How do you actually know if therapy is working for a child with autism or ADHD? What to track, when to raise concerns with the therapist, and when it might be time to reassess.
Your child has been in occupational therapy (OT) for six months. They go every week. The therapist seems warm and engaged. Your child does not dread it. But you find yourself sitting in the waiting room wondering: is anything actually changing? The therapist gives you brief updates at pickup, but you are not sure how to weigh what you are hearing against what you see at home. You feel like you should know by now whether this is working—and the fact that you don't is its own source of anxiety.
This is one of the most common places parents land after the initial relief of finally getting services fades. Securing therapy feels like the finish line, but it is really the starting line of a longer question: is this the right therapy, delivered well, producing real results for my child?
The honest answer is that progress in autism and attention-deficit/hyperactivity disorder (ADHD) therapy is rarely dramatic or linear. But it is also not invisible if you know what to look for—and having a system for tracking it changes everything.
Therapy progress is slow by design. The skills being built—sensory regulation, social communication, attention, executive function—develop over months and years, not weeks. Because you are with your child every day, you are also the least positioned to notice gradual change. It is the same reason parents are often the last to notice their child has grown two inches.
There is also the question of what counts as progress. A child who still has meltdowns but recovers from them twice as fast is making significant progress that a surface-level observation would miss. A child who still struggles to initiate peer interaction but now tolerates proximity to other children without distress has moved meaningfully—just not in the way a parent expecting dramatic transformation might recognize.
This is why therapist reports alone are not enough. You need your own tracking system, running alongside the clinical one.
You do not need a complicated system. What you need is consistent, dated observations over time—because progress only becomes visible when you can compare where your child is now to where they were three or six months ago.
Keep a simple running log after each therapy session: one or two sentences on what the therapist said, anything you noticed in your child's behavior that week, and any specific goal that was mentioned. Once a month, add a broader note—what feels harder this month, what feels easier, what you are still waiting to see change.
Beyond the general log, track the specific goals in your child's therapy plan. Most therapists set goals at intake or at regular review points. Ask for those goals in writing if you do not have them. Then watch for movement on each one specifically rather than evaluating therapy as a vague whole.
At home, pay attention to functional change rather than symptom reduction. The question is not "is my child still doing the hard thing?"—it is "is the hard thing interfering with daily life less than it was?" A child who can now get through a grocery store trip with one warning instead of a full shutdown has made functional progress, even if the underlying sensitivity is unchanged.
If you are three to four months into therapy and cannot identify any specific area of change—not dramatic change, but any change—that is worth a direct conversation with the therapist. You can say exactly that: "I want to make sure I'm tracking the right things. Can you walk me through what progress looks like for the goals we set, and what you're seeing so far?"
A good therapist will welcome this conversation. They will be able to point to specific data, describe behavioral shifts they have observed in session, and either reassure you with evidence or acknowledge that the approach may need adjustment. If a therapist responds vaguely or seems defensive, that is itself useful information about fit.
Ask at every review point—typically every three to six months for most therapy types—whether the current goals still reflect your child's most pressing needs. Goals should evolve. A therapy plan that looks identical a year in is a plan that may have stopped following the child.
Therapy is trial and error, and that is not a failure—it is the nature of working with a developing child whose needs shift over time. If you have had the direct conversation with the therapist, given it a full review cycle, and still cannot identify meaningful progress, it is reasonable to ask whether a different approach or a different provider might serve your child better.
This is hard to do when a relationship has been built, and it is hard to do when the next waitlist is six months long. But months spent in therapy that is not working are months not spent in therapy that might. Trust your observations. You are not being impatient if you have been watching carefully for six months and asking the right questions.
For guidance on what red flags in the therapeutic relationship look like—beyond just slow progress—see how to know if a therapist is the right fit.
Start your tracking system today, even if therapy has been underway for months. A note written now about where your child currently is becomes the baseline you will compare against in three months. The What's Next Health document vault gives you one place to store therapy notes, track goals across providers, and build the longitudinal picture that makes progress—or the lack of it—visible. If you are coordinating notes across multiple therapists, managing multiple therapists covers how to keep everyone working from the same page.
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