I have been an occupational therapist (OT) for 20 years and worked with children for over half that time. When I transferred from adults to pediatrics, I had no idea what I was doing. I had briefly learned aboutsensory integration treatment in OT school. I knew that it was a specialty of OT practice and a framework for understanding children’s behavior and difficulties at a neurological level. Children who need sensory integration treatment have trouble with daily activities because they process bodily sensations abnormally. I wanted to do my best for the children I would be treating, so I read books and attended workshops about sensory problems in children. Clinically, I experimented with suggestions for addressing sensory problems from those books and workshops; such as sensory exposure using water-based toys, bins full of rice or shaving foam on mirrors.

To the parents with whom I worked, I parroted the same suggestions for increasing sleep or dealing with problems behaviors; warm baths, consistent bedtime routines, using weighted vests or blankets. I modeled techniques for increasing eye contact with my children with autism; physical modeling and hand-over-hand guidance, engaged play, and discreet trials (an attempt to elicit a desired response in exchange for something the child likes). All those methods worked for some children… a little bit. But no book or workshop truly explainedwhy children with autism, ADHD, learning difficulties, or sensory processing problems were different. No source I encountered explained why I might choose one method over another or what to do when nothing seemed to work.

Most importantly to me, nothing I tried in my first year of working with children provided the rapid results I wanted to see. I wanted results so evident that I would knowfor certain that what I was doing was helping children adapt to their world. Because if I wasn’t helping a child make concrete, functional changes in their abilities, then I was wasting families’ precious time.

Everything I tried felt as if I was putting out little fires, but not addressing the big blaze. A child would have a definitive deficit that affected their family, such as, “Timmy won’t sit for more than three minutes, so we can never have a family meal together.” I would offer suggestions specific to mealtimes for the family to try, given what I thought might be making it difficult for Timmy to sit still. I felt as if I was offering solutions to individual problems a child had, like so many “band-aids” to place over the outside, without understanding the problems each child was facing on the inside. I didn’t really understand how to help children interact with their world more functionally, from within themselves.

A large part of my frustration was knowing that I had no more knowledge about how to help a child than their parents or teachers. Parents are the experts on their children. Why were they bringing their children to me? What could I possibly suggest or add that they had not researched on the internet, considered or tried on their own?

By way of example, a parent might ask, “Can you help my child learn to tie their shoes?” When a child ties their own shoes, they have a sense of accomplishment, are more independent, and free up precious moments of time from a harried parent. I desperately wanted a child to be able to tie their shoes. However, other than repeating the tying proceduread nauseum (for both of myself and the child), I had no idea how to teach a child to tie their shoes, or more accurately, toget a child to learn to tie their shoes. What I needed to know was how to help a child toteach themselves how to tie their shoes. This is how all children learn new skills; they observe, possibly with an explanation from a more experienced person, then they are let loose on the field to build the skills from the ground up.

Children can’t teach themselves to tie their shoes if they lack the requisite skills of attention, visual control, finger isolat