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  • Writer's pictureLaura Deer, M.S. CCC/SLP, CAS

Follow my lead...

You might be wondering what is the difference between child-directed therapy and clinician-directed therapy. Also…which approach is best for your child? Is it possible to use both approaches during a single therapy session?

What is the difference between child directed and adult directed therapy?

Child directed therapy is where the therapist or family member follows the child’s lead. If the child shows interest in the balls then the clinician/family member directs his/her attention to the balls. The adult talks about what the child is focused on and shows interest in. Typically, this model has less structure and follows the child’s attention and direction.

Clinician (or adult) directed therapy is where the adult directs the course of therapy or interaction with the child. This model typically puts more direct demands on the child, is more structured and is within a controlled environment such as at a table. Picture schedules and reinforcement charts are often used to help keep the child motivated. The clinician decides on the activities but can provide the child with choices.

How do I know which approach is best for my child?

Directly after graduate school I probably would have answered this question simply: You use child-directed therapy for the early intervention population (birth to 3 years) and you use a adult-directed approach for school-aged children. I might have even explained that young children typically don’t follow adult directions, so using child-directed makes more sense. With the school-aged population, we expect children to follow a routine and adult given directions within the school setting, so it makes sense using more of an adult-directed therapy model.

After taking Neuro-Linguistic Programming Training (NLP Training), my answer is slightly more insightful and isn’t really defined by age. First of all, NLP isn’t a typical training that speech language pathologists do. A life coach friend of mine recommended this training and I was intrigued. The training covered a lot, but one portion covered the concept of gaining rapport.

NLP pretty much explained that rapport was built upon imitation. When we like someone, we subconsciously end up imitating them. You might notice this through some direct things like imitating someone’s fashion sense or imitating things they say. Other more subtle behaviors can be imitating body posture or even taking a drink of water soon after someone else does it.

When we imitate children we are gaining rapport with them. We are also teaching them how to imitate and when we see them imitate us we know they are interested in our actions and we are gaining rapport. Children might imitate our play, our actions and our sounds. Encourage and praise this development. As they learn to follow our lead more and more then we can take more control over therapy activities and guide them into more structured learning. Some therapy sessions might encompass both therapy strategies as the child transitions into a more adult-directed model.

For children with autism and other special needs, the Son-Rise program uses this principal of joining a child in their activities instead of going against them. Then as the child gains rapport with the therapist they begin to follow their lead more and more. You can learn more about the Son-Rise program by going to:

Using an adult-directed model too soon might not feel natural to the child. When you fore something there is resistance. The child might resist the learning process by avoiding direction or they might resist through a full-blown tantrum. When they know it is time to learn they might shut down vs being open to new information coming in.

If you don’t use an adult-directed model soon enough then you might miss out on multiple learning opportunities. Once a child is ready for an adult-directed model they can be taught more information in a short amount of time. They can learn through drill practice and structured learning which may help acquire skills at a faster pace.

For all children, it is important to know they are learning from a place of motivation and interest. First you might need to go into their world to join in on what makes them motivated. As they see you are with them in their space of interest then they will follow you into your world as well. Before you know it, your child will be motivated by following your lead as you teach them new and exciting things.

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