An Occupational Therapy Practitioner’s Perspective on Challenging Behavior
The Question
It’s 7:50 in the morning. You need to leave the house in ten minutes for an important appointment. Your child is refusing to get dressed. You’ve reminded them three times, offered choices, explained why it’s important, and maybe you’re starting to feel frustrated yourself. If you’re a parent, chances are you’ve experienced some version of this scenario before.
Whether it’s tantrums, meltdowns, refusal, hitting, aggression, difficulty with transitions, or behaviors that may appear defiant, challenging behaviors can leave parents feeling overwhelmed and unsure of what to do next. In these moments, it is natural to focus on stopping the behavior as quickly as possible. Most adults are asking the same question: “How do I get my child to do what needs to be done?”
A Different Question
As occupational therapy practitioners, we often begin with a different question: “Why is this behavior happening?”
This distinction is important because behavior is only the part we can see. Beneath the behavior may be sensory processing differences, challenges with emotional regulation, difficulty understanding language, motor planning challenges, anxiety, fatigue, communication difficulties, or a developmental need for autonomy and control. While addressing behavior may provide short-term solutions, understanding the underlying factors can help create long-term success.
As occupational therapy practitioners, we understand that behavior is communication. Every behavior tells us something about how a child is experiencing and interacting with the world around them. Our role is to look beyond the behavior itself and identify what may be contributing to it. Is the child experiencing sensory overload? Are they struggling to process language or understand the expectation being placed upon them? Are they emotionally overwhelmed, anxious, fatigued, or frustrated? Are they having difficulty with transitions or flexibility? Or are they expressing a developmentally appropriate desire for independence and control?
The answer is rarely straightforward, which is why understanding the “why” behind a behavior is one of the most important clinical skills an occupational therapy practitioner can develop. What appears to be the same behavior on the surface can have very different underlying causes.
A child who refuses to put on their shirt may be overwhelmed by the feeling of the fabric against their skin. Another child may be struggling to transition away from a preferred activity. Yet another child may be having difficulty processing multiple directions being given at once. One child may be anxious about where they are going, while another may be overwhelmed before the day has even begun. The behavior may look identical, but the support each child needs is very different.
This is where occupational therapy practitioners often bring a unique perspective. Rather than focusing exclusively on what a child is doing, we also consider what their sensory systems, nervous system, emotions, developmental capacities, motor abilities, and environment may be contributing to the experience. Understanding these factors helps us identify the root causes that may be driving challenging behaviors.
DIRFloortime® in Occupational Therapy
From a DIRFloortime®-informed perspective, behavior provides valuable information about a child’s individual differences and their experience of the world. Rather than viewing behavior as something that simply needs to be corrected, we seek to understand what the child’s nervous system is communicating. This understanding allows us to support regulation, engagement, and participation in a way that is meaningful and respectful of the child’s developmental needs.
Successfully supporting children through challenging behaviors requires both consistency and flexibility. Consistency provides predictability, safety, and trust. Children benefit from knowing what to expect and understanding that expectations remain clear and supportive. At the same time, flexibility is equally important. Skilled occupational therapy practitioners recognize that every child has unique sensory preferences, emotional capacities, strengths, and challenges. What works in one moment may not work in another, and it is our responsibility to adjust our approach based on the child’s needs in that moment.
One of the greatest challenges in supporting children is recognizing when they are becoming overwhelmed before a full meltdown occurs. A child who initially appears resistant or unwilling to participate may actually be struggling with sensory processing, emotional regulation, motor planning, communication, or difficulty adapting to change. Without appropriate support, these challenges can quickly escalate. Effective practitioners learn to identify triggers, recognize early signs of stress, and develop individualized strategies that help children return to a regulated state while preserving the therapeutic relationship.
This is especially important when supporting children with sensory processing differences, autism, ADHD, anxiety, or other developmental challenges. Behaviors such as meltdowns, aggression, refusal, or emotional outbursts are often rooted in a child’s difficulty navigating the demands of their environment rather than a desire to be difficult. When we shift our focus from controlling behavior to understanding behavior, we gain valuable insight into what the child truly needs.
Applying the Question
So let’s return to the child refusing to get dressed.
An occupational therapy practitioner may wonder:
Is the clothing uncomfortable or triggering a sensory response?
Is the child overwhelmed by the transition?
Are there too many verbal directions being given at once?
Is the child anxious about where they are going?
Is getting dressed difficult because of motor planning or coordination challenges?
Is the child tired, hungry, overwhelmed, or already dysregulated before the day has begun?
Does the child understand what is being asked of them?
The answers will be different for every child.
At its core, occupational therapy is about helping individuals participate successfully in the activities that matter most in their daily lives. That means looking beyond the behavior and understanding the child as a whole person. Through observation, relationship-building, co-regulation, sensory integration, developmental understanding, and a deep respect for individual differences, occupational therapy practitioners help children build the skills needed to navigate challenges, strengthen relationships, and engage more fully in the world around them.
Because when we understand the reason behind a behavior, we are better equipped to support the child behind it.
Dr. Lilibel Bernhardt, PhD, COTA/L
DIRFloortime® Provider
Director of Operations
REConnections DIR Center
