Autistic Student Won't Engage in Therapy? What to Try
When an autistic student won't engage in therapy, that's data. Learn how to invite before you expect and stay child-led while still working on your goals.
You walk in with a plan for the session. Your student turns their back, walks away from everything you offer, or says no the moment anything feels like an expectation.
You want to honor that. You also have goals to work on, because you're a therapist or a teacher, and both of those things are true at once.
When an autistic student won't engage in therapy, the thing you're asking is often not the barrier. The way you're asking is. Start with an invitation instead of an expectation: let the student watch first, join later, or regulate first, and treat the "no" as information about what's getting in the way. Modeling, visual supports, and video modeling all appear on the 2020 list of 28 evidence-based practices for autistic learners from the National Clearinghouse on Autism Evidence and Practice.
Susan Golubock, an autistic retired occupational therapist and the founder of Making Sense of Autism, and I talked this through on camera. Below: how Susan invites a student to watch, how to tell what's getting in the way, and what to do when a student arrives already overwhelmed.
Get your Free Tool! Invitation Before Expectation guide — https://www.makingsenseofautism.com/invitation
What should I do when an autistic student won't engage in therapy?
Get curious about the barrier before you try anything else, then invite the student to watch. Susan's version is simple: "I have some ideas of what I'd like to do today. Would it be okay if you watch?" She only asks for something the student can actually do, and she asks permission first.
If a student can't sit still, she names it without judgment: "You have a real need to move. Your body's telling you." Then she asks whether their body is ready to sit and watch.
After she's shown the activity, she offers a choice: do you want me to do that again, or would you like a turn? If the answer is "your turn," she takes another turn, as many as the student will sit through.
Why does letting an autistic student watch first work?
Watching gives a student time to process and a picture to plan from. Susan explains that she can't picture what words are asking her to do, but when someone shows her, she can work out a way to get the same result, even if it isn't the way they'd do it.
She points to the same idea in sports: watching skilled players can improve your own game because you store a mental image of what you're aiming for.
It carries over to speech therapy. When we model a sentence or describe an object, we can add a visual by writing it out, adding pictures, or drawing lines for how many words we'll use. The visual supports auditory processing, meaning how the brain makes sense of spoken language, by showing what we're modeling.
How do I still work on goals if my student isn't participating?
Treat non-participation as data about what makes participation hard. The goal of the session isn't compliance. It's understanding what's getting in the way, and once you meet a student's need, they're more likely to meet yours.
Watching and co-regulating still give you something to collect: what the student understands when you offer choices, and whether they self-advocate, verbally or nonverbally. They may surprise you.
Check your wording too. Even "It's time to work" can land as an expectation, so try "This is what I'm going to do, but here are other options if you decide." And knowing something isn't the same as accessing it in the moment, because processing, sensory needs, regulation, attention, and working memory (holding information in mind while you use it) can all widen that gap. If you want a practical place to start, our free Invitation Before Expectation guide walks through it.
Learn more here: Knowing Something Isn't The Same As Accessing It
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