Regulation Before Readiness: Why Readiness Matters In Occupational Therapy

As occupational therapists, participation is at the centre of what we do.

We are interested in whether a child can get dressed, enter the classroom, join a group, write, play, manage a transition, communicate a need, complete a routine or participate in family and community life.

But there is an important distinction between having the skill required for an occupation and having access to that skill in the moment.

A child may know how to write but struggle to organise attention, motor planning and persistence in a busy classroom. They may have the language to solve a social problem, yet be unable to access that language when overwhelmed. They may independently complete a self-care routine in one context and need significant support in another.

The skill may still be present. What has changed is the child’s available capacity for participation.
This is why I believe readiness deserves more attention in occupational therapy.

Readiness is not the same as calm

When I use the word readiness, I am not referring to a child being quiet, compliant or perfectly regulated. A child can be animated, moving, excited or highly engaged and still have sufficient capacity to participate. Instead, the clinical question becomes:

Does this child currently have access to the capacities this occupation requires?

That may include attention, motor planning, flexible thinking, communication, emotional regulation, executive functioning, sensory processing and the ability to tolerate the demands of the task.

Recent occupational therapy research reinforces the importance of keeping self-regulation connected to occupational performance rather than treating regulation as an isolated outcome. A 2026 scoping review of OT, self-regulation and primary schools found that regulation was often discussed without being clearly operationalised in terms of students’ occupational performance, engagement or participation. The authors specifically called for stronger occupational conceptualisation of self-regulation.

That distinction matters. Our goal is not simply a “regulated child”. Our goal is a child who can participate in meaningful occupation.

Capacity is contextual.

Readiness also cannot be understood by looking only at the child.

The child’s external environment may include noise, people, sensory input, space, routines, predictability, time pressure, expectations and task demands.

Their internal environment may include fatigue, hunger, pain or discomfort, arousal, anxiety, emotions, interoceptive state and physiological or sensory load.

All of these can influence participation.

This is strongly aligned with occupational therapy’s contextual perspective. Research examining environmental influences on occupational participation has highlighted that environmental and contextual factors may either facilitate or constrain engagement. School-based research similarly suggests that adapting physical and social environments can support participation rather than focusing intervention solely on changing the individual child.

So when a child suddenly cannot access a previously demonstrated skill, our reasoning needs to extend beyond:  “Can they do it?”   We might instead ask:  “What is this occupation asking of the child, and do they currently have enough capacity to meet those demands?”

That opens up very different intervention possibilities. Perhaps the child needs support to stabilise. Perhaps the demand needs to change. Perhaps we need to alter something in the internal or external environment. Perhaps the child is recovering and needs scaffolding rather than full independence. Or perhaps they have sufficient capacity and our best intervention is to reduce our support and allow participation to emerge.

Timing changes intervention

This is where readiness becomes especially relevant to OT clinical reasoning. The same intervention may be helpful at one moment and completely mismatched at another.

When a child is highly escalated, adding language, reasoning, problem-solving or repeated instruction can add further demand.

As capacity begins to return, the child may be able to participate with support.

When sufficient capacity is available, teaching, practising, reflecting, problem-solving and greater independence become much more accessible.

The question is therefore not simply: “What strategy should I use?”  It is: “What does this child need from me at this point in their regulation and participation?”

Recent Australian research with occupational therapists working with children with self-regulation needs similarly describes practice as requiring person-centredness, collaboration, coaching and adaptability in order to support meaningful occupational participation.

And importantly, the literature also cautions us against pretending that “self-regulation” is one simple, universally agreed construct. A recent scoping review identified multiple overlapping constructs within OT literature, including self-regulation, executive function, emotion regulation and interoception.

That is one reason I find a capacity-and-participation lens useful clinically.  It brings us back to occupation.

Regulation before readiness. Readiness before performance.

Occupation-focused intervention remains fundamental to paediatric occupational therapy, and research suggests occupation-based and occupation-focused approaches can support participation, although the evidence base still has limitations.

For me, regulation-informed practice adds another layer to that reasoning.

Before expecting occupational performance, we consider whether the child currently has sufficient capacity to access what the occupation requires.

Not: “Are they calm?”
Not: “Are they behaving?”
But: “Are they ready to participate, and if not, what can I change?”

That might mean changing something about the occupation. It might mean changing the environment. It might mean changing what the adult is doing. And sometimes it means recognising that the child is ready and deliberately stepping back.  Because support should not remain static either.  The aim is participation, growing capacity and, where developmentally appropriate, increasing independence.

The next time a child struggles with an occupation you know they can perform, try asking:

Does this child lack the skill, or do they currently lack access to the capacity needed to use it?

That distinction may completely change what you do next.

A Free Resource for you : Ready to Participate?
I created Ready to Participate? as a practical prompt for therapists, parents and educators to consider the child’s current state, task demands and both their internal and external environments before deciding what kind of support may be needed.

DOWNLOAD 'READY TO PARTICIPATE?' HERE  👇

https://www.theregulationhourglass.com.au/lp-ready-to-participate?

I’ll also be exploring this thinking in Regulation Before Readiness at the 'Little People Big Dreams Conference' in Darwin on 17 October 2026.

Regulation before readiness.
Readiness before performance.
Participation is the goal.

References:

Cossart, L., Thomacos, N., Bhopti, A., & Fossey, E. (2026). Occupational therapists, self-regulation, and primary schools: A scoping review. Australian Occupational Therapy Journal, 73(4), e70101. https://doi.org/10.1111/1440-1630.70101

Philpott-Robinson, K., et al. (2024). The experiences of occupational therapists supporting children with self-regulation needs: A qualitative descriptive study. Australian Occupational Therapy Journal, 71(6), 1041–1058. https://doi.org/10.1111/1440-1630.12985

Philpott-Robinson, K., et al. (2025). Conflicting definitions of self-regulation in occupational therapy: A scoping review. Physical & Occupational Therapy in Pediatrics, 45(3), 318–357. https://doi.org/10.1080/01942638.2024.2434468