How long do we need to continue? Dr Kondekar addresses when OT Speech Learning Medicines Schooling may be stopped..in autism ADHD

Duration of Intervention in Neurodevelopmental Conditions: Moving From Fixed Timelines to Developmental Appetite

A Conceptual Perspective 

Running title: Developmental Appetite Model

Santosh V. Kondekar, MD, DNB (Pediatrics), Fellowship in Neurodevelopmental Pediatrics

Neurodevelopmental Pediatrician

Mumbai, Maharashtra, India

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Corresponding Author

Dr Santosh V. Kondekar

Neurodevelopmental Pediatrician

🌐 www.autismdoctor.in

📧 autismdrmumbai@gmail.com

📍 Mumbai, Maharashtra, India

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Abstract

One of the most common questions asked by parents and clinicians managing children with neurodevelopmental conditions such as autism and ADHD is: How long should therapies and medications continue? Traditional clinical thinking often seeks defined timelines or endpoints. However, developmental trajectories are heterogeneous, and rigid duration models fail to capture individual variability. This editorial proposes a conceptual framework — the developmental appetite model — where duration of intervention is guided by readiness, goals, functional gains, and the individual’s capacity for self-directed regulation rather than diagnosis alone. The model emphasises that interventions should continue while they add meaningful value and support the development of internal regulatory capacity.

Keywords

Autism, ADHD, duration of therapy, neurodevelopmental disorders, rehabilitation, self-regulation, developmental model, intervention planning

Introduction

Clinical practice frequently encounters pressure to define clear stopping points for therapies and pharmacological interventions. Families seek predictability, while clinicians aim to balance benefit with burden. Yet neurodevelopmental conditions are characterised by variable trajectories influenced by cognitive capacity, language development, environmental supports, and individual motivation (Shonkoff & Phillips, 2000; Dawson et al., 2010).

Attempts to define uniform timelines risk oversimplifying complex developmental processes. A more nuanced framework is needed — one that aligns duration with developmental readiness rather than chronological age or diagnostic category.

The Developmental Appetite Model

The concept of developmental appetite proposes that intervention should continue as long as there is meaningful capacity and motivation for growth that improves functional independence, participation, and quality of life.

The analogy parallels human nutrition: individuals eat as long as appetite and the intention to sustain health exist. Similarly, developmental interventions continue while there is readiness to learn and potential for functional gain.

This model aligns with developmental systems theory, emphasising interaction between individual capacity and environment (Bronfenbrenner & Morris, 2006).

Determinants of Duration

Readiness for Self-Regulation

The ultimate goal of intervention is transition from externally supported regulation to internally mediated control. Self-regulation is a core developmental outcome influenced by executive function maturation (Blair & Diamond, 2008).

Duration should therefore be guided by the child’s ability to understand consequences, reflect on behaviour, and demonstrate adaptive decision-making.

Language and Cognitive Insight

Language plays a central role in behavioural self-management. Vygotskian theory emphasises language as a mediator of thought and self-control (Vygotsky, 1978).

When verbal comprehension and insight improve, counselling approaches such as cognitive behavioural strategies become effective, allowing reduction in external supports.

Functional Goals and Ambitions

Duration of intervention is influenced by functional goals, ranging from basic independence to high academic or vocational achievement. The International Classification of Functioning (ICF) framework highlights participation and activity as central outcomes (World Health Organization, 2001).

Acceptance Versus Optimization

The neurodiversity paradigm emphasises acceptance and quality of life rather than normalization alone (Kapp et al., 2013). Differences in family priorities naturally result in different intervention durations.

Individual Motivation

Intrinsic motivation significantly influences engagement with therapy and learning (Ryan & Deci, 2000). Higher motivation often sustains longer developmental engagement.

Rehabilitation Therapies Within the Model

Rehabilitation disciplines such as speech therapy, behavioural interventions, and educational supports aim to improve participation and adaptive functioning rather than cure underlying neurodevelopmental differences. Duration should be guided by functional gains and evolving developmental goals.

Medication Within the Developmental Framework

Pharmacological interventions primarily support regulation, attention, and emotional stability. Evidence-based guidelines emphasise periodic reassessment of medication need and benefit (Wolraich et al., 2019). Medication should be conceptualised as a scaffold supporting development rather than a permanent requirement.

Ethical Considerations

The developmental appetite model raises important ethical considerations including avoiding indefinite continuation without measurable benefit, preventing premature discontinuation, and balancing parental expectations with child autonomy.

The guiding principle should be proportionality — matching intervention intensity with functional need.

Clinical Implications

Adopting this framework encourages:

Goal-based planning

Periodic reassessment

Shared decision-making

Recognition of developmental heterogeneity

Focus on quality of life alongside functional outcomes

Limitations

This model is conceptual and not prescriptive. It relies on clinical judgement and may be influenced by cultural expectations and resource availability. Further empirical research is required to operationalise measurable indicators of developmental readiness.

Conclusion

Duration of therapies and medications in neurodevelopmental conditions cannot be reduced to predefined timelines. The developmental appetite framework provides a pragmatic approach, emphasising readiness, goals, and meaningful functional gains. Interventions should continue while they enhance participation and support the emergence of internal regulatory capacity.

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Key Message

Intervention should continue while it nourishes development and taper as self-directed regulation emerges.

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Conflict of Interest

The author declares no conflict of interest.

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Funding

No external funding was received.

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Author Contributions

Conceptualisation, writing, and final approval: Santosh V. Kondekar.

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Acknowledgements

The author acknowledges children and families whose developmental journeys continue to inform clinical understanding.

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References

Blair C, Diamond A. Biological processes in prevention and intervention: The promotion of self-regulation as a means of preventing school failure. Development and Psychopathology. 2008;20(3):899-911.

Bronfenbrenner U, Morris PA. The bioecological model of human development. In: Damon W, Lerner RM, editors. Handbook of Child Psychology. 6th ed. Wiley; 2006.

Dawson G, Rogers S, Munson J, et al. Randomized controlled trial of an intervention for toddlers with autism: The Early Start Denver Model. Pediatrics. 2010;125(1):e17-e23.

Kapp SK, Gillespie-Lynch K, Sherman LE, Hutman T. Deficit, difference, or both? Autism and neurodiversity. Developmental Psychology. 2013;49(1):59-71.

Ryan RM, Deci EL. Intrinsic and extrinsic motivations: Classic definitions and new directions. Contemporary Educational Psychology. 2000;25(1):54-67.

Shonkoff JP, Phillips DA. From Neurons to Neighborhoods: The Science of Early Childhood Development. National Academy Press; 2000.

Vygotsky LS. Mind in Society: The Development of Higher Psychological Processes. Harvard University Press; 1978.

Wolraich ML, Hagan JF Jr, Allan C, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of ADHD in children and adolescents. Pediatrics. 2019;144(4):e20192528.

World Health Organization. International Classification of Functioning, Disability and Health (ICF). WHO; 2001.