CliniKids Director Professor Andrew Whitehouse and Integration Project Manager Sarah Pillar explore one of the most common questions when it comes to support for autistic children - how much is the right amount of therapy?
Among the most common questions we are asked when it comes to therapy for autistic children is how much therapy should a child be receiving.
This is a really logical question to ask. It reflects the love and concern that parents have for their child, and their strong desire to make decisions that will best support their child now and into the future.
However, it can also be an unhelpful question for parents to ask themselves, for a couple of reasons.
First, like all children, all autistic children have unique strengths, challenges, interests and personalities. Every child is also different in how they learn, and what provides them purpose and belonging. The same is true for the family around each child. Each family is different in their make-up and family culture, in what gives them joy, and in what creates stress. These unique attributes mean that is not possible to provide specific recommendations that apply to all children and families.
Second, autism is different to other areas of health and medicine that may have fairly standard recommendations that apply to large number of people. (For example, the use of a standard dose of medication for children with ADHD). While the origin of autism may be biological, the therapies and supports that create positive change are most often educational, environmental and social. These are areas that do not fit a standard ‘prescription’ across all children, and instead are strongly driven by the aspects beyond diagnosis.
What does the research evidence tell us?
Considerable research over the past three decades have provided good evidence that start to help us understand more about this area. Four clear facts have emerged:
1. Early therapies and supports are important.
Early experiences, including therapy early in a child’s life can help shape early brain development, and this early foundation provides a ‘springboard’ for the development of more advanced skills. Early therapy can also provide a way for parents to receive important advice and guidance at a time when this is particularly needed. Importantly, a focus on early therapies doesn’t mean that supports at later ages are not important or effective as well – they are. Both are important.
2. There is no ‘standard amount’ of therapy.
There is no set amount of therapy that will lead to better outcomes for all children. Some children will require what we call ‘intensive’ supports, which involves substantial amount of time with a practitioner each week. However, many children do not require such intensive supports, and may benefit best from only a small amount time with a practitioner weekly, fortnightly, monthly or just on occasion as required.
3. ‘More’ does not necessarily mean ‘better’.
Research evidence does not indicate that more therapy leads to better outcomes for all children.
4. Quality is as important as quantity.
A focus on asking ‘how much’ can sometimes mean that we don’t focus enough on the critical factor of therapy ‘quality’. Having practitioners who are qualified, with current knowledge and skills, and who have access to supervision, are key elements of good practice. The quality of therapy is every bit as important as the amount of therapy a child receives.
What is a better question to ask?
The research evidence tells us that when we ask ‘how much’, we are actually asking the wrong question.
Instead, a better question to ask is: How much is the right amount of therapy for my child and family, right now.
An answer to this question emerges through a partnership between the child, their family and the practitioner. Each person brings unique knowledge and skills to that decision. How much therapy is needed is determined by the child’s goals, strengths, challenges, and family context. It is only by weighing up all of the information available that a shared decision can be made as to what is the right amount of support now. Ongoing monitoring and review of support gaps or successes, can then decide what, if anything, needs to change to better suit the needs of the child and family.
What else should I know?
There are a number of other considerations that can be important families when making therapy decisions.
- Sometimes we have to “slow down to speed up”.
Taking time to slow down and consider which supports will have the biggest positive impact on a child is very important. It can be easy to get caught up in one course of therapy and just keep going. Sometimes stepping back, revisiting a foundation skill, or giving time for a child to consolidate their learning can be the very best support for them in that moment in time.
- Community connection is ‘therapy time’.
Therapy is all about supporting a child’s learning so they can participate and enjoy good health, happiness and community connection. It is important that the time a child spends in therapy adds to their participation and connection with their community, rather than takes away from it. Time spent at the local playground, visiting friends, or attending school are all a part of connecting a child with their community. Families should feel confident to value the time a child spends connected with their parents and linked into their community – this time can be every bit as valuable as time spent with practitioners.
- Therapy needs change over time.
As children grow, and their families grow with them, they will have different needs. The environment that surrounds the child will change, and goals will evolve and change focus. Any therapy recommendation for a child and their family is specific to that ‘snapshot’ in time. These will change as life progresses.
- Family wellbeing is important in supporting autistic children.
Children are surrounded by their family, and that environment plays a major role in their development and wellbeing. Children tend to learn and participate best when their family have skills and resources to manage stressors, as well as having strong connections to formal and informal social supports (friends, extended family, counselling, support groups etc). Understanding how the family environment can be best structured to support the child – including through managing time demands on parents and children - is a very important consideration.