Big Emotions, Big Emotions, My, Oh My!

Big Emotions, Big Emotions , My, Oh My!

By Michaela E. Gordon, OTR/L

I’m excited to share my latest children’s book, Big Emotions, Big Emotions, My, Oh My!

Sometimes when children feel anxious, angry, upset, or overwhelmed, they don’t necessarily want to talk about it. And when emotions are already running high, the thought of being told that they need to “manage” or “control” those emotions can feel overwhelming in itself.

That was one of the reasons I wanted to create this book.

Rather than simply telling children exactly what they should do when they have big emotions, I wanted to create a story that helps them see they are not alone and that there are many ways to work through emotions.

First, Kai learns to ask for help.

Kai begins the story feeling stuck. He knows that his big emotions are getting in his way, but he doesn’t know what to do. So instead of trying to figure everything out by himself, he asks his friends for help.

Throughout the story, Kai learns from each of them—and eventually from his older brother, Peter.

One of the messages I hope children take away is that friends, siblings, caregivers, teachers, and other trusted people can be part of their support system. They don’t have to figure everything out on their own.

Second, Kai discovers that big emotions happen to everyone.

Each of Kai’s friends experiences big emotions, but they don’t all experience them in the same way.

One child feels worried. Another becomes angry and wants to yell or throw things. Another feels overwhelmed. Their experiences are different, and so are the ways they respond.

This is important because there isn’t one specific way to experience or work through an emotion and there isn’t a “right” way to manage emotions. The caregiver section of the book reinforces this idea, explaining that children can discover and practice the tools that work best for them.

Third, the children share simple tools.

Each friend introduces Kai to a different strategy.They are intentionally simple, practical, and require no special equipment or materials. They include things like noticing feelings in the body, taking slow breaths, using movement or pressure, keeping hands and bodies safe, and using kind and reassuring self-talk.

These are tools children can practice and use throughout their day—at home, at school, on the playground, or wherever big feelings happen to show up.

And importantly, Kai learns that the goal isn’t necessarily to make his feelings disappear. As his brother explains, he can keep asking for support and trying different tools to discover what works for him.

And then there is the rhythm and humor.

I wrote this book in a rhythmic, playful format because I wanted the story to be engaging and easy for children to take in, especially when we’re talking about something that can otherwise feel heavy.

There is also plenty of humor woven throughout the story. Sometimes a little laughter and playfulness can make a difficult topic feel much more approachable.

The result is a book that talks about big emotions without making big emotions feel like a problem that needs to be fixed.

Instead, Kai learns:

Big feelings happen to everyone.

He doesn’t have to face them alone.

He can try different tools.

And he can learn what works for him.

A little something for adults, too!

At the end of the story, I included a note for caregivers and professionals with additional information about big emotions and simple ways to support children.

It includes ideas for talking about emotions, helping children notice how feelings show up in their bodies, practicing regulation tools, thinking through challenging situations, and supporting children as they learn to navigate difficult moments.

Life can be stressful and difficult to navigate sometimes—for children and adults alike.

My hope is that Big Emotions, Big Emotions, My, Oh My! helps children feel a little less alone when those big feelings show up and gives them a few simple tools they can carry with them.

I hope it helps many children, families, caregivers, and professionals along the way.

You can purchase a copy of Big Emotions, Big Emotions, My, Oh My! on Amazon.

Thank you so much for supporting my books and the work I do.

I hope you love it! ❤️

To Avoid or to Expose: That Is the Question

To Avoid or Expose: That Is The Question

By Michaela Gordon, OTR/L

As occupational therapists, we spend a great deal of time thinking about how the nervous system receives, processes, integrates, and responds to sensory information.

For some individuals, ordinary sensory experiences can be overwhelming. A loud classroom, fluorescent lights, certain textures, movement, touch, smells, or visual stimulation may push the nervous system beyond what the person can comfortably manage. When this happens, we often make accommodations: we turn down the lights, reduce background noise, provide noise-canceling headphones, modify clothing, decrease visual clutter, or help the person move into a quieter environment.

These accommodations can be incredibly important. But there is another approach.

Rather than always reducing sensory input, occupational therapy can also work toward improving a person’s ability to process and integrate sensory information. Through carefully selected sensory experiences, graded challenges, repetition, and active engagement, we can sometimes help a person develop greater capacity to respond to sensory information.

So which approach is correct? Should we avoid sensory input, or should we expose someone to it? I believe the answer is both.

The more important question is not whether we should avoid or expose. The question is when, how much, and for what purpose?

The nervous system is designed to adapt. One of the most fascinating characteristics of the nervous system is its ability to change in response to experience.

Neuroplasticity refers to the brain’s capacity to change its structure and function in response to experience, learning, environmental demands, and sensory input. Research has demonstrated that sensory experience plays an important role in shaping developing neural systems, particularly during sensitive periods of development. Research has also found that sensory deprivation and altered sensory experiences can produce measurable changes in neural organization.

This raises an important question for sensory processing: If the nervous system can adapt to the sensory experiences it receives, what happens when certain sensory experiences are consistently removed?

There is a theory that when sensory input is provided at a certain level of intensity and frequency over a duration over time, the repeated sensory experiences may contribute to neuroplastic changes in the nervous system. In other words, the nervous system can learn from what it repeatedly experiences.

With carefully graded sensory input, we may be able to create opportunities for the nervous system to develop and strengthen neural connections and more efficient ways of processing and responding to sensory information.

This is one of the principles underlying sensory integration therapy.

The goal is not simply to expose someone to more sensory input. The goal is to provide the right sensory experience, at the right intensity, with the right frequency and duration, while keeping the challenge within a range that allows the person to remain regulated and engaged.

Over time, repeated experiences may support adaptation and more efficient sensory processing.

I am not suggesting that accommodations cause sensory sensitivity. The research does not establish that. But exposure is not the same as flooding. This distinction is critical.

If a child is extremely sensitive to sound, putting them into an extremely loud environment and telling them to “get used to it” with no defined beginning or end or support is not what I mean by therapeutic exposure.

In occupational therapy, we are often trying to find what I would call the just-right challenge.

The challenge needs to be meaningful enough to encourage adaptation, but manageable enough that the person’s nervous system can remain engaged. This might mean front loading the person so they know their system will be challenged and what to expect. This might mean starting with a very small amount of sensory input. It might mean changing the intensity, duration, or context of the experience. It might mean providing another sensory input that helps the person organize themselves. And it might mean using an accommodation while simultaneously working toward increasing capacity.

The goal is not to force tolerance, but to build options.

So what happens when we only accommodate? Accommodations are not inherently problematic. In fact, accommodations can be essential. If a child cannot tolerate the sound of a fire alarm, providing hearing protection may allow that child to participate safely in school. If fluorescent lighting causes significant distress, changing the lighting may allow someone to remain in a classroom. If a person becomes overwhelmed in a crowded environment, reducing the sensory load by limiting the amount of time in that environment may allow them to participate in an activity that would otherwise be inaccessible.

These are meaningful occupational outcomes, but I think we should also ask another question: Could an accommodation sometimes become the only strategy, when there is an opportunity to build greater capacity?

There is emerging research examining sensory accommodation in families of autistic children and children with sensory over-responsivity. Accommodation can reduce distress and help families function, but researchers have also raised questions about whether extensive accommodation can sometimes limit opportunities for coping and adaptation.

Again, this does not mean that accommodations are bad. It means that we should consider their cost and benefit.

-What is this accommodation allowing the person to do?

-What is it helping them avoid?

-Is the accommodation increasing participation?

-Is it reducing unnecessary suffering?

-Is it providing a bridge toward greater independence?

-Or has it gradually narrowed the person’s world?

These are very different questions.

We can learn something from sensory deprivation research. Research on sensory deprivation provides another interesting perspective.

We know from developmental neuroscience that sensory experience plays an important role in the organization and refinement of the developing brain. Severe deprivation during critical periods of development can alter the development and organization of sensory systems. Research has demonstrated that enriched and deprived sensory environments can produce different structural and functional changes in the developing nervous system.

This does not mean that a child who wears headphones in a noisy classroom is experiencing “sensory deprivation.” That would be an inappropriate comparison. The situations are vastly different. However, these studies reinforce a broader principle: The brain develops and adapts in relationship to the experiences it receives; therefore having experiences is very important.

And that is one reason I believe it is worth asking whether we are providing enough opportunities for people to experience the sensory world in ways that are safe, meaningful, and appropriately challenging.

Sensory integration is about more than tolerating sensations. When sensory integration therapy is provided thoughtfully, the goal should not simply be: “Can I make this child tolerate something they don’t like?” The goal is much broader. The questions we can ask are:

-Can the child participate more successfully in school?

-Can they play with peers?

-Can they tolerate movement?

-Can they manage the sensory demands of getting dressed?

-Can they participate in family activities?

-Can they remain organized when the environment becomes more stimulating?

-Can they recover more efficiently when they do become overwhelmed?

-Can they develop greater flexibility in how they respond?

The answers to these questions determine the person’s occupational goals.

And recent research provides encouraging evidence for this approach. A 2025 systematic review of randomized controlled trials found strong evidence that Ayres Sensory Integration® supported autistic children in achieving individualized goals related to occupational performance, function, and participation. A 2026 systematic review of occupational therapy interventions using Ayres Sensory Integration® similarly concluded that there is good evidence supporting its use to improve participation in everyday activities for children with sensory integration and processing challenges.

Importantly, these studies do not suggest that sensory integration is a treatment for every behavior or difficulty. Rather, they support its use for individualized functional goals.

Therefore, the answer may be neither avoidance nor exposure. Perhaps the real answer is what combination of accommodation and direct intervention leads to the person’s best ability to adapt.

Sometimes adaptation means changing the environment. Sometimes adaptation means helping the person develop greater capacity. Sometimes it means both. For instance, a child may need headphones today, but that doesn’t necessarily mean they will need headphones forever. The plan may be that the child wears noise-canceling headphones during specific times of the day, but then engages in a therapeutic music program to improve their ability to process auditory input over a course of time.

There is no universal sensory prescription. The right approach depends on the individual.

We need to consider the person’s:

physiology
sensory patterns
developmental level
cognitive flexibility
emotional regulation
ability to communicate
adaptability
personality
environment
occupational demands
values
preferences
goals

Most importantly, we need to ask what the person wants and needs to be able to do.

If someone has no desire or functional need to increase their ability to adapt to a particular sensory input, perhaps there is no reason to make that a therapeutic goal.

But if sensory sensitivity is preventing someone from going to school, eating in restaurants, traveling, participating in family events, working, sleeping, playing, or engaging in meaningful activities, then expanding sensory capacity may be incredibly valuable.

The conversation should never be one-time. I think this is where occupational therapy has an important role.

We should continually ask:

-What is helping?

-What is limiting?

-What is this person ready for?

-What is too much?

-What might be a meaningful next challenge?

-What accommodations are necessary?

-And what capacities might we be able to build?

The answers can change.

A child who needed extensive accommodations six months ago may now be ready for a new challenge. A child who was tolerating an activity may suddenly become overwhelmed because the environment changed, their sleep changed, their health changed, or the demands increased. A person may need more protection during one period of life and more challenge during another.

So, should we avoid or expose? Maybe the better question is: What does this person need right now to participate successfully—and what might help them participate more fully in the future?

An accommodation can be a destination, but it can also be a bridge while we offer other types of therapeutic interventions. The art of occupational therapy is knowing the difference.

And sometimes, the most appropriate answer is not to choose between the two, but to use both.

References

Acuña, C., Gallegos-Berrios, S., Barfoot, J., Meredith, P., & Hill, J. (2025). Ayres Sensory Integration® with children ages 0 to 12: A systematic review of randomized controlled trials. American Journal of Occupational Therapy, 79(3). https://doi.org/10.5014/ajot.2025.051023

Piller, A., Glennon, T. J., Andelin, L., Auld-Wright, K., McHugh Conlin, J., Teng, K., & Tarver, T. (2026). Occupational therapy interventions using Ayres Sensory Integration® for children and youth (2015–2024): A systematic review. American Journal of Occupational Therapy, 80(1). https://doi.org/10.5014/ajot.2025.051130

Green, S. A., Hernandez, L., Lawrence, K. E., Liu, J., Tsang, T., Yeargin, J., Cummings, K., Laugeson, E., Dapretto, M., & Bookheimer, S. Y. (2019). Distinct patterns of neural habituation and generalization in children and adolescents with autism with low and high sensory overresponsivity. American Journal of Psychiatry, 176(12), 1010–1020. https://doi.org/10.1176/appi.ajp.2019.18121333

Bengoetxea, H., Ortuzar, N., Bulnes, S., Rico-Barrio, I., Lafuente, J. V., & Argandoña, E. G. (2012). Enriched and deprived sensory experience induces structural changes and rewires connectivity during the postnatal development of the brain. Neural Plasticity, 2012, 305693. https://doi.org/10.1155/2012/305693

Nwabudike, I., & Che, A. (2024). Early-life maturation of the somatosensory cortex: Sensory experience and beyond. Frontiers in Neural Circuits, 18, 1430783. https://doi.org/10.3389/fncir.2024.1430783

Ben-Sasson, A., & Zisserman, A. (2025). Sensory family accommodation for autistic and sensory overresponsive children: The mediating role of parenting distress tolerance. American Journal of Occupational Therapy, 79(3). https://doi.org/10.5014/ajot.2025.050790

You Are a Supernova: A Book That Just Came to Me By Michaela Gordon, OTR/L

You Are a Supernova: A Book That Just Came to Me

By Michaela Gordon, OTR/L

Some books begin with an idea you’ve been thinking about for a long time. Others seem to arrive almost fully formed. You Are a Supernova! was definitely the latter.

By the time I wrote this book, I had already written Zoey and Her Amazing Energy Bubble!, Holding On, Letting Go, and Cal and His Amazing Attention Pie! Each of those books came to me in its own way, but each was rooted in ideas and frameworks I had already been thinking about. I had theories I was exploring, concepts I wanted to explain differently, or ways of looking at familiar ideas that I thought children might benefit from seeing in a new way.

But You Are a Supernova! was completely different.

I wasn’t planning to write another book, but one day, the word supernova simply popped into my mind. I remember thinking, What is a supernova? I honestly didn’t really know. Then the word came to me again, and then a couple more times, so I looked it up. Eventually, one night, the words and rhythm just started coming together, and I quickly wrote them down. It felt less like I had decided to write the book and more like the book had decided it needed to exist!

Once I started exploring the idea of a supernova, I became fascinated by what it could mean as a metaphor for a child. We often tell children, “You’re a superstar!” or “You’re amazing!” Usually, though, we say those things because of something they’ve done. They got a good grade, learned something difficult, were kind to someone, or accomplished something they had been working toward. Those things are absolutely worth celebrating, but I started thinking about the fact that underneath all of those accomplishments is something even more fundamental—their existence. What if we could help a child understand that their life is already an extraordinary gift—not simply because of what they may accomplish, but because of the miracle of their existence and the potential they have been given to bring those things into existence? And even when they don’t reach their goals or accomplish something extraordinary, there is still something remarkable about simply being here—to experience, to feel, to wonder, to try, to connect, and to enjoy the life they’ve been given.

Each of us has been given a body to live in and experience the world through. We have a brain that allows us to think and imagine, senses that allow us to see, hear, touch, taste, and smell, a heart that connects us to other people, and a completely unique combination of qualities, interests, abilities, and ways of seeing the world. We don’t know yet what all of those things will become, and that’s part of the excitement. What will you discover? What will you learn? What will you create? Who will you love? What experiences will shape you? What will you do with this incredible life you’ve been given?

And yet, life doesn’t always unfold the way we imagine it will. Some of us will experience challenges within our bodies, while others will face difficult circumstances that we never expected. We don’t all get the same starting point, and we don’t all have the same journey. I think part of the beauty of being human is learning how to continue moving forward, even when life becomes difficult, and discovering what is possible within the circumstances we have been given.

That is something I wanted to capture through Theo and Grace. They are witnesses to each other throughout the story. They share experiences, notice one another, and see each other through the good moments and the harder ones. They don’t have to fix everything for each other. Sometimes, simply having someone there who sees you, experiences life alongside you, and reminds you of who you are can be incredibly meaningful.

The message I want to share with children is that there is great potential within them—the possibility of experiencing all sorts of things, discovering what they are capable of, and perhaps doing things they never imagined possible, even against the odds. I want children to understand that they don’t have to prove their worth before they begin living their lives, and I want them to be brave enough to dare greatly. They are already here, already uniquely themselves, and already carrying so much possibility. The question isn’t whether they are valuable enough. The question is—what will they do with the amazing gift of being here?

The more I thought about it, the more miraculous that seemed to me. Think about everything that had to happen for any one of us to exist. We began as a single cell, and somehow that eventually became a person with so many things that make us the same, yet within that sameness, each of us is one of a kind—from our fingertips to the patterns of our veins. The book begins with that idea of the incredible journey that brought us here and then moves into the idea that there is an entire little universe inside each of us. At the same time, we are part of a much larger universe—the very universe we came from.

And then there is the connection to the stars. I loved discovering more about supernovas and how the elements created through stellar processes are part of what makes planets and life possible. The idea that we are, in a very real sense, made of stardust is quite something. It almost sounds like something that was made up for a magical story, and yet it is very real. We aren’t inflating the message or creating a fantastical idea to make children feel special. We are simply pointing out something that is true—and I think the truth itself is pretty incredible.

Of course, children don’t always feel inspired or see life as miraculous. They make mistakes, they lose, they get angry, they feel sad, and they compare their lives to other people’s lives. They can look at someone else and think that person is better, smarter, more talented, or simply luckier. Grace and Theo experience those very ordinary parts of being a child throughout the story. I wanted the book to acknowledge those feelings rather than simply telling children to be positive. You can have a bad day. You can mess up. You can feel disappointed. You can wish something about yourself were different. None of those things change the fact that you are still a supernova.

That’s really what I wanted this book to offer: a reminder that you are already something extraordinary, even while you are still learning, growing, making mistakes, and figuring out who you are. That idea is also what led me to write the caregiver note at the end of the book. As adults, we spend so much time helping children learn how to function in the world, and those skills absolutely matter. But I think we also have to be careful not to accidentally teach children that their worth comes from how well they perform. We can encourage growth without making achievement the measure of someone’s value.

I think You Are a Supernova! is a very simple book with a very big idea. I hope it becomes a book that someone gives to a child because they love them. Maybe it’s a birthday gift, a bedtime story, or something a parent reaches for after a particularly hard day. Maybe it’s for the child who is frustrated because something isn’t coming easily, or the child who is comparing themselves to everyone around them, or simply a child who needs a little bit of wonder.

It would be such an honor to see You Are a Supernova! find its way onto bookshelves all over the world. I truly love the message behind this book, and because it came to me so unexpectedly, it feels especially meaningful to now watch it make its way out into the world. I would love your help and support in getting this message out into the universe that inspired it. If you know a child who could use this reminder—or simply want to share a little bit of wonder with someone you love—you can pick up a copy of You Are a Supernova! on Amazon. Every book shared helps this little story reach another child who may need that reminder.

Helping Children Build Skills for Adulthood: Why Future Planning Starts Earlier Than You Think

Helping Children Build Skills for Adulthood:

Why Future Planning Starts Earlier Than You Think

By Michaela E. Gordon, OTR/L

No one expects a young child to wake up one day and suddenly know how to navigate the world independently. Yet from the very beginning, children are naturally drawn to the adult world. They are generally eager to imitate us.

They pretend to cook in toy kitchens, answer toy phones, push shopping carts, dress up as doctors, teachers, firefighters, veterinarians, parents, and construction workers. They proudly announce they’re “going to work.” They want to stir the batter, carry the groceries, water the plants, push the vacuum, and help with whatever the adults around them are doing.

These moments may seem like simple play, but they’re actually some of childhood’s most important occupations.

Through observation, imitation, role-playing, repetition, and participation in everyday routines, children develop motor skills, executive functioning, communication, emotional regulation, self-esteem, and social-emotional skills. Every experience helps strengthen the foundation they’ll use throughout their lives.

As occupational therapists, we know these everyday experiences aren’t simply helping children succeed today. They’re laying the foundation for tomorrow.

Why Think About Adulthood During Childhood?

Every parent hopes their child grows into an adult who experiences meaningful relationships, purpose, opportunities, and as much independence and choice as possible.

For families raising children with disabilities or neurodivergence, these hopes often come with additional questions.

Will my child go to college?
Will they work?
Will they live independently?
Will they need lifelong support?
How can I prepare them without taking away their childhood?

As occupational therapists, we don’t wait until adulthood to think about adulthood.

Rather than asking only, “What does this child need today?” we also ask the following:

What kind of life do they hope to have?
What are their strengths?
What interests motivate them?
What supports help them thrive?
What opportunities can we create today that may expand their choices tomorrow?

Why This Matters

According to the U.S. Bureau of Labor Statistics, only 22.7% of people with disabilities were employed in 2024, compared with 65.5% of people without disabilities.

Additionally, adults with disabilities are less likely to complete higher education. In 2025, approximately 24% of adults with disabilities (ages 25 and older) had earned a bachelor’s degree or higher, compared with 42% of adults without disabilities.

For students who attend college, another major transition occurs after high school. The protections provided under the Individuals with Disabilities Education Act (IDEA) no longer apply. Students must disclose their disability, request accommodations, communicate with professors, manage their schedules, and advocate for themselves.

These statistics aren’t meant to define any one child’s future. Every child and family is unique, with different strengths, values, goals, and resources. Every person’s path will look different, and many individuals with disabilities go on to pursue higher education, meaningful careers, independent living, and fulfilling lives. Rather, these numbers remind us why intentionally building life skills throughout childhood is so important.

I believe employment, higher education, independent living, and community participation can continue to improve as we increase awareness, provide meaningful supports, and intentionally help children develop the everyday skills they’ll need long before they become adults.

What Research Has Taught Us

Decades of research have consistently shown that when developmental concerns are identified early and children receive appropriate intervention, they often experience improvements in communication, adaptive behavior, developmental skills, school readiness, and family outcomes (Anderson et al., 2003; Pak et al., 2023).

Therefore, I believe that if we intentionally begin building the skills children will eventually need—not all at once, but gradually over many years—we give them more opportunities to participate successfully as adolescents and adults.

Every Skill a Child Learns Today Creates More Opportunities for Tomorrow

One of the beautiful things about childhood is that learning happens through everyday experiences. A toddler helping stir pancake batter may one day prepare meals independently. A child choosing between two outfits is learning decision-making and expressing preferences. Helping carry groceries develops healthy interdependence and confidence. There are many more opportunities just like these that develop skills needed for the future.

Occupational therapists often see something much bigger than the task itself. For instance, we don’t just see a child buttoning a shirt. We see a child learning:

Bilateral coordination
Motor planning
Problem-solving
Persistence
Frustration tolerance
Executive functioning
Confidence

Every small skill becomes part of something much bigger.

Childhood Is Practice for Adulthood

Learning doesn’t only happen during therapy sessions. It happens during everyday moments when children are making mistakes, trying again, and gradually developing new skills. Sometimes these moments are messy. Other times they’re frustrating. Sometimes our children resist, have meltdowns, and when we’re running late, it’s simply easier for parents to do the task for them. And sometimes that’s exactly what they need.

At the same time, if we always step in, children lose opportunities to practice. Those missed opportunities can gradually become patterns, which may shift expectations over time and eventually become barriers if we lose sight of the bigger picture.

One question I often encourage families to ask is:

“Is this something my child might be able to learn with practice?”

If the answer is yes, it’s probably worth creating opportunities to practice—even if progress happens slowly.

The World Has Changed

Technology has transformed daily life to the point that much of what we do now happens through the little computers we carry in our pockets. We use technology to organize our lives, communicate, socialize, make appointments, pay bills, and order what we need.

These advances have created incredible opportunities and increased accessibility for many individuals with disabilities. At the same time, children today may have fewer natural opportunities to practice talking with unfamiliar people, solving unexpected problems, navigating community environments, or advocating for themselves.

Future planning isn’t about avoiding technology. Rather, it’s about intentionally creating meaningful opportunities to practice the skills children will need throughout life. In many ways, we have to be more purposeful than previous generations because everyday life no longer provides as many natural opportunities to develop these skills.

For example, many of us rely on our phones to keep track of appointments, reminders, and notes. But what if your child one day has a job where phones aren’t permitted during the workday? Will they have had opportunities to practice writing information down, remembering directions, organizing tasks, or using other strategies to stay on track if they need to?

Future planning isn’t about insisting every child master every task. It’s about preserving options.

There Is No One Right Destination

There isn’t one definition of a successful adulthood. Some adults attend college, some learn a trade, some work full-time, while others volunteer. Some live independently, while others choose to live with family. Some will be largely independent, while others may always require significant support. All of these lives can be meaningful.

Our goal isn’t independence at all costs, but rather participation in a life that feels meaningful and purposeful to each individual. To achieve that, children need opportunities to make choices, develop skills, and practice using those skills over time.

A Free Resource for Families

To help families begin thinking about these skills, I created the Functional Independence & Transition Skills Checklist, a simple planning tool.

It helps families recognize their child’s strengths, identify areas where additional support may be helpful, prioritize meaningful goals, and think ahead about the everyday experiences that build confidence, independence, and participation over time.

Whether your child is a toddler, a teenager, or a young adult, it’s never too early—or too late—to begin building these skills.

My hope is that this checklist simply helps you begin thinking about what may come next. If you’d like to get started, download the checklist below.

This step-by-step tool can be completed independently, with your healthcare provider(s), or by a teen or adult. It can serve as a living document to help identify strengths, prioritize goals, and explore where additional supports or advocacy may be helpful.

➡ Functional Independence & Transition Skills Checklist

Wishing you all health, joy, and all the wonder that life has to offer!

References

Anderson, L. M., Shinn, C., Fullilove, M. T., Scrimshaw, S. C., Fielding, J. E., Normand, J., & Carande-Kulis, V. G. (2003). The effectiveness of early childhood development programs: A systematic review. American Journal of Preventive Medicine, 24(3 Suppl), 32–46. https://doi.org/10.1016/S0749-3797(02)00655-4

Guralnick, M. J. (2017). Early intervention for children with intellectual disabilities: An update. Journal of Applied Research in Intellectual Disabilities, 30(2), 211–229. https://doi.org/10.1111/jar.12233

Pak, N. S., Chow, J. C., Dillehay, K. M., & Kaiser, A. P. (2023). Long-term effects of early communication interventions: A systematic review and meta-analysis. Journal of Speech, Language, and Hearing Research, 66(8), 2884–2899. https://doi.org/10.1044/2023_JSLHR-22-00608

U.S. Bureau of Labor Statistics. (2025). Persons with a disability: Labor force characteristics—2024.

U.S. Bureau of Labor Statistics. (2026). People with a disability: Labor force characteristics—2025.

U.S. Government Accountability Office. (2024). Higher education: Education could improve information on accommodations for students with disabilities (GAO-24-105614).

“Every skill a child learns today creates more opportunities for tomorrow.”

Why I Stopped Telling Children to “Pay Attention” — The Story Behind Cal and His Amazing Attention Pie

Why I Stopped Telling Children to “Pay Attention” — The Story Behind

Cal and His Amazing Attention Pie

By Michaela Gordon OTR/L

I remember sitting in a class somewhere around 2006 or 2007 when the instructor said something that stayed with me. Researchers could measure different aspects of attention, but attention itself wasn’t nearly as simple as people often made it sound. That comment stuck with me, partly because I had spent much of my own life hearing the same words many children hear: “Pay attention.”

What always puzzled me was that I thought I was paying attention.

I wasn’t staring at the teacher or necessarily listening to directions, but my mind wasn’t empty either. I was thinking about something. Planning. Daydreaming. Remembering the feeling of my body moving through the water as I swam. Following butterflies while the soccer game carried on around me. Watching other people. Wondering about something I was touching. My attention had gone somewhere.

That question stayed with me:

If I’m always paying attention to something, then what exactly do people mean when they tell me to “pay attention”?

Years later, while working with a little girl in therapy, I began experimenting with that question. Instead of assuming she wasn’t paying attention, I wondered whether her attention was simply somewhere different than where the adults around her wanted it to be.

Originally, I thought about three spaces: Mental Space, People Space, and Touch Space.

Mental Space was where thoughts lived. It was planning, remembering, imagining, daydreaming, and simply letting your mind wander. Sometimes we drift into Mental Space and don’t even realize it. Other times, it’s where our creativity and best ideas come from.

People Space was harder to describe. It wasn’t just about socializing. It was more about sharing awareness with others and understanding what the moment called for. A child crossing the street with Mom, participating in a lesson, having a play date, or working together with friends might need a larger People Space. People Space wasn’t about everyone doing the same thing. It was about being aware of what was happening around you and what was expected in that moment.

Touch Space originally meant touching things, but over time I realized it was much bigger than that. It wasn’t just exploring objects with our hands. It included fidgeting with your feet, leaning against furniture, rolling on the floor, tilting your chair back, pressing your body into things, and becoming completely absorbed in building, creating, or feeling the physical world around you. Sometimes Touch Space can help us focus, and other times it can become so big that everything else disappears.

Years later, after learning more about interoception, I realized something was missing: Body Space.

Our bodies are constantly sending us messages in the background. Hunger, fatigue, temperature, the need to use the bathroom, anxiety, excitement—the list goes on. Our bodies are constantly helping us regulate and letting us know what we need. Sometimes those signals are quiet, and sometimes they become so loud that they naturally take up more of our attention.

Eventually, I realized something important: people are almost never paying attention to nothing. Even when our attention isn’t where others expect it to be, it’s usually somewhere.

Even while we sleep, our brains are still processing information. Most of us are never completely in one space. Instead, our attention is divided among thoughts, physical sensations, touch and movement, and awareness of the people and events around us.

That’s where the idea of the pie chart came from.

I began thinking about attention as a pie whose slices could grow bigger or smaller.

The spaces themselves weren’t good or bad. Bigger wasn’t always better.

The question wasn’t, “Which space should I get rid of?” The question was, “What size should each slice be right now?”

If you’re riding in the car on a road trip with a book in your hands, it makes sense for Mental Space and Touch Space to be larger while People Space becomes smaller.

If you’re crossing the street with your mother, People Space needs to become much bigger.

If you’re creating artwork or building something, Touch Space may become the largest space and help you stay engaged.

If you’re anxious before performing in front of others, your Body Space may suddenly become huge because your racing heart, sweaty hands, and butterflies in your stomach are telling you that something important is happening.

Or maybe you’re in a museum and someone reminds you not to touch the exhibits, but you find yourself fascinated by the texture of the paint sticking up from the canvas or the tiny details on a sculpture. If your Touch Space becomes much bigger than your People Space, you may end up frustrating the people around you, accidentally breaking something, or feeling bad afterward—not because you’re bad or because you weren’t paying attention, but because your attention was focused in a space that wasn’t the best fit for that particular situation.

Sometimes our spaces help us. Sometimes they don’t fit the situation. The important part is learning to notice.

For some people, especially those with ADHD, that process can be harder.

There are many systems involved. Executive functions help us plan and think ahead. Sensory systems provide information that helps us regulate. Alertness systems help us wake up and sustain attention. Motivation and reward systems influence what feels interesting enough to stay with. Anxiety and emotions can also take over and make it difficult to think clearly.

Attention isn’t one thing. It is many systems working together.

Which is why I gradually became less interested in telling children to “pay attention.”

Of course, I still catch myself saying it sometimes. We all do. Life gets busy, and sometimes we’re trying to stop something quickly. But over time, I realized that repeatedly saying “pay attention” wasn’t really teaching a skill.

Nothing changes simply because someone hears those words.

First, we have to figure out where our attention is. Then we can take actionable steps to shift it.

Instead of asking children to “pay attention,” I became more interested in helping them ask:

“What am I paying attention to right now?”

“What space am I in?”

“What space would help me the most?”

Because if we’re forever reminding children to pay attention without helping them understand where their attention is, no skill is really being built.

I wanted to find a way that I could share this concept with others, which is why I wrote Cal and His Amazing Attention Pie.

Through Cal’s classroom presentation, children are introduced to Body Space, Mental Space, Touch Space, and People Space. They learn that no space is “good” or “bad.” They discover that attention is always changing and that they can learn to notice where they are and make adjustments when needed.

The book is filled with humor and grace because I believe that is the way it should be. We want kids to feel curious and accepting of all parts of themselves.

Struggling with attention is not a moral failure. In fact, many children are doing amazing things in the spaces they naturally spend time in. The key is timing and learning how to shift so they have some agency over how they spend their time. This gives them opportunities to grow—not only in the areas where they are already strong, but also to develop other skills that will support them throughout their lives.

I also wanted the book to support the adults who care for children. That’s why the back of the book includes resources for parents, teachers, and therapists. I explain some of the brain systems involved in attention, offer practical sensory and cognitive supports, and provide ideas for helping children build awareness and flexibility instead of relying only on reminders like “Pay attention.”

My hope is that children come away with a new understanding of themselves.

My hope is that children stop asking, “What’s wrong with me?” and start asking, “What am I paying attention to right now, and is it helping me?”

Because attention isn’t something children fail at. It’s something they can learn to notice, understand, and gradually shape.

If you’re interested in learning more, you can pick up a copy of Cal and His Amazing Attention Pie on Amazon and use it as a shared reference with the children in your life. My hope is that the story and caregiver resources will provide a common language that helps children, families, teachers, and therapists better understand attention together.

Holding On, Letting Go

Holding On, Letting Go:

Why I Wrote This Book

By Michaela Gordon, OTR/L

I published Holding On, Letting Go at the end of last year, but the story itself had been with me for a long time.

It was a book I kept coming back to—one that unfolded over time. It began as a quiet contemplation, and when I first put it into words, it came quickly. But shaping it into something that felt safe for children and meaningful to share took time, care, and intention.

There were experiences that made me think about what it means to love someone, to grow, and eventually, to let go.

Watching families move through change—especially when a child is involved—has a way of staying with you. It invites questions that don’t always have easy answers.

At the same time, I was in a season of change myself—and that, too, became part of the story.

There are moments in life that bring you face-to-face with what really matters. Moments that shift your perspective. Moments that ask you quietly but persistently, to hold on to what is meaningful… while also learning how to let go of what you can’t control.

That tension—between holding on and letting go—became the heart of this book.

As an occupational therapist, I often think about how much our sense of safety comes from the rhythms of our lives. The people we see every day. The routines we rely on. The connections that ground us.

When those are disrupted—whether through loss, change, or uncertainty—it can feel incredibly disorienting.

For children, this can be especially hard.

Grief doesn’t look the same for every child. Some want to talk. Some don’t. Some ask questions, and some process through play, movement, or simply being close to someone they trust.

There is no one right way.

Our role isn’t to rush them through it—it’s to meet them where they are.

In occupational therapy, we support children by helping them feel safe in their bodies, regulated in their nervous systems, and connected to the world around them. We help rebuild a sense of predictability through routine, relationship, and meaningful activity.

Sometimes, a story can become part of that support.

Holding On, Letting Go tells the story of Ella, a little dandelion, and the conversations she shares with her mom and grandma as she begins to notice change. Through their relationship, she learns that life is always moving—growing, shifting, and evolving—and that love continues, even when things look different.

If you had asked me ten years ago if I would be writing children’s books, I would have said no. But I wrote one—and then I wrote another. This was the second.

I was hesitant to share it. It holds a sensitive and meaningful topic, and that carried a lot of weight for me. But the story came to me in a way that felt clear and important, and I knew it was something I needed to write.

Since publishing it, I’ve been able to share this book with families during moments when they needed it most. I’ve also shared it with individuals who have experienced loss, and it has brought them great comfort. You’re truly never too old for a children’s book.

Some of us are preparing for change.

Some of us are moving through loss.

And some of us are simply trying to find the right words to support the people we love.

What I’ve learned is this:

It’s not just a children’s book.

It meets people wherever they are.

Because there’s a part of us that’s still learning how to hold both joy and pain… how to stay present with all that we love, while also making space for what we can’t hold on to forever.

My hope is that this book offers a gentle place to begin.

A way to open conversations.

A way to sit with big feelings.

And a reminder that even in letting go, love doesn’t disappear—it continues on, in ways we can still feel.

If you feel like this book could support you or someone you love, you can find Holding On, Letting Go here:

https://a.co/d/05xJWlhS

It’s one of those books people often don’t think they need—until the moment they do.

Clearing Up PDA Theory

Beyond High Demand and Low Demand: A Flexible Approach to PDA

By Michaela Gordon, OTR/L

Over the past year, conversations about PDA (Pathological Demand Avoidance) have grown louder — and sometimes more divided.

Some voices emphasize nervous system safety above all else.

Others emphasize skill-building and resilience.

Many parents are left wondering where they fit in that spectrum.

This post isn’t here to take sides. It’s here to widen the lens.

Because children are complex. Development is complex. And no single explanation captures every child fully.

What Is PDA?

PDA was first described in the 1980s by psychologist Elizabeth Newson in the United Kingdom. It is not currently listed as a separate diagnosis in the DSM-5 or ICD-11.

Today, PDA is generally described as a profile seen in some autistic children. Common characteristics include:

Intense resistance to everyday demands
High anxiety
Strong need for autonomy
Emotional reactivity
Periods of shutdown or escalation

Many children described as having PDA traits also meet criteria for autism. Whether it is a subtype, profile, or overlapping presentation is still debated in research.

What is clear is this: the children described under this profile often experience demands as disproportionately stressful.

The Nervous System Explanation

In some communities, PDA is described primarily as an autonomic nervous system response — meaning everyday demands are perceived as threats, triggering fight, flight, or freeze.

From this perspective, reducing demands (often called a “low-demand approach”) is seen as protective and supportive. Many families report that lowering pressure reduces conflict and improves connection.

That makes sense. When stress decreases, capacity increases.

But regulation is influenced by more than one system.

A child’s ability to handle demands may be shaped by:

Autonomic nervous system state
Sensory processing patterns
Executive functioning skills
Cognitive flexibility
Motor planning abilities
Interoception (body awareness)
Environmental stress load

No nervous system exists in a permanently fixed state. Capacity shifts day to day.

When a child struggles more than usual, that is not regression. It is responsiveness to stress.

Regulation First — But Not Regulation Only

You may hear the phrase: “Regulate first, then proceed.”

This is important. Children cannot learn new skills when they are overwhelmed.

But it’s also important to remember something else:

Learning always involves some stress. Trying something new, losing a game, making a mistake, or shifting plans. Discomfort is part of growth. The goal is not to eliminate stress completely.

The goal is to keep stress in a manageable range. Too much stress leads to shutdown. Too little stress can prevent growth. Supported stress builds resilience.

When a child shows intense avoidance, it signals that their stress system activates quickly. In those moments, the adult’s role is to stay regulated, stay connected, and calibrate the level of challenge carefully. We do not abandon expectations. We adjust the path toward them.

Safety means we do not push a child past their limit for the sake of compliance. It does not mean eliminating all discomfort. Children need safety from overwhelm. They also need experiences that build mastery.

The Risk of Over-Reduction

When PDA is explained solely as chronic nervous system flooding, there are potential risks:

Assuming dysregulation is permanent
Removing developmental challenges entirely
Reinforcing avoidance instead of building skills
Overlooking executive or motor skill gaps

In the short term, reducing demands can bring real relief. Stress lowers. Conflict decreases. Relationships stabilize. That matters!

But children described as having PDA traits also have goals.

They want friendships, competence, and independence. They want to grow.

The struggle is rarely a lack of desire. It is often an internal conflict between overwhelm and expansion.

Too little challenge can quietly narrow a child’s world.

This does not mean children need more pressure.

It means they need calibrated support. The goal is not high demand and it’s also not no demand. The goal is thoughtful demand — challenge matched to capacity, inside connection.

From Low Demand to Flexible Demand

Rather than eliminating demands indefinitely, I propose a concept I call Flexible Demand — adjusting expectations to match a child’s current regulation bandwidth.

Within this framework, I conceptualize support in bands — reflecting a child’s regulation bandwidth — rather than fixed, progressive levels.

Children move fluidly between support bands, as internal and external factors continually shift their window of tolerance. This movement is not necessarily regression —it is responsiveness to changing demands and environments.

Band A – Stabilization Mode

Reduce performance pressure. Increase predictability. Simplify tasks.

Band B – Scaffolding Mode

Introduce just-right challenges. Use collaboration. Gently expose to manageable discomfort.

Band C – Expansion Mode

Increase autonomy. Reduce scaffolds. Allow natural consequences with emotional availability.

Movement between bands is expected and healthy.

When Behaviors Feel Severe

It is also important to recognize that not all intense avoidance is purely developmental.

If you notice:

Sudden regression in skills
Extended mutism
Prolonged shutdowns
Episodes of unresponsiveness
Self-injury or dangerous aggression
Abrupt changes in baseline functioning

Medical or mental health evaluation may be appropriate.

Conditions such as seizure disorders, mood disorders, catatonia in autism, or other co-occurring challenges can sometimes present in ways that look like extreme avoidance.

Seeking clarity is not a failure. It is advocacy.

We’re Better Together

There are many conversations happening right now about PDA. Some prioritize nervous system safety. Others emphasize skill-building and graded exposure. Some focus strongly on autonomy. Others on structure.

Underneath the different language and models, most parents and professionals share the same goal:

We want children to feel safe, understood, and to grow into capable, confident humans.

We do not have to choose between compassion and challenge.

We do not have to choose between safety and growth.

These ideas do not compete.

They can work together.

If we stay curious instead of defensive…

If we stay collaborative instead of divided…

If we remember that no parent is trying to harm their child…

Then we are already moving in the right direction.

If this framework resonates with you, I’ve created a more detailed parent guide that expands on these ideas and offers practical examples of using the Flexible Demand model in everyday situations.

If you’d like a copy, feel free to reach out – I’m happy to share it.

What Pediatric Occupational Therapy Is (and isn’t)! By, Michaela Gordon, OTR/L

What Pediatric Occupational Therapy Is (and Isn’t)!

By Michaela E. Gordon, OTR/L

Throughout my time as an OT, I have worked hard to find ways to capture, explain, and demonstrate the full scope of occupational therapy. I think back to all the settings I have worked in and how I worked as an occupational therapist in those settings/systems. Each setting taught me something new that I carried into the next—broadening my understanding and deepening my practice as an OT. Here are some examples from my experience as an OT over the years:

Mental Health Center: Collaborated with a multidisciplinary team of medical professionals to discuss cases and coordinate care, facilitated self-care and life-skills groups, and developed sensory-based programs to support regulation and coping.

Pediatric Burn Hospital: Fabricated splints in the operating room to support long-term range of motion in the upper extremities, fitted facial orthoses and pressure garments to minimize scarring, developed adaptive devices for self-care tasks, and provided emotional support to patients and families navigating recovery.

Hospital Setting: Supported infants in the NICU to promote feeding and sensory regulation, conducted neuro-motor and self-care assessments for adults in acute and subacute units, and designed discharge plans to promote safe transitions home or to other care facilities.

Nursing Homes: Addressed memory and cognitive strategies for daily routines, and implemented strength, coordination, and range-of-motion programs to improve independence in self-care and mobility.

School for Children with Autism: Collaborated closely with a team of medical and educational professionals to provide sensory–motor, social–emotional, and self-care interventions; trained parents and teachers on carryover strategies; and supported community participation through vocational and independent-living experiences such as starting jobs at local businesses, shopping, money management, and dining out.

Public Schools: Conducted school-based assessments, provided direct services for students with identified needs, consulted with teachers to support students who did not qualify for services, and participated in IEP meetings to collaborate with families and interdisciplinary team members.

Aquatic Therapy: Used neurodevelopmental and sensory-based techniques in the water to promote regulation, strength, coordination, and safety.

Early Intervention: Provided home- and community-based services to infants and toddlers, focusing on early sensory–motor, fine motor, and self-care development. Supported parents and caregivers through education, hands-on training, and individualized home programs.

Clinic-Based Practice: Served children of all ages, with an emphasis on sensory–motor development, fine motor skills, and self-regulation. Ran early intervention and social skills groups, collaborated with other professionals (e.g., PTs, SLPs), and provided home programming and parent training to promote skill carryover.

Private Practice (In-Home): Worked with families in their natural environments to support sensory–motor, self-care, social–emotional, and executive functioning skills. Designed individualized home programs, provided parent education, and integrated holistic interventions such as aquatic therapy and craniosacral therapy.

Private Practice (Office Setting): Offer similar services to in-home care with expanded access to specialized equipment and materials, incorporating sensory–motor play, regulation-based supports, and holistic interventions.

Community Outreach: Partner with schools and community centers to educate families and professionals about occupational therapy, facilitate support groups, help with developing community programs, and promote public awareness through blogs, social media, and outreach materials.

Each of these settings offered unique insights into how occupational therapy helps individuals adapt, recover, and grow. Whether in hospitals, schools, clinics, or the community, the common thread is helping people participate more fully and meaningfully in their everyday lives.

As you can see, the role of the OT can widely vary based on the setting/system, the role of the other professionals involved, and the experience of the therapist. I’m sure you could meet another OT that will tell you other ways they have worked in the field.

In terms of pediatrics, I would say pediatric occupational therapists are most well-known for helping kids with developing sensory and handwriting skills. However, we do so much more than that! I find that once an OT starts working with other professionals and families, they are often surprised to find out all the ways we can help kids and families.

Occupational therapy is one of the most versatile fields in healthcare. While it overlaps with psychology, physical therapy, and speech therapy, OT is distinct in its focus on helping children participate in the many occupations of daily life—everything from getting dressed and playing, to learning, socializing, and building independence. Our goal is to strengthen the skills that make everyday living meaningful and successful.

The Domain of Occupational Therapy (AOTA, OTPF-4)

According to the American Occupational Therapy Association (AOTA), the domain of occupational therapy outlines the full range of areas OTs address to support meaningful participation in daily life. This framework is described in the Occupational Therapy Practice Framework: Domain and Process, 4th Edition (OTPF-4, 2020).

The domain is composed of five interrelated areas:

1. Occupations – The everyday activities people want, need, or are expected to do. For children: play, education, self-care, rest/sleep, and social participation.
2. Client Factors – The underlying capacities that influence performance. Includes values, beliefs, body functions (sensory, cognitive, emotional, motor), and body structures.
3. Performance Skills – The observable, goal-directed actions used in daily life. Includes motor skills (e.g., posture, coordination), process skills (e.g., organization, attention), and social interaction skills.
4. Performance Patterns – The habits, routines, and roles that structure daily life. For children, these may include school routines, bedtime rituals, and family roles.
5. Contexts – The environmental and personal factors that influence participation. Includes physical, social, cultural, temporal, and virtual environments.

Together, these areas describe the scope of what OTs assess and address—providing a holistic, person-centered framework that supports participation across all areas of life.

In the following sections, I describe what this looks like in practical terms—how occupational therapists may help children and families build the skills and supports they need for everyday life.

What OT Is

Occupational therapists support the whole child—addressing interconnected systems of sensory, motor, cognitive, and emotional development. These domains are interdependent and together build a child’s capacity to learn, connect, and thrive in daily life. Below are the primary areas pediatric OTs focus on when helping children reach their fullest potential.

Sensory Integration and Other Sensory-Based Approaches

Occupational therapists (OTs) assess and treat sensory integration challenges using evidence-based approaches that help children process sensory input more effectively and participate more fully in everyday activities such as play, learning, and self-care. One of the most established models is Ayres Sensory Integration® (ASI), developed by Dr. A. Jean Ayres, which focuses on enhancing the brain’s ability to organize and interpret sensory information through play-based, child-led activities.

In addition to ASI, OTs may draw from a range of sensory-based and sensory-informed frameworks to address individual differences in regulation and participation. These may include the Sensory Processing Model (Winnie Dunn), which helps identify sensory seeking or avoiding patterns to guide environmental adaptations; The Alert Program® (“How Does Your Engine Run?”) and The Zones of Regulation®, which teach children to recognize and manage their arousal states; and the Sensory Diet Framework (Patricia Wilbarger), which provides structured daily sensory activities to promote attention and self-regulation.

OTs may also incorporate specific sensory-based modalities—such as the Wilbarger Deep Pressure and Proprioceptive Technique (Brushing Protocol), Therapeutic Listening® (Sheila Frick), and Astronaut Training, which integrates vestibular, visual, and auditory processing—when clinically appropriate and with specialized training.

All of these approaches are used within an individualized, occupation-centered treatment plan that supports the child’s ability to regulate, attend, and engage meaningfully in daily routines across home, school, and community settings.

Gross Motor & Physical Development

Occupational therapists address foundational movement skills that support a child’s ability to play, learn, and participate in daily life. This includes developing balance, coordination, postural control, strength, endurance, and body awareness.

A core focus of gross motor development is bilateral coordination—helping the left and right sides of the body work together in an organized way. OTs also support motor planning, or the ability to generate motor ideas, plan and sequence actions, and carry them out with timing and fluidity.

Through engaging, play-based movement activities, children build the gross motor foundations they need to participate in functional tasks at home, school, and in the community—from climbing and playground play to navigating hallways, carrying materials, and maintaining posture during classroom activities.

Fine Motor & Visual–Motor Skills

Occupational therapists help children develop precise hand movements, coordination, and control that support participation in everyday activities such as dressing, feeding, writing, and play. This includes building hand strength, grasp patterns, in-hand manipulation, and bilateral coordination for tasks that require both hands to work together.

At the fine motor level, OTs also address motor planning—helping children generate ideas, plan and sequence actions, and carry them out smoothly with appropriate timing and fluency. This process allows children to approach fine motor tasks such as cutting, coloring, writing, manipulating small toys, and using everyday objects like containers and bags with greater confidence and efficiency.

OTs also support visual–motor integration, helping children coordinate what they see with how they move. These skills are essential for tasks like handwriting, lining up numbers for math, completing mazes or tracing paths, and connecting dots—all of which build the foundation for academic success and everyday functional performance.

Through engaging, play-based activities, OTs help children strengthen fine motor control and visual–motor coordination so they can participate more fully in classroom, play, and self-care tasks with precision, confidence, and independence.

Visual–Perceptual & Oculomotor Skills

Occupational therapists help children develop the visual foundations needed for learning, play, and everyday functioning. This includes both oculomotor control—how the eyes move—and visual–perceptual processing—how the brain interprets what the eyes see.

Oculomotor skills involve the ability to track moving objects, visually shift from point to point, adjust focus between near and far distances, and move the eyes independently from head movements. These skills are essential for reading, writing, copying from the board, ball skills, and navigating environments safely and efficiently.

In addition to oculomotor control, OTs address visual–motor integration (coordinating visual input with motor output) and broader visual–perceptual skill development. These include the ability to recognize and remember visual details, distinguish forms and symbols, perceive spatial relationships, and identify objects within complex backgrounds. Together, these ‘motor-reduced’ visual-perceptual skills—such as visual discrimination, memory, spatial awareness, form constancy, sequential memory, figure-ground, and visual closure—help children process visual information accurately and efficiently.

Through individualized, activity-based intervention, OTs strengthen the connection between vision, movement, and perception—helping children participate more successfully in classroom, play, and daily life tasks.

Cognition & Executive Functioning

Occupational therapists help children strengthen the mental skills that allow them to plan, organize, remember, and carry out daily tasks effectively. These executive functions support participation in learning, play, and self-care routines.

OTs work with children on skills such as attention, memory, organization, sequencing, and problem-solving—all of which help them stay focused and complete tasks from start to finish. Intervention often involves teaching children how to visualize their day and break larger tasks into smaller, more manageable steps.

Examples of OT support in this area include:

– Using timers, visual schedules, and checklists to help children understand routines and transitions.
– Supporting the organization of living spaces, school areas, and materials such as desks, lockers, and backpacks.
– Teaching children to sequence tasks—like getting dressed, packing for school, or following multi-step classroom directions—in a logical and efficient order.
– Using memory strategies to help recall important information such as days of the week, home addresses, or phone numbers.
– Encouraging self-monitoring and task persistence—helping children notice when they are distracted, return to the task, and complete it successfully.
By fostering these cognitive and executive function skills, occupational therapists help children become more independent, confident, and capable of managing their responsibilities at home, school, and in the community.

Play, Social Participation, and Social–Emotional Development

Play is a child’s most natural occupation and the foundation for learning, connection, and emotional growth. Occupational therapists use play-based interventions to build the skills children need to engage meaningfully with their world—socially, emotionally, and behaviorally.

Through play, OTs support children in developing emotional regulation, social communication, relationship-building, problem-solving, and flexibility. Play provides a safe, motivating space to practice managing frustration, coping with challenges, and taking turns or sharing with peers.

OTs also help children recognize and express emotions appropriately, read nonverbal cues, and develop empathy and self-awareness. Using frameworks such as The Zones of Regulation®, The Alert Program®, and other self-regulation models, therapists teach children to identify body cues, regulate energy levels, and apply calming or alerting strategies to meet the demands of different environments.

In this way, play becomes a powerful medium for developing social participation, emotional understanding, and self-regulation—allowing children to practice these essential life skills naturally within joyful, meaningful experiences.

OTs also collaborate with caregivers and educators to ensure that play and social–emotional strategies generalize across home, school, and community settings.

By fostering joyful, connected participation, occupational therapy helps children build the emotional resilience and social confidence needed to thrive in relationships and in life.

Behavioral Management

Occupational therapists actively address behavior as part of a child’s ability to participate in daily life. Rather than viewing behavior as something to “fix,” OTs understand it as a form of communication about a child’s sensory, emotional, cognitive, or environmental state. Often, maladaptive behaviors emerge in response to underlying developmental challenges and/or relational or social-environmental factors. As those foundational skills strengthen, OTs help children learn and practice new, more adaptive behaviors that support participation and success across settings.

Intervention is not designed to suppress behaviors but rather to build regulation, self-awareness, and adaptive responses through supportive, relationship-based, and developmentally appropriate strategies.
In practice, occupational therapists draw on a range of evidence-based and developmental strategies to support behavioral growth, including:

Focus on self-regulation: OTs use frameworks such as The Zones of Regulation®, The Alert Program®, and other sensory-based strategies to help children identify their arousal states, interpret body cues, and choose tools that promote calm and focus.

Behavioral management methods: When appropriate, OTs may integrate structured, evidence-based behavioral management programs—such as 1-2-3 Magic (Dr. Phelan), The Nurtured Heart Approach (Howard Glasser), or Positive Discipline (Dr. Nelsen)—to support consistency, clear boundaries, and positive behavior reinforcement. These approaches emphasize balanced, developmentally appropriate use of structure and consequences, helping children and families establish predictability and mutual respect. When used within an occupational therapy framework, these methods complement self-regulation, emotional awareness, and relational skill-building—without replacing psychotherapy or ABA.

Environmental design: Behavior is influenced by the environment. OTs modify sensory input, physical setup, schedules, and routines to prevent dysregulation and reduce triggers.

Collaborative coaching: OTs use coaching and education-based approaches to help parents, caregivers, and teachers understand their child’s sensory and emotional needs. Through modeling, reflection, and consistent practice, OTs support families in applying regulation and behavioral strategies across home, school, and community settings.

Goal orientation: Behavioral change is achieved through improved sensory modulation, emotional regulation, and task fit, leading to genuine participation rather than surface-level compliance.

In short, OTs manage behavior from the inside out—building the foundations of self-awareness, regulation, and environmental support so children can thrive across home, school, and community settings.

Family Dynamics, Parenting Support, and Interpersonal Relationships

Occupational therapy is inherently family-centered. Children grow, learn, and self-regulate within the context of their relationships—so OTs work closely with parents and caregivers to strengthen the systems that support each child’s development.

Therapists help families understand how sensory, motor, emotional, and cognitive factors influence behavior and daily function. We collaborate to create predictable routines, reduce stress around daily tasks, and establish strategies that help everyone feel more connected and capable.

Parenting support may include developing structured routines, visual supports, and sensory-regulation tools that fit seamlessly into daily life. OTs also provide education and coaching to help caregivers interpret their child’s cues, respond effectively during moments of dysregulation, and promote independence while maintaining emotional connection.

In addition, OTs help families navigate interpersonal dynamics—supporting communication, role balance, and shared problem-solving among family members. By fostering understanding and compassion within the household, occupational therapy strengthens not only the child’s development but the well-being of the entire family system.

Self-Care and Activities of Daily Living (ADLs)

Self-care is a cornerstone of pediatric occupational therapy. OTs help children build the skills, routines, and confidence needed to participate in everyday activities such as dressing, feeding, hygiene, toileting, and grooming—promoting greater independence at home and school.

Intervention may include improving fine motor coordination, bilateral hand use, sequencing, sensory processing, and body awareness—skills that allow children to complete daily routines smoothly and confidently.

As children grow, these foundational self-care abilities expand into more complex daily living tasks—often referred to as instrumental activities of daily living (IADLs).

Instrumental Activities of Daily Living (IADLs)

As children mature, occupational therapists support their participation in more complex daily tasks that promote independence and prepare them for adolescence and adulthood. These “instrumental” activities build upon the foundation of self-care and include organizing school materials, managing homework routines, packing backpacks, preparing simple meals or snacks, participating in chores, and learning to plan and manage time. For teens, IADLs may expand to include money management, shopping, community navigation, and caring for others or pets.

By developing these higher-level life skills, OTs help children and adolescents build confidence, self-reliance, and readiness for the increasing demands of home, school, and community life.

Rest and Sleep

Healthy sleep routines are essential for emotional regulation, learning, and overall well-being. OTs evaluate how sensory preferences, daily habits, and environmental factors affect a child’s ability to fall asleep, stay asleep, and wake feeling rested. Therapists work closely with families to develop calming bedtime and wake-up routines, adapt the sleep environment for comfort and consistency, and integrate sensory or self-regulation strategies such as deep pressure input, rhythmic movement, or breathing exercises.

By addressing the sensory, environmental, and behavioral aspects of sleep, OTs help children and caregivers establish rhythms that promote rest, balance, and readiness for each day’s activities.

Health Management

Health management involves building awareness, habits, and routines that support physical and emotional well-being. For children, this may include learning to recognize body cues such as hunger, fatigue, or overstimulation; understanding and participating in health-related tasks like using inhalers, taking medication safely, or caring for braces or glasses; and developing organizational and time-management strategies that promote consistency in daily self-care.

Occupational therapists also work with families to build structure around nutrition, hydration, physical activity, and mindfulness practices, tailoring these routines to each child’s developmental and sensory profile. By addressing health management holistically, OTs empower children to take an active role in maintaining their well-being—laying the groundwork for lifelong self-care, confidence, and resilience.

Leisure

Leisure refers to the free-choice activities that bring enjoyment, relaxation, and fulfillment. For children, leisure often grows out of play but becomes more purposeful as they develop personal interests, hobbies, and ways to recharge. Occupational therapists help children and teens explore what they enjoy, identify barriers that limit participation, and build the skills needed to engage in meaningful recreational activities.

This may involve fostering confidence to join a sports team, encouraging creative outlets like art or music, or helping children find calming, screen-free ways to unwind. Supporting leisure allows children to experience balance—between learning, responsibility, and rest—while nurturing creativity, self-expression, and a positive sense of identity.

When self-care, instrumental activities, rest, health management, and leisure are addressed together, children develop balanced rhythms that support both physical independence and emotional regulation. By helping families create predictable, nurturing routines across morning, school, and bedtime transitions, occupational therapy fosters confidence, participation, and a sense of mastery in the tasks that shape everyday life.

Transition & Vocational Skills

For older children and teens, OTs help prepare for transitions to higher grades, community participation, and future employment. This includes teaching organization, time management, community navigation, and self-advocacy skills.

Assistive Technology & Environmental Adaptation

OTs recommend and train children in the use of adaptive tools such as pencil grips, slant boards, communication switches, and computer access devices. They also modify physical and sensory environments to promote accessibility and comfort.

Specialty Approaches: Aquatic & Equine OT

Beyond traditional settings, OTs may use water or horse movement as therapeutic tools. Aquatic OT enhances sensory-motor coordination; equine-assisted OT promotes balance, confidence, and emotional connection.

Liaison, Consultation, and Care Coordination

Occupational therapists often act as bridges between professionals, families, and systems of care. We collaborate with teachers, speech-language pathologists, psychologists, medical specialists, and other providers to ensure each child’s support plan is cohesive and effective.
Through regular communication and team meetings, OTs help align therapeutic goals across settings—making sure that strategies used at home, school, and in the community reinforce one another.

OTs also assist parents in assembling and coordinating an interdisciplinary care team, ensuring that every provider understands the child’s sensory, emotional, and functional profile. This collaborative model allows interventions to work synergistically, maximizing the child’s growth, participation, and success across environments.

Although occupational therapists are able to help in many ways, there are many other types of therapies that are highly beneficial in supporting children and families. Because occupational therapy encompasses such a broad scope of practice, it’s equally important to understand what falls outside of that scope. Recognizing these boundaries helps parents appreciate why they may work with an OT and another professional on similar goals—but in slightly different ways. It also highlights that the OT’s role may shift when other specialists are already fulfilling complementary aspects, such as serving as the primary care-team coordinator.

What OT Isn’t

While pediatric occupational therapy addresses the whole child—integrating sensory, motor, cognitive, emotional, and behavioral systems—OT is just one of many valuable supports a child may benefit from. What matters most is that children receive the right combination of services from providers who are a good fit, and that all professionals and caregivers work collaboratively for the child’s success.

Because occupational therapy has such a broad and integrative scope, it’s equally important to understand what OTs do not do. The following distinctions highlight how OT overlaps with—but remains distinct from—other disciplines such as speech therapy, physical therapy, psychology, and applied behavior analysis.

Not Physical Therapy

OTs and physical therapists (PTs) often share similar tools and techniques, and both address the musculoskeletal and neuromuscular systems to help children build strength, coordination, and body awareness. However, their focus and goals differ.

Physical therapists (PTs) specialize in the quality and mechanics of movement. They focus on alignment, strength, endurance, range of motion, and gait (walking) patterns, often addressing orthopedic, neurological, or developmental movement conditions. PTs are typically the professionals who evaluate and treat gait abnormalities, balance issues, and postural control, and in some cases, may diagnose or manage physical conditions related to motor function.

Occupational therapists (OTs) work on similar motor foundations—but always through the lens of function and participation. OTs address how strength, coordination, and balance translate into meaningful daily skills such as dressing, writing, feeding, or sitting upright in class. They integrate sensory, cognitive, emotional, and physical systems to help children use their bodies purposefully and confidently across home, school, and play settings.

In many pediatric programs, OTs and PTs work side by side—PTs supporting how the body moves, and OTs focusing on what that movement allows a child to do. Together, they provide a holistic approach that nurtures growth, independence, and everyday success.

Not Speech Therapy

OTs may address feeding and oral-motor mechanics (chewing, swallowing, posture for feeding), but they do not provide therapy for articulation, expressive/receptive language, or fluency. These are within the expertise of speech-language pathologists (SLPs).

Not ABA Therapy

While OTs address behavioral management, they do so from a developmental, sensory, and emotional regulation perspective—not through the strict operant-conditioning framework of Applied Behavior Analysis (ABA).

OT focuses on understanding why behaviors occur — by exploring sensory needs, emotional regulation, cognitive processes, and how the environment fits the child.

ABA focuses on modifying which behaviors occur — using reinforcement, structured teaching, and behavior analytic techniques to increase desirable behaviors and reduce undesired ones.

Together, they can complement each other—ABA supports measurable skill learning, and OT builds the internal and environmental foundations that sustain it.

Not Psychotherapy

Occupational therapists absolutely address aspects of mental health—such as emotional regulation, stress management, social participation, and coping within daily routines—but they do not provide psychotherapy or clinical mental-health treatment. Processing trauma, family conflict, or deeper emotional patterns falls within the expertise of psychologists, marriage and family therapists (MFTs), or licensed clinical social workers (LCSWs).

OT focus: Supporting mental health through participation—helping children recognize emotions, use sensory or movement-based regulation tools, develop coping routines, and build confidence in daily roles (home, school, play).

Psychotherapy focus: Exploring the roots of emotional distress—such as trauma, relationships, or thought patterns—through talk therapy, play therapy, or other relational methods to promote emotional healing and insight.

Together, these disciplines complement each other: OT helps children manage daily life and strengthen regulation skills, while psychotherapy provides deeper emotional processing and long-term psychological healing.

Not Educational Therapy

While OTs address skills that support learning—such as attention, executive functioning, visual–motor integration, and self-regulation—they are not educational therapists. Educational therapists primarily provide academic intervention, remediation, and tutoring for specific learning differences (e.g., dyslexia, dyscalculia, ADHD-related study skills). In contrast, occupational therapists focus on the underlying developmental and functional foundations that make learning possible: sensory processing, posture, motor coordination, attention, and participation in classroom routines. OTs often collaborate with educational therapists and teachers to ensure a child’s functional skills and learning strategies work hand in hand.

Not Vision Therapy

Occupational therapists address visual–perceptual, visual–motor, and oculomotor skills as they relate to participation in daily activities like reading, writing, and play. However, OTs are not vision therapists and do not prescribe or provide interventions involving prisms, colored lenses, or optical corrections. Vision therapy is within the scope of a developmental optometrist or ophthalmologist. OTs and optometrists often collaborate—OT focuses on functional participation and environmental adaptation, while the optometrist addresses visual efficiency and eye health.

Conclusion

Pediatric occupational therapists support the whole child—addressing sensory, motor, cognitive, emotional, and behavioral systems together. Through evidence-based practice, collaboration, and thoughtful environmental design, OTs help children participate meaningfully in the daily occupations that shape their growth and well-being.
With that being said, occupational therapy is just one of many valuable supports a child may benefit from. What matters most is that each child receives the right combination of services—from providers who are a good fit—and that all professionals and caregivers work collaboratively for the child’s success.

OTs also recognize that a child’s well-being is shaped not only by direct therapy, but by the environments and relationships that surround them. By partnering with families, teachers, and other care providers, OTs help design spaces, routines, and interactions that nurture participation, confidence, and connection across all areas of daily life.

Resources for Further Exploration

Core AOTA Frameworks and Standards

– American Occupational Therapy Association. (2020). Occupational Therapy Practice Framework: Domain and Process (4th ed.). American Journal of Occupational Therapy, 74. (Suppl. 2). https://research.aota.org/ajot/article/74/Supplement_2/7412410010p1/6486
– American Occupational Therapy Association. (2021). Standards of Practice for Occupational Therapy. American Journal of Occupational Therapy, 75 (Suppl. 3). https://research.aota.org/ajot/article/75/Supplement_3/7513410030/23113
– American Occupational Therapy Association. (2021). Guidelines for Occupational Therapy Services in School-Based Practice. American Journal of Occupational Therapy, 75 (Suppl. 3). https://research.aota.org/ajot/article/75/Supplement_3/7513410060/23118
– American Occupational Therapy Association. (2021). Scope of Practice Chart. https://www.aota.org/-/media/corporate/files/advocacy/scope-of-practice-chart-10-21.pdf
– American Occupational Therapy Association. (2022). Model Occupational Therapy Practice Act. https://www.aota.org/-/media/corporate/files/advocacy/state/resources/practiceact/final-model-practice-act-2022.pdf

– American Occupational Therapy Association. (2017). Occupational Therapy’s Role in Physical Rehabilitation. OT Practice.

–American Occupational Therapy Association. (2015). The Role of Occupational Therapy in Rehabilitation for Individuals with Neuromuscular Conditions. AOTA Fact Sheet.

-Case-Smith, J., & O’Brien, J. C. (2015). Occupational Therapy for Children and Adolescents (7th ed.). Elsevier.

Sensory Integration, Social-Emotional Learning, and Collaboration

– Schaaf, R. C., et al. (2021). Effectiveness of Occupational Therapy Using a Sensory Integration Intervention for Children with Developmental Disorders. American Journal of Occupational Therapy, 75 (6).
– Bazyk, S., & Bazyk, J. (2021). Fostering Social Participation and Emotional Well-Being in Children Through Occupational Therapy. American Journal of Occupational Therapy, 75 (3).
– Ward, S. C., et al. (2020). Collaboration Between Behavior Analysts and Occupational Therapy Practitioners. Behavior Analysis in Practice, 13 (4).
– Dunn, W. (2014). Sensory Processing Frameworks and Everyday Participation. AOTA Press.
– Williams, M. S., & Shellenberger, S. (1996). How Does Your Engine Run? The Alert Program® for Self-Regulation. TherapyWorks, Inc.
– Kuypers, L. (2011). The Zones of Regulation®. Think Social Publishing.
– Frick, S., & Young, S. (2009). Listening With the Whole Body: Therapeutic Listening® and Sensory Integration. Vital Links.

Specialty Practice Areas

– American Occupational Therapy Association. (2023). Spotlight on Pediatric Aquatic Occupational Therapy. https://www.aota.org/about/for-the-media/aquatic-occupational-therapy
– American Occupational Therapy Association. (2023). Incorporating Hippotherapy in the Treatment of Pediatric Populations. OT Practice.
– American Occupational Therapy Association. (2018). Role of OT in Comprehensive Integrative Pain Management. https://www.aota.org/-/media/corporate/files/practice/role-of-ot-in-comprehensive-integrative-pain-management.pdf
– American Occupational Therapy Association. (2023). Social and Emotional Learning Info Sheet. https://www.aota.org/-/media/Corporate/Files/Practice/Children/SchoolMHToolkit/Social-and-Emotional-Learning-Info-Sheet.pdf

Enjoying the Holidays With Your Neurodivergent Child

Enjoying the Holidays With Your

Neurodivergent Child

By Michaela Gordon, OTR/L

It is that time of the year again. Summer is behind us and we have entered the fall and winter seasons. The clocks have turned back and the weather has cooled. If that isn’t enough change, most of us celebrate 4 holidays up to the New Year! That is a lot of change! As much as we enjoy communing and celebrating, the holidays do come with some level of stress. This can be especially challenging for our neurodivergent children. Whether your child has ADHD, Autism, Anxiety or Sensory Processing Disorder, it is important to consider everyone’s needs as you make plans during this holiday season so everyone can enjoy themselves.

Here are some holiday suggestions so you can plan ahead:

Try to stick with your self-care schedule as much as possible. Kids generally do best, when they stick to their daily self-care routines. It can be an anchor at the start and end of their day to re-center them. This means going to bed and waking up at the same time, eating balanced meals at regular times, and brushing teeth and bathing at regular times.
Bring familiar items with you if you won’t be at your house. Again, the holidays come with a lot of novelty and this sometimes can overwhelm kids. You can consider bringing toys, blankets, books, food, or anything else that will make the child feel more comfortable while visiting friends and family.
Share with your kids the events that will happen and also discuss what you don’t know to allow for some flexibility in their thinking about the novel events. It can be helpful to let kids know what activities they will be doing and who they will be doing them with. Showing them pictures of places and people can also be helpful. It’s really important to also let them know about the unpredictable by using “maybe” or “might” statements. Example: “We are going to your Aunt Margaret’s house for Thanksgiving. We are going to leave after breakfast and it will take 3 hours to get there. When we get there, you can go out and play in the yard and then we are all going to have dinner together. Some things might happen that we don’t know about. We might get stuck in traffic or it might rain. We will come up with a new plan if that happens.”
Have an exit plan if needed. Sometimes things just become too much, even when we have tried our best to make sure the holidays as successful as possible. This means you may have to arrive a little later than expected or leave a little earlier to reduce the stimulation and demands that are becoming too much for your child. You can also go into a quieter room to do a preferred activity or go outside for some movement and fresh air.
Know your child’s tipping point. Some kids can handle lots of treats, candy, screens, and high intensity play, and then return relatively quickly to a calmer state, while for other kids, that can send them right into a spiral, turning a fun event into a sad ending. You know your child best so even though it’s supposed to be a fun, care-free experience, you may have to put a limit on items and activities that historically cause overstimulation.
Ask for support and help. You don’t have to do the holidays alone and bear through them. Ask the people you trust for help. It might be helpful to have a conversation before you arrive about what your child’s needs are so that family and friends can be prepared ahead of time. Whether it is making them special food, playing with your child while you socialize, turning down the music, or not insisting on a hug, asking for support can make the day a lot more enjoyable.

May you all be safe, healthy, and joyful this holiday season!

What is Dyspraxia?

What is Dyspraxia?

By Michaela Gordon, OTR/L

You most likely understand a therapist when they use the terms coordination, balance, and strength. However, do you understand the term praxis or dyspraxia?

Praxis can be broken down into three steps. Before a child can perform a motor action, two cognitive steps occur. The first cognitive step is ideation. Ideation is the ability to come up with new ideas for using your body and objects. In other words, is the child able to figure out what to do when they are presented with something new?

The second step is motor planning which involves planning out the sequence of motor steps to accomplish a task. Part of motor planning includes the timing of each step and getting the body into the various static and dynamic positions for each step moment by moment. In other words, now that the child has an idea of what they want to do, do they know how to put that idea into action in a timely and fluid way?

After these two cognitive steps have occurred there is then motor execution. Motor execution is the observable result of all these steps. In other words, was the child able to accomplish the task, and if so, was their performance within a range appropriate for their age?

The concept of praxis may be confusing for parents to understand if their child presents with high verbal skills or a vivid imagination but also presents with poor ideation in praxis. Ideation in praxis is specifically coming up with new ways to move or use the physical body in the physical world.

The other variable that may be difficult for parents to understand is the difference between praxis and motor patterns. The reason this can be hard to understand is because your child may be able to perform and even sometimes excel at one or more motor tasks i.e. riding a bike, or playing tennis, but then may not be able to perform a new motor task, even if that task is easier than the other tasks they excel at. Praxis requires focused attention in order to conceptualize and plan the novel task. The child’s level of praxis will not be revealed until the child engages in a novel task.

A motor skill (or a motor pattern) is a task that is familiar and has been repeated many times to the point that the motor pattern has become programmed into their muscle memory. When this happens, the child can perform those motor patterns automatically. For some children, if an element of a familiar task has been changed i.e. a longer rope, a smaller ball, someone else joins in, the task is done in a new environment etc., this may be enough novelty where praxis is needed and the child may have difficulty performing the task or may simply refuse to engage in the task.

One important contributor to the development of praxis is body scheme, which is a sensory-cognitive map of the physical self. Body scheme is developed through multisensory information with tactile and proprioceptive processing (sometimes referred to as somatosensory) being the biggest contributor to body scheme. Body scheme provides the child with physical safety to explore their environment, the ability to connect with the social world, to learn and develop motor skills, to refine movement, and influence regulation.

Issues with praxis may be referred to as motor planning issues or dyspraxia. Dyspraxia means difficulty with praxis even in the presence of normal intelligence and environmental opportunities. Somatodyspraxia means praxis issues that originate from issues with body scheme due to inefficient tactile and proprioceptive processing.

If praxis issues are present, it may take regular practice over a period of time to learn simple tasks and the child may need to re-learn the task on some level each time. Dyspraxia is easier to determine as occupational therapy services and programs are implemented since you often see this issue when the child is engaging in a novel task or engaging in tasks within a novel environment.

Dyspraxia can be addressed through sensory integration treatment and other sensory-based modalities.

Environmental and task modifications may need to be made at home and school to support the child while they build up their praxis skills. The child may also benefit from using cognitive strategies so they can better manage challenging tasks on their own. Lastly, engaging in a daily home program that supports the development of their sensory-motor skills is both important and helpful for long-term results.

Big Emotions, Big Emotions , My, Oh My! By Michaela E. Gordon, OTR/L

To Avoid or Expose: That Is The Question By Michaela Gordon, OTR/L