There are different opinions on whether or not all autistic children need therapy. Some professionals recommend extensive therapies. Others caution parents that just because a child is autistic it does not automatically mean that therapy is needed. Parents who hear these opposing opinions from professionals or find them on social media can feel lost as to what is best for their child. I wanted to share my thoughts to help parents think through their decisions.
There is a difference between asking if the child needs therapy or if the child can benefit from therapy.
A child might objectively need therapy but be unable to benefit from it. For example, kids with PDA profile often struggle even in child-led therapies because many therapist-child interactions are perceived as demands. Children who are already overwhelmed by the demands of school might not be able to benefit from therapy because they are out of energy and need time for recovery. In-school therapy for these children can be difficult because of the additional transitions that need to be managed. Children in burnout cannot benefit from therapy.
There is also a question of what kind of therapy it is.
Is this therapy that is neuroaffirming? Does it center the child’s traits and developmental needs as an autistic individual? Are the child’s preferences taken into consideration? Or is it therapy that is focused on “fixing” the child? Is the goal of therapy to make the child act more neurotypical and be more compliant? Does the therapy center the views of adults on what the child should want and do? Unfortunately, our world is filled with uninformed and ableist providers who will use physical prompting, and hand-over-hand assistance, and ignore children's distress, dysregulation, and sensory discomfort. Many autistic kids spend their time learning to make eye contact or stop stimming. It is better to have no therapy than to be in therapy that sets goals that are harmful to autistic kids, with providers who teach children that they should push through dysregulation and that their accommodations, such as sensory breaks, need to be earned.
There is an issue of child-provider fit.
Is the child connecting to the therapy provider? Is the child enjoying therapy sessions, or is the child hating on the therapist, refusing to go, and begging for the therapy to stop? If the child does not see therapy as helpful and is fighting it, the child will not benefit from it. You cannot “force feed” skills to a child. There has to be a “buy-in” from the child if we want to see engagement and learning. Before any work can be done, there has to be a sense of trust and safety with the provider.
There is a question of whether or not the child is motivated for therapy.
Most young children do not question being taken to different therapies. But as children grow, they often start questioning why they are going. They often realize that instead of going to therapies, their peers participate in extracurriculars, play online, or just hang out. Therapies can take a lot of time, and leave children with what feels like not enough time to chill and do what they want. When children are not motivated for therapy, they will not be able to benefit from it. To increase motivation, we need to center the child and make therapy worthwhile for them by working on things that matter from the child’s point of view.
There is a difference between needing therapy and needing support.
I think that all autistic kids need support as they grow, but that support does not always have to come in the form of therapies. There are families who choose and have the time to become very informed and provide a lot of the support that is typically provided by professionals. There still might be a time when more specialized support is needed that only a qualified professional can provide. It might also happen that it will become too much for the parents to provide all the support for the child. But for some kids, and for some chunks of their lives, family support might be enough.
The need for therapy changes over the years.
Whether or not an autistic child needs therapy, and what kind, can change over the years. “Therapy” covers a lot of different things, such as speech and language therapy, occupational therapy, physical therapy, psychotherapy, sensory integration and processing therapy, etc. As the child grows, their developmental tasks, as well as demands, expectations, and challenges facing them, change as well. The need for therapy should be constantly re-evaluated based on how the child is doing.
Family and accessibility considerations.
There are can be family factors that may make it difficult for the child to attend private therapies. If parents are already overwhelmed with childcare responsibilities, work, and other obligations such as being caretakers for their parents, adding therapy appointments to the schedule and getting the child there regularly, and on time, can be an impossible burden. Even home-based services can feel disruptive and burdensome if parents feel that they need to clean the house when the therapist comes in, or if it is difficult to make sure that someone is home every time there is an appointment. There are also financial considerations that affect access to therapies. Many insurance policies only cover ABA services and nothing else. For parents with limited financial resources who do not want their children to have ABA, it is a tough choice between being able to have insurance pay for services and feeling comfortable with the care their children are receiving. Paying for therapies out of pocket is very expensive and is an impossible financial burden for many families. If a child receiving therapies stresses the family system beyond capacity, then therapy cannot be beneficial.
Tying it all together:
We know that autism comes with predictable challenges. For example, around 90% of autistic children have motor skills challenges. Rates of anxiety, depression, and suicidality are much higher in autistic children than they are in their typical peers. The co-occurrence rates between autism and such conditions as ADHD and learning disabilities are high in autistic kids. Autistic children are more likely to be the victims of bullying and other times of victimization. Some of these risks have to do more with how our society functions rather than with the condition itself. Nevertheless, the resulting issues are a part of an autistic experience. There is also a high rate of co-occurrence between autism and many other medical and mental health conditions. It is to be expected that managing these challenges and conditions will require professional help.
In my experience, most autistic kids at some point will need support with motor skills, regulation, self-advocacy, executive functioning, understanding themselves, etc. Growing up with differences needs to be processed. Learning about one’s needs and strengths is not automatic. Understanding own strengths and weaknesses and still feeling OK about oneself is a developmental task that most of us work on life-long. Autistic kids will likely need support in processing all of this. But decisions about therapy vs support, and “what, when, and what for” of therapy need to be weighed with many considerations.
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