Do Occupational Therapists Work on Sensory Integration in Schools?
Do Occupational Therapists Work on Sensory Integration in Schools?
This is a common question in online occupational therapy groups. The response is typically a “no" in those groups. To some extent this is correct because sensory integration is a very specific therapy that requires specialized training and often tools or equipment that we do not typically have access to in the school systems.
However, most people will say that we can address sensory needs on a consultation basis.
But I don’t think this is asking the right question. Instead, we should be asking if OT’s address self regulation in the schools.
Sensory processing is one small piece of self regulation. Despite years of people using “sensory processing disorder” as though it’s its own diagnosis, sensory processing problems are really a symptom of something else. They most commonly come with ADHD, autism, and anxiety, but there are other things that may cause a child to present with sensory symptoms (trauma, lead poisoning, or a persistent lack of sleep, for example). So if all we’re doing is addressing a symptom we’re often missing all of the pieces of the puzzle that contribute to self regulation. We may be doing a disservice to a child by not acknowledging and addressing all factors. As a result, sensory strategies alone are likely insufficient.
Now that I’ve cleared that up, let’s ask the right question:
Do Occupational Therapists Address Self-Regulation in Schools?
There is not a cut and dry response to this despite people wanting there to be one. Just like anything we address with direct services we have to consider a lot of factors.
- Is this within an OT's skill set to address? Children with self-regulation difficulties often have anxiety and need to feel safe first. They may benefit most from having a trusted adult available. Occupational therapists are rarely in any one building full-time to be that person. In addition, an experienced special education teacher may have more tools and strategies than a newer occupational therapist.
- Are there other people at the school who are also trained to address this? Strategies such as Zones of Regulation are also provided by special education teachers, social workers, and counselors.
- Are sensory responses the primary factor affecting their ability to self regulate? We probably need to be involved if this is the case.
- Is the environment really the issue? We can only do so much to support children who may be overstimulated by Things we have no control over, Like loud teacher voices, Overstimulating visuals, and Unrealistic expectations From Other school staff.
- Are there other factors contributing to self regulation that are better addressed by someone else on the team? For example, if a child has difficulty expressing their needs due to pragmatic language delays, then a speech therapist may be a better team member to address self-regulation.
Consider All Factors Related to Self-Regulation
All of these factors have to be considered by the IEP teams when deciding whether occupational therapy will directly address self-regulation with a student, whether they are found to have sensory processing differences or not.
I have found that my involvement varies significantly based on the school team and the specific needs of the student. I work with some children directly on self-regulation, I have some students who receive indirect support, and there are quite a few children at my schools who have no OT support even though they have sensory processing differences because their needs are met by other school team members or accommodations.
Factoring in Caseloads, Schedules and Time
Notice that I didn’t mention scheduling or time as a factor. Whether we or other team members can fit them into our schedule cannot be a factor in our decision to recommend consultation rather than direct therapy. This would be considered “administrative convenience” which is not an allowable reason for lowering the frequency of service delivery or not providing services. It happens, unfortunately, but would not be defendable in a due process situation.
Other Considerations When Addressing Self-Regulation
- Not every child with sensory processing differences needs occupational therapy, even on a consultation basis.
- Many sensory tools are mainstream now. In the past, OTs were always the ones to assign things like wiggle cushions and fidgets, but these are present in most schools now for any staff member to use. We don’t need to gatekeep the use of most of them.
- An OT may have more flexibility than other school staff to pull a student for one-on-one support when this may be best for the student and their specific needs.
- OTs are most likely to consider the big picture, not just sensory, but executive functioning, language, academics, etc., and how that may all factor into a child’s behavior.
Some of the Best Ways to Support Self-Regulation in Schools
One of the challenges I face when trying to provide support for students who have self-regulation differences is that because so many sensory tools and strategies are mainstream, I often don’t know what has been tried and hasn’t been tried. When there isn’t a specific issue to problem solve, like a child who picks their skin or puts everything in their mouth I can offer supports that can benefit the whole school. This is more effective than trying to create a sensory plan for individual students if I am addressing their needs through indirect support. Ways we can do that:
- Set up a “Relaxation Station” with calming sensory tools. I think we need to have a visual for these to help children check in with their energy levels and/or emotions.
- Encourage classrooms to partner with each other for “errands” by having children take books or paper reams (or other things for heavy work) to the partner class when a child needs a sensory break.
- Educate school teams about all of the factors that contribute to self-regulation. I think that one of the most important ones to share is the executive function of cognitive shift.
So, Do Occupational Therapists Work on Sensory Integration in Schools?
As you can see this is not a yes or no question. There are a lot of things for school teams to consider when a child has behavior issues and may also have sensory processing differences. I encourage occupational therapists to include the statement in this blog on evaluation reports to help parents and teachers understand that self-regulation involves more than sensory processing.
