Starting Therapy in a Low Demand Way

autism practical tips reader question Apr 03, 2023


“My child is about to start occupational therapy. How can we do this in a low-demand way?"


When I am getting ready for a new thing, I start with being a demand detective for that thing itself- not with my kid. I ask so many questions that the person on the other end of the phone starts to laugh. I have been told countless times, “No one has ever asked me that before.” I ask about the waiting room, all the steps of any evaluations. I ask about other children and conversations among adults. Many OT sessions will do a parent report at the end of the session, so I ask about that. My goal is to find out what the standard protocol is and to determine how flexible they can be.

Every situation is filled with demands. My goal isn’t to eliminate them all. It is to find out which demands are going to be too hard for my particular kid, and then to proactively make a plan for how we are going to drop those demands in ways that accommodate my child’s unique needs.

Am I being “a pain”? Asking for too much? I don’t think so. Their goal is to connect with my child and serve their needs. I am helping them onto the fast track fro success by creating an environment of safety for my child so they can connect, learn, and hopefully thrive.


A this point, I’ve had at least one long conversation with the therapist or the front desk, and I’m getting an evolving sense of the place’s culture. Are they eager to work with us, sharing stories of similar children, and asking me curious questions? Are they guarded and weary, making me feel guilty for my questions?

Do I feel safe?

Can I picture my child in this space as they are, not only on their best behavior, but their worst too?

If not, don’t be afraid to walk away.


With all of this information, gently float the idea with your child. “There’s a grow-up called Nicole who has a huge gym full of swings and slides and places to jump…” (Trail off and see how this information settles in.) “If you wanted to go check it out and see if it’s a good place for you to play, you could. They aren’t open today, but I can schedule a time.”

Be prepared that they may shut down completely, have questions, or want to go immediately. This is the struggle, right? The not knowing. The being-prepared-for-all-scenarios.

Listen to your child’s body language. Do they stiffen on particular words? DO they act as though they didn’t hear you at all?

This does not need to be a back and forth conversation, or an in depth conversation. You are allowed to take it slow, take it at your child’s pace. You can bring it up again at a different time, print out pictures of the gym (or whatever part you think your child will love), you can watch a video while they are nearby and see if they wander over curious. Try “strewing” information about this place and this person.


Ask yourself, What does my child actually feel comfortable with? (And remember: this is your real child, as they are today, not the fantasy kiddo you sometimes imagine.) If they only feel comfortable with the idea of talking about this with you, or looking at a video, stay there. Do not push or extend it. Is the idea of meeting this person on the computer and having them watching while they play video games in their comfort zone? Are they okay to play in the gym but cannot handle the presence of any other kids?

Staying firmly and clearly within your child’s comfort zone communicates safety, which enables them to tolerate the newness, the challenge, and the internal demands of excitement, fear, and anticipation.

Many therapies use the “stretch just beyond” mentality: finding the comfort zone and then adding one more thing to it, to show that they can tolerate the discomfort. This is a place for advocacy. You would rather remain clearly within their comfort zone. You are thinking about how to help them come back week after week, not just attend once.


Do your own work to show up ready to set your current plan aside with signs of stress.

Reiterate that they have plenty of control over this: “This sin’t to please me. I am happy either way.” Make sure this is actually true, or they will sense your ambiguity, and trust will decrease. If they say, “I don’t want to go!” then drop it fully. Don’t bring it up four times. You can ask once, “Okay, so I’m hearing that it’s a no-go today?” And then let it go.


Start with the therapy office and ask more questions than you thought possible.

Float the idea with your child, and go slowly.

Give your child true control.

Do your own work to know your deep why, which will enable you to drop what needs to be dropped.

Not now does not mean never.


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