WDYD when they refuse to cooperate with therapy?

macchiatto · December 2014

When X was little (3ish), there were plenty of times with PT and OT when he would be silly or uncooperative. Those therapists let him pick a little treat at the end of the session if he did a good job and they found that if they either said he wouldn't get a treat or that they'd have to send Mom out of the room if he didn't cooperate, that he would straighten up.

Now he's about to turn 6 and is working with a new in-home PT and a couple other therapists. PT has always been the one he's most resistant in b/c he has hypotonia, mild SPD and just doesn't enjoy moving around or challenging himself physically all that much. I think he feels like he might not be successful so he can't be bothered to try. It doesn't help now that he has therapy 2 days/week (just moved down from 3) right after full-day Kindergarten. His motivation seemed to be improving recently though; he told his PT that he wanted to get stronger and he wanted her to help him get stronger and be able to do things other kids his age can do. (He recently scored at 45m on his re-eval; he is 71m old.)

Today he told his PT that he wanted her to pack her bags and leave and refused to work with her anymore. She is very experienced and good with him and she tried to talk through it with him and gave him chances to change his mind but he was basically just telling her to leave, that he didn't want to work anymore, and not taking it seriously. For context, he's been doing very well in Kindergarten and takes great pride in coming home on "green" every day but cooperation with PT is very hit or miss. How do/would you handle this?

hopecounts · December 2014

Can they use a first/then approach to try and get him back on board?

First he does X then he can do Y (a preferred activity/access to a preferred item)

then cycle through as needed to get him through what he needs to do.

At DD's school during table time she gets 1.5 minute access to a preferred something (toy/iPad access/fiddle toys) then they work for 5. rinse and repeat with working on extending the work section and decreasing the play section as appropriate to get her up to 'normal' attention to work with minimal reinforcers needed.

bumpuser511563 · December 2014

A good therapist would actually keep trying until times up. They would also have a plan b or plan c if the other plans didn't work.

I liked what hopecounts said because that was what worked for DS.

I did have the experience of our private COTA cutting 4 sessions. Not fun.

There was one instance the school ST called it quits on one session because DS didn't want to work. This instance irritated me more. It was a one time occurrence.

macchiatto · December 2014

Thanks so much for the responses. You all are very helpful.

@auntie, revisiting the talk is a good idea and thank you for the specific suggestions. I do feel like he's taken ownership of his hypotonia but it's definitely worth revisiting now that he's had some time to process the idea. His PT was doing some of that in the session. During his re-eval recently she actually talked through the report with him instead of just with me, which was a first for him, and she's talked to him about what *his* goals are, why they're working on the things they're working on, etc. and he seemed to respond well to that.

I had to go in the other room with my other son for a minute to help him out (PT goes better if he's occupied in another room, so screen time it is!) so I missed when X first told the therapist to pack her bags and leave and what her initial response was. I think she has said something to him before along the lines of, "If you're not going to cooperate, then I may as well pack up and leave" (not in a huffy way but in a matter-of-fact way).

@bubba2b She has also negotiated with him breaks, or a first/then, If you do these goals, then I'll read a story to you for 3 minutes, etc. She incorporates animals and his beloved stuffed lion into the session to help motivate him and also talks to him about big-picture reasons why they're doing what they're doing.

X is a tricky kid in some ways. He's very sweet and conscientious but he also gets in these moods where he just doesn't care. This happens when we're trying to get him to get ready for school, or clean up his toys, or in therapy sessions, etc. He'll either be kind of in his own world, or laughing impishly about being defiant, and he doesn't really care about rewards, consequences, etc ... unless you gradually up the stakes and suddenly it's like a switch flips and he cares so much that he gets hysterical and starts sobbing and falls apart. Sometimes it's hard to find a happy medium with him.

Oh and @McRib, therapy timing is not ideal but there's nothing we can do about it.

He didn't qualify for an IEP so therapies are after school. He's gone from 7:40 a.m. to 3 p.m. for Kindergarten (I pick them up from school on therapy days so he's home earlier) and therapies are from 3:30-4:30 on Weds and Thurs now, so he has 30 mins for snack/down time before his therapist arrives.

macchiatto · December 2014

We revisited the talk this morning and he had PT right after lunch today (rescheduled because of the holiday). X did fantastic; 100% cooperation and was very excited about "being on green" for therapy and getting a sticker for his chart, and I think he has a better understanding now that while Ms. Liz can help him with his goal of getting stronger, that he's the only one who can do the work and make it happen.

WDYD when they refuse to cooperate with therapy?

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