So What do I do when they won’t participate?
Dear Reader: ” So What do I do when they won’t participate?” is the first in a series of articles that will address neurodivergent-affirming therapy strategies for therapists who need some practical ideas for how to begin the paradigm shift in their practices.
Neurodiversity-affirming therapists, parents, and educators often learn quickly what NOT to do when working with children. We learn to cease planned ignoring and nonconsensual physical prompting. We stop showering kids with rewards to participate in activities, and we don’t punish them by denying them access to the items and activities they love because they didn’t comply or perform a task correctly. We stop forcing kids to tolerate aversive stimuli like loud noises and textures they abhor to “desensitize them.” We stop prioritizing compliance at the cost of human dignity and autonomy.
We know what not to do, but what do we do when, despite our best efforts, challenges inevitably arise when working with kids?
Specifically, what do we do when a child won’t participate in therapy?
While there are plenty of companies and individuals eager to sell therapists and parents nicely packaged programs that claim to prevent these challenges, often under the guise of neurodiversity affirming care, therapy that is truly ethical and respectful of neurodivergence is a framework for viewing the world rather than a nicely sequenced set of prompts, activities, and worksheets.
As a result, the only real solution to understanding why children don’t participate in therapy requires a fundamental shift in our perspective and, ultimately, necessitates a different question altogether. I know that isn’t the answer so many of us are looking for, but hear me out.
What if, instead of asking how to get kids to participate, we asked ourselves why they don’t want to participate?
When a child is refusing to participate in one of our planned therapeutic activities, our goal shouldn’t be to get them to comply and participate.
Why? Because, when a child is refusing, we don’t have the child’s consent and our activity is no longer therapeutic. Rather than continuing to focus on getting the child to participate with us, the therapeutic activity should become getting to the bottom of why the child is having trouble and working together to solve the problem.
In other words, rather than perceiving refusal as a child’s manipulative attempt to get out of doing work, it is vital that we uncover the barriers hindering a child from learning while also ensuring that what we are intending to teach is meaningful for them and that they are truly in a place of emotional and sensory regulation to participate.
In order to do this successfully, we have to abandon the old ABA adage that, when children don’t participate, “the demands are too high or the motivation/reinforcement is too low.”
Why? Because people are more complicated than that. This succinct phrase doesn’t account for the complexity of the internal emotional landscape, sensory experiences, traumas, and perspectives of both neurodivergent and neurotypical individuals.
While there are certainly times when giving a child enough praise or stickers will result in them doing something they initially refused, it doesn’t really get to the bottom of why they refused in the first place, so we really aren’t ever getting to the root of the problem. And there are also times when no level of demands or reinforcement is going to induce a child to participate, as is often the case during meltdowns and autistic burnout, so, attempting to vary “demands” and/or “reinforcements” won’t increase participation and may, actually, increase the child’s distress.
This change in mindset requires real work on the part of the therapist, and it’s not something that happens all at once.
In our clinical training, we are taught to target the objectives, tally our checkmarks, calculate our percentages, and move onto the next objective, ideally getting in as many trials and targeting as many objectives as we can per session.
When a child refuses to participate in what we’ve asked them to, we often perceive their refusal as getting in the way of therapy when, in fact, we could be using our clinical skills to help the child regulate, identify the source of their behavior, and get their needs met. This means that we are doing therapy even when the child isn’t participating in the task we planned.
- We are doing therapy when we sit in silence and rock a crying child who needs it to co-regulate.
- We are doing therapy when we listen to a child talk about an argument they had with a friend.
- We are doing therapy when an overtired child chooses to sleep during our session, and we work with their caregiver to establish strategies and change the child’s schedule to better meet their needs.
Ultimately, providing neurodiversity-affirming therapy requires us to adopt a different way of understanding our clients’ needs and our roles as therapists. To practice like neurodiversity affirming therapists, we have to start thinking like neurodiversity affirming therapists. To demonstrate what this looks like, we’ll be exploring a series of case studies demonstrating what ethical, respectful therapy looks like through a neurodiversity-affirming lens.
Let’s get to work.
About the author: Caroline Braun, M.S., CCC-SLP, is an Autistic speech-language pathologist practicing near Baltimore, Maryland. Through her private practice, she provides neurodiversity affirming language and feeding both virtually and in the home environment. Caroline is an aspiring researcher with a particular interest in responsive feeding therapy and affirming parent-mediated interventions. You can find Caroline at: https://www.carolinebraunslp.com/
And here: https://therapistndc.org/places/caroline-braun-ccc-slp/
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