You call Rordan’s mother for your monthly contact to check on services and ask her how things are going. She sheepishly tells you that Rordan has made little progress with his crawling and that she doesn’t think he likes physical therapy much. When you ask why she thinks he doesn’t like it, she tells you that he cries during every visit and that he’s even started crying when he sees the PT walk in the door. She’s not sure what to do and she wonders if other children find therapy to be so hard.
Intervention Shouldn’t Make Children Cry
I don’t think early intervention should be so difficult or miserable for a child that he cries each time. A little fussing now and then isn’t necessarily a bad thing, especially when, for example, the child doesn’t get his way and is pushed a bit out of his comfort zone. Think of the toddler who hasn’t had to make any sounds to get what he wanted now being expected to use a sound to get his cup – not always a happy camper at first but this passes when he learns that sounds get him what he wants. However, this is very different from a child who finds intervention to be so challenging that he cries each time the provider comes to the door.
Important Questions to Consider
Clearly, there’s a need to find out what is happening during the early intervention visit. These questions might be important:
Who is doing what during the visit? – Find out who is interacting with the child during the session and what that person may be doing (or not doing) that is so upsetting to the child.
Why does the parent think the session is such a challenge? What would she/he like to see happening differently? – It can be easy to “blame” the child for not cooperating but the problem usually lies with the adults. Ask the parent for insights.
What does the therapist think is happening during the visit? – Gathering information from everyone involved is always important. This is probably a very challenging visit for the therapist too.
What is the purpose and structure of each visit? – If the purpose of the visit is for the child to “get through” the therapy session and the visit is structured by the PT stretching the child, then you’d need to question how appropriate this is to the mission of early intervention. (PDF, New Window)
Is this a good match between the service provider and the family? – Sometimes it’s just not a good match and that’s okay. Many families won’t ask for a change of service provider because they don’t want to hurt the provider’s feelings so the service coordinator can offer this option to see if it is what’s needed.
Could there be a medical issue that is impacting intervention? – A good question for the entire team, including the pediatrician. I collaborated with a family years ago who had a child who cried often during visits. Eventually she was so fussy that they took her to the ER and she was found to have undiagnosed hydrocephalus. I’ve also seen this with another child with multiple disabilities who had dislocated hips and required very specialized handling.
So if you were Rordan’s service coordinator, what would you do? How would you get these questions answered?
Would you schedule to join and observe the next intervention visit?
Would you schedule an IFSP meeting with the parent and PT present to discuss these challenges?
Would you change providers right away?
What would you do?
If you were Rordan’s therapist, what suggestions would you have?
Share your ideas for this situation in the comments below!