Understanding Regulation as a Developmental Process (Not a Behaviour Issue)

Occupational therapists are often asked to “fix” a child’s behaviour.

Yet in practice, we know that behaviour is rarely the starting point. It is the visible expression of underlying sensory, emotional and neurological processes that are still developing.

When regulation is viewed through a behavioural lens alone, interventions often miss the developmental sequence that children must move through before skills can be accessed.

What We’re Seeing in Practice

Many OTs report seeing children who:

• are expected to use strategies they cannot yet access

• are labelled as oppositional, avoidant or inattentive

• appear inconsistent in their regulation across settings

• respond well in therapy but struggle elsewhere
  

These patterns are not failures of intervention. They are indicators that regulation is being approached out of sequence.

Regulation Develops Before It Is Directed

Neurodevelopmental research consistently shows that regulation emerges gradually and relationally. Children rely on co-regulation, sensory support and environmental structure long before they can independently apply self-regulation strategies.

When we ask a child to “use their strategies” before their nervous system is organised, we place cognitive demand on a system that is already under strain.

From an OT perspective, this is a mismatch between developmental readiness and expectation.

Why Behaviour-First Approaches Often Stall

Behaviour-focused approaches can be useful tools, but when they are introduced too early, they often:

• increase stress on the nervous system

• reduce engagement

• create inconsistency across environments

• place responsibility on the child rather than the system
  

Regulation is not taught through instruction alone. It is built through repeated, supported experiences of safety, rhythm and attunement.

A Developmental Lens Changes Clinical Reasoning

When regulation is understood as a developmental process, clinical decision-making becomes clearer.

Instead of asking:
“How do we stop this behaviour?”

We begin asking:
“What level of regulation is this child able to access right now?”
“What support does their nervous system need before skills can emerge?”

This reframing allows OTs to prioritise sensory foundations, environmental adaptations and co-regulatory supports before layering higher-level strategies.

A Shared Language Supports Fidelity

This way of thinking underpins the Regulation Hourglass framework, which offers a shared developmental language for understanding regulation across home, school and therapy contexts.

Importantly, the Regulation Hourglass™ framework does not replace clinical reasoning. It supports it, helping OTs communicate complex regulation concepts clearly while maintaining professional depth.

Closing Reflection

When regulation is understood developmentally, children are no longer seen as resistant or unmotivated.

They are seen as learners whose nervous systems are still under construction.

And our role, as OTs, is to meet that development with precision, patience and respect.