Autism 101

For parents who are wondering why their child interacts with the world differently than some other children do, and are wondering whether it might be autism, it can be hard to understand all the different ways that autism might present. This post is intended as an overview of: the clinical definition of autism, understanding what “the spectrum” means, some of the signs and symptoms of how autism might present, information about screening and diagnosis, and resources to support parents of neurodiverse kids.

The Diagnostic Definition

When I was a kid, we tended to think of autistic people only as the people who showed significant impairment in multiple domains: non-verbal, developmentally delayed, frequently stimming (e.g. rocking, flapping their hands).

Then there were a bunch of other kids who were skilled in many areas, but had some unusual behaviors. We called them “quirky” or “odd ducks” or said they “march to the beat of their own drummer.”

Then the term Asperger’s syndrome appeared, and was often applied to kids who were gifted and “quirky.” And we would talk about people in terms of “where are they on the spectrum” or “are they low functioning or high functioning?”

Now, Asperger’s is no longer a distinct diagnosis. It’s been pulled back under the umbrella of Autism Spectrum Disorder (ASD).

The criteria for an ASD diagnosis in the DSM-V require showing symptoms in both of these categories:
A) Persistent deficits in social communication and social interaction (deficits in social-emotional reciprocity, in nonverbal communicative behaviors used for social interaction and in developing, maintaining, and understand relationships) and
B) Restricted, repetitive patterns of behavior, interests, or activities (as manifested by at least two of: S
tereotyped or repetitive motor movements, use of objects, or speech; Insistence on sameness, inflexible adherence to routines, or ritualized patterns of behavior; Highly restricted, fixated interests that are abnormal in intensity or focus; Hyper- or hypo-reactivity to sensory input.)

Or to put it in a less deficit-based language: A) may have challenges interpreting and following the same social rules as their neurotypical peers or expressing / responding to emotions in the same ways neurotypical people might  and B) strong preferences for predictable routines, specific interests and repetitive movements. Reactions to sensory input and external demands may be more intense than typical.

About 1 in 44 children is diagnosed with autism. Within the diagnostic criteria, there’s a range of behaviors from subtle to blatant, and from minimal impact to major impacts on school and home.

What is a spectrum disorder?

When autism is described as a spectrum, it doesn’t mean this. (source)

continuum labeled not autistic at one end, and very autistic at the other end

Or this (source)

continuum, labelled "a little quirky" on the left, "definitely autistic" in the middle, and "tragic" on the right

Autism is a more complex way of interacting with the world that can’t be described on a simple numeric scale, and can’t be simplified to either “not a problem” or “tragic”.

I’ll share a few different ways that it has been illustrated, so you can find the one the best resonates with your experience.

The autism spectrum can look something more like this:

An illustration of a circle where the "pie pieces" are labeled language, executive function, etc. and dots indicate where the person might have more strengths vs. more difficulties

(That image comes from this great comic on “Understanding the Spectrum” by Rebecca Burgess – I highly recommend reading it.)

This graphic (source) breaks the spectrum into five categories, similar to Burgess, though the colors and the way they break things out are a little different:

GAO

And they explain that “the type and severity of characteristics varies from person to person” as seen in this diagram of three individuals’ ‘spectrums.’

Picture1

C.L. Lynch on theaspergian.com uses this illustration

spectrum

Then gives a few examples of how this would apply for an individual person.

spectrum 2

I don’t know which one of these graphics might be helpful for you, but I find it very helpful to think of these more nuanced descriptions rather than a single axis of “a little quirky” to “tragic.”

I know that if someone asks me if my son is “high functioning” or “low” or asked “how autistic is he”, I would find it difficult to answer those questions. It’s much easier to tell you – “here are the things he’s good at, here are some behaviors he does that might seem odd to you but don’t harm anyone or anything, and here are some challenges he has and some accommodations you could make that might help him to manage them.”

More Zones to Consider

The DSM-V criteria are two-fold: a) social-emotional differences, and b) restricted, repetitive patterns.

You’ll notice in the illustrations above that they each split the signs of autism a little differently, but here are some of the typical patterns that some autistic people might display. [Note that all autistic people are individuals, so any individual may have some of these signs and not others. As a parent, I found that if I went down any checklist of signs, I had many that I said “nope, that doesn’t describe my kid” and others where I went “ooh boy – that is exactly what I see!”]

  • Social-emotional: may have challenges reading social cues, inferring what behavior is expected in a social situation, expressing their emotions in the same way a neurotypical person might expect them to or understanding / responding to other people’s emotions. Some may avoid eye contact. May be content playing / working by themselves and not appear to need the same social connections that others might. (Or might long for social connections and be very sensitive to rejection.)
    • The Floor Time approach to child-directed play can help an autistic child connect with others in play.
  • Sensory Processing: some autistic people may be hypo-sensitive to stimuli; many may be hyper-sensitive.
    • Tactile stimulation (like tags on clothing or seams on socks or being touched) may distract and distress them. Or, they may seek tactile input, banging their heads, pressing up against others, wanting lots of hugs and loving weighted vests and blankets.
    • Some may have lots of oral sensory issues. They may be super picky eaters or may gag easily. Others seek sensation, sucking and chewing on a variety of items.
    • Many autistic people can get overwhelmed by sounds – they may be less able to filter out all the noise that neurotypical people ignore (traffic on the road, the hum of the refrigerator…) and may be happiest with noise cancelling headphones on in loud situations.
  • Emotional regulation challenges: may have bigger reactions to a situation than typical. This could mean being so excited they bounce up and down, gallop around or flap their hands because the joy is too great to contain. It can mean meltdowns where too much stimuli, too many demands, or big disappointments overwhelm them and they react by screaming, hitting, or other behaviors for a prolonged period of time. (Note: the Zones of Regulation tools can be very helpful for autistic kids to work on emotional regulation skills.)
  • Preference for routine / difficulty adjusting to changes and transitions. Many thrive in an environment with lots of structure, and very predictable routines. When a transition between activities is coming, they need a little more warning that it’s coming and help letting go of one thing and moving on to something new. Sometimes even with all the help you can give, an unexpected change or hard transition from a beloved activity to anything else can cause big meltdowns.
  • Specialized Interests: A common characteristic is long-lasting, all-consuming  interest in specific topics, whether that’s dinosaurs, astronomy, flags, Rubik’s cubes, or collecting memorabilia. When they start to talk about that topic to someone, it may become a prolonged monologue where they may not recognize when the other person has lost interest and is ready to move on, because they cannot imagine ever losing interest in that topic. They may also love repetition and repetitive movements.
  • Impulse control and executive function may be harder for some autistic people. Discipline techniques that work with neurotypical folks may not be as effective with autistic children. (I find the Incredible Years and Ross Greene have the most helpful approaches.)
  • Language / communication: some autistic people are less verbal or non-verbal.
  • Motor skills: some autistic people may have motor challenges, ranging from “clumsy” to limited ability to control their movements,

Not everyone who has a few of these behaviors is autistic. And not everyone who is autistic has all these characteristics. And all of these characteristics can manifest in subtle, barely noticeable ways or can be blatantly obvious to the casual observer. Again, autism is a spectrum disorder that can be a bit hard to pin down.

It’s also worth noting autism can present differently in girls and be more difficult to diagnose especially for gifted girls).

Awareness vs. Acceptance

In much of popular culture, autism is viewed in a very negative light. You’ll hear people talking about it as a tragic diagnosis, and people seeking a “cure” for their child’s autism, and using deficit based language, even a supposed “advocate” may do so during events like Autism Awareness Month.

The Autism Self-Advocacy Network recognizes Autism Acceptance Month, which “promotes acceptance and celebration of autistic people… making valuable contributions to our world. Autism is a natural variation of the human experience, and we can all create a world which values, includes, and celebrates all kinds of minds.”

Autistic people have unique strengths. For example, many have intense attention to detail, a high degree of persistence, and ability to analyze data. Their “obsessive” interests can lead to stunning expertise in their chosen career fields. And “Sometimes being autistic means that you get to be incredibly happy. And then you get to flap. You get to perseverate. You get to have just about the coolest obsessions.” (Source)

A Note on Co-Morbidity and Social Issues

Autism also has several co-morbidities: conditions that often occur with autism.  “Over half of autistic youth [also had] attention deficit disorder (53 percent) or anxiety (51 percent), nearly one quarter had depression, and 60 percent had at least two comorbid conditions. Other common comorbid conditions include sleep disorders, intellectual disability, seizure disorders, and gastrointestinal ailments.” (Source) Many of the challenges we think of as being due to autism actually come from these co-morbidities. We should think of them as separate issues and handle them separately.

And many of the “challenges” of autism actually come from societal attitudes toward autism. For example, if a child jumps up and down with excitement, is that really a problem behavior that needs to be corrected? If a teenager gets overwhelmed by noises, so chooses to wear noise-canceling headphones in many situations, is there a reason anyone else should care about this? If someone can’t stand it when the different foods on their plates touch each other, isn’t it easy to use just a little extra care when dishing them up instead of using a lot of energy telling them that “you just have to learn to cope with that”? If the neurotypical community understood more about neurodiverse people, and made simple adjustments, it would greatly reduce the “challenges of autism.”

Screening and Diagnostic Testing

If you’re wondering about your child, or a child you know, start with this list of symptoms, or red flags to watch for. https://www.cdc.gov/ncbddd/autism/signs.html

If you’re still concerned about possible signs of autism, use a screening tool:

If you’re still concerned, talk to your child’s health care provider, and/or contact your state’s public early childhood system to request a free evaluation to find out if your child qualifies for intervention services. This is sometimes called a Child Find evaluation. If your child is under three years old, look at the ECTA website. If your child is 3 years old or older, contact your local public school system. Look here for all the details about how to access testing.

In King County, Washington, some resources for diagnostic testing include: Kindering (especially for kids under age 3), UW Autism Center (this is where my daughter was tested at age 20), and Seattle Children’s Autism Center. Some private practice psychologists also offer testing. For example, our son was tested by Heather Davis at Brook Powers Group, who had worked with him in their Incredible Years program.

Here is a podcast with tips for what to do when you’re waiting for an autism diagnosis or a PDF on the same topic.

Are you debating about testing?

Some parents debate about whether or not to test. Or they test, and get a diagnosis of “we can’t say it’s autism but we can’t rule it out.” They wonder about whether to seek out special education services. For more on those topics and on what to do while waiting for a diagnosis, check out my post on “Autism? ADHD? Delayed? Or just quirky?

What was the Cause? Is there a Cure?

It can be tempting to ask “what causes autism” and for many parents, that’s a quest to understand whether they “did something wrong” that led their child to be autistic. There’s no one cause for autism. There may be genetic factors, or environmental factors, or a combination of environmental factors with genetic susceptibility. Personally, I have not found it helpful to look backwards and wonder about the cause – it’s better to focus on what we need to do to move forward into the future.

I also do not seek a “cure” for autism. (Partially because that implies it is a problem that needs to be fixed rather than just a different way of being in the world which benefits from accommodations.) Some parents spend a great deal of time and energy seeking a way to fix their child. There are some effective treatments which can help make things more manageable for the family, but there are also some “treatments” you’ll find on YouTube videos or random people’s blogs that can either cause harm, or simply just take more time, energy and money than they are worth.

For example, many parents have reported significant improvements in behavior problems with dietary changes. If you find diet changes that are generally considered nutritionally sound and they prove helpful for you, then hurray! But if a special diet is prohibitively expensive, or if it deviates from mainstream nutritional advice and might cause nutritional deficits, or if your kid is just a super picky eater and it’s a huge battle, it’s worth knowing that there’s not a lot of research that proves this is essential.

Resources on Autism

General Resource Guides

There are lots of resource guides from various organizations. Try these from the Seattle Children’s Autism Center, Autism Parenting Magazine, and the AAP. Plus these communication resources. Note: I have not vetted all these resources. If you discover any materials that approach autism as a terrible disease to be cured, or focus on ways to “fix” autistic kids, set those aside. I personally choose materials that talk about autism as a neurological difference that shapes who they are and how they interact with the world, and talks about ways we can increase accessibility for them. 

Autism Navigator has a free online class (approx 3 hours) on Autism in Toddlers. They have handouts you can print on everyday learning activities, how parents can support language and emotional skills, and Q&A for parents.

Discipline and Behavior Challenges

  • This article is short and helpful: 15 Behavior Strategies to Help Children with Autism.
  • There are tons of helpful resources at challengingbehavior.org: visual schedules, tip sheets on making daily routines easier, handouts on teaching emotional IQ, addressing behavior like hitting or biting.
  • If it’s available in your area, I highly recommend the Incredible Years program. (We worked with Shanna Alvarez in Seattle, who was fabulous.) While the parents meet, the kids attend “Dinosaur School” which teaches social and emotional skills. Note: my Discipline Toolbox is highly influenced by what we learned at Incredible Years.
  • Ross Greene has some really helpful tools, summarized as “Kids Want to Do Well – If they’re not doing well, ask yourself what skill or resources they are lacking.”
  • If emotional regulation is a challenge for your child, check out my post on Big Feelings and the Zones of Regulation approach.

Building Connections with Your Child

Floor Time, or Child Directed Play, is a powerful way to connect with any child, but especially children who have challenges with social-emotional connections. Click here to learn about Floor Time: child-directed play. On Autism Navigator, learn how to support social communication development, and transactional supports to promote learning.

More resources

There are helpful resources at https://brightandquirky.com which has webinars with leading experts on how to support kids who are gifted AND autistic (or have other behavioral issues).

And for your child, here’s my list of Children’s Picture Books about Autism and other “quirky kids” stories. Seeing themselves reflected in a book might be helpful for them.

If you’ve got one of those kids whose brain and body are always moving super fast, leaping from one thing to the next, make sure to check out my post on “the race car brain.” If you’ve got a shy child who observes more than they engage, check out my post on the slow to warm up child.

Benefits of Multi-Age Programs

multi-ageL

In the U.S. most programs for children tend to be limited to children who are all close to the same age – for example, the children in a kindergarten class all turn five somewhere between Sept 1 of that year and August 31 of the next year. But some programs (like Montessori schools, Sunday school programs at churches, or scout troops) are multi-age, with a broader age range. (For example, I teach a multi-age STEM enrichment class for ages 3 – 7). Here’s why I love them:

Benefits of Multi-Age Programs

  • Knowledge and Skill Development: Younger children learn from older children. Older children reinforce and deepen their own understanding of a topic or skill by teaching it to the younger kids. This knowledge is passed on in a variety of ways:
    • Unintended modelling – when an older child is just doing something they want or need to do, (like using the potty or drawing a picture of a dog), they may not even be aware the younger child is observing and absorbing. But children love to learn about what other kids are doing.
    • Social play: The younger ones are exposed to things like better emotional regulation and more sophisticated problem-solving which helps them learn these skills earlier. The imaginary play is also richer as the older ones give ideas to the younger ones and have to figure out how to articulate those ideas so the younger one can play along.
    • Casual mentoring. When an older child wants the younger one to participate in a game or activity, she will just quickly explain it to the younger one so they can have fun together. When the older one is slowed down by the younger one’s lack of knowledge, sometimes they move in to help rather than waiting for the teacher to help. (Like putting on boots so they can go outside for recess.)
    • Resources: Younger children learn which classmates they can go to for help with various tasks, and may seek out their help before asking a teacher. (At one lunch, kids were given fortune cookies. All the non-readers went straight to the kids who could read to ask for a quick answer to ‘what does this say?’)
    • Intentional teaching. Sometimes teachers will ask a child who has mastered a skill to teach it to a child who hasn’t yet mastered it. The learner benefits by gaining information in a way that may be more fun and more confidence-building than learning from an adult. The child who is teaching has the chance to review his own knowledge from a new perspective.
  • Individualized curriculum, tailored to children’s unique skills, not just their age
    • Children are more able to learn at their own pace, making continuous progress rather than having to “wait till second grade, when we cover that.”
    • Some kids are really advanced in some areas and a little behind in other areas. Being in a multi-age classroom makes it more likely that they’ll find peers to fit in with in both those areas.
  • Children may stay with the same teacher for multiple years.
    • The teacher gets to know the child’s strengths and weaknesses, and is better able to tailor the lesson plan to meet that child’s unique needs.
    • There is a stronger parent-teacher relationship.
    • For the child, there’s the benefit of consistency, and a sense of safety and security in the classroom which enables better learning.
  • Less competition / labeling.
    • In a single age classroom, it’s easy to compare kids and say that some are gifted, some are delayed. In a mixed age classroom, it may be clearer that there’s a range of development: the one who does best in math class may have the hardest time in music class, regardless of age.
    • A child who struggles more with social skills might be ostracized by their age peers, but might find companionship in the younger kids in the classroom.
  • A more cooperative, caring learning environment.
    • Older kids learn to be patient, nurturing, responsible. (With guidance from adults!)
    • Role-modelling. The older children learn how to set a good example. “When the teacher asked the older children who were not observing the class rules to remind the younger ones what the rules were, the older children’s own “self-regulatory behavior” improved.” (Katz)
    • In group time, I find that the younger ones are better at sitting still and focusing because they see the older kids do so. The older kids like to show off their knowledge and can often answer the questions the younger ones ask – this builds confidence for the older ones and the younger ones are more excited to learn things from the big kids than they are to learn from a teacher!

The Race Car Brain

There are some children whose brains and bodies always seem to be racing. The parent may feel like they start playing with blocks with the child and then the child runs off to paint and while the parent is still putting blocks away and cleaning up paint, the child has already flipped through a few pages of five different books and is climbing the bookshelf.

Talking to them may also feel like this – they ask a question, and as you start to answer it, they ask another question, and before you can answer that one, they tell you what they had for breakfast. Parents (or teachers) may feel like they can never quite catch up.

It’s easy to fall into patterns of continuously scolding them to “stop!” or “pay attention!” It’s easy to see them as problem kids. However, they have a lot of important strengths, like curiosity, enthusiasm and energy.

Dr. Ned Hallowell* would say to these kids: “Your brain is very powerful.  Your brain is like a Ferrari, a race car.  You have the power to win races and become a champion. However, you do have one problem.  You have bicycle brakes.  Your brakes just aren’t strong enough to control the powerful brain you’ve got.  So, you can’t slow down or stop when you need to.  Your mind goes off wherever it wants to go, instead of staying on track.  But not to worry… we can strengthen your brakes.”

Strengthening their Brakes

We can do several things to help them slow down and learn new skills, like a longer attention span, persistence, and impulse control:

  • Routines: having predictable schedules, where they know what to expect and know what is expected of them. Visual schedules may help.
  • Break it down: they may have a very hard time doing a big task, but find it easier if you break it down into small specific tasks. So instead of saying “clean up this mess”, say “we have four steps – the first step is to put the Legos in the basket – when you’re done with that, let me know and I’ll tell you step two.”
  • Practice sticking with a task: try setting a timer and say “we’re going to do this activity together for at least five minutes. When we give persistence muscles a workout, they get stronger.” (Before you do this, try to get a baseline of how long they typically stick to a task. If they typically can do 3 minutes, you don’t want to set a timer for fifteen… that would be too much of a stretch.)
    • Use a timer they can read and see the progress on (like an hourglass where they can see that their time is halfway up, or a kitchen timer, where they can see that the dial is halfway toward zero are both easier to understand than a digital countdown)
  • Tell them what to focus on. Instead of just saying “focus” or “pay attention” tell them exactly what to pay attention to: “I’m going to tell you the three things we need to do today, so I want you to listen till you hear all three things.” Or “right now the priority is eating breakfast – can you focus on counting each bite you take till you get to ten?”
  • Physical supports: Some children focus better in a class when they sit on a ball where their body can wiggle or they spin a fidget spinner while their brain pays attention. My child could focus better when he wore a weighted vest because the pressure gave his brain some tactile stimulation. Some children focus better if there’s some white noise or quiet background music. (It’s over-stimulating for others.) Experiment to see what helps your child.
  • De-clutter. Too much stimuli can over-activate these kids. If they’re in a room with just a few toys, they do fine. If they’re in a room full of toys and decorations, they flit from one to the next non-stop. (Read about “How Many Toys is Enough.”)
    • These kids LOVE novelty! But instead of buying more toys, I like providing new experiences outside the home – taking classes or going on field trips gives their brain the novelty it craves while still keeping a home environment that helps to settle them with familiar items to explore in depth.
    • You can also mix up existing toys without having to add new – like putting the toy dinosaurs with the blocks, or using toy cars with the paint.
  • Connect to their interests. If there’s something they have to do, but it doesn’t capture their attention, find a way to make it more engaging. For example, if they need to practice writing their letters and they are dinosaur fans, you don’t have to practice writing the words a teacher assigns – they could practice writing pachycephalosaurus.
  • Brain and body breaks: Make sure they do have plenty of opportunities to play and burn off lots of energy.
  • Spend more time outdoors. Nature can be very calming to people whose brains are always racing.

Discipline and Race Car Brains

It’s important to know that some discipline techniques that work well with other kids don’t work well with these kids. Parenting advice is not one size fits all.

Check out: 8 practical tips for parents of children with challenging behaviors. For my racecar kid, I found the book Incredible Years by Stratton had the most helpful discipline tools. I wrote several posts on discipline based on these techniques. Find links to them here.

I also find neuropsychiatrist Daniel Siegel’s writing on brain development to be very helpful. He says the “downstairs brain” is responsible for survival and emotions. It’s fully developed in a toddler. The upstairs brain is responsible for advanced functions like language, decision-making, impulse control and empathy. These take years to develop. When a child is very upset, extreme emotions block their ability to use
their upstairs brain. They “flip their lid” and regress back to the downstairs brain. When they’re in this state, you can’t reason with them, you can’t ask them to make choices, you can’t expect them to “use their words.” Learn more: http://msue.anr.msu.edu/news/understanding_the_upstairs_and_downstairs_brain.

So, if you have a racecar kid in the middle of a meltdown, you’re not going to be able to reason with them or have long discussions about the implications of their choices. They can’t pay attention to a deep discussion when they’re at their best, and especially not if they’ve flipped their lid. They’ll do better with clear rules, concrete statements of what behavior you want to see, and quick consequences for misbehavior. See more tips in the Discipline Toolbox.

Is it ADHD?

*Note: Hallowell, who coined this metaphor, specializes in ADHD, so he is using race car brain to describe the ADHD brain. I am using it more broadly.

Many toddlers or preschoolers who may seem like racecar kids may slow down as they get older and develop better brakes, so may not ever be considered ADHD. They still benefit from this early learning of skills to slow themselves down and you’ll benefit from using these tools to keep those early years a little calmer

However, many race car brain kids do get diagnosed eventually as ADHD. About 9% of children do have ADHD. Learn about criteria for an ADHD diagnosis and deciding whether to have your child assessed for ADHD, and how to access testing.

Online Preschool

pexels-photo-3975663

Lots of early childhood programs moved online in 2020 during the coronavirus pandemic. The majority have moved back to in-person, but online preschool programs will likely always be an available option in the future.

When parents hear that toddler classes or preschools are meeting online, they may have questions about whether it could be an effective method for learning. It is definitely not the same as in-person learning, and it is more developmentally appropriate to be in-person, hands-on, with lots of happy children interacting in the same room. However, there are lots of possible benefits to an online preschool or toddler program if that is the best option for your family, whether that’s due to health issues or disability, or to living in a location without access to good in-person options.

Here’s what can be gained in online preschool:

  • Routines: having a predictable activity in your weekly schedule helps to provide some structure. It provides an event to look forward to and reflect on.
  • Other Faces and Voices: seeing other children and a teacher can be delightful, your child will learn by observing their peers, class can also expose them to diversity and broaden their world, plus we know that children learn language better when they hear a wide variety of adult speakers.
  • A Listening Ear: for classes where they offer sharing time, children will have someone else to share their exciting ideas with, and will have a chance to practice their expressive language skills
  • A Chance to Practice Manners and Classroom Skills: one of the important aspects of an early childhood experience, whether that’s story time at the library, Sunday school at church, or preschool is that children get to practice sitting still, listening to someone else, participating in a group activity, and taking turns – they can practice all these things in an interactive call on Zoom.
  • Learning New Things: whatever the content of the class – music, stories, dance, art, or science, your child can easily learn new ideas from an online teacher, and if you’re listening in, you can reinforce the learning much more effectively than you could have reinforced what they were taught at a drop-off preschool.
  • New Inspiration: your child will get new ideas and you will get new ideas for things to try out at home and explore and learn from – you don’t have to feel responsible for coming up with all the learning ideas on your own.

Here is a handout where I offer lots of tips on help child succeed on Zoom and get the most benefit from an online program.

If you’re considering an online preschool, then you’ll want to ask many of the same questions you would ask of an in-person option: What do they teach? How do they teach it? Who is the teacher – what is their background and why do they choose to teach? And who are the other students? Learn more about these questions: https://gooddayswithkids.com/2014/01/17/questionsforpreschool/.

One major provider of online learning is Outschool. I have taught many classes there and my son has taken many classes. I wrote a comprehensive review of Outschool – the benefits and possible downsides. Many of these would also apply to other online programs.