Why More Strategies Don’t Always Lead to Change in Occupational Therapy
Occupational therapy practitioners are trained to see complexity. For example, when a child presents with challenges, we quickly recognize the sensory component, the executive functioning demands, the environmental mismatches, and the communication patterns. With experience, it becomes fairly easy to generate multiple possible directions for intervention.
Families often want that clarity from us. They have waited for the evaluation, are paying a co-pay, and are tired from all the things. It makes sense that they would hope the occupational therapist can offer the perfect strategy to make it all better.
I understand that hope because I live on both sides of it. I am an occupational therapist and also a parent of a neurodivergent child who receives occupational therapy services. When we first started pediatric occupational therapy, I assumed that once we had the right strategies in place, things would settle down quickly. But alas, this is not how change unfolded in our home.
Things are significantly better now, but progress required repetition, practice, and steady adjustment. It required choosing a few strategies and staying with them long enough to see what actually shifted. Improvement did not come from accumulating more information. It came from implementing a small number of ideas consistently.
Recently I read a post from a pediatric outpatient OT working with neurodivergent children. The parents were overwhelmed and burned out, and sometimes sessions were only once a week for 30-minutes. The therapist wanted to create more handouts and more educational resources to support families outside of session. The instinct is understandable. When time is limited and needs are high, it feels responsible to provide more parent education, more sensory strategies, and more structure for the home environment. We do not want to waste the small window we have. But in many cases, the problem is not a lack of education. It is a mismatch between intervention dose and family capacity.
Capacity and Burnout in Pediatric Occupational Therapy
When a parent is burned out, cognitive bandwidth is reduced, emotional regulation is thinner, and working memory is compromised. This is not a motivation issue or noncompliance, but it is a capacity constraint. In that context, adding more strategies to a home program can increase cognitive load rather than improve follow-through.
Occupational therapy home program adherence depends as much on capacity as it does on clinical reasoning. Even well-designed, evidence-informed recommendations will not be implemented consistently if families do not have the bandwidth to carry them out.
The Limits of a 30-Minute Occupational Therapy Session
In a thirty-minute pediatric occupational therapy session once a week, we cannot meaningfully address regulation, sensory processing, executive function, communication style, parenting approaches, and a comprehensive home program. When we attempt to cover all of it, our effort becomes diffuse and progress in any one area is limited.
It can feel as though offering multiple suggestions demonstrates expertise. We want families to leave with value. We want to address the full complexity we see. But comprehensive care is not the same as effective care.
Prioritization as Clinical Skill in Occupational Therapy
What tends to move outcomes forward is a small, manageable change paired with a clear action plan. Instead of redesigning an entire routine, we might focus on one transition that consistently escalates. Instead of providing several sensory tools, we might identify one predictable regulation strategy and define when it will be used. Instead of overhauling communication patterns, we might practice one specific response in one specific context.
This approach does not lower standards. It aligns intervention with readiness.If a family has not been able to follow through on multiple handouts, adding another will not change the pattern. If they experience one clear success, they are far more likely to build momentum from there.
Precision in Occupational Therapy Intervention
In constrained systems, prioritization becomes a core clinical skill in occupational therapy. The question shifts from teaching everything we know to identifying the smallest change that would meaningfully reduce friction this week.
Doing less in this context is not about minimalism. It is about precision. It requires restraint and strong clinical reasoning to decide which concerns can wait and which target is most likely to create forward movement.
Before expanding a home program or introducing additional strategies, it may be worth asking whether the current plan truly matches the family’s capacity. In many cases, tightening the focus produces more durable change than expanding the list.
I invite you to reflect on how much education you are delivering in a typical session and whether the amount matches what the client can realistically implement right now. Is there room to narrow the focus so that follow-through becomes more likely? Precision often requires restraint, because sometimes the most skilled decision in an occupational therapy session is choosing what not to address.