Can a Child be “Too Old” For Therapy?

Is it too late? Is it possible to make any progress at this point? Can things still get better?

We hear these questions quite a bit in pediatric therapy. Parents are often shocked to hear that we work with children well into their teens. In fact, in our world, the concept of “old” is relative. (Although I did recently have a child ask if I was eighty years old the other day, which is beside the point, but still…ouch.)

To put this in perspective, I once had a referral for an 11 year old with handwriting difficulties. His parents reported that they wanted to work on the issue while he was “still young.” Sure, in terms of life, 11 years is obviously young, but to a therapist, in reference to letter formation? An 11 year old is already pretty old!

With this scenario in mind, I wanted to discuss what it means to have an “older” child in therapy.

Yes, change is almost always possible!

We operate under the idea of neuroplasticity – or the idea that the brain can change. You might have heard of more recent research that states the brain doesn’t even fully develop until around age 25. So basically, there’s always room to grow. The more important question is – how much work will it take, and how much is a family and child willing to follow through? Listen, it’s not impossible, it just gets more difficult sometimes. Why? Well, see below:

Re-learning an old habit is more difficult than creating the right one from the start.

Things might be easier when a child is younger because we can implement strategies before habits are made and before we’re working against something already in place. You’ll have to admit, it does seem a bit easier to learn something brand new, rather than learn it, practice it, memorize it, and then re-learn it a completely different way.

That 11 year old handwriting referral is a perfect example. He has had plenty of time since pre-school to develop bad habits and ingrain inefficient writing patterns. Re-learning letter formations would take time and tons of repetition to become automatic again.

The same goes for parents. If you are learning behavioral strategies, or understanding something like sensory processing issues for the first time, it will take a bit to get used to your new frame of reference and how you interact with your child.

Participation and age might be inversely proportional.

This isn’t always true. I have plenty of older children that LOVE coming to therapy. But it’s important to keep in mind that as a child gets older, they have more say in their day to day lives. If they aren’t willing to participate, or aren’t interested in making changes, progress might be limited.

I have actually met teenagers who are gung-ho about changing their handwriting. One in particular worked EVERY day on practice to change letter formations, and honestly, the results were amazing. However, if you are pulling teeth to even get a few practice trials, then you likely aren’t going to see much change.

This is also true of sensory processing skills. If an older child doesn’t want to participate, or doesn’t buy into the idea, they aren’t going to get the same benefits as a young child that is excited to engage in therapeutic activities.

Other barriers might be more important than age.

A few of the biggest factors that influence progress are things like follow through of home programming, consistent attendance in therapy, active participation in sessions, and of course, diagnosis and medical history. These factors can be so much more important than an arbitrary age.

The focus of therapy might change with age.

As a child gets older, the focus of therapy might switch from habilitative to adaptive. What does that mean? Basically, if you can’t fully make changes in a certain area, there are ways to adapt situations to make them easier. For example, maybe a child needs to write on larger lined paper or use highlighted areas for writing. Maybe instead of changing their pencil grasp, you find an adaptive writing utensil. Maybe instead of telling time, you use a picture schedule. There are SO many ways to make positive changes in a child’s life; the difficult task is knowing when to push forward, and when to adapt.


About TheAnonymousOT

Pediatric Occupational Therapist
This entry was posted in Occupational Therapy, Therapy Process and tagged , , , , , . Bookmark the permalink.

One Response to Can a Child be “Too Old” For Therapy?

  1. stimtheline says:

    I didn’t start OT until I was 28! You’re spot on with the adaptive therapy thing, my occupational therapist and I spend a lot of time trying new ways to make old issues easier. For instance, I just got a new silicone toothbrush that I’m very hopeful about! I hope your post helps people realize that anyone who needs it can benefit from OT.


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