Finally, It All Fits Together!

An OT reflection on integration, clarity, and confident clinical reasoning

As paediatric OTs, we are trained across many domains, sensory processing, emotional regulation, behaviour, executive function, participation, environment.
And yet, in day-to-day practice, these pieces are often taught, assessed, and discussed as if they live in separate boxes.

Sensory reports here.
Behaviour plans there.
Executive function goals somewhere else.
Emotional regulation “woven through” but rarely anchored.

Many of us quietly hold all of this in our heads, doing the integration internally through experience and instinct. But that invisible work takes time, cognitive load, and emotional energy, especially when cases are complex, presentations fluctuate, or systems demand clear explanations.

What if those pieces finally lived in one place?

The problem was never your clinical thinking

OTs are not lacking insight. We are lacking shared structure.

In practice, we are constantly asking:

• Is this a sensory load issue or an emotional one?

• Is this behaviour a signal of overwhelm or a skills gap?

• Are executive demands exceeding regulation capacity?

• Do we change the task, the environment, or the support?

We already think in systems.
But without a unifying framework, that thinking stays fragmented — and explaining it to parents, teachers, support workers, and funding bodies becomes harder than it needs to be.

The Regulation Hourglass™: one home for it all

The Regulation Hourglass™ was built to solve this exact tension.

It brings sensory, emotional, behavioural, and executive function considerations into a single, integrated framework — organised by regulation capacity rather than surface behaviour.

Instead of asking “What strategy do I use?”
It helps you ask “What can this nervous system access right now?”

Within the Hourglass:

• Sensory processing explains the body’s load and thresholds

• Emotional regulation reflects safety, connection, and stress responses

• Behaviour is understood as communication, not compliance

• Executive function is accessed after regulation capacity is available

They are no longer competing lenses.
They are parts of the same picture.

Sharper reasoning. Faster decisions.
More confidence.

When everything lives in one place, something powerful happens to your clinical reasoning.

You begin to:

• Spot patterns earlier

• Match support to capacity more accurately

• Adjust sessions fluidly without second-guessing yourself

• Explain your decisions with clarity and confidence

• Write goals and reports that actually reflect what you see in practice
  

Your thinking doesn’t become rigid.
It becomes cleaner.

The framework holds the structure, you bring the nuance.

This isn’t about doing more.
It’s about organising what you already know

The Hourglass doesn’t replace your models, training, or experience.
It organises them.

It gives language to what experienced OTs already do intuitively and scaffolds what newer OTs are still learning to see.

And perhaps most importantly, it allows everyone around the child — parents, educators, support workers — to finally understand why you are recommending what you are recommending.

Finally, it fits

Sensory.
Emotional.
Behavioural.
Executive function.

Not as separate programs.
Not as competing explanations.
But as one integrated conversation between the nervous system and the environment.

When it all fits together, your work feels lighter.
Your reasoning feels stronger.
And your confidence grows — not because cases are simpler, but because your framework is clear.

The Hourglass doesn’t simplify the child.
t simplifies the thinking — so the child can be supported properly.