When to be concerned

What if my child is resisting therapy?

Ideas to move forward

When should I be concerned about my child’s progress?

Here are some general guidelines to help you know when and if you should be concerned with your child’s progress. Of course, you know your child best, so if your child is not progressing in the same manner as they have in the past, that might warrant concern.

Mild CAS

You can generally expect to see progress with speech, in some form, at every therapy session for a child with mild CAS. Keep in mind that if your child is working on language goals, you may not see progress on language goals every session. For more information about language, see the page "Building Your Child's Language" at the bottom of this page.

Moderate CAS

You can generally expect to see progress with your child's speech skills on a weekly basis if your child is attending therapy two or more times per week. Your child may also be working on other goals, such as AAC (augmentative and alternative communication) or language, that may progress at a faster or slower rate.

Severe CAS

You can generally expect to see progress with your child's speech skills on a monthly basis if your child is attending therapy two or more times per week. Your child may also be working on other goals, such as AAC and language, that may progress at a faster or slower rate than speech skills.

What if my child is resisting therapy or refusing to participate?

Everyone, including children, has bad days when they do not want to do activities that are hard for them. For children with CAS, this includes speech therapy. However, if you are noticing a trend, it might be time to take a closer look at why your child is resisting therapy. 

It's too hard

The goals your child is targeting in therapy need to be in the "sweet spot" or zone of proximal development. This means that the goals are challenging but attainable with help from the speech-language pathologist (SLP). This is called scaffolding (when the SLP provides the assistance needed to your child for them to attain a new goal the child can not do on their own). If your child is not succeeding at the goal even with the SLP's help, or success takes too much effort, the goal might be too hard or need to be divided into smaller sub-goals.

Your child is too tired

Many children with CAS are not only working hard in speech therapy, but also have other challenges at school or other therapies, like physical therapy (PT) and occupational therapy (OT). Sometimes there are too many demands and your child is too tired to work hard at speech. If this is the case, closely examine your child's activities and prioritize. Remember, having down time (i.e. time to play and be a kid) is vital for children. Schedule this time in, too!

Lack of trust

It is essential that your child has rapport with the SLP. This means that the child trusts the SLP to help them do things they can't do on their own, such as say new words/phrases. Trust/rapport has to be established between your child and the SLP at the beginning of their therapy relationship. It also has to be maintained. This means that there may be times, especially at the beginning of therapy, when the SLP will design activities specifically to work on building trust with your child. The activities will vary depending on your child, but often involve having fun with decreased demands for speech, like not asking your child to say new or challenging words. If your child does not trust the SLP or the trust has been damaged or eroded, it must be re-established.
Note that it is also important for you as the parent to trust the SLP. Building trust looks different for your relationship with the SLP but is also imperative. Children take cues from their parents as to whether or not to trust others. If you do not trust the SLP, your child is not likely to, either.

Personality conflict

Just as in any relationship, sometimes there is a personality conflict between your child and the SLP or perhaps you and the SLP, which your child may pick up on. While your child's SLP can make certain adjustments to his/her interaction style with your child, such as being more or less "excited" during sessions, there are other aspects of personality that can not be changed. If this is the case, the SLP may not be a good fit for your child and it would be worthwhile to seek out a different SLP.

Ideas to move forward


Meet with your team to brainstorm ideas. See the "Taking a Team Approach" page (link at the bottom of this page) for more information about gathering a team to support your child. Remember that you as the parent or caregiver are a key member of your child's team! You know your child best and can provide key information that might help the SLP better understand what is hindering your child's progress. Have a trusting relationship means keeping lines of communication open to address concerns from either you or the SLP to keep things moving forward.

Talk with your child

If your child is old enough, talk with them about how things are going and what is particularly hard for them.

Identify the challenge

If possible, try to identify what it is about your child's current goals or therapy that is causing difficulty.

Change it up

Don't be afraid to try something different! This might mean a schedule change, different rewards for progress, new activities. Sometimes a small but novel change can get a child moving again.

Consult with another professional

You may need a consultation with a specialist or perhaps even a professional in a different area to help your child progress. For example, children with attention issues may need to be seen by a psychologist or psychiatrist.

Re-evaluate services

Your child's needs will change over time. The combination of services and therapy providers that worked great at one point may no longer be the best fit. Take a step back to evaluate all of your child's services and the providers. Sometimes, there's too much on your child's plate at once for them to make progress; sometimes they need more therapy. Think about frequency of services (need to be increased or decreased?), the approach(es) being used, and the therapists.

Take a break

Children with CAS work hard in therapy and sometimes they just need a break to rest and recharge. Therapy "burnout" happens. Don't be afraid to take some time off. If your child receives private therapy, holidays and breaks from school can be a natural time for a break. Discuss with your therapist(s) the appropriate amount of time for a break.

Tips for Taking a Team Approach

Learn More

Building Your Child’s Language

Learn More

How To Help Your Child

Learn More