#320 Dealing with Avoidance and Escape During Therapy Sessions


In this podcast, we’ll discusses a common problem therapists face… little friends who try to run away when you’re supposed to be teaching them something!!

I’ll be talking with a therapist who is currently facing this situation with one of her clients. Listen in as we walk through the problem solving process!

Important points to consider…

What’s at the root of escape/avoidance? It’s always some version of…”I don’t want to do what you’re trying to make me do? We have to help a child find ways to stay by looking at:

  • his activity and interest preferences – “What does he like to do?”
  • his strengths and weaknesses – “What’s making this so hard for him?” “What might make it easier?”
  • any other red flags that may help us understand what’s going on – “Are there underlying issues or a diagnosis that explain this difficulty?”
  • what are our expectations – “Is this goal too hard?” “Should I back up?”
  • what’s the history of this issue – “Does he routinely try to get away or escape when things are hard or is this a new problem?” “How does his family normally react when this happens?” “What things have worked or not worked?”

Put it all together to come up with ideas that may work better to help him during sessions. For this kid, based on what his therapist said, we talked about the following ideas:

  1. Move therapy outside and build interaction there first since this is his best environment. Continue your super ideas of helping mom find ways to make this play more interactive – waiting for eye contact, “playful obstruction” so that he has a reason to include you, and giving him a “word” to express his intentions like “go.”
  2. Try social games involving physical movement where he remains in control since he seems to want to stop movement activities when he’s off the ground (likely sensory responses). Since he likes leading other people, try Ring Around the Rosies, Ride a Little Horsie, Row Your Boat, all games that involve holding hands. Mom is the best person to be his play partner during these routines since she will be his play partner all week when therapy is over! (Every therapist should have 10 to 15 go-to social games to use in sessions. A fantastic resource for this is Teach Me To Play WITH You.)
  3. Include his individual activity preferences – watching TV and playing in the truck. (We discussed specific ways to do this on the show.) Build-in these activities since they are motivating and are a “reward” for participating and communicating.
  4. Think about introducing food! Many toddlers respond well to food and the reward is built in!
  5. Work on play skills beginning with deconstruction and other structured teaching ideas. Click the links for videos to explain these strategies.
  6. Consider the Picture Exchange Communication System since he needs another way to communicate and isn’t a good candidate for signs yet. Get the manual and stick to the “rules” as closely as you can rather than coming up with another way to use pictures. It sounds like he needs a systematic introduction to use pictures and this is the best method out there!

**If you’d like to learn how to implement these therapy approaches, most of them are included in part 2 of my course “Is It Autism?”  You’ll see lots of video clips with kids in therapy sessions so that you can see how to introduce these strategies.

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