Occupational Therapy
Occupational therapy (OT) helps children participate in daily "occupations" - the activities that fill their day, from self-care to school to play.
OTs focus on function - helping children do the things they need and want to do in daily life. This includes self-care, school tasks, and play.
For neurodivergent children, OT often addresses sensory processing, motor skills, and practical strategies for daily challenges.
Areas occupational therapy addresses
Examples:
- •Pencil grip and handwriting
- •Using scissors
- •Buttons, zips, laces
- •Utensil use for eating
OT approach:
Building strength, coordination, and motor planning through targeted activities.
Examples:
- •Ball skills (catching, throwing)
- •Balance and coordination
- •Bike riding
- •Playground activities
OT approach:
Often works with physiotherapy. Focus on motor planning and coordination.
Examples:
- •Over- or under-sensitivity to touch, sound, movement
- •Seeking or avoiding sensory input
- •Difficulty with sensory-rich environments
- •Impact on attention and regulation
OT approach:
Assessment of sensory profile. Strategies to support regulation. Environmental modifications.
Examples:
- •Dressing and undressing
- •Toileting
- •Personal hygiene
- •Meal preparation (older children)
OT approach:
Task analysis, breaking skills into steps. Adaptations and visual supports.
Examples:
- •Managing belongings
- •Following multi-step routines
- •Time management
- •Homework organisation
OT approach:
Environmental organisation, visual schedules, checklists, routines.
Ayres Sensory Integration (ASI)
Specific therapy approach using play-based activities in a sensory-rich environment.
True ASI is specific and intensive. Many "sensory" activities are inspired by but not ASI.
Sensory diets
Planned activities throughout the day to provide needed sensory input.
Should be individualised based on sensory profile, not generic lists.
Environmental modifications
Changing the environment to reduce sensory challenges.
Often most practical: reduce noise, provide quiet space, adjust lighting.
Sensory tools
Fidgets, weighted items, movement breaks, etc.
Trial and error needed. What helps one child may not help another.
Evidence considerations
| Approach | Evidence | Notes |
|---|---|---|
| Functional OT (skill building) | Strong | Teaching specific skills in context is well-supported. |
| Environmental modifications | Strong | Adjusting environment to support function has strong logical basis. |
| Ayres Sensory Integration | Moderate | Some evidence for specific populations. Requires trained therapist. |
| Sensory diets | Limited | Widely used but limited controlled research. Individual response varies. |
| Weighted vests/blankets | Mixed | Some individuals benefit but research is inconsistent. |
| Fidget tools | Mixed | May help some individuals. Can be distracting for others. |
When to seek OT referral
- Significant difficulty with handwriting affecting schoolwork
- Difficulty with self-care skills expected for age
- Sensory sensitivities significantly impacting daily life
- Motor coordination difficulties (may indicate DCD)
- Difficulty with fine motor tasks affecting independence
- Need for specialist assessment of functional skills
Supporting development at home
- Play dough and clay
- Threading and lacing activities
- Drawing and colouring
- Building with small blocks (Lego)
- Using tweezers/tongs in play
- Visual schedules for routines
- Backward chaining (start with last step)
- Consistent routine and practice
- Adapted tools if needed
- Identify and respect sensory preferences
- Create calm spaces for breaks
- Offer movement breaks
- Warn about sensory changes
- OT making claims about "curing" autism or ADHD
- Very expensive programmes with guaranteed outcomes
- Dismissing child's distress during sensory activities
- Focusing only on compliance, not function
- No individualised assessment - same approach for everyone
- No parent involvement or carryover strategies
Function is the goal. Good OT focuses on what your child needs to do in their life, not on normalising their sensory responses or motor patterns for their own sake.
Environmental modification - changing the environment to fit your child - is often more effective than trying to change your child to fit the environment.