Better therapy sessions for kids with special needs: therapists share!

I recently asked a bunch of pediatric therapists how kids can get the maximum benefits from therapies: speech therapy, occupational therapy, physical therapy, ABA therapy, whatever therapy! All of these experts are contributing columnists to PediaStaff, and they didn't hold back on advice or honesty. Hope you find their words as helpful as I did!

From Melanie Potock, a pediatric speech language pathologist and feeding specialist in Longmont, Colorado who blogs at My Munch Bug 

DO... 
• ...Feel free to video our session to share with your partner, nanny or other caregivers.
• ...Call me if you have any sickness in your home that day. I see so many kids who are medically fragile and it’s helpful for me to know if I am about to enter Strep Throat Territory!
• ...Let me know if you feel you need to change to another therapist. Not every therapist’s style is the right fit for every child, or every family. Therapists understand that as a parent, you are just trying to do what you feel is best.
• ...Celebrate each and every step of progress with me! Therapists have the benefit of watching many, many kids make this journey over the years. We know each step on this path. It’s important for everyone to celebrate even the tiniest accomplishments and not become overly focused on the final destination. We will get there, one step at a time!

DON'T... 
• ...Hesitate to tell me if you think something that I have suggested just isn’t working for your child or your family. I promise to listen, adjust the therapy and not take it personally.
• ...Clean up the house just because I am coming over to do therapy. I want my visits to the home to make your family’s life easier. Believe me, I’m used to seeing dirty dishes on the counter.
 • ...Lose the therapy tools I loaned to you. I’m happy to loan them, but I can’t afford to replace them. And if your toddler accidently spilled grape juice on the book I loaned you on speech and language development, please let me know before I loan it out to another family.
 • ...Be upset with me when I need to cancel at the last minute due to bad roads. As a therapist who drives from home to home and covers many miles in a day, road conditions vary and I often get caught in bad weather while it is still nice in your neck of the woods.
• ...Ask me to change your child’s diaper or take them to the potty, unless it is a part of your child’s therapy plan.

From Stacy M. Menz, a pediatric physical therapist in the greater San Francisco Bay area who blogs at Starfish Therapies

• Do encourage collaboration between your therapists and other team members (including caregivers). Often the other team members will be working on things that are easy for another therapist to carry over, which allows extra skill practice to be 'snuck' in. (An example: if a speech therapist is working on the child producing sounds such as m,b,p then a PT can have the child practice those sounds if they are playing with toys that have things like cows or sheep).
• Don't make exercises stuff you have to "fit into" your day—incorporate the exercises and 'homework' into your routine as much as possible so it is part of the day. Often your therapist will have ideas on how to do them; perhaps they can done when you change a child's clothes or diapers. Just be clear on what you can handle as a family so that your therapist can pass on the top priority for you to practice.
• Do give your child time to be a kid and have free time, or take a short therapy vacation. Letting them have time to play and interact with the world can often provide their bodies a valuable opportunity to practice, process and integrate all the new skills they are learning.

From Rona Silverstein, an occupational therapist in the northwest suburbs of Chicago 

DO...
• ...Communicate with the therapist and participate in the sessions if appropriate.
• ...Ask questions of the therapist—we love to discuss and share our perspectives.
• ...Provide us with your perspective on what is going on. You are an expert as you know your child way more than we do.

DON'T... 
• ...Forget the session is about your child. Keep the focus on him, offering encouragement and participating in problem solving.
• ...Ask questions at the end of the session. We may feel rushed and in a time pinch.
• ...Think we know all the answers. We don't! We do have a unique perspective though, so don't hesitate to ask us what we think.

From Becca Jarzynski, a pediatric speech-language pathologist in Eau Claire, Wisconsin who blogs at Child Talk 

• Do ask questions! Sometimes we therapists get in our own heads and forget to explain things well. That’s our fault, not yours! Never feel like a question is to simple or to silly. It’s your right as a parent to understand what we are talking about. Make us slow down. Ask as many questions as you want and don’t stop asking until you have gotten the answers you deserve.
• Don't hold back on sharing with us. A good therapist will not only get to know your child, but you and your family as well. Tell us what you love to do each day. Tell us the struggles you face. Tell us the successes you’ve had. The more we know, the more we can help you integrate what is best for child development into what is best for your family.
• Do take our suggestions with a grain of salt. We are probably going to give you too much to do—we're therapists, it’s what we do. Although we have the best of intentions, sometimes we worry too much about the child and too little about the family. Give yourself permission to ignore us sometimes. Tell us if what we are asking you to do isn’t reasonable. Remember that no matter how important therapy is (and it is important), it must be balanced with maintaining a healthy family, full of love. Trust yourself to find that balance.

From Joleen R. Fernald, a pediatric speech-language pathologist in Dover, New Hampshire 

DO...
• ...Be punctual to your appointments. I know you have so much going on in your life, but we have lots to get done in a short period of time!
• ...Tell me when homework is too much. I recall early in my career when I would remind families to read at least 30 minutes per day with their child. Then I had children of my own. I suggest 5 to 10 minutes now!
• ...Try out any exercises with me present so we can make sure you feel comfortable doing them.
• ...Understand that you, the parent, are far more knowledgeable about your child than I do; however, also understand that I am the expert in speech and language and together we make a wicked awesome team!

DON'T... 
• ...Act as if you understand what I am explaining when you really do not. I don't mind explaining; please ask.
• ...Respond for your child. Let him work it out for himself so he can learn.
• ...Tell me you practiced your homework every day when in reality, you practiced on the way up the stairs to see me.
• ...Forget to update insurance information or paperwork. This can be very expensive for you and a pain in the neck for me. I'd rather spend my time working with you and your child than chasing down insurance reimbursement.

From Karen Head and Meghan Graham, speech-language pathologists, and Jill Perry, a pediatric occupational therapist; based in Boston, they're the founders of All 4 My Child, a site about collaborative tools and technologies 

• Do explain your family culture and routines to your therapist.
• Don't feel that you need to be a therapist—"mom" is the most important role you play.
• Do share those special little moments of progress (or just adorableness) with your therapist. We treasure them.

Therapy and special needs: 11 ways to have a good relationship with your child's therapist

1. When your therapist walks in the door, do not say "So glad you're here! Gotta go get a smoothie/a new pair of shoes/a life, see you in forty five minutes!"

2. Have an annual or biannual Child State of the Union, a conference call between you and all of the therapists—speech, occupational, physical, the whole gang. They'll each work better knowing what the other person is up to. (Note, your shrink does not have to participate in this call.)

3. You know it's true: Therapy takes three people—the therapist, your child and you. Therapy sessions in and of themselves do not produce miracles, but combined with the exercises and tactics you put into use, they can.

4. That said, if you're feeling overwhelmed by all the stuff you've been asked to do with your child, say so. Better that than pretend you have actually done it all. Not that any parent would ever do that. Noooooooooooooo, not us.

5. If you're not convinced that a particular tactic is effective, be open about your concerns—but be open-minded to the way the therapist works, too. Out-of-the-box approaches can go a long way for our kids.

6. Word, it is best not to request things like "Could you show him how to prepare a four-course meal?" and "Do you think you could teach him how to hold a vacuum?"

7. Keep a notebook where your therapist can jot down progress notes, a helpful record for both of you (and a must for working moms). Refrain from drawing little hearts or sad faces next to her notes.

8. Also: Do not kiss her—or him—on the lips when your child does something incredible, although it is OK to squeal and/or do cartwheels.

9. Once in awhile, show the therapists print or online special needs equipment catalogs and see if there is anything they recommend or would like to try. So many of them spend their own money on stuff; it's nice to pitch in, and it's a good way to find cool stuff that'll work for your child.

10. If you capture your child's first steps or first words in a photo or a video, or your child finally grasps a crayon and colors a picture, share it with the therapists. Way to make them proud!

11. Patience! Yes, it's so hard to have because you so want your child to walk, to talk, to use his hands, to do. He will, hopefully, but on his own timeline. No amount of effort, by the therapists or by you, can make a child with disabilities do things sooner than he is ready to. And when he wows you? You should probably still refrain from kissing the therapist on the lips.

OK, parents and therapists, got something to add?

Dealing with therapy guilt

Rebecca's comment on yesterday's post about a "Therapy Mom" bumper sticker still makes me smile. Sometimes, I feel like such an expert in therapy techniques I could be a therapist myself. One mom who used to live near us got so fed up with the lack of quality speech therapists in our area, she went to school and trained to be one. I don't know why, but good speech therapists are always the hardest kind to find.

Several of you talked about feeling guilty for not getting enough therapy and not doing enough. I've been there, felt that. But here's the thing: therapy is great, yet there's so much beneficial stuff you can do for your kids throughout the day. And it doesn't have to involve doing therapeutic exercises or moves or anything therapists "told" you to do. I loved what Cathy said: "I feel like every thing I do for my little guy is therapy. Even playing games every night to work on counting, letters, concepts, etc." And Tiffany: "We sure do a lot of 'incorporating it into every day life so it doesn't seem like therapy' and a lot of 'family life fun' therapy!

It's so true. Playfully bicycling a child's legs as you change his diaper, tossing pennies into the fountain at the mall, just sitting on the porch and singing with a kid—it's all beneficial to their bodies and brains. Worrying about whether a child is getting enough formal therapy only makes you anxiety-ridden, which is not good for you or your child. Which brings me to the excellent question Janet asked: "Where do you draw the line between being a therapy-mom and letting your child just be a kid?"

When kids are this young, they don't think of therapy as "therapy." Besides, a good therapist makes sessions fun and engaging. It shouldn't seem like a chore. When Max first started going to school, I was talking with his speech therapist and she told me that the way she would get him to focus was to say, "Max, we have to work now, and then we can play after." I asked her to quit saying that, because I didn't ever want Max to think of therapy as "work." It's like when you tell kids "Eat your vegetables and you can have dessert," they learn to think of veggies as the devil and dessert as the reward.

Max has a lifetime of therapy ahead of him. One of these years, he may realize it's therapy but for now, it's still fun. And while I get him a fair amount of it—especially speech—I also take heart in knowing that playing with him and goofing around and exposing him to new places and generally loving him up are all helping him come along.

P.S. If you haven't entered the giveaway to win one of Melanie's awesome crowns/capes, go to it! She's an awesome special-needs mama.

Photo of Praying Hands sculpture at Oral Roberts University, Tulsa, Oklahoma/mulmatsherm