Additional Therapy: is more always better? By: Shaindy Rapps, OTR, SBL

• January 13, 2025
• 12 Min Read

By: Shaindy Rapps, OTR, SBL, Principal of Williamsburg Preschool Program

I think we can all agree that it is every parent’s desire to do their utmost for their child, both those that are neurotypical and those with special needs.  As parents we invest so much into ensuring that our children are given every opportunity to be their best selves.  I think we can also agree that in the last twenty years there have been great strides in the understanding of children with special needs and an explosion of tools used to help these children maximize their potential.  Traditional and alternative therapies abound, and as technology improves and travel is more commonplace, many avenues of treatment are more accessible than ever.  Now putting these two factors together put parents in a quandary.  Yes we want to provide the maximal input to help our children progress but there are so many choices and so many different avenues to try.  But how much is too much?  Is more always more? The answer to that question, as the answer to many personal questions is …. It depends.  It is not possible in a general article to come up with a pat answer or formula as to how much extra therapy is beneficial for each child because that is a very unique decision for each family.  However, there are questions that one can ask and factors to consider to help determine how much therapy is right for one’s child and family.

The first factor to bear in mind is the amount of resources a new or additional therapy endeavor will expend.  When we talk about resources, what first comes to mind is out of pocket cost, which obviously plays a large role in determining if extra therapy or intervention is feasible.  But resources come in other forms as well, namely time, physical and emotional energy.    Most families do not have an unlimited supply of the aforementioned resources hence, the money, time and effort that are being invested in an additional therapy venture are likely being taken from another source.   Devoting considerable time outside the house attending therapy sessions or implementing follow up exercise programs at home may place an additional level of stress on an already busy household.   Furthermore, since many supplemental therapies are privately funded, there may be an added intensity to ensure that the parents are getting their money’s worth.  This may result in the push to never miss a session or daily therapy regimen, which creates tremendous pressure.  How does this affect all members of the home including siblings that might be picking up the slack for an absent parent or stepping in to implement home programs?

A second consideration is the toll that additional therapy takes on the child themselves.  Our children with special needs most often need to work much harder than their typically developing peers to accomplish the same goals.  Most are enrolled in full day special education programs or mainstream classrooms in which they receive a host of related services.  Is adding additional structured therapy after school too much?  Would we provide a typical child of that age so much structured time?  All children need a chance to unwind and relax after the rigors of a school day.  Often overlooked is the benefit of children being a part of regular family and community life.  Opportunities abound for children to gain cognitive, social, and play skills just by navigating everyday interactions within the home environment.  On the flip side, after school therapy slots are hard to come by and parents may choose to have children leave school to attend therapy.  Parents may also travel to distant locations for therapy “intensives.”  How disruptive is the additional therapy to a child’s schedule?  What are they missing in school when at outside therapy?  Most children thrive on consistency and structure.  In addition most school days are scheduled with much foresight, with specific goals targeted at different parts of the day.  When children are continuously pulled out of school or miss large chunks of time it may be very hard for them to continue to function successfully in the classroom environment. 

A third consideration to take into account is the child’s response to the intervention.  Children learn in the context of relationships and need to experience feelings of safety and trust.  Not all practitioners are of this mindset and some believe that they can “push through” despite the child’s protests.  When children cry through therapy sessions or are made to endure experiences that they perceive as unsafe, they are experiencing stress.  When children are exposed to prolonged periods of stress, the secretion of stress hormones into the system have the potential to negatively impact brain development and architecture.  Furthermore, children may quickly lose trust in all adults which can affect their relationships with regular teachers, therapists, and caregivers.  They may become avoidant and non compliant across the board because they no longer perceive adults as safe and pleasurable individuals whose role is to support them.

If one does determine that a specific therapeutic service or provider will be beneficial, be an informed consumer.  Be wary of those that make promises to affect dramatic change.  There are no quick fixes  without a lot of hard work and effort.  Ask questions, work together to establish goals.  Ask for a timeframe – how long should you expect before seeing results?  How long does a typical course of treatment take?  Is this intervention research based?  Be in touch with others who have actually engaged in this therapy process first hand.  Once you start the therapy process set up a timetable to reevaluate.  Are you seeing changes?  At what rate?  Is the change making a functional difference in your child’s life? 

In conclusion, we are blessed to live in an age of abundant knowledge and tools to help our children.  Let us carefully consider how we use these resources to best support our children to move forward while maintaining our equilibrium, sense of purpose and view of the bigger picture.