Off to Preschool? Or off to Therapy?

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 Here is a scenario I encounter on a regular basis with the clients I serve:
After receiving a diagnosis of ASD the parents receive a list of recommendations about what to do next. Things like speech therapy, occupational therapy, special needs school settings, and early intervention/ABA therapy are almost always on that list.

Invariably, there is a small problem. Due to the intensive nature of ABA therapy (especially if its provided in an early intervention context) the parent soon realizes they have to make a choice. Should the child be enrolled in a local preschool? Or should the child receive several hours of therapy per day? Which one is “best”?

I see so many parents facing this dilemma, without the needed information to make a decision. Obviously no matter what they choose there will be pros and cons, but I like to help people make informed decisions as much as possible. So if you were my client, what follows is what I would typically say:

  1. Is it really Either/Or? – I have worked with families who were able to enroll their child into a part time preschool setting, which allowed for plenty of time each week for therapy. I have also seen many scenarios where the preschool/daycare allowed the therapists to enter the classroom, to fully maximize therapy hours. So before moving straight to making a choice, find out if a compromise is possible.
  2. Pros of preschool/daycare option- The main benefit of placing a child with a developmental delay in a setting with their peers, is socio-emotional development. The child is learning to socialize with peers, seeing how typically developing children play/talk/behave, and learning to receive instruction from adults other than mom and dad. For many of my clients, the daycare/preschool setting is also their first experience with following a schedule/having routine in their day. However, the biggest issue I see is the appropriateness of the preschool setting. If the setting is not conducive to catching the child up developmentally, then it’s pretty similar to just sticking a plant in a room full of toddlers. 
  3. Pros of intensive therapy option- The main benefit of pursuing intensive therapy  is overall development and skill acquisition. Pursuing a rigorous therapy schedule means that the core deficits the child is exhibiting will be clinically evaluated and treated, as well as reducing or replacing problem behaviors that impede learning. Also, part of intensive therapy is parent training, which is priceless for most families. Having a team of professionals help you learn how to better engage, teach, or correct the behavior of your child can be life- changing. However, working with a therapist 1:1 cannot compare with the social opportunities provided in a classroom. While social opportunities can be embedded into treatment, often it’s not as varied or frequent as what the child would get at school. Add to that, many of my clients just feel very strongly that they want their child to have the same option of a school experience as any other child.

Clearly, this isn’t a decision to make lightly. 
With different clients, I give different recommendations about which option would be “best”. There is no way to make a blanket statement about what all young children with Autism need the most, as far as treatment.

Making this decision should involve the child’s treatment team, include observation of the classroom the child would be placed in, as well as careful review of the yearly learning objectives for that classroom. 

By the end of the year, what skills will the child have gained? How will skills be taught? Does the classroom teacher have experience/training on ASD or behavior management? What is the school policy on addressing challenging behavior? These are just a few examples of the kind of questions the preschool/daycare should be able to answer.

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