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  • Writer's pictureAlley Dezenhouse Kelner

Hokey Pokey Therapy

This is a rant. You’ve been warned.

As a clinician in the field of early intervention, I am often amazed at the myriad of options available to parents of children with special needs. At first glance, your first thought might be...”SWEET! More is always good, right?!”

Unfortunately, this isn’t always the case. For a parent navigating the world of early intervention there are 2 categories of therapies available: evidence based, and non evidence based.

Evidence based means, to simplify to some extent, validated by science and clinical expertise—supported by a vast body of research which is scientifically sound. From a clinician’s perspective, this is the gold standard.

Non evidence based doesn’t mean the therapy doesn’t work, it simply means that scientifically speaking the therapy has not been evaluated by a large enough number of studies, and/or the outcomes have not been conclusive enough to yield a clear analysis. Essentially, the opposite of evidence based.

I think we can all agree on what has been stated so far, it’s a simple matter of definitions. If you’re confused, go here for more details:

Here’s where things get tricky.

I have a bone to pick with practitioners who use their position, which implies knowledge and expertise, to advocate for therapies that aren’t evidence based—without explicitly saying so in their wording.

More and more Colleges and regulatory bodies are emerging in order to regulate professionals, and ensure ethical practice. Unfortunately, those professionals currently unaffiliated with a regulatory body are not working within any guidelines which prevent unethical practice. It goes without saying that there are unregulated professionals who have strict ethical guidelines—heck, I was one for many years prior to registering. My issue is with those who are, probably unintentionally, breaching best practice ethical standards by not clearly stating their particular therapies are NOT evidence based.

As a parent, you have a right to know, and then decide fully informed.

It is for every parent to decide what is best for their child—while I personally value science as a measure of efficacy when it comes to treatment—others may not and that is totally valid. There is no scientific evidence to support eating hot sauce—but it doesn’t stop me! I am not trying to imply that we should all live and die by science, but when it comes to the BIG decisions (like your kid’s future) my personal and clinical opinion is that science knows best. Again, you're the parent so it's your opinion that matters, not mine.

Some of you are wondering what the heck I am referring to; I am uncomfortable calling out specific therapies being offered by other clinicians so instead I will give an example (and urge you to do your own research armed with this information).

Fieldtrips are fun!

They provide countless opportunities for growth, communication, social interaction—you get the idea. Fieldstrips provide the basis upon which tons of skill development can occur; let’s say someone acknowledged this, and started offering Fieldtrip Therapy—this would be a problem for me.

First of all, the kind of therapy isn’t “fieldtrip”—there is no such therapy. Can you still learn on a fieldtrip? Probably. But if so, you’re probably doing so within a framework of an existing therapeutic or educational model (which may or may not be evidence based).

Just last week my students went to Dairy Queen for an opportunity to practice buying ice cream, counting change, using social skills---this wasn’t Dairy Queen therapy...this was ABA therapy at DQ. Do you follow?

Here’s another super simple example.

Balls are fun!

Playing with balls is fun. Playing ball games can offer many opportunities for skill building, in fact ball play can be incorporated into a number of different kinds of therapy. Ball therapy, strictly speaking, does not exist.

Going into a ball pit? Fun!

Using a ball bit as part of your Occupational Therapy, Speech Therapy, ABA therapy,

psychotherapy, etc...totally viable. That said, it doesn’t make Ball Pit Therapy a recognized practice in its own right.

People play very fast and loose with the word therapy, and you it shouldn't be at your expense.

I am sure I am offending some people. I can accept that.

That said, I place no judgement on those who use non evidence based, or experimental therapies, however—from an ethical perspective, I believe it is essential to the clinician’s integrity to clearly state the nature of the therapy, especially when many have very limited resources and with proper information may opt to spend their money on something which is rooted in evidence.

The hokey pokey is super fun...but hokey pokey therapy just doesn’t exist.

That doesn't mean you shouldn't do it, but would you pay 100s of dollars a year to "turn yourself around?" Well, that's what it's all about!

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