Occupational Therapy for SEN: Accessing Support in the UK

Your child struggles to hold a pencil. They can’t tolerate the feeling of certain fabrics or the sound of the hand dryer. They trip frequently, knock things over, and find PE lessons overwhelming. Getting dressed takes forever, and they still can’t tie their shoelaces despite being nine years old. You’ve been told repeatedly that they’ll “grow out of it,” but they haven’t.

These challenges—with fine and gross motor skills, sensory processing, coordination, and daily living tasks—are the domain of occupational therapy (OT). For many SEN children, particularly those with autism, dyspraxia/DCD, ADHD, or sensory processing difficulties, OT can be transformative. It’s not about making children “normal”—it’s about giving them strategies and support to navigate a world that isn’t designed for how their bodies and senses work.

But here’s the challenge: OT is chronically underfunded in the UK. NHS waiting lists are long, school-based OT is rare, and accessing it through an EHCP can feel like pulling teeth. This comprehensive guide will help you understand what OT is, how it can help your child, and—crucially—how to actually access it within the UK system.

What Is Occupational Therapy for Children?

Occupational therapy helps children develop the skills they need for daily life—what OTs call “occupations.” For children, these occupations include:

Areas OT Addresses:

• Self-care: Dressing, eating, toileting, grooming
• Fine motor skills: Handwriting, using cutlery, fastening buttons, tying laces
• Gross motor skills: Balance, coordination, physical confidence
• Sensory processing: Managing responses to sensory input (sounds, textures, movement)
• Cognitive skills: Attention, organization, planning, problem-solving
• Social participation: Play skills, turn-taking, cooperative activities
• School activities: Sitting still, using scissors, following routines, navigating the school environment

OTs are trained to assess how a child’s physical, sensory, and cognitive abilities affect their ability to participate in these daily activities. They then provide interventions—exercises, strategies, equipment, environmental modifications—to help children develop skills and work around difficulties.

Who Benefits From Occupational Therapy?

OT can benefit children with a wide range of SEN conditions:

Common Conditions Supported by OT:

• Autism Spectrum Condition: Sensory processing difficulties, motor planning, daily living skills, transitions
• Dyspraxia/Developmental Coordination Disorder (DCD): Motor coordination, handwriting, organization, self-care
• ADHD: Attention, organization, sensory regulation, emotional regulation
• Sensory Processing Disorder: Over or under-responsiveness to sensory input, sensory seeking behaviors
• Cerebral Palsy: Physical adaptations, mobility aids, daily living skills
• Learning Disabilities: Independence skills, life skills, modified approaches to tasks
• Hypermobility/Joint Conditions: Core strength, proprioception, fatigue management

What Does an OT Assessment Involve?

An OT assessment is comprehensive and typically includes:

Assessment Components:

• Parent/Carer Interview: Discussion of your concerns, your child’s history, daily challenges
• Developmental History: Milestones, medical history, previous interventions
• Standardized Tests: Specific tests for motor skills, sensory processing, visual perception, etc.
• Observation: Watching your child complete tasks, play, interact
• Sensory Profile: Questionnaires about your child’s responses to sensory experiences
• Functional Activities: Real-world tasks like getting dressed, writing, using cutlery
• School Observation: (Sometimes) observing your child in the school environment

The assessment usually takes 1-3 sessions, depending on complexity. Afterward, you’ll receive a written report with findings, diagnosis (if applicable, e.g., dyspraxia), and recommendations for intervention.

Common OT Interventions for SEN Children

Once assessed, OT intervention might include:

Sensory Integration Therapy

For children with sensory processing difficulties, OTs use sensory integration approaches:

• Sensory diets: Scheduled sensory activities throughout the day to help regulation
• Sensory circuits: Morning movement programs in schools
• Deep pressure activities: Weighted blankets, compression vests, bear hugs
• Proprioceptive input: Heavy work activities (pushing, pulling, carrying)
• Vestibular activities: Swinging, spinning, balancing activities
• Sensory rooms/spaces: Designated calming or alerting environments
• Desensitization programs: Gradually exposing children to challenging textures, sounds, etc.

Fine Motor Skill Development

For handwriting difficulties, coordination problems, or self-care challenges:

• Pencil grip exercises: Building hand strength and grip patterns
• Pre-writing activities: Tracing, threading, cutting, playdough
• Adaptive equipment: Pencil grips, sloped boards, specialist scissors
• Alternative recording methods: Typing, speech-to-text, scribing
• Daily living skills: Practicing buttons, zips, laces, cutlery use

Gross Motor and Coordination Support

For children with dyspraxia, balance issues, or motor planning difficulties:

• Motor planning activities: Breaking down complex movements into steps
• Balance and coordination exercises: Obstacle courses, balance beams, ball skills
• Core strength building: Activities to improve posture and stability
• Bilateral coordination: Activities using both sides of the body together
• Visual-motor integration: Hand-eye coordination activities

Environmental Modifications

Sometimes the best “therapy” is changing the environment:

• Seating adjustments: Wobble cushions, footrests, move ‘n’ sit cushions
• Classroom positioning: Recommendations about where child sits
• Sensory-friendly modifications: Ear defenders, fidget tools, movement breaks
• Visual supports: Schedules, checklists, timers
• Task modifications: Shorter tasks, alternative formats, extra time

How to Access OT in the UK

This is where it gets complicated. There are several routes to accessing OT, each with pros and cons:

Route 1: NHS Pediatric Occupational Therapy

How to access: GP or pediatrician referral to NHS children’s OT service

Pros: Free, qualified therapists, can feed into EHCP assessments

Cons: Long waiting lists (6-18 months common), limited sessions once accessed, high thresholds for acceptance

Reality check: Many NHS OT services are overwhelmed. Don’t be surprised if your referral is rejected for not meeting threshold criteria, or if you wait over a year for initial assessment. This doesn’t mean your child doesn’t need OT—it means the service is rationed.

Route 2: School-Based OT

How to access: Some schools (particularly special schools) have OT support

Pros: Delivered in school context, can train staff, ongoing support

Cons: Rare in mainstream schools, often group rather than individual sessions

Route 3: OT Through EHCP

How to access: Request OT assessment as part of EHC needs assessment, or at annual review

Pros: If included in Section H (Health Provision), LA must arrange it

Cons: LAs often argue OT is “education” not “health” to avoid commissioning it; battles common

Route 4: Private Occupational Therapy

How to access: Find HCPC-registered private pediatric OT

Pros: Quick access, comprehensive assessment, tailored intervention, detailed reports for EHCP

Cons: Expensive (£300-£700 for assessment, £60-£120 per session)

Finding Private OTs:

• Royal College of Occupational Therapists: Find an OT directory
• HCPC Register: Check therapists are registered
• Specialist OT clinics: Search for pediatric/neurodevelopmental OT clinics in your area
• Parent recommendations: Ask in local SEN groups

Getting OT Provision Into an EHCP

If your child needs ongoing OT support, you want it specified in their EHCP. Here’s how to make that happen:

Step 1: Get an OT Assessment

Whether NHS or private, you need a professional OT report that:

• Clearly identifies your child’s OT needs
• Explains the impact on education and daily life
• Makes specific, quantified recommendations (e.g., “Weekly 1:1 OT sessions for 30 minutes”)
• States that needs cannot be met without specialist OT intervention

Step 2: Request OT Advice During EHC Assessment

When the LA conducts the EHC needs assessment, they must seek advice from relevant professionals. Explicitly request that they obtain OT advice. If they don’t, submit your own private OT report.

Step 3: Check Section H (Health Provision)

OT should appear in Section H (Health Provision) of the EHCP. It should specify:

• Frequency (weekly, termly, etc.)
• Duration (30 minutes, 1 hour, etc.)
• Format (individual, small group, consultation to staff)
• Delivery location (school, clinic, home)
• Provider (NHS, private service commissioned by LA/CCG)

Step 4: Challenge If It’s Not Included or Is Vague

If the draft EHCP doesn’t include OT provision, or uses vague language like “access to OT advice as needed,” challenge it during the consultation period. Be specific about what you want added and why.

Common LA Arguments Against OT Provision:

• “The school can meet those needs” - Challenge this: can the school provide specialist sensory integration therapy? Do they have a qualified OT?
• “OT is education provision, not health” - Counter: OT addresses health needs (sensory processing, motor development) that impact education
• “We’ll provide consultation to staff instead” - This may be insufficient if your child needs direct therapy
• “NHS will provide” - If NHS has refused or has 18-month waiting list, this is not adequate

If the LA refuses to include OT, you can appeal to tribunal. OT provision is frequently contested and frequently won at tribunal.

What Parents Can Do at Home

While you wait for OT assessment or between sessions, there’s a lot you can do at home:

Sensory Support Strategies

• Create a sensory diet: Build in calming and alerting activities throughout the day
• Heavy work activities: Carrying shopping, pushing/pulling, animal walks
• Oral motor input: Crunchy foods, chewy tubes, drinking through straws
• Calming corner: Quiet space with cushions, blankets, calming activities
• Movement breaks: Trampolining, swinging, dancing, yoga
• Fidget tools: Appropriate fidgets for hands-busy, mind-focused

Fine Motor Development Activities

• Playdough and clay: Strengthens hand muscles
• Threading and lacing: Builds coordination and concentration
• Cutting activities: Start with play dough, progress to paper
• Cooking together: Whisking, stirring, rolling, pouring
• Arts and crafts: Painting, coloring, collage
• Building activities: Lego, blocks, construction toys

Gross Motor and Coordination

• Obstacle courses: Indoor or outdoor, crawling under, jumping over, balancing on
• Ball skills: Throwing, catching, kicking, rolling
• Bike/scooter: Balance and coordination practice
• Swimming: Excellent for body awareness and coordination
• Climbing: Parks, climbing frames, soft play

When OT Provision Isn’t Being Delivered

If your child’s EHCP specifies OT provision but it’s not happening, this is a breach of the legal document. Here’s what to do:

• Document the breach: Keep records of missed sessions, lack of provision
• Raise with school/LA in writing: Email asking when OT will commence/resume
• Request emergency annual review: If provision has been missing for significant period
• Formal complaint: LA complaints procedure
• Contact local NHS/CCG: If health provision, they’re responsible for commissioning
• Legal complaint: LA is in breach of legal duty; consider mediation or tribunal

How Tediverse Supports Your OT Journey

Accessing and maximizing OT support requires organization and evidence:

Tediverse OT Support Features:

• Sensory Tracking: Log sensory meltdowns, triggers, effective calming strategies
• Motor Skills Monitoring: Track handwriting progress, self-care independence, coordination development
• OT Recommendations Log: Keep OT reports and track which recommendations are implemented
• Progress Documentation: Evidence whether OT intervention is working
• Appointment Tracking: Monitor if EHCP-specified sessions are actually happening
• Share With OT: Invite your OT into Care Circle for ongoing communication
• Evidence for Reviews: Generate reports for annual reviews or amendment requests

Final Thoughts: OT Is Worth Fighting For

Occupational therapy can be life-changing for children with sensory, motor, and coordination difficulties. It’s not about fixing or normalizing your child—it’s about giving them the tools, strategies, and support to navigate daily life with greater ease and confidence.

Yes, accessing OT in the UK is frustratingly difficult. Yes, you’ll likely face waiting lists, gatekeeping, and battles over provision. But don’t give up. Your child deserves support that addresses their sensory and motor needs, not just their academic needs.

Start by gathering evidence of your child’s difficulties. Request NHS referral but don’t wait indefinitely—consider private assessment if you can. Push for specific OT provision in the EHCP. And in the meantime, use home strategies to support your child’s sensory and motor development.

Occupational therapy is healthcare, education support, and life skills development all rolled into one. It’s absolutely worth advocating for.

Related Resources

• Sensory Processing Disorder: The Hidden Barrier to Learning
• EHCP Application Guide: Complete UK Process
• School Placement Appeals: Fighting for the Right Environment
• SEN Parent Burnout: Prevention Strategies & Self-Care Guide