For years, occupational therapists were the ones who monitored the sensory needs of children in schools. We have been the gatekeepers to sensory tools such as cushions, fidgets, weighted toys, and chair bands. However, now those things are much more accessible to everyone and don’t necessarily require an OT to be involved for children to access them. So, when is the expertise of an occupational therapist needed to support a child’s sensory needs at school?

Occupational therapists have educated parents and teachers about the importance of sensory-based strategies to support children’s learning and overall function in schools for years, and we seem to have made an impact! Many of the sensory terms used by OTs have become familiar to non-OTs. For years, occupational therapists promoted “heavy work” as a fix for nearly all behavioral issues, and this is helpful for many children. As a result, classrooms often have movement breaks that include some of this.

However, we have reinforced the importance of sensory input so much that other factors that influence a child’s ability to self-regulate may be overlooked, even when the child does have some sensory issues. As a result, OTs may not always be the best professionals to support a child with self-regulation difficulties.

When Is the Expertise of an OT Needed in Schools If There Are Sensory Issues?

First, it is helpful to consider all of the factors that affect self-regulation. As part of our sensory evaluations, we should consider which of these factors is having the most significant impact on a child’s function.

If a child has significant sensory processing differences affecting their function at school, consider the following factors when deciding whether OT is required as part of a formal school support plan, such as a 504 Plan or Individualized Education Program (IEP) in the United States.

To Provide Some Sensory Tools

If the child’s needs are met with readily available sensory tools, such as chair bands, fidgets, or weighted lap pads, and strategies such as movement breaks, the involvement of an OT may not be needed at all.

However, the expertise of an OT is important if you are considering the use of some sensory tools that may still be easy to obtain, including weighted vests, pressure vests, vibration plates, and sometimes oral fidgets.

Why? We are likely to consider and fully understand the risks and benefits. For example, there are many contraindications to using a vibration plate. I live in North Carolina and rarely recommend pressure vests because they are made of neoprene, and it gets so hot here. Many children who have sensory needs also have poor interoception and may not recognize that they are overheating.

OTs will also think about whether the child has the motor skills to remove things like pressure vests or weighted vests and whether they have the ability to communicate when they want to wear them or decline wearing them.

To Find the Best Strategies for Nervous System Regulation

I work with some students who find rote movement activities boring and who are more regulated with movement when music is added. But I have others who love things like burpees and will do those to support their nervous system.

I also work with some students who prefer no movement and actually do best when they can get a mental break to complete a logic puzzle or build with Legos.

We may also be the ones to recognize that whole-class movement breaks are more overstimulating than helpful for some students. Those children may do better using that time in the hallway to draw on a whiteboard.

To Provide Explicit Instruction

Occupational therapists may provide a fidget lesson to help children understand expectations when using sensory tools and explore which ones work best for them.

For example, I wouldn’t just give a child a mini massager to use for sensory input. Why? Because I know they will nearly always put it on the table or floor to watch it move instead of using it on their body. I would want to make sure they understood how to use it to get the most benefit and could demonstrate that.

I may also provide a fidget lesson or a lesson on using gum appropriately at school if we are considering those strategies.

To Help Provide Structure or Environmental Support

A predictable environment is usually best for a child whose nervous system is dysregulated. While an OT is not required to make a child a visual schedule, we may be able to support the team by doing this.

We may recognize which location in the room is best for that child or notice that they are too distracted by the air conditioner next to them, even though they are near the teacher and that location was thought to be best.

Sometimes we can observe things that teachers can’t because they are focused on their lessons and have many students to monitor.

To Suggest Modifications

If a child is struggling to participate in art because they are afraid of getting glue on their fingers, we may suggest alternatives, such as applying liquid glue with a paintbrush instead.

I have also observed that some children with auditory sensitivities don’t have easy access to their noise-canceling headphones, so I may suggest that the headphones be placed in a different location.

When Is the Expertise of an OT Not Likely to Be Needed?

If there are other factors affecting the child’s self-regulation more significantly, such as executive functioning or anxiety, then OT may not be indicated.

Some things, such as modifications, environmental supports, or environmental changes, can be recommended at the time of the evaluation and aren’t likely to require ongoing support. Some explicit instruction may not require ongoing intervention either if only specific lessons are needed. The OT’s time may be better spent teaching other adults in the building how to implement these lessons.

If a child is already using common tools, such as fidgets or chair bands, and these are helping, other strategies may not need to be explored. If the family or school team already knows which strategies are calming or regulating for the child, OT may not be indicated.

Conclusion

The goal shouldn’t be to involve an occupational therapist simply because a child has sensory processing differences. The question should be whether the child needs the specific expertise of an OT to participate and function at school.

Sometimes that expertise is essential for identifying appropriate strategies, considering safety, teaching a child how to use a tool, or recognizing environmental factors that others may not notice. Other times, the child’s needs can be supported by the adults who are already part of their school day.

Being thoughtful about when OT expertise is truly needed allows us to use our skills where they can make the greatest difference while also recognizing that not every sensory need requires occupational therapy.