Is There Such a Thing as Too Much Therapy?
When a child is first identified as autistic or receives a diagnosis of ADHD, a learning disability, or sensory processing differences, parents can feel both overwhelmed by the information and relieved to have a plan. Yet, sometimes the plan is also overwhelming. As a school psychologist, I was trained to identify concerns and recommend solutions. The more solutions the better, right? Not always.
While options can be good, every child is unique. Not every therapy needs to happen at the same time and not every recommendation has to be done to promote progress. In fact, overwhelming a child shuts down progress.
The lengthy “Recommendations” section at the end of a psycho-edcuational evaluation report only includes information from a psychologist. Your child may also receive an evaluation from an occupational therapist, speech/language therapist, or physical therapist. As specialists, we are trained in one area and make recommendations in that area. When multiple specialists are involved, parents might be receiving recommendations for play therapy, speech and language therapy, occupational therapy, physical therapy, medication management, vision therapy, social skills group, academic tutoring, or a combination of all of these. Tired yet?
Many parents feel guilty if they don’t do all of the things the experts are recommending. However, remember how you felt when your high school teachers assigned multiple tests and projects at the same time and didn’t realize what your homework schedule looked like because they weren’t communicating with each other? Each assignment had a purpose, but all together you were so stressed you didn’t know where to start? Too many therapy recommendations can feel like that, too. Just like children can be over-scheduled with sports practice, art classes, and music lessons, children in need of developmental therapies can also be over-scheduled, too.
So, how do we prioritize one therapy over another?
As one of those “experts” recommending support for your child, let me reassure you: There is a zone of learning for all of us, and your child is no exception.
Yes, too few therapies may lead to a child not progressing as fast as they could with needed support; however, too many therapies can cause children to become anxious or fatigue easily which could lead to shut down, resisting appointments, and not being available for learning.
There is a middle ground here where optimal learning takes place. If you’re concerned that you might be asking too much of your child, consider these questions:
1. Is my child’s progress in therapy stalling?
Of course we want our children to make progress quickly, but more therapy won’t always lead to faster progress. Over-scheduling children can squash growth. We all reach a point where we are too overwhelmed to learn.
For neurodivergent children who tend to be more sensitive to anxiety and easy to fatigue, their developmental progress may stall because their brain is working so hard to manage the anxiety surrounding the sensory needs, fatigue, and hunger they feel on a daily basis. If you are noticing daily fatigue or anxiety in your child, it’s time to lower demands, prioritize rest and connection, and then the progress will come with time.
2. Is my child resisting going to therapy?
If your child won’t join the therapist or won’t even get out of the car after they have enjoyed therapy before, they may be experiencing higher anxiety for some reason, be very tired at that time of day, or the skills they are working on are too hard. Your therapist can guide you in figuring out what’s going on and adapting to help your child feel less anxious and more available for learning.
We also need to be careful about forcing children to go to therapy. While young children may not remember their experiences playing in an OT gym enough to explain them later on, if their body is stressed during therapy, their nervous system is likely to remember some associations from the experience. School-age children and teens will definitely remember their experiences and we don’t want them to have negative memories of being “forced” to go to therapy only to grow up resisting asking for help when needed. We can all benefit from therapy at some point in our life, but it has to be on our own terms, when we feel open to it.
This leads into the most important part of the therapy balance and that is our responsibility as adults to make sure therapy is the right fit for a child’s emotional well-being at that particular time in their development.
Many autistic teens and adults have spoken out about the negative effects of feeling coerced into behavior change through discrete trial training in applied behavior analysis (ABA). While we continue to listen to autistic voices to guide therapeutic practices to become more trauma-informed and neuro-affirming, the most important part of deciding the fit of therapy for our children is their felt sense of safety. Sure, our children may work hard on a skill with a therapist, but they should always feel safe and trusting of that therapist and so should we. If you don’t understand a therapist’s reasons for a certain approach, ask for more information.
3. Are you or other family members overly-stressed due to the therapy schedule?
This is a tough one to define because the entire experience of having a child in multiple therapies can be stressful and everyone’s stress tolerance is variable. Yet, there could come a time when the logistics of therapy appointments are stressing parents to the point that it impacts your relationship with your child.
Always prioritize relationships, because without them, no learning is possible. We have to find a balance between making progress in therapy and maintaining a trusting parent-child connection, because that is part of our children’s progress, too!
4. Do you notice a decrease in anxiety over summer and holiday breaks?
Every summer, when school is out, many parents I work with begin to see their child’s anxiety lift. School is very stressful for many neurodivergent children. The sensory overload, the task demands, and the social expectations keep children’s stress level high most days during the school year. Summer is a reprieve, like someone has loosened the pressure valve and kids can have fun, without long days of expectations to keep up, and without the homework.
If you see your child make developmental gains over the summer due to fewer activities, take notice. Prioritize which therapies your child is making the most progress in and stick with those come fall. Some families even add a therapy in the summer because their child can handle more without the demands of school. Every child is different and you know yours the best!
5. It's OK to Take a Break!
Talk to your child’s therapist about the goals they are currently working on and your child’s progress. Sometimes school, play, and family time is a lot of work for kids. Talk with your child’s pediatrician or any of your child’s therapists to decide if you need to pick just one therapy to focus on right now and let them help you decide which one.
On occasion, a child takes a break from seeing me in play therapy to focus on body regulation and motor skills in occupational therapy. Once these skills improve, we continue therapy to greater success. There are also times I see a child reach social goals in play therapy with me and it is time to move on to a group setting to practice their skills with other children. Parents and therapists can monitor a child’s progress and make changes at any time.
Therapy is hard work for children (and for you), so paying attention to stress levels within different seasons of life can be helpful. Ultimately, your child’s stamina, happiness, and forward-moving progress are your guides for making these decisions.
Let’s Stay Connected!
~Dr. Emily
P.S. Join us in July for the next LIVE Parent Workshop which will be all about psycho-educational evaluations! We’ll discuss how to decide if your child needs one, what to expect, and how to read that report. Register at the link!
I’m Dr. Emily, child psychologist and former school psychologist, and I’m on a mission to help parents and teachers be the best adults we can be for the neurodivergent kids and teens in our lives. This isn’t about changing the kids, it’s about changing us. Learn more with my resources for parents, teachers, and schools at www.learnwithdremily.com.
**All content provided is protected under applicable copyright, patent, trademark, and other proprietary rights. All content is provided for informational and education purposes only. No content is intended to be a substitute for professional medical or psychological diagnosis, advice or treatment. Information provided does not create an agreement for service between Dr. Emily W. King and the recipient. Consult your physician regarding the applicability of any opinions or recommendations with respect to you or your child's symptoms or medical condition. Children or adults who show signs of dangerous behavior toward themselves and/or others, should be placed immediately under the care of a qualified professional.**