In describing a multimodal approach, two salient themes emerged; the human factor and the systems factor. The human factor included three variables: first, the individuality of each child and family; second, the comorbidity of the diagnosis; and third, diverse professional training and expertise. These three factors inhibit the development of a concise multimodal approach and instead create a practice of trying ‘on different strategies until one fits’. One participant stated, ‘…something that might work well with one family, one child, and one teacher, that sort of constellation of variables would not work with another just because of the different players, the different expertise, the different knowledge base’. Another participant stated: ‘there are interventions . . . like a menu of interventions and some interventions will work really well together depending on the players, and some interventions will not work really well together depending on the players’.