Choosing the Right Therapies for Your Child

All sorts of therapies are available these days, some more effective than others. Some are funded in insurance packages, many are not. Some require intensive time commitment, some do not. Many are expensive. Some can even cause long lasting trauma.

How do you decide what is best for your child? Where is the best place to invest your precious time and money? Who do you trust with the most important job of becoming part of the team helping your child? It can be overwhelming and expensive trying to decide what to choose, or indeed whether to step out of a therapy once deeply into it, if it feels like it isn't working.

A positive and balanced approach to choosing therapies is to look at the specific needs of your child and work on those. If your child has speech delay, then find a good speech therapist. If they have low muscle tone or gross motor skills issues, then occupational therapy or physiotherapy would be good options. If your child needs help with school work, then a tutor might be a good idea. If your child is having problems in social situations, then a good psychologist or play therapist might be best.

Regardless of what the therapy is, it can be hard to choose a therapist, and to know whether to stick with them, too. Sometimes the therapist can leave us with an uneasiness that we don't know what to do with, and then we're left with a tough choice whether to step away from that therapist and find someone else, or double down and see if it pays off.

It's incredibly difficult at times, because the risks are great. It feels like we have a tiny window of time to make an impact, and of course we only want the best for our children. None of us wants to do any harm, so these choices often feel paralysingly huge.

There are three key themes to keep in mind when making these decisions.

Are the therapy goals focussed on assimilation 

or accommodation?

Is your child being asked to cooperate

or comply ? 

Is your child being asked to do anything that would be considered inappropriate or harmful for a non-autistic child? 

I've compiled a list below of things to think about in any therapeutic situation. I hope these questions help you to figure out which therapies and therapists are right for you and your child.

Good things to look for:

Is the primary objective to work to the child's strengths and support areas where skills development is needed?
Does the therapist allow the parents to watch the therapy?
If you have concerns, does the therapist respond to you in an acknowledging way and work with you to resolve any problems?
Does the therapist work with you as part of a team?
Does the therapist understand that autism is a neurotype, not a disease?
Does the therapist try to see the world through the eyes of your child and use empathy as a helpful tool?
Can the therapist identify a meltdown as opposed to a tantrum? Do they manage both of these with kindness, patience and compassion?
Does the therapist teach assertiveness and self-advocacy?
Are they kind and respectful to your child at all times?
Do they respect the autonomy of your child?
Are the enjoying the company of your child?
Is your child excited to see them?
Is the therapist excited to see your child?
Does the therapist assume competence?
If your child is non-verbal, does the therapist assume good intellectual capacity?
If your child is non-verbal, does the therapist accommodate other ways to communicate?
Are they targeting the therapy in age and capacity appropriate ways?
Do they understand and respect that behaviour is communication?
If your child says no, does the therapist understand and respect that a child has this right?
Does the therapist encourage your child to communicate their need for breaks?
Does the therapist allow stimming behaviours?
Do you think your child feels safe during therapy?
If your child gets upset, does the therapist respond with kindness and empathy?
Is the therapy fun and respectful?
Is it adaptive to the needs of your child?

Things to avoid:

Is the premise of therapy that the child needs to be "fixed" in some way?
Is your child expected to become as indistinguishable from their peers as possible?
Does the therapist think that the only way to better quality of life, happiness and fulfillment relies on the child presenting as less autistic?
Does the therapist talk about fixing or curing autism?
Does the therapist do anything you wouldn't allow to happen to a non-autistic person?
Does the therapy require a huge time commitment? (a good way to measure this is to ask yourself, would you commit a non-autistic child to any activity at all with this same time commitment?) 
Does the therapist control the facial expressions of your child during therapy? (eg: does your child have to comply with a smile, regardless of their true feelings?)
Does the therapist push, pressure, coerce or threaten (eg: loss of rewards)?
Is therapy a battle, or a team effort? Is the therapist working together with your child, or are they pitted against one another?
Does the therapist tell you to deny access to the therapeutic rewards at home, in order to ensure compliance in therapy? 
Does the therapist restrict access to anything important, such as food, favourite toy, special interests, the right to take breaks?
Does the therapist punish at all if the child is non-compliant?
Does the therapist ignore stress in your child and keep pushing?
Does the therapist ever force compliance? (eg: any form of restraints, pinning, grabbing, using fear to make child comply?)
Does the therapist turn the situation into a battle of wills?
Are there rewards for too many things? (ie: If everything is rewarded, the child loses the ability to intrinsically motivate.)
Do you feel helpless/upset/judged after talking with the therapist?
Is it a one size fits all approach?
Does the therapist force eye contact?

Your child

Once into a therapy, look for signs in your child to decide whether it's an effective and positive experience. The following signs may or may not be related to therapy, but are worth considering in conjunction with whatever you know is happening in your child's life.

Are they regressing, irritable, fearful, exhausted?
Are they having more meltdowns?
Are they self-harming, becoming more demanding/aggressive?
Withdrawing? More anxious?
Fearful of adults?

Conversely, are they excited to see their therapist?
Growing in confidence?
Better able to assert themselves?
Developing new skills?
Embracing new experiences?
Becoming more resilient?