Does more therapy for children equal more progress? - האם עוד טיפול לילדים שווה יותר התקדמות?
- motim51
- 1 day ago
- 3 min read
One of the questions every parent asks themselves is what amount of therapy their child needs in order to make progress.
Recently, this topic has been receiving increasing attention in research.
At the most recent INSAR conference, a special panel was held on this topic.
The dosage of therapy is reflected in several elements:
Daily intensity = number of hours per day
Duration of the intervention = total number of days of intervention
Cumulative intensity of therapy = total number of therapy hours
One of the prominent articles on this topic is a comprehensive study published in 2024, in which the authors conducted a meta-analysis of 144 studies that included 9,038 young autistic children (up to age 8).
The study examined whether more hours, longer duration, or a higher cumulative dosage of intervention are actually associated with better outcomes among autistic children.
The main conclusion is that no reliable association of this kind was found across most types of interventions, and therefore there is no strong basis for the assumption that greater intensity = greater benefit.
In this study, common intervention approaches were examined, including behavioral approaches such as ABA, developmental approaches such as DIR, NDBI approaches such as PRT, ESDM, and JASPER, and technology-based approaches such as computer games.
It should be noted that there are several other high-quality studies with smaller sample sizes that support the same view: that more hours do not necessarily lead to better outcomes.
One of the prominent studies on this topic is a 2021 study by Prof. Sally Rogers, which examined the effect of 25 hours of therapy compared with 15 hours of therapy per week.
The intervention itself was provided for one year, and the children were followed for up to two years.
There were four study groups:
Children who received 15 hours per week of behavioral intervention.
Children who received 25 hours per week of behavioral intervention.
Children who received 15 hours per week of ESDM intervention.
Children who received 25 hours per week of ESDM intervention.
The bottom line is that here too, no significant differences were found in treatment outcomes, neither between the approaches nor between the treatment dosages.
In other words, 25 hours per week were not better than 15 hours of therapy per week.
The clinical implication
The practical message is that we should be cautious about making a blanket recommendation of 20-40 hours of therapy per week simply because "more is better."
Beyond the fact that more therapy hours do not necessarily have a significant clinical effect, a blanket recommendation for so many hours of therapy per week is not practical for many families.
In some cases, it can create unnecessary stress, feelings of guilt, and a negative atmosphere that may interfere with the family’s ability to support the child effectively.
The researchers emphasize that the absence of evidence for a positive association does not mean that intervention is not beneficial at all, but rather that there is no strong support for the idea that increasing the amount, in and of itself, improves outcomes.
Therefore, it is recommended to think about quality, individualized fit, and a reasonable level of burden on the family and the child, rather than focusing only on the number of hours or the number of therapy sessions the child receives.
In the expert panel at the conference, emphasis was placed on the number of learning opportunities provided to the child during intervention and on their quality, rather than necessarily on the number of therapy hours.
References:
Rogers, S. J., Yoder, P., Estes, A., Warren, Z., McEachin, J., Munson, J., ... & Whelan, F. (2021). A multisite randomized controlled trial comparing the effects of intervention intensity and intervention style on outcomes for young children with autism. Journal of the American Academy of Child & Adolescent Psychiatry, 60(6), 710-722.
Sandbank, M., Pustejovsky, J. E., Bottema-Beutel, K., Caldwell, N., Feldman, J. I., Crowley LaPoint, S., & Woynaroski, T. (2024). Determining associations between intervention amount and outcomes for young autistic children: A meta-analysis. JAMA pediatrics, 178(8), 763-773.
doi:10.1001/jamapediatrics.2024.1832
🟢 For all updates on autism and events at our center, join our quiet WhatsApp group 🟢
Comments