Ask An Expert / Treatment

My 6-year-old son has seen two occupational therapists, and both wanted to stop treatment at six months. What’s going on?

OTs focus on achieving specific goals. Your son's may need to be updated.

Kenneth Schuster, PsyD
Ken Schuster, PsyD

Clinical Neuropsychologist, Learning and Development Center; Director of Clinical Training

Child Mind Institute

My 6-year-old son has been diagnosed with sensory processing disorder, motor incoordination and hypotonia. He has been in therapy (OT) for about a year now.I have observed that therapists do not want to handle the case for over 6 months. By the time the 5th month approaches, they start talking about weaning the child off the therapy. It's happened to us with two therapists in a row. But when I asked a very respected physician how long this therapy should go on, he said, "You are looking at doing this for the next few years."So here is my guess — the law of diminishing returns kicks in, and therapists do not want to continue after the first 6 months, when the progress appears to be declining. Does their work get harder after this timeframe and they do not want to do it? Or is there some other reason? I do not want to keep changing therapists and my child certainly does not want to either. It's not even easy to find good pediatric therapists. Plus, the flow is lost.

The length of time for which a child receives occupational therapy should be very individualized — the time frame has to do with the occupational therapist’s goals and expectations, and the child’s progress. At the outset of therapy, the OT typically makes a plan with very specific goals that are based on information about the child’s struggles. These are derived from the OT’s evaluation and from other professionals’ recommendations (e.g., physician, psychologist, etc.).

The OT sticks to that plan and when the child has made sufficient progress towards reaching his goals, it is usually time for discharge. This is similar to any other kind of therapy. You’re right that seeing the amount of progress decline is normal. Many kids make a lot of progress very quickly and then their progress appears to slow as the goals get more challenging

It is possible that your son has made sufficient progress toward his goals and it is appropriate to discharge him — this is the ultimate expectation of all therapies! But the big question here is: What is sufficient progress? The occupational therapist seems to be saying that he has made enough progress, but you and your physician are seeing a need for more. Here are two approaches you might consider.

First, should his goals be updated? If he’s making good progress but there are still weaknesses then, yes, it makes sense to update his goals. That could be done either by an updated referral from his physician specifying the areas of weakness, or an updated occupational therapy evaluation. Also talk to the OT about what you are seeing at home and how the work in the office is transferring. If there are still gains to be made, then updating goals is a really important part of therapy.

Second, if the OT is considering weaning off therapy to foster independence, another approach to this is making sure that the skills your son is practicing are being transferred into real life. So, instead of just doing therapy in a gym, the occupational therapist can “push” into school, home, or the playground to make sure that your son is building real life skills — not just skills in the gym.