Can an Occupational Therapist Diagnose and Treat Dysregulation?

Parents often ask a very reasonable question:

“Can an Occupational Therapist diagnose my child with dysregulation?”

The short answer is no —
but we can do something just as important.

Occupational Therapists do not diagnose medical or mental health conditions. What we do assess, explain and treat is functional regulation difficulty — and that distinction matters far more than many people realise.

First: What Do We Mean by “Dysregulation”?

Dysregulation is not a diagnosis.

It is a descriptive term used to explain when a child is having difficulty:

• managing emotions

• coping with stress or change

• maintaining attention

• tolerating sensory input

• recovering after being upset

Dysregulation describes how a child’s nervous system is functioning in the moment, not why in a diagnostic sense.

A child can experience dysregulation:

• with or without a diagnosis

• occasionally or frequently

• temporarily or long-term

• in some settings but not others

This is why diagnosis alone never tells the whole story.

What Can an OT Diagnose — and What Can’t We?

What Occupational Therapists Do Not Diagnose

OTs do not diagnose:

• Autism

• ADHD

• Anxiety disorders

• Trauma diagnoses

• Mental health conditions

These diagnoses are made by paediatricians, psychologists, and psychiatrists.

What OTs Do Assess and Treat

Occupational Therapists are specifically trained to assess and treat:

• regulation capacity

• sensory processing patterns

• emotional and behavioural participation

• functional impact on daily life

In other words, we don’t diagnose labels —
we assess how regulation difficulties affect everyday functioning.

For many families, this information is far more useful than a label alone.

The OT Lens: Function Before Labels

Occupational therapy is grounded in one core question:

“How is this impacting the child’s ability to participate in daily life?”

This includes:

• learning

• play

• self-care

• relationships

• classroom participation

• transitions

• independence

A child does not need a diagnosis to:

• struggle at school

• melt down after a long day

• avoid tasks

• feel overwhelmed

• rely heavily on adults to cope

OTs step in at the point of functional impact, not diagnostic certainty.

How OTs Assess Dysregulation (Without Diagnosing)

OT assessment focuses on patterns, not labels.

This may include:

• observation across tasks and environments

• caregiver interviews

• sensory and regulation questionnaires

• analysis of triggers, recovery time, and supports

• functional participation measures

Rather than asking “What diagnosis fits?”, we ask:

• When does regulation break down?

• What does the child have access to in that moment?

• What helps — and what makes it worse?

• How quickly can they recover?

• How much adult support is required?

This gives families and schools actionable information they can use immediately.

Where the Regulation Hourglass™ Fits

This is exactly where the Regulation Hourglass™ framework comes in.

Instead of labelling a child as “dysregulated”, the Hourglass helps parents and professionals understand regulation as a state, not a trait.

Children move fluidly through phases:

• Ripples – early signs of overload

• Rapids – escalating stress

• Pool – reduced access to thinking skills

• Anchor – supported regulation

• Flow – calm, flexible engagement

• Waterfall – independent regulation across contexts

The goal is not to keep children calm at all times.

The goal is to help them move safely back towards Flow and Waterfall, building capacity over time.

Can OTs Treat Dysregulation?

Yes — absolutely.

OT intervention for dysregulation focuses on:

• increasing access to regulation skills

• reducing overwhelm

• building recovery capacity

• supporting participation

• strengthening independence

This may include:

• sensory and environmental adjustments

• co-regulation strategies for adults

• task grading and pacing

• emotional literacy tools

• routines and predictability

• skill-building when the child is ready

Importantly:

OTs do not “fix” behaviour.
We support nervous system capacity so behaviour can change naturally.

Why This Matters for Parents

Many parents feel pressure to “get a diagnosis” before seeking help.

But regulation support does not need to wait.

OTs can help when:

• things feel hard but unclear

• behaviour fluctuates

• stress seems to build without obvious reason

• your child copes well sometimes but not others

Early OT support often:

• prevents escalation

• reduces family stress

• supports school success

• builds long-term independence

And if a diagnosis is later needed, OT input often strengthens that pathway rather than replacing it.

Diagnosis vs Support: Both Have a Place

A diagnosis can:

• unlock funding

• provide clarity

• guide services

But regulation support:

• happens every day

• happens in real life

• adapts to the child’s current capacity

• changes as the child grows

OTs work in the space between diagnosis and daily life —
where real progress happens.

The Take-Home Message

Occupational Therapists do not diagnose dysregulation —
because dysregulation isn’t a diagnosis.

But OTs are uniquely skilled at:

• understanding regulation in context

• supporting nervous system access

• improving daily participation

• building independence over time

And with frameworks like the Regulation Hourglass™, this can be done in a way that is:

• compassionate

• practical

• developmentally respectful

• deeply empowering for families