences and our genetic blueprints. And so, all of us have little differentiations in what our brains look like, how our brains function.

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Carrie Alvarado, PhD, OTR: And so we could say that we are a range of neurodiversity, right?

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Carrie Alvarado, PhD, OTR: But what we see is that there are a large number of us who we might designate as neurotypical or neuronormative, and this is considered the neuro-majority. So this is the dominant brain style, while you and I might have little subtle differences in the way that our brains function, because we've had different experiences, we have a different genetic blueprint.

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Carrie Alvarado, PhD, OTR: we still might have enough kind of heterogeneity or similarity between how our brains function and learn, with one another that we are considered the dominant brain style. And this is the brain style that it…

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Carrie Alvarado, PhD, OTR: other people, who are neurodivergent, or who are experiencing neurodivergence, are measured against, okay? So, neurodivergence means I am different enough

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Carrie Alvarado, PhD, OTR: from the dominant neurocognitive norm that I'm considered divergent, neurodivergent, right? So I'm not neuronormative.

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Carrie Alvarado, PhD, OTR: my variation in my brain is causing me to learn and experience myself and the world around me in enough of a different way that I have a neurodivergent brain. And this is certainly the case in autism, certainly the case in lots of developmental differences that we see.

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Carrie Alvarado, PhD, OTR: people experience. The etiology of neurodivergence can be very varied.

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Carrie Alvarado, PhD, OTR: So it can be innate as an autism.

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Carrie Alvarado, PhD, OTR: As in dyslexia, as in ADHD, as in lots of different learning styles, processing styles that we see in children and adults. It can be acquired.

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Carrie Alvarado, PhD, OTR: neurodivergent, so this is what we might see in the instance where there's, you know, there's a head injury, or there's a neurodegenerative condition, like Parkinson's, or someone's experienced trauma, and so now they have PTSD, and they're…

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Carrie Alvarado, PhD, OTR: brain is now processing the world around them very differently than it did before, right? So that's acquired.

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Carrie Alvarado, PhD, OTR: And then sometimes it can be intentionally acquired. Usually this is more temporary, so this might be what happens if, you know, there's some kind of a use of a substance, and that's causing you to experience your sensorium, the world around you, your own body, in a very different way, but usually for a smaller period of time.

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Carrie Alvarado, PhD, OTR: So, let's talk about some of the foundations and rationale for PACT, and how PACT aligns itself along what we call the neurodiversity-affirming paradigm of care, okay? As a PACT clinician, really all of us as PACT clinicians are trained to

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Carrie Alvarado, PhD, OTR: view autism as an innate form of natural brain variation, right? It is a neurodivergence from the neuronormative brain.

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Carrie Alvarado, PhD, OTR: We function within the neurodiversity affirming paradigm, which means that we emphasize that we accept this autistic child as they are, we are going to make accommodations in our approach, in our relational ecosystem and the physical surround for this child to support them, and our role as a packed clinician

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Carrie Alvarado, PhD, OTR: It's really to empower parents To empower their children.

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Carrie Alvarado, PhD, OTR: The focus of PACT therapy is to prioritize children who can authentically communicate. We're not prompting a child to communicate in a specific way. We are trying to help support that child developing their own voice and to convey their own intent and ideas and emotions.

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Carrie Alvarado, PhD, OTR: We are really centered around creating a sense of emotional safety for children and their parents.

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Carrie Alvarado, PhD, OTR: And we also are very centered around developing relational connection over normalization. We are not trying to normalize this child who is neurodivergent. We respect, we value, we validate neurodivergence.

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Carrie Alvarado, PhD, OTR: can play an important role in our society, certainly. Neurodivergence comes with a huge array of benefits and strengths, but it can also come with some vulnerabilities, and so we try to push in and accommodate and support those vulnerabilities as well.

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Carrie Alvarado, PhD, OTR: In PACT, we presume, competence. PACT assumes children and their parents, importantly, are very capable communicators with very valid intentions and interests, despite having very different communication styles.

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Carrie Alvarado, PhD, OTR: And we really do stress reduction, we, I'm sorry, we stress stress reduction over performance. We are not focused on a child performing in a specific way, or increasing their ability with very rote skills. We are interested in reducing stress.

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Carrie Alvarado, PhD, OTR: Reducing the load on the child who is processing and learning differently to enhance their ability to learn and connect with the world around them in a different way.

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Carrie Alvarado, PhD, OTR: So, this is really important, and it's a real large turn, you know, fork in the road from what some traditional therapies have been,

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Carrie Alvarado, PhD, OTR: working toward for children on the spectrum, historically. Some of the limitations of traditional therapies that PACT is trying to counter are that a lot of traditional autism therapies have been focused on the child complying, suppressing specific behaviors, and have really actually often been very neglectful of the child's emotional well-being

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Carrie Alvarado, PhD, OTR: And their autonomy.

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Carrie Alvarado, PhD, OTR: We've learned a lot from the lived experiences and advocacy of autistic individuals and their families. We have listened, and we have created an approach that is responsive to families that tell us.

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Carrie Alvarado, PhD, OTR: I experienced distress and trauma from an intervention that was coercive to me, that didn't feel like it was healthy and promoting my child's well-being.

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Carrie Alvarado, PhD, OTR: And this has really prompted demand for ethical reform and new, more attuned, more mental health-focused, approaches.

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Carrie Alvarado, PhD, OTR: And so…

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Carrie Alvarado, PhD, OTR: New approaches like PACT really do emphasize a collaboration, a collaboration between ourselves and the parents and the children that they love so deeply. It emphasizes respect, and it emphasizes the child's active participation. We want the children to love their time interacting with their parents.

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Carrie Alvarado, PhD, OTR: We want them to feel empowered and competent during these interactions. We never want them to feel coerced. And so that is why PACT is squarely centered around following the child's lead, the child's intention, the child's regulation, the child's motivation.

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Carrie Alvarado, PhD, OTR: We're focused on well-being and agency for, again.

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Carrie Alvarado, PhD, OTR: both the child and the full family system. Modern therapies like PACT are really prioritizing what is the emotional impact of this intervention, right? How am I protecting, and maybe enhancing, even, the long-term mental health of the families that I'm supporting?

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Carrie Alvarado, PhD, OTR: How do I assure that these children and these families experience enhanced quality of life alongside their ability to engage in more sustained and more durable periods of shared attention, or to signal more often from a communicative idea that they've got?

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Carrie Alvarado, PhD, OTR: So we really are more fully centered around the long game and the emotional and mental health well-being of families.

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Carrie Alvarado, PhD, OTR: So again, this is a shift. This is a large paradigm shift from the prior, the kind of old-school approaches that were used with children on the spectrum. This paradigm really emphasizes adapting the environments

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Carrie Alvarado, PhD, OTR: And the societal expectations for these children and families to support their neurological differences.

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Carrie Alvarado, PhD, OTR: We don't approach them as, disordered or broken or something that we need to fix. We approach them as neurologically different and requiring of an environmental and a relational surround that really bends and supports that difference.

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Carrie Alvarado, PhD, OTR: So, PACT focuses on that parent-child interaction. It promotes mutual understanding, and instead of placing the onus of change on the child, we are inviting the family to shift the dynamic so that that child can flourish and have,

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Carrie Alvarado, PhD, OTR: A really optimized environment to express themselves over time.

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Carrie Alvarado, PhD, OTR: We're centered around goodness of fit. We are supporting a parent who is attuned and responsive and feels regulated and competent in the moment of interaction with their child, and that affords the child a larger sense of regulation and safety in that interaction.

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Carrie Alvarado, PhD, OTR: And this is a really large shift in the world of therapy and intervention. This shift calls for clinicians like myself, and like maybe many of you listening today.

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Carrie Alvarado, PhD, OTR: to really approach families with humility. You know, historically, we were the experts. We'd gone to school for all of these years, we'd paid all this money for our educations and all of this extra training, but what we have to do as clinicians is really step into this role and understand

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Carrie Alvarado, PhD, OTR: I know a lot about autism. I know a lot about PACT and, you know, lots about, supporting families and child development.

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Carrie Alvarado, PhD, OTR: But you, parents, are the experts in your child, and when we can join forces, and when I can approach through a lens of curiosity, I afford you the ability to really stretch your wings and feel your own strength, and also approach your child with a different level of curiosity. I've joined you as a partner with PACT in supporting your child who's developing differently.

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Carrie Alvarado, PhD, OTR: So, some of the therapy foundations of PACT are really, these are some of the really central components of PACT. We are interested in supporting social communication through natural parent-child interactions.

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Carrie Alvarado, PhD, OTR: that are embedded in daily routines. All of the PACT that I do is done via telehealth, so the videos are taken in the home environment.

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Carrie Alvarado, PhD, OTR: Within the child's toys, with the child's living room, dog is present, maybe baby brother is present, grandma might be in the room. Sometimes the videos that we receive are out at the park in the neighborhood, things like that as well. But we want to see what is this natural interaction looking like, and that way, when we're facilitating those interactions or highlighting those moments of interactions, these are things that the parent is going to be able to identify

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Carrie Alvarado, PhD, OTR: Within their interactions with their child on a day-to-day basis, which is really, really important.

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Carrie Alvarado, PhD, OTR: Again, another key element of PACT is that we are working to reduce autistic stress.

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Carrie Alvarado, PhD, OTR: The different strategies and techniques that we use in PACT are all centered around lightening the load for the child.

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Carrie Alvarado, PhD, OTR: Let's slow it down. Let's simplify the language that we're using. Let's make sure that language is tied to what the child is already motivated by and attending to.

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Carrie Alvarado, PhD, OTR: Right? And so this helps us help parents adjust to the child's regulation state in the moment, and to join them in a place where they're feeling more regulated and safe and ready to engage.

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Carrie Alvarado, PhD, OTR: Again, we're centered around agency for the child. We want to pause to afford the child the ability to drive and initiate. We want the child to have time and space to organize a response to something that's happened during the play interaction.

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Carrie Alvarado, PhD, OTR: And to disengage as well when they need to, right? We all have different social bandwidth, and sometimes, even, you know, neurotypical people need to take a beat, need to have a moment to reorganize, regroup, recalibrate, find homeostasis.

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Carrie Alvarado, PhD, OTR: And when we afford the child the ability to do that, we show them, I respect you, you have needs to reorganize right now. If I give you the time to reorganize, you're gonna re-engage with me. But that really requires the parent developing a sense of trust.

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Carrie Alvarado, PhD, OTR: In the child, and trust in their own ability to re-engage that child when they come back.

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Carrie Alvarado, PhD, OTR: Right.

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Carrie Alvarado, PhD, OTR: So, the facilitative and reflective video feedback that we use, again, is really how we help parents recognize, okay, the child is really regulated right now, oop, the child is looking a little hyper-aroused right now, what are you doing here, already beautifully mom or dad, to afford the child a little bit more space and time to reorganize?

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Carrie Alvarado, PhD, OTR: well, you know, I slowed down my approach. I waited for him to, you know, turn back to me. I didn't just step in and, you know, start up a new interaction. I waited for him to reinitiate. So pausing and positioning and waiting and reducing the load of the language, making sure you're using

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Carrie Alvarado, PhD, OTR: comments instead of questions. All of these pieces are about helping the parents

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Carrie Alvarado, PhD, OTR: recognize what the child is needing and interested in and motivated in in the moment, to create that sense of child agency and child safety. So, here I included a quote, I've got a couple of them sprinkled in here, just to kind of bring it to life for us. This is a quote from a mom who was using PACT with her daughter, who had some language.

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Carrie Alvarado, PhD, OTR: But who was having a really hard time, affording her child the space to be the leader, be the driver in the interaction, and to express herself. So this is a quote from that mom. She hasn't told me, it's because you don't understand me in over a month.

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Carrie Alvarado, PhD, OTR: And the truth is, I really didn't understand her. I expected her to act in a certain way that just wasn't her. Now I let her be herself, so I can learn from her.

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Carrie Alvarado, PhD, OTR: And this is a really, really important,

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Carrie Alvarado, PhD, OTR: kind of awakening and an awareness for this mom, because she's understanding that she was kind of

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Carrie Alvarado, PhD, OTR: directing and driving the child and not able to read and respond to her cues in a really attuned way, and that child was feeling misunderstood. And now, because she's stepped back, the child is able to assert herself and is feeling more confident as a communicator.

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Carrie Alvarado, PhD, OTR: More validated, more seen.

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Carrie Alvarado, PhD, OTR: So the impact of PACT, based on the feedback that we get from the families that we support, and the lived experience of autistic adults who have participated in PACT as well, is really important for us to talk about. We're talking about a neuro-affirming approach.

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Carrie Alvarado, PhD, OTR: This is important not only for the children that we're supporting, but it's also important because a lot of our parents are also neurodivergent themselves in one form or another.

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Carrie Alvarado, PhD, OTR: So PACT, again, increases children's confidence, their self-agency, it fosters their ability to understand, and reduces the pressure for them to mask their autistic traits. Again.

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Carrie Alvarado, PhD, OTR: In fact, we're honoring that child as they are. We are there to support them, to think that, you know, show them that we think all of their ideas are beautiful and bright and really exciting, and we want to join them in that space.

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Carrie Alvarado, PhD, OTR: Because of this, we really support the child feeling connected, feeling safe in interaction.

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Carrie Alvarado, PhD, OTR: we are fostering emotional attunement that works both ways. The child is now checking back with their partner more often, reading and responding to the tone of their voice, their nonverbal cues, and their language. And this really helps to continue to deepen connection and understanding between the dyad or the triad, if both parents…

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Katy Willis: Thanks, I know that.

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Carrie Alvarado, PhD, OTR: I think somebody's mic popped open, if you could mute it for me, thank you.

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Carrie Alvarado, PhD, OTR: And then it also helps to support authentic identity development for the child, right? And this is important, again, not only for the children that we're supporting, but for the parents. We know that impact…

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Carrie Alvarado, PhD, OTR: We, again, are working with adults who might be neurodivergent themselves, or there is someone else neurodivergent in the family, and so it is really, really important that we are working to

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Carrie Alvarado, PhD, OTR: protect, and promote that child's authentic identity as an autistic person moving forward, and to help support them developing more emotional resilience over time. So this is a quote from another family that I've worked with. There was an aunt in the family who was autistic, and he was kind of…

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Carrie Alvarado, PhD, OTR: living with the family, and watching Pact from a little bit of a distance, and learning more about PACT, as she was watching it used with her nephew. So, this is a quote. I, as an autistic person myself.

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Carrie Alvarado, PhD, OTR: I'm familiar with the challenge a lot of us have in maintaining a calm nervous system. It was heartwarming watching Renee and Sammy become partners in observation through PACT, uncovering Cameron's likes and dislikes, which helped him to build a sense of connection and safety.

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Carrie Alvarado, PhD, OTR: A nervous system that can connect, can learn.

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Carrie Alvarado, PhD, OTR: And so, that was a really beautiful response and reflection that she shared with me after the time with Cameron, and it was really important to me because, again, as a clinician of PACT, it is very, very important to me that I am supporting this family in a way that is respectful and responsive and neuroaffirming.

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Carrie Alvarado, PhD, OTR: So, again, further, many of the families that have used PACT intervention, have engaged in PACT training, have said it has had a transformative impact on their families. It has not only benefited the child and parent relationship that was, you know, highlighted in the videos.

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Carrie Alvarado, PhD, OTR: But it's actually helped mom and dad become

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Carrie Alvarado, PhD, OTR: more confident advocates for the child. They really feel their expertise that they have with their child. And it also benefits collaterally other children in the family system.

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Carrie Alvarado, PhD, OTR: grandparents as well. It helps to reduce parental anxiety. So often, when I'm working with parents, they tell me.

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Carrie Alvarado, PhD, OTR: I realized now, through this work in PAC, that anxiety was driving my interactions with my child. I was going so fast, I was using so much language, I was asking so many questions, I was not noticing what he was interested in, and I was redirecting to my idea, because I thought my interactions with my child needed to look a certain way, right?

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Carrie Alvarado, PhD, OTR: Impact helps caregivers shift from that anxiety driver to the

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Carrie Alvarado, PhD, OTR: Really being able to attune, to feel confident, to feel responsive, to feel engaged, and this helps to reduce their burnout and their sense of helplessness when they're working with their child and interacting with their child day to day.

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Carrie Alvarado, PhD, OTR: Again, families who just have a neurodivergent child, or family systems that I've worked with where the whole family is neurodivergent, this has been so helpful in them accepting not only their child's neurodivergence.

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Carrie Alvarado, PhD, OTR: Not only accepting it, but really celebrating it often, but also really recognizing and accepting their own

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Carrie Alvarado, PhD, OTR: neurodivergence as well. I've had so many neurodivergent adults tell me

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Carrie Alvarado, PhD, OTR: I needed this when I was a child. I wished that I had had someone who had worked with my parents and helped them understand me.

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Carrie Alvarado, PhD, OTR: So that I would have felt seen and valued as I was, right? And so…

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Carrie Alvarado, PhD, OTR: Families report that greater acceptance of neurodivergence, and it really kind of spreads throughout that entire family system.

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Carrie Alvarado, PhD, OTR: And my role, again, as the collaborator, as the therapist in this family dynamic, it's such an honored position for us as a therapist to be invited into this family dynamic.

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Carrie Alvarado, PhD, OTR: My role is to build this trust with families through collaborating with them, through bringing my expertise in sensory processing, or child development, or autism, you know, in general.

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Carrie Alvarado, PhD, OTR: And their expertise, and their child, and their family, and their culture, and their relationship, so that we can create shared language, so we can create a sense of reduced judgment, and a place where it feels safe to grow.

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Carrie Alvarado, PhD, OTR: Again, the impact on long-term mental health of an approach like this cannot be understated.

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Carrie Alvarado, PhD, OTR: Feeling emotional support, not only for the children, but for the families, really builds lasting self-worth and resilience for autistic individuals, and even if they have neurotypical parents for them as well. PACT

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Carrie Alvarado, PhD, OTR: really supports the use of co-regulation. My role as a clinician is to co-regulate with mom, dad, whoever the primary carer is for the child.

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Carrie Alvarado, PhD, OTR: And to create a sense of relational safety, and there is a parallel process by which the parent then feels more capable, more ready, more supported to provide that co-regulation and relational safety to their child.

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Carrie Alvarado, PhD, OTR: The long-term mental health benefits of this are, you know, going to be studied, you know, already have been studied to a certain extent, but a lot of these children are just now growing up, and we're learning more about how beneficial this was for them.

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Carrie Alvarado, PhD, OTR: But we know that, in general, relationally supportive environments reduce anxiety, reduce depression, and reduce burnout risk later in life for autistic adults and autistic children as they age.

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Carrie Alvarado, PhD, OTR: using an approach like PACT helps the child learn to advocate for themselves, helps the family learn to advocate for the child until they can advocate for themselves.

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Carrie Alvarado, PhD, OTR: It also makes sure that we are measuring change that is meaningful. We are not only interested in how many words your child can say, if your child can, you know, use a pencil, if your child can, you know, go to the toilet on their own. Those are all really important

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Carrie Alvarado, PhD, OTR: milestones. But we're also really interested in what is your child's sense of validation in this world?

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Carrie Alvarado, PhD, OTR: What is your sense of belonging in this world? What is your sense of competency as a communicator and as a person? And that is really, really a gift that this kind of an approach gives to families.

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Carrie Alvarado, PhD, OTR: So, some of the pieces of PACT that I think are most in alignment with neuroaffirming care, some of the things that make it a really ethical approach, is that it is built around informed ascent. And this means, again.

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Carrie Alvarado, PhD, OTR: The parent is really supported to interpret, understand, wait for a child's verbal or nonverbal signal as, I am ready to play with you, I am excited to play with you, or, give me a second, I need a minute.

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Carrie Alvarado, PhD, OTR: We are really trying to help that child develop a sense of agency.

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Carrie Alvarado, PhD, OTR: and advocacy for themselves as early as possible. We want that child leading and demonstrating to us that they want to be an interactive partner to us.

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Carrie Alvarado, PhD, OTR: Again, we're building around this goodness of fit principle. We are not trying to force compliance. We are trying to adapt relational environments to support a child who wants to be in interaction with us and who feels capable and competent and safe when doing that.

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Carrie Alvarado, PhD, OTR: We are supporting collaborative power dynamics. Again, this is not a situation in which me, the therapist, I'm the guru, I'm the expert stepping in, and mom and dad and, you know, everyone else, you know, listen to me, I know it all.

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Carrie Alvarado, PhD, OTR: That is absolutely not the case. I wish that was the case, but it's not. I benefit so much when I collaborate as a team player with you. And this really promotes transparency, it promotes reflection, and it promotes humility in interactions with families.

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Carrie Alvarado, PhD, OTR: It is an ethical, responsive practice. PACT embeds ethical integrity as a core driver of respectful and effective autism intervention. And PACT clinicians, like I said.

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Carrie Alvarado, PhD, OTR: We are really trained. It is a part of our Fidelity training. We have a neurodiversity-affirming work group in PACT that is really centered around making sure that this approach is used in a way that is aligned with

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Carrie Alvarado, PhD, OTR: Being accountable, listening to autistic voices so that we can continue to refine and evolve this approach as we learn more from autistic people to make sure that we are fully aligned with what autistic people need and want and feel, really adds value to their lives.

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Carrie Alvarado, PhD, OTR: So, this is a quote from an autistic parent, and I'm actually gonna have to jump out of this, slide to be able to read it to you, but it is a key…

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Carrie Alvarado, PhD, OTR: it is a key, quote that is really, really important, so I'm going to take just a second to pop out of this so I can read it to you, because I don't have it on the slide, I apologize.

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Carrie Alvarado, PhD, OTR: So, the quote says, my son was diagnosed with autism at the age of 3. His neurologist told us that he would never be independent or make friends, and that traditional behavioral therapy was his only hope for a meaningful life.

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Carrie Alvarado, PhD, OTR: Of course, this terrified us, and we put him in traditional behavioral therapy immediately. We yanked him out after about 2 weeks, because framing therapy as doing work with a deficits-based approach was breaking his spirit.

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Carrie Alvarado, PhD, OTR: Luckily, we found PACT.

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Carrie Alvarado, PhD, OTR: Intuitively, it just felt right that mindfully playing with our son was the best way to help him. And, as an autistic mom, I needed to learn imaginative play, too.

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Carrie Alvarado, PhD, OTR: The packed parent sessions helped us reframe the doom and gloom mindset given to us at diagnosis.

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Carrie Alvarado, PhD, OTR: Now Isaac is in the first grade and thriving. He is a happy little comedian. He has a lot of friends and even a girlfriend. He is mainstreamed at school, participates in multiple sports and clubs, and is being evaluated for the Gifted and Talented program.

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Carrie Alvarado, PhD, OTR: Isaac gets the credit for all of his accomplishments because he is an awesome kid who earned them.

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Carrie Alvarado, PhD, OTR: But without Pat teaching us how to help him see the awesomeness in himself, I fear the doom and gloom prediction from his neurologist would have been correct.

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Carrie Alvarado, PhD, OTR: He will always have struggles, but Pact helped cultivate a desire to connect, a positive attitude, and resilience as a part of his core personality.

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Carrie Alvarado, PhD, OTR: Looking back, traditional behavioral therapy and the deficits-based model othered my son, and the packed approach fostered not only our acceptance and curious exploration of strengths and… of his strengths and challenges, but his, too.

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Carrie Alvarado, PhD, OTR: And I just think that's such a beautiful way to frame, how this approach helped this parent stop, and really the physician who diagnosed him, you know, stopped putting him up against a marker that wasn't fair for him, and started to see this child for who he truly was.

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Carrie Alvarado, PhD, OTR: Okay.

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Carrie Alvarado, PhD, OTR: So lastly.

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Carrie Alvarado, PhD, OTR: If you would like to learn more about PACT, these are a couple of the really key seminal pieces of research that demonstrated the efficacy of this model. You can see this first one was published in the Lancet in 2010, and there was another large Lancet publication in 2016. These were really large, randomized control trials that demonstrated

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Carrie Alvarado, PhD, OTR: benefits of PACT, and specifically in social communication initiations for the child. Enhanced parental synchrony, that responsivity, that calibration, that balance dynamic was looking a lot better afterward.

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Carrie Alvarado, PhD, OTR: And the really important feature of this is that the changes for the child and the family sustained and generalized once the intervention was pulled away, and that is really elusive.

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Carrie Alvarado, PhD, OTR: in autism intervention. So this is really, really a very exciting finding from PACT. If you are a clinician on this, or an educator on this, on this webinar.

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Carrie Alvarado, PhD, OTR: There are two different phases to packed training.

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Carrie Alvarado, PhD, OTR: First level packed is a series of asynchronous courses that you take through Hografit Limited, and this is the website where you can learn more about that.

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Carrie Alvarado, PhD, OTR: And this is done on your own time, you receive the manual, and you kind of are taken through steps and learning how to, you know.

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Carrie Alvarado, PhD, OTR: view videos and learn more about the different stages of PACT. And then there's Level 2 PACT accreditation training, and this is usually a two-day live training, sometimes it's four half days, but the… this is a training where you do meet live on… you know, live, online with an instructor.

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Carrie Alvarado, PhD, OTR: And there are a variety of different offerings and times available for different trainings in PACT. If you're interested, you can go directly to the PACT UK website, and they've got a really nice list for you there of upcoming trainings.

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Carrie Alvarado, PhD, OTR: So I just want to make sure that you guys know about the upcoming, talks that we'll have in future webinars.

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Carrie Alvarado, PhD, OTR: On the 11th of June, we've got our next one, which is a therapy journey for neurodivergent children, which should be wonderful. And you can see that these are really going… flowing all the way through the fall. So, I hope if you enjoy today, that you will join us for upcoming webinars.

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Carrie Alvarado, PhD, OTR: Our emphasis is really to excite people about this new and innovative way of supporting families.

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Carrie Alvarado, PhD, OTR: Thank you so much.

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Carrie Alvarado, PhD, OTR: I think I've got just a few minutes to take a couple of questions live, and I'm gonna go ahead and stop share. Do we have any questions in the chat? I haven't been able to keep tabs on that and running the.

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Carrie Alvarado, PhD, OTR: Great, wonderful. I'm seeing, I see a… I'm a psychologist trained in PACT, love, love the method, I'm so glad to hear that.

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Carrie Alvarado, PhD, OTR: I'm so glad, as speech-language pathologist, wonderful.

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Carrie Alvarado, PhD, OTR: Great.

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Carrie Alvarado, PhD, OTR: And don't, you know, don't be shy, you can grab the mic, too.

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Carrie Alvarado, PhD, OTR: Wonderful! So yeah, if you, go to the PACT website, you'll see there's a, PACT Professionals, link. You can click on that, and it'll take you into how to get further training if you're interested. Wonderful.

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Carrie Alvarado, PhD, OTR: It is, it is such a passion. I'm really, really grateful in my career to have found this intervention. It's,

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Carrie Alvarado, PhD, OTR: a really beautiful way to make a large difference in a smaller amount of time, and to really fully empower families, to feel like they've got it. You know, they've got it, they understand their child.

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Carrie Alvarado, PhD, OTR: parents, how do parents get to learn about PACT apart from the NHS? I think that we, you know, we've got a bunch of webinars coming up where you can learn more. I think there is a link on the PACT website as well that probably has other resources for parents, too.

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Carrie Alvarado, PhD, OTR: And if you're interested in connecting with a PACT professional, I do believe that the map on the PACT UK website is live and active, so wherever you are in the world, you can kind of zoom in and see if there's someone in your area that's providing this intervention. And I would encourage you to work, to reach out to them.

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Carrie Alvarado, PhD, OTR: Great.

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Carrie Alvarado, PhD, OTR: All right, well, thank you guys so much for spending your time with me today. I really am… it's so lovely to connect with other people who are using PACT, so if you're already using the model and are just excited about it like I am, you know, wonderful to connect with you. If you're a parent who's looking for something different.

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Carrie Alvarado, PhD, OTR: and new, and supportive of you to add to your intervention, you know, for your child or your family. This is a really wonderful ad. I have so many families that I've worked with, with older children.

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Carrie Alvarado, PhD, OTR: you know, 7, 6, 7, 8 years old, who say, gosh, I would have loved to have found this when he was younger. You know, man, this is what I needed. It's like a map for me. And so it's really, really lovely when parents,

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Carrie Alvarado, PhD, OTR: Find this… this… no matter where you are in your journey.

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Carrie Alvarado, PhD, OTR: Do you email a certification for this webinar? Oh, yeah, I'm not sure. That's a… that's a question for Claire. Claire, if there… is there.

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Claire (admin): Yeah, if anyone needs a certificate of attendance, we can sort that out, no problem.

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Carrie Alvarado, PhD, OTR: Okay, so yeah, just email PACT UK and they'll take care of that.

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Carrie Alvarado, PhD, OTR: I really, really appreciate that.

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Carrie Alvarado, PhD, OTR: Yeah, thank you.

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Carrie Alvarado, PhD, OTR: Thank you, it's exciting, it's really meaningful work. All right, everybody, well, you take care, thank you so much for joining us today, and we'll hope to see you in future webinars, okay? Thanks.

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DawnSynnuck: Barry, cheers. Bye!

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Carrie Alvarado, PhD, OTR: Bye. Thank you.