One of the biggest frustrations in life is that we can't make other people do what we want them to do! And when a child has special needs, this can be particularly frustrating. Of course parents can always say "no" or demand things be done their way. But that doesn't avoid power struggles, it often provokes them. So let's try other things first.
Most power struggles can be avoided by including the child in the decision making by giving choices: "Would you like to do your medical treatment in the afternoon or in the evening?" Or "Would you like to take your pills with chocolate milk or with orange juice?" Notice that either choice will make us perfectly happy!
Power struggles are often avoided by listening to the child's point of view before we give our own and the requests we'd like to make: "Thanks for sharing with me how important you feel it is to go riding at the arena this afternoon. I'm taking that under consideration. Now that I've listened to your point of view, I'd like to share mine on my concerns about the dust and your asthma."
Power struggles tend to be avoided when a parent is both firm and loving which is not to be confused with being tough and demanding. It is difficult to demonstrate "firm and loving" in writing but it involves smiles, eye contact, sense of humor, a pleasant tone of voice and gentle touch: "Honey, my expectation is that you will do your breathing treatments first thing after school. Thanks." (And when the child back-talks or is negative, repeat the statement.) The opposite of this, which invites a power struggle, involves shouting across the kitchen, "Our agreement was that you'd do your treatments after school, so do it right now!"
Using questions with the assumptive "thank you" often works with younger children. It's not always as easy as this example, but then again, oftentimes it is when used with loving firmness:
"Honey, I think it's time now for you to test your blood sugar."
"I don't want to do it!"
"I'm sure you don't honey but what am I asking you to do?"
"I don't want to."
"What am I asking you to do?"
"Check my blood sugar......"
"Right! Thanks honey."
It can be pretty slick. Thanking the child for the right answer confuses some into thinking you're thanking them for doing it .... and then they do it! Try it out- it even works well with some spouses!