I remember the exact moment my stomach sank. We had barely finished the intake, yet the coordinator was already suggesting a high number of weekly hours. It felt fast. It felt canned. I wanted help for my kids, not a preset package that fit a billing system.
Here are the first signs that told me something was off. If you see them, pause and ask hard questions.
- Hours decided before goals. The schedule came first. Your child’s needs should come first.
- Compliance over communication. Targets focused on “sitting” and “quiet hands,” not regulation or language.
- You cannot observe. I was discouraged from watching. Family coaching was minimal or missing.
- Technicians run most sessions. The supervisor rarely met my child in real life settings.
- Distress is treated like defiance. Meltdowns were logged as “attention.” Sensory needs were ignored.
- The answer is always more hours. Struggles led to longer blocks, not different methods.
If your child has trouble staying focused in therapy, the solution should not be more table time. Ask for movement breaks and sensory tools. If your child scripts or uses AAC, they should not be pushed to perform on demand. Honor how your child communicates.
Coverage is not care. If your child leaves sessions depleted, that is data.
Insurance steered us here fast. ABA was simple to authorize. OT, speech, and feeding therapy were delayed or capped. That bias shaped the recommendation more than our children’s needs. I wish someone had told me to slow down and build a plan that fit my kids, not a spreadsheet.
What helped us pivot:
Ask for evaluations in writing. Request OT for sensory and daily living. Request speech for communication and AAC. Add feeding therapy if mealtimes are hard.
Set family-valued goals. Dressing, safer play, asking for help, tolerating hair washing. Not just “sits for 10 minutes.”
Run a short trial. Four to eight weeks. Track sleep, meltdowns, appetite, and willingness to join. If home life gets harder, change course.
Insist on transparency. Observe sessions. Ask who is with your child and how often supervision happens. Require a plan for generalizing skills to home and school.
Appeal insurance limits. Ask for letters of medical necessity. Request concurrent authorizations for OT and speech. Your pediatrician can support this in writing.
It can feel overwhelming. You are not alone. You are allowed to pause, to say “this does not feel right,” and to try what actually helps your child feel safe, understood, and able to participate in daily life. Trust your gut. It is a valid data point.
