What’s so tough about brushing your teeth?

What's so tough about brushing your teeth? Let’s face it. Brushing your teeth is No Fun At All. You rub a bristly brush all over your teeth and gums and sometimes it hurts! That same brush is topped with a paste that tastes highly unnatural and foams the more you brush. And look at how you have to contort your hand just to get the brush to scrub every surface! How is a kid supposed to learn to do that?

Brushing teeth can be particularly tough for kids with sensory and/or motor control issues. They may hate the feel of the brush on their gums or their teeth, or they may hate the vibrations of an electric toothbrush. Or they may find the taste of toothpaste impossible to tolerate.

Give your kid a sense of control

First explain why dental hygiene is important.  If your child understands the benefits of toothbrushing, you may get better buy in.

Allow your child to experience the toothbrush on other parts of his body before asking him to put it in his mouth. Let him feel it in his hands, then on his arms, his neck, his cheeks. By slowly working your way towards his mouth, it will be less frightening when you finally ask him to open his mouth and let you brush his teeth.

Letting your child brush his own teeth will also allow him to anticipate when the toothbrush and toothpaste are going into his mouth, which will make it easier for him to brace himself. He may not get his teeth as clean as you do, but it’s a process, and giving him the opportunity to do it himself will build his sense of self-competence.

Allow him to pick out his own toothbrush.  He might be more willing to brush his teeth with a toothbrush in his favorite color or with a cool design on it.


Brush with softer bristles

If your kid has trouble with the sensation of the bristles on her teeth, she may prefer a toothbrush with soft bristles. Other solutions include using a washcloth, a cotton swab, or your finger. Or, you can try a silicone fingertip brush with nubs instead of bristles.

Many kids find vibrations soothing, and enjoy brushing with an electric toothbrush. If you want the best of both worlds, you can use an electric toothbrush with silicone bristles.

Adaptive Toothbrush

For kids with developing motor skills, using an adaptive toothbrush with three heads that allow you to brush the top and both sides of your teeth at once, without tilting the brush,  can make it much easier to do a good job with dental hygiene.


How do I do this?

Some kids really don’t know how to brush their teeth. Kids love it when you do things with them, so brushing your teeth together can be a great way to show her what to do. Stand next to her while you both look in the mirror, and use exaggerated motions so it’s very clear what you are doing. Wait for her to imitate what you are doing before moving to the next step. Your child can also practice brushing the teeth of a doll or puppet.


If it’s the taste of the toothpaste, you may want to let your child try different flavors  until he finds one he likes. Buy a small tube of a number of different kinds of toothpaste, and figure you are going to throw away a lot of toothpaste. Then your child can try the different options and tell you which ones are tolerable. You can put a small dab on the index finger, and have him touch his tongue to it and indicate how tolerable it is on a scale from 1 (tastes like raw sewage) to 5 (divine). I’d make sure to give him a HUGE REWARD for being willing to do these tests!

Some toothpastes foam more than others. If your kid is having trouble keeping the toothpaste in his mouth while brushing, a non-foaming toothpaste might work better.

If toothpaste is Right Out, you might consider using a fluoride rinse. If your child won’t swish the liquid around in her mouth, she might tolerate having you brush the fluoride rinse on her teeth.

Water temperature

Believe it or not, some kids have trouble with the temperature of the water. Try lukewarm water if you think this may be the issue.

This is going to take forever!

For other kids, it’s the time – they don’t realize how long 2 minutes really is. You can play a song while they are brushing or use a timer to help them think about how long they’ve been brushing.

Teach the skills one at a time

If your kid is struggling with every aspect of brushing his teeth, think about teaching the skills one at a time. Start by asking him to brush his teeth with a wet toothbrush (without toothpaste). Once he’s got the motor skills down, find a toothpaste he likes, and have him start brushing using that toothpaste. Layer the skills on, one at a time so it isn’t overwhelming.

Remember: Kids do well when they can! Your job is to figure out what is hard about toothbrushing, and help your child master the skills while respecting his or her profile. 


Kayaking Through Life: Supporting kids with challenges

Kayaking Through Life: Supporting kids with challengesIn a previous post, I talked about the importance of providing just the right amount of challenge. I made it sound so easy. It’s not. Kids respond in different ways to being challenged, and the ways they respond can drive a parent’s response. Below is a story that is a metaphor for raising kids who have very different responses to being challenged.

Last week, we were on vacation and went kayaking. My husband was at a conference, so I took my boys by myself. We have been kayaking as a family a number of times before, but always with two of us in each kayak – one adult and one child.

My oldest was worried about kayaking on his own, but there was no one else on our tour who was able to partner with him, so he had to figure out how to do it by himself (with help from the tour guide). He did a fantastic job; he kept up with the guide, controlled his kayak, and did well. At the end he felt good about the trip and his abilities.

That was not the case for my youngest, who was in a two-person kayak with me. Kayaking on the ocean, against the wind and tide which were pulling us strongly back to the shore, was a lot of work. My youngest has increasingly been unable to push himself to do things that are hard, and kayaking that day was hard work! So he would dip his paddle in, first on one side, then on the other. But he never actually pulled the paddles through the water so as to propel the kayak forward.

Mind you he is a teenager and now over 5 feet tall. When he was smaller and weighed less, it was easy enough to control the kayak with him in it. But I am no longer strong enough to maneuver and compensate for him. I was paddling as hard as I could to keep us from going backwards to the shore, and away from the group. I just couldn’t do it. About halfway into the tour, I realized that if we were going to have any hope of keeping up with the rest of the group, I had to move to the center of the kayak, and tell my son to quit paddling so my paddles wouldn’t hit his. This was the only way I could keep control of the kayak.

I was so grateful when the guide took pity on us and strapped a lead to our kayak to help us stay on track. With that assistance, and my more effective positioning, we were able to stay more or less with the group, even though my son was getting a free ride, doing no work at all.

Kayaking in Assateague

Kayaking in Assateague

It was a lot less frustrating, but I was exhausted, and worse, my son didn’t learn anything.

In the end, I regretted taking the trip, even though it was a wonderful tour. My youngest and I would have been much better off renting kayaks and dabbling around on our own in the marshes and along the shore, or working on paddle skills without the pressure of having to keep up with the rest of the group.

Later I realized that this was a good metaphor for what happens as we try to parent different kinds of kids. The kids who feel competent (even if they are scared) respond well to being challenged.

But there are other kids who are afraid of taking on challenges due to repeated failure, fear of failing, perfectionism, or some other challenge that has taught them that they will not succeed even when they try really hard. These kids can respond by becoming passive and increasingly hard to teach.

Our society demands that kids keep up, staying on a developmental track that allows them to function independently by the age of 18. If you have a child for whom that goal isn’t realistic, you may find yourself kayaking against the wind and tide, pulled farther and farther from the group.

When “No!” Means “I’m Scared or Overwhelmed!”

When "No!" Means "I'm Scared or Overwhelmed!"In The Many Meanings of “No”, you learned that “No!” doesn’t always mean No. Sometimes “No!” means I’m scared or overwhelmed! How can you help a child who is so emotionally overloaded that he or she is unable to do as you requested?

“I’m overwhelmed, and can’t do anything right now.”

Have you ever gotten bad news just before someone asked you to do something? When you are processing something that evokes strong emotions, your limbic system (where you process those emotions) kicks into overdrive, blocking communication between different areas of the brain, especially those used in remembering and doing. When you are feeling strong emotions, it’s very difficult to do anything other than get through the most intense moments.

Trying to get your child to do anything when she is upset is useless; you must wait until she calms down before expecting any action. There are many strategies you can use to help your child feel understood, and to help her calm down; I list a few of them below.

  • Use empathy. Let your child know that you understand what he is going through. Instead of repeating, “It’s time to get out of the bathtub now!”, say something like, “I can understand why you don’t want to get out of your bath — we are having so much fun playing together!”
  • Give him something to look forward to. “If you get out now we can have a snack and read a story before going to bed.”
  • Communicate nonverbally. Some kids have more trouble processing words when they are overwhelmed. For these kids, show them that you love them and will help them through this. Communicating with actions (a sympathetic gaze or a gentle squeeze of the hand) or just by calmly sitting nearby can help a child who is feeling out of control to calm down.
  • Remove all demands. Some kids get so overwhelmed that they just need to be alone until they have control over themselves again. For these kids, you can gently say something like, “I see you are really struggling. I’m going to go into the other room until you feel calmer.”

“I’m scared!”

I remember once being stuck on the side of a mountain while hiking. I was not wearing the appropriate shoes, and I thought that if I moved, I’d go tumbling down the side of the mountain. It took me 45 minutes to figure out how to safely get off the rock face and back on the dirt path that led me the rest of the way up the mountain. If I had been forced to move faster, I might well have lost my footing and fallen down the cliff. Making me go faster would not have had a happy ending.

Sometimes when a child refuses to do something, it is because they are terrified.

Here are some strategies that can work for a child who is scared:

  • Use empathy. Sometimes just knowing that someone else knows you are struggling, and is rooting for your success is all a child needs to muster up the courage to forge ahead. In our Raising Your Challenging Child class, Dr. Shapiro and I devote one of our sessions entirely to empathy because it’s such a powerful technique.
  • Help your child know what to expect. Some kids get anxious because they don’t know what to expect. I had a friend who put it really well – she said, about her parents’ divorce, “It was just one of the many things adults do that made no sense to me as a child.” Think about it from your kid’s point of view – they are expected to just do as we say, without understanding why, and without having any control over their own world. I’m a big fan of visual schedules (pdf) for kids like this. For situations where kids may need explicit instruction in what is expected, Carol Gray’s Social Stories are terrific, as are her comic-book conversations.
  • Anticipate the unexpected. Thinking through how to handle more than one outcome can be empowering. Two strategies that can help your child learn to do this are SOCCSS and Goal-Plan-Do-Check.
  • Meditation. Just this week, my son came downstairs the day of his science fair and told me he was panicking. I asked him if he would do a meditation on anxiety with me, and he said he would give it a try. We use the app Stop, Breathe, Think, and had purchased the “anxiety pack” for $1.99. After a 6 minute meditation, my son said he felt calm, and his teachers reported that he did an amazing job, and didn’t seem at all anxious. Wow!
  • Identify thinking errors. Sometimes kids get anxious because they think things like, “This will take forever!”, or “I can’t do ___”, even though there is no evidence that this is true. Learning about common thinking errors, and thinking of more realistic replacement thoughts (“This will take 15 minutes,” or “I need more information before I can do ____”) can help your child feel less anxious.
  • Help your kid label emotions; brainstorm coping strategies. Some kids are completely unaware that they are starting to get dysregulated until they completely lose it. Kari Dunn Buron’s Incredible 5-Point Scale provides a method for helping kids to identify their emotions before they reach the critical point.

Anxious and overwhelmed kids can’t do anything until they calm down. Helping them anticipate what will happen, and teaching them coping strategies will help them take on new challenges, even when you have asked them to do something hard. Teaching them to self-advocate and to consider other ways to accomplish their goals will serve them well when they hit barriers in less forgiving environments. 

When “No!” Means “I’m Confused…”

When "No!" Means "I'm Confused..."

When “No!” Means “I’m Confused…”

In The Many Meanings of “No”, you learned that “No!” doesn’t always mean No. Sometimes “No!” means I’m confused! How can you help your child if he or she doesn’t understand what you want? Below I describe three types of confusion, and give suggestions for how to help.

“I don’t understand….”

Sometimes a task that seems incredibly simple to you feels overwhelmingly complex to your child. There can be a number of reasons he doesn’t understand. Perhaps you used a word he doesn’t know, so it sounds to him like you just asked him to “Please bring me a flibblenator.” Check for comprehension.

Instead of telling your child what you don’t want, tell him what you do want. Instead of “Stop hitting the coffee table with that stick,” say “You can hit the carpet with your stick.” This way your child doesn’t have to figure out by trial and error what it is that you want him to do.

Sometimes a task that seems simple to you has a lot of steps that you aren’t even aware of. If your child doesn’t seem to know what to do, break the task down to its components and then give one direction at a time. Praise your child for accomplishing each step, so he feels motivated to keep working.

“I don’t know how to get started.”

Have you ever been asked to do a project that feels so complex that you don’t have a clue where to start? You start on one part of the job, and then you realize that you need to do another part too. You start on that part, and realize there’s an additional part to do. If you can just begin you will make progress… but where to start? If this is what your child is struggling with, you can try to do the project together, working side-by-side. For example, if your child won’t put on his socks, say, “My feet are cold, so I’m going to put on some socks. Your feet seem cold too – do you want to put on our socks together?”

“I am trying to figure out what you want, and I need some time.”

Some kids take a while to figure out what you said and to put it into action. (This is known as slow processing speed.) Perhaps they have trouble figuring out what people are saying. Perhaps they have trouble translating requests into action. If your kid takes a little longer to do certain tasks, the best strategy is to patiently ignore the “No!” and wait.

There are kids who can take as long as five minutes to translate a request into action, and five minutes can feel like an eternity when you are waiting.

To get a feeling for how long it is, set a timer for one minute. Then think of something you want to do, turn the timer on, and wait for a full minute. It feels like a really long time! Now think about doing that when you are waiting for your child to respond to a request.

For kids like this, you may need to start factoring in more time to get things done. For example, if your child regularly has trouble getting ready on time in the morning, try getting up 15 minutes earlier so there is more time to get through the routine.

Showing your child exactly what they need to do will help them follow your directions when they don’t understand what you want. Be patient, and remember that what is obvious to you as an adult may not be so obvious to your child. 

The Many Meanings of “No!”

The Many Meanings of "No!"“NO!”

It’s a natural response. You ask your child to do something, and they respond with defiance. How do you respond?

“I said….”?

“You’d better….”?

“If you don’t, I’ll have to….”?

“Why don’t you ever listen to me?”

But “No!” can mean many things, and the best response will differ depending on what your child is trying to tell you. (Remember what Ross Greene says: “Behavior is communication!”)  Don’t take it personally. Your child isn’t telling you no because she doesn’t like you. As with most behaviors, this one is all about her.

“NO!” can mean:

  • “I don’t understand what you want.”
  • “I am trying to figure out what you want, and I need to buy some time.”
  • “I don’t know how to get started.”
  • “I’m overwhelmed, and can’t do anything right now.”
  • “I’m scared!”
  • “I can’t do it!”
  • “I didn’t realize you were talking to me, so I didn’t hear what you said, and I know you are going to be mad, and it takes a lot of words to explain all that….”
  • “I don’t understand why it is important.”
  • “I am busy doing something else right now.”
  • “I forgot what you wanted me to do, but I’m worried that you will get mad at me if I tell you that.”
  • “I want to do it myself.”
  • “I never had to do it in the past, so why should I do it this time?”
  • “I don’t have very many ways to express myself, and it’s really easy to say ‘No!'”
  • … ?

You’ll note that I didn’t include “I don’t want to!” in that list. There is almost always a reason behind the “No!”, and your job is to figure out what that reason is and address it.

Before I delve into ways to address the meaning behind the “NO!”, however, it’s important to address the issue of parenting style.

Your Parenting Style Can Drive Your Child’s Response

We often speak to children as if we have control over them, but the simple fact is that we do not. You can force a young child to bend to your will, but eventually he will be big enough that this strategy will no longer work.

Sometimes adults use controlling and demanding language with their kids. We are tired, time is short, and we just need to get things done. But consider how you respond when you feel like someone is trying to control you, order you around, or tell you what to do. I know I tend to feel a bit defiant. The same is true for children. It’s more effective to communicate with respect and clarity, to have reasonable expectations, and to allow consequences to teach.

Some general rules:

Think of yourself as a guide

Your kid wants nothing more than your attention. If you are with him, guiding him to do as you asked, he will be much more compliant than if you send him off to do it on his own. Asking your child to help you clean the kitchen is, in part, a request to spend time together. Asking him to clean the kitchen by himself is not nearly so appealing.

Ignore the “No!”

As you will read in future articles in this series, the reason behind the “No!” is rarely about defiance. In most cases it’s best to avoid responding to the “No!” and instead respond to the underlying message. (Unless, of course, the child’s safety or the safety of others is at risk.) Wait patiently for your child to do as you requested.

It’s also important to avoid rewarding your child by attending to their other demands while you wait. For example, if you ask your child to get dressed and he refuses and then asks for breakfast, you can say, “I’d love to feed you breakfast after you are dressed.”

Reward the “Yes!”

When your child does as you requested, make sure to reward her immediately. Different kids like different types of rewards, so be sure that what you are doing is actually rewarding to her. Some kids respond best to tangible reinforcers (M&Ms, pennies, tokens in a token-reward system, etc.). Others prefer verbal praise. Some kids like exuberant overt praise while others are embarrassed by such a strong show and prefer more subtle acknowledgement (e.g., thumbs-up or a wink).

As your child moves towards doing as you requested, no matter how small the steps, you can begin to re-engage and give her attention. For example, if you’ve just asked her to come down to dinner, and she moves a single tiny step towards the stairs, you can say something like, “I love that you are coming to dinner. Thank you!”

Solve problems collaboratively

If refusal is chronic, and you cannot figure out what is driving it, use Ross Greene’s approach to working with your child to understand what is going on, and to find a mutually acceptable solution. Remember, “Kids do well when they can.”

When a child says, “No!” it is usually because she has an unsolved problem or an unmet need. Trying to understand and address the problem or need creates a sense of trust and connection between the two of you that will help your child to do as requested. I described some of those unmet needs at the beginning of this article. In the following posts, I will describe what you can do to get to “Yes!”

“I’m confused!” (posted May 26th, 2015)

  • “I don’t understand what you want.”
  • “I am trying to figure out what you want, and I need to buy some time.”
  • “I don’t know how to get started.”

“I’m overwhelmed or scared!” (posted May 31st, 2015)

  • “I’m overwhelmed, and can’t do anything right now.”
  • “I’m scared!”

(Image source)

Meet Your Kids Where They Are

Meet Your Kids Where They Are“He could do it yesterday, so I know he can do it!”

Have you heard (or thought) this before? It can be hard to figure out why a child patently refuses to do something he did just the day (or hour) before.

Ross Greene said it best: “Kids do well when they can.” If the child isn’t doing what you’ve asked, it’s time to ask, “Why can’t he do it?”  One reason might be that it is beyond his ability at that moment in time.

I’ve been thinking about this ever since I attended a parent training session conducted by Adrienne Bashista of Families Affected by Fetal Alcohol Spectrum Disorder. After describing the brain damage babies suffer when their mothers drink too much alcohol during pregnancy, Ms. Bashista talked about the importance of teaching children by meeting them where they are, rather than where you wish they were.

Performance is Variable

Think about something that is hard for your child right now.

graph showing how children's abilities are not constant, but are instead variable

Children have good days and bad days, just like the rest of us. Variability is a normal part of the human experience.

Perhaps she can’t get dressed independently. Or he is unable to sit still for more than five minutes. She never comes to the table when called. Or perhaps any work that involves writing leads to a meltdown.

What does your child’s performance look like from day to day? Is it always the same?

Probably not. Instead, performance probably looks like this graph.

Just because your child could do it yesterday doesn’t mean he can do it today. We all have good days and bad days. So does your child.

Your Child Can’t Always Meet Your High Expectations

I remember thinking that my young child should be able to do an art project without getting paint all over his face, hands, clothes, and the floor. My expectations were high!  But my son couldn’t meet my expectations. That paint was fun to play with! He could stick his fingers in it and swirl it around. And if his face itched? No worries – he just scratched it with his paint-covered fingers. Oh, and was he supposed to wear a smock while painting? Too late for that! And how in the world did that paint get all over the floor?

graph showing how you can adjust your demands to match your child's abilities

Accommodation is when you adjust your demands so they more closely match your child’s abilities.

My son was having a great time painting, and there was paint everywhere. At first, I was really upset because I thought he should be able to paint without getting paint all over everything. But I realized that I was expecting too much of my son, and I needed to adjust my expectations so I could meet him where he was. I got him a smock. We used water-soluble paints. We spread newspaper on the porch, and I only let him paint outside. I adjusted my expectations and the environment so that they more reasonably matched his abilities.

The graph above is the same as the previous one, but it shows my demands (expectations) as the red line. The left side of the figure shows what it looked like when my expectations were much higher than what my son was able to do. Once I adjusted my expectations and adapted the environment, my demands were more in line with my son’s abilities. This adjustment is the essence of accommodation.

Expecting Much More Than Your Child Can Handle is Frustrating

Think about a time when you expected more of your child than he or she could reasonably handle. We all do it – it’s part of parenting. It is even healthy because it pushes our children to learn new things. If we never had expectations that were beyond our children’s current abilities, we wouldn’t teach them anything.

But there’s a balance to it. In my experience, I’m at my absolute worst as a parent when my expectations are far beyond my kids’ abilities. Sometimes my unrealistic thoughts lead me to make unrealistic demands.

I remember one time I took my son to see a live performance of Stravinsky’s Rite of Spring. He’d been to an orchestra concert only once before, and had to leave because it was too loud. Why I thought he would enjoy Stravinsky is beyond me. I took him, and he was having a really hard time – wiggling in his seat, trying to stay awake. Eventually he ended up crawling under his seat and curling up into a little ball.

I was so frustrated.

Graph showing that frustration comes when parental expectations exceed the child's abilities

When you expect more than your child can handle, it’s easy for both of you to get frustrated. By adjusting your expectations to match your child’s abilities, it’s easier for everyone.

Looking back, I have to wonder, “What was I thinking?” My son couldn’t sit still when watching a highly engaging movie. And he didn’t know the music. Not to mention that there are a lot of people who don’t like Stravinsky; I could have picked something a little more accessible.

Later that year, my husband took him to see the National Symphony Orchestra play the music for Final Fantasy. My son loved it. It helped that the concert was outdoors, and so he could get up and run around if he wanted to. My husband didn’t make unreasonable demands of my son, and they both had a wonderful time.

When the adult demands more of the child than the child is capable of, both child and parent get frustrated. Meeting your kids where they helps everyone feel calmer.

Teaching Involves Providing Just the Right Amount of Challenge

While it’s important to accommodate, it’s also important to teach your child. To do that effectively, though, you have to meet your children where they are, and then push them a little bit.

The figure below shows how a child might learn a new skill. The adult has expectations that are a bit beyond the child’s current ability, but the expectations aren’t too high, so the child doesn’t feel overwhelmed.

graph showing how you can teach when you expect just a little more than your child is capable of

By expecting just a little more, you can gently push your child to learn without scaring them. The challenge is in figuring how much you can push so your child feels it is safe (and even fun) to try.

I like to use the example of teaching a child how to put on her socks. It seems so simple. “Put on your socks.” But putting on your socks is actually a really complicated process.  (Here’s a wonderful Guide To Putting on Socks (pdf) that lays it out, step by step with pictures.)

  1. Hold the sock with the heel on the bottom. Put your thumbs on the inside and your fingers on the outside of the sock.
  2. Pull the sock over your toes. Make sure to line the toes up, and make sure the heel will go over the heel, and not off to the side.
  3. Pull the sock over your heel, lining up the heel of the sock with the heel of your foot.
  4. Pull the sock over your ankle.

You might teach this skill by doing steps 1-3, and having the child do the last step. Once they have mastered pulling the sock over their ankles, you can do steps 1 and 2, and have them do steps 3 and 4. Continue backing off your support one step at a time until they can put on their socks independently. (This is a technique called backward chaining.)

By providing just the right amount of challenge, your child can learn. The tricky part is figuring out how much challenge is just right. The only way to figure that out is by trial and error.

Don’t worry about setbacks. Remember – performance is variable, and it takes time to learn a new skill. By patiently meeting your child exactly where he or she is at that moment in time, you can teach almost anything.

Is That the Therapy I Want to Do?

Is this the therapy I want to do for my child?In talking to other parents,  you may learn about an intervention that has helped someone else with a profile similar your child’s. These therapies are sometimes quite expensive, and many are not covered by insurance.  How do you decide what to do?

The following questions can help.

What is the research evidence? 

Some interventions have a long list of peer-reviewed research documenting their effectiveness. For example, studies validating the approach used in Cognitive Behavior Therapy as a treatment for anxiety disorders date to the 1950s. Other interventions are relatively recent, and may not have as many studies documenting a positive impact.  Working memory training is an example of a recent intervention that has some evidence validating the approach, but there are still questions about whether it generalizes beyond the tasks it trains.

It is important to note that all interventions have to start somewhere, and just because there isn’t strong research support doesn’t mean the approach doesn’t work. But it does mean that it is more of a gamble than a therapy that has a long history of research documenting its efficacy.

What is the financial cost?

  • How much does it cost?
    • Does the provider take your insurance? Or are they out-of-network?
    • How much will your insurance reimburse?
    • What will your final out-of-pocket expense be?
  • How many sessions will it take?

All these factors will help you calculate the actual cost of the therapy. Think through this ahead of time. Can your family afford it?

What is the emotional cost?

Therapy is hard work. Your child will be asked to do things that are quite hard. Does your child have the emotional reserves to do the work necessary to make progress?

There is also a cost to you. If your child is resistant, do you have the emotional reserves to deal with fighting with your child about doing the therapy?

How much time will it take?

Do you have the time and flexibility to work this therapy into your schedule?

  • How long will it take to get there?
  • How long is the appointment? What is the recommended frequency?
  • Are you expected to do work between sessions? How long will that take? What is involved?

Could it harm my child?

The Hippocratic Oath is “Do no harm.” Unfortunately, some interventions have the potential to be harmful. Make sure you are aware of the side effects and potential disadvantages for a child with your profile before you expose your child to the therapy.

What exactly does the therapy do? 

It sounds obvious, but make sure you understand  exactly what issues the intervention will target. Make sure the issues you are targeting are high-priority so your child doesn’t burn out. (See “What is the emotional cost?”, above.)

Measure your baseline at the beginning of the therapy and again on a regular basis during the therapy. This will help you determine whether the therapy is having a positive impact. Ask the provider how long it will take for you to see changes. If you don’t notice a positive change, terminate the therapy.


I have a mantra: “You can’t boil the ocean”. It’s easy to think that if we enroll our children in as many therapies as possible, we can “fix” them. It’s better to pick one problem that is your highest priority and focus on that. Answering these questions will help you to strategically select interventions that have the potential to effectively address high-priority problems.

(Image source)