“That Kid” Who Won’t Sit Still: 12 Tips for Making Therapy Work

We’ve all met “That Kid.”  The one who has seemingly endless energy.  The one you have to brace yourself for before he enters the room.  The one who can never, ever seem to sit still for therapy.  What’s a therapist (or parent!) to do?

Before we even begin to talk about how to help active children in therapy, we need to consider some of the things that happen outside of or before the session that might help us better understand how to help “That Kid.”

  1. What happens before the session?  If the child is driving an extended period of time just to reach you, maybe you need to start with a more gross-motor activity, or encourage the parents to arrive fifteen minutes earlier (if possible) to allow the child time to run around, eat a snack, or have some free-play time in the waiting room.

  2. What is happening at home?  If the child is in an environment full of sugary snacks, low parental involvement, and lots of electronic media time, her little brain is not being nurtured in a  way that promotes sustained attention.  It’s time to back up and do some parent counseling.  How can you help support this family to build in some routines at home that will transfer not only to success in therapy, but also to the long-term development of executive function skills?

  3. Be sensory smart.  Does the child have a comfortable chair where his feet are well-grounded?  Is the child cold, tired, hungry, or wet?  Are there distractions (toys, posters, etc.) in the room that are drawing the child’s attention?  Think about how you can make the environment friendly for sensory regulation.

  4. Check your expectations.  Are you being realistic about what can be expected from a child at eighteen months?  Two years?  Grade three?  Sometimes inattention during a session is the simple result of a mismatch between

  5. Call in your team!  While some amount of fidgeting and inattention is normal for children, there are times when a child’s hyperactivity can give you, as the therapist, pause.  Have a firm knowledge of developmentally appropriate behavior, and when you see behaviors that fall outside of these guidelines, don’t hesitate to consult with other professionals (like an occupational therapist or developmental psychologist), who might be able to help you help this child.

  6. Think out of the box.  Plan some out of the box activities, or follow the child’s lead.  You can just as easily administer an articulation test under the table as you can on top of it.  Does it really, really matter if the child sits or stands to participate in an activity?  Sometimes, moving the toy from the table to the floor is all you need to recapture a child’s attention and encourage him to participate.

  7. Adjust your pacing.  As long as the child is transitioning well between activities, it may just be that he’s the kind of kid who likes to do 4-6 activities per session rather than 3-5.  Some children love to get involved in lengthy, multi-step, multi-goal projects.  Others like to be on the move.  It takes more work on the therapist’s part to come up with more activities, but as long as you are able to capture the same clinical and diagnostic information either way, the only thing holding you back is your own flexibility and creativity.

  8. Offer choices and mix it up.  Does it really matter in what order you complete the activities you’ve planned?  Probably not.  Let the child choose what comes next.  It’s a great way to encourage buy-in and attention.  Have a good mix of “active” activities and those that encourage more focused attention and quiet concentration.  That way, you can help the child get out his wiggles while still building in some time to work on developing better attention skills.

  9. Hold on tight!  Sometimes children just need to have something in their hands to keep them occupied, happy, and paying attention.  When you take out the toys, pass one piece off to the child quickly so that he’s immediately a part of the action.

  10. Run errands.  Save your energy during the session and make the child in charge of fetching the next toy.  It’s a good large-motor break between activities and gives him a purpose and motivation to participate in the next thing.  After all, he is the one who brought it to the table!  You can even make “running errands” into a listening exercise by giving the child multi-step directions for how to get the toy (do two jumps and turn around) or where the toy is located (it’s in the second green bin on the middle shelf).

  11. Show your schedule.  Map out the sequence of  events using a whiteboard or picture schedule.  Use a visual timer to help children see how much time is left for each activity.  Give the child information about what to expect to help put some of the control back in her hands.

  12. Make it real life.  Help parents see how to incorporate therapy techniques and language goals into everyday activities with their busy child.  Learning doesn’t only happen in structured work at the table.  Our job is to coach parents to make language, listening, learning, and fun an everyday event.

Working with “That Kid” who is constantly on the move can be a real challenge for therapists.  But honestly, sometimes I think half the challenge is battling the inertia within ourselves that just wishes for the calm, docile child who sits down in the chair at minute one of therapy and doesn’t budge until minute 59.  Comparatively, those kids seem like a breeze!  It’s important to wipe the slate clean before each session and fight our own fatigue to really give each child and each parent 100% of our energy, and to always view each child and family in a favorable light.  Remember that you’re targeting a frustrating behavior, not a frustrating child, and your attitude can make all the difference.

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