Why do children refuse to participate in therapy?

I think it's really valuable when professionals and parents make a shift in their thinking where the question changes from "Why won't my child participate in therapy" to "What do I need to do to change the environment so the child wants to learn?"  The responsibility for teaching any skill then becomes the responsibility of the professional and realistically, it's the only position to hold that gives us any power in the teaching situation.  Whenever one of my therapists has difficulty, we look at the following:1) Are we using powerful enough reinforcers.  Without motivation, we have no reinforcers and without reinforcers, we aren't teaching.  We need to find lots and lots of things that the child enjoys and deliver them contingent upon the types of responses we want.2) Are we reinforcing frequently enough?  For some children, we need to start by reinforcing every attempt they make at performing the skill we're teaching.  Maybe we're just reinforcing the movement of the lips toward the target vowel or even placing the tongue in the correct place to make a target sound.  As the skills become easier for the child, we reinforce less frequently to strengthen the target skill.3) Are the skills we're teaching possible for the child?  This is often a big problem for children with apraxia as frequent failure at their attempts results in them wanting to avoid the teaching situation.  For example, we might be asking a child to imitate an entire word and they just don't have the motor planning skills for that.  Instead, we could start with a movement, a vowel, or a single syllable...Whatever the child can produce successfully then teach the combined movements gradually.4) Are we using effective prompting methods?  Different children do better with different prompting methods.  Some do better with visual prompts such as hand signals or picutres.  Other's do better with tactile prompts such as PROMPT.  We need to work with each individual child to know which prompting strategy works best for that child.The most important thing to remember that if a child is attempting to escape or avoid any teaching situation, it's the teaching (NOT the teacher but the variables involved in the teaching situation), and not the child, that's the problem.Tracy Vail

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