Are We Solving the Right Problem?

Occupational therapists have always been problem solvers.

We observe.

We analyse.

We identify barriers.

Then we develop interventions to improve participation.

But recently I've found myself asking different questions.

What if we've become so focused on participation that we've forgotten to ask whether the child has the regulation capacity to participate in the first place?

That isn't a criticism of our profession.

It's an invitation.

Over the past week I've been reviewing autism support systems across Japan, Finland USA and New Zealand, alongside current discussions surrounding Australia's future direction through Thriving Kids.

- Each country looks different.

- Each system has strengths.

- Each system has limitations.

Yet one question keeps surfacing.

Are we designing interventions around behaviours...or around nervous systems?

These are not the same thing.

When regulation capacity fluctuates throughout the day, our interventions cannot remain static.

The same visual schedule that supports a child during one moment may become meaningless during another.

The same executive functioning strategy that works beautifully during calm may disappear completely during overwhelm.

The same social skills program may unintentionally demand capacities the child temporarily cannot access.

None of those interventions are wrong.

They simply depend on timing.

As occupational therapists, we pride ourselves on individualised practice.

Perhaps the next pivot of paediatric OT is not simply asking:

"What does this child need?"

but also asking:

"What is this child's nervous system capable of accessing right now?"

Those are very different clinical questions.

State-dependent intervention changes everything.

It influences how we assess.

- How we prioritise goals.

- How we interpret assessment findings.

- How we coach families.

- How we collaborate with teachers.

- How we judge progress.

And perhaps most importantly...

...how we define success.

Because success is not determined by a child's compliance.

Success is whether our support matched the child's current capacity, so that they could participate, learn and thrive.

I wonder if this is where Australian paediatric occupational therapy has an extraordinary opportunity.

- Not to abandon participation.

- Not to replace sensory integration.

- Not to dismiss executive functioning.

- Not to discard behavioural approaches entirely.

But to organise them through a regulation-informed lens that helps us know when each approach is most likely to succeed.

The intervention may not need to change.

The timing might.

As our profession continues to evolve, perhaps our greatest contribution is not adding another intervention.

Perhaps it is becoming better at knowing when to use the interventions we already have.

That is a conversation worth having.

And I believe it has the potential to change how we support children, families and educators for years to come.

Are your intervention strategies matching the child's current regulation capacity, or simply their diagnosis?

https://www.theregulationhourglass.com.au/download-your-free-daily-routine-visual-1