This study posed the research question: How do school-aged children with sensory processing challenges experience the performance of day-to-day occupations in their real-life contexts?

Methods

The researchers used interpretive phenomenology as their methodological framework. For those unfamiliar with phenomenology, it’s a qualitative approach that can reveal a deeper understanding of people’s experience of everyday occupations and what matters to them within their lives. The study employed photo-elicitation interviews—a method combining visual data collection with an interview process that’s particularly effective for eliciting children’s voices in research.

Five children with sensory processing challenges aged 7 to 12 years participated in the research which was conducted in the southeast of England. The children needed to be of school age with sufficient verbal language development, have sensory processing challenges as measured by the Sensory Processing Measure–Second Edition within 6 months prior to interview, and have no major documented neurodevelopmental or intellectual disorder or significant visual or hearing impairments. Two participants had additional diagnoses—dyslexia and global developmental delay.

The first author conducted all meetings and interviews. An initial meeting with each family clarified study procedures and built rapport, with participants playing an activity of their choice with the researcher. One interesting part about the data collection was that the children were asked to take 10 to 15 photographs of various occupations in their lives using their parents’ phones or tablets and these were included in the data analysis.

One-to-one, face-to-face interviews took place at the child’s home or therapy clinic. The children joined alone whilst their parents waited within reach, allowing children to talk freely whilst feeling safe. A flexible approach meant children could decide which order to talk about photographs, withdraw any, or not discuss them. Children could also engage in other activities as needed, such as drawing or eating a snack.

Interviews followed a semi-structured guide and specifically didn’t refer to sensory processing challenges because the study focused on occupational performance, and participants may not have been necessarily aware of their sensory processing challenges. Data analysis followed interpretive phenomenology steps. The analysis was inductive and iterative, beginning with and continuing parallel to data collection.

The Results

The analysis identified five overarching themes. Most photographs related to play and leisure occupations, with a few including academic learning and self-care tasks.

The (Hidden) Struggle in Doing

All participants captured a struggle in doing childhood occupations that may pass unnoticed by people around them. Participants were able to do many tasks independently but also encountered substantial difficulties and didn’t always feel understood by others. Their struggle wasn’t always obvious, leading to their performance being judged differently to how they felt about situations.

Maxie described: “Sometimes it was just hard to listen to my teacher because she speaks really loudly and sometimes it just blocks my ears… I kind of couldn’t hear well… “

Participants experienced a mind-body disconnection in doing. Isaac expressed: “You know what sketch means, it means without doing the pencil so hard, but doing it softer. I find that really hard!… I really want to learn it… I do get it in my mind but I find it tricky.”

Another dimension was the extent of struggle across various occupations, from simple self-care to complex school activities. Leo shared about pouring a drink: “It’s difficult to do simple tasks like pouring a glass of squash… when I tried to pour it, it went, like it missed it, and it went all over.”

The Struggle to Persist in Doing

Participants revealed their need to persist in practising for longer to learn some occupations. Their journey toward mastering abilities led to multiple experiences that could shape occupational engagement. Sometimes persistence led to success and pride. However, children could also experience progress without feeling fully capable or confident.

Although children generally persisted, they could feel defeated by lack of tangible progress, which could turn into withdrawal and a sense of tiredness. Leo reflected on his drawing schoolwork: “I can’t really get better at it. I would like to learn more about it, but I actually can’t… I tried like, a lot. But now I kind of just give up.”

After prolonged exposure to challenging occupations without improvement, participants expressed strong despair, particularly when they had no option to discontinue. Aurelia stated about handwriting: “I hate it… like any other one it was horrible, it was writing.”

Doing With Others and Belonging: Can I Belong?

All participants emphasised the importance of engaging in activities with peers and friends, perceiving it as intrinsic to their doing. The meaning of the occupation itself could diminish, whilst with whom it was done added significant value. Aurelia shared about her friend: “Well, we were drinking hot chocolate… Half of my life I do with her… I have a whole chart of stuff I did… I just mark every time I see her.”

Access to shared play activities was vital for children’s sense of belonging. Some could engage in play without difficulties impacting participation, and their sense of doing and belonging felt routine. However, this belonging faded when they couldn’t engage with others, with fragile emotions often lying below the surface. Leo described: “Everybody was playing football like, and I really wanted to get into it… I felt really left out, I didn’t have many friends… because all of them just went to play what they wanted, and I was just kind of left behind because I couldn’t really do it… I couldn’t fit in.”

Needing Extra Support in School Learning

Participants revealed extra support in school learning as central to them, describing their school experience as either supported or hindered.

Participants’ difficulties could affect academic output, leading to a sense of misunderstanding and unfairness. However, extra support meaningful to the child could facilitate true potential. Leo shared: “Before school was really difficult… because my handwriting was so bad, they thought I was incapable, they moved me down… then I got my laptop and started writing really good things, I got top marks in everything, and I got moved back up.”

However, implementing adaptation strategies didn’t always result in feeling supported. Frustration arose when a strategy lacked meaning for the child. Maxie, now home-schooled, described: “They kept on pulling me out of the lessons for stupid clubs, like toast club, what, what kind of club is that?… we just sit in chairs and eat toast. I mean, what’s the point of that?”

Making, Building, Creating: When I Am in Charge

Participants expressed a need for self-sufficiency, feeling fulfilled when creating something independently. Their inner drive to make, build, or create allowed them to take charge of activities. Leo shared about his modelling: “Yeah I did this completely by myself… It makes me feel good about myself like it feels like I’ve actually done something that I can be proud of.”

Furthermore, the process itself of creating something was enough to bring satisfaction, regardless of output. Isaac described: “I built that chair, but I don’t have it anymore. I mean, it collapsed!… great, I liked it, fun.”

Practical Takeaways

For school-based occupational therapists, this research offers several crucial insights. Firstly, the findings reveal a sense of hidden difficulties in children’s experiences, so children with sensory processing challenges experience difficulties that aren’t clearly understood by themselves or others. This suggests we need to enhance children’s understanding of their own sensory processing challenges to empower them by increasing their awareness of their needs. If children can articulate why certain tasks are difficult for them, they may be better positioned to advocate for appropriate support.

The research highlights that whilst some children feel supported in their school learning, others can feel hindered by lack of support or strategies they find useful. The findings emphasise the need to actively involve children in decision-making processes concerning their participation at school. Intervention goals set by children tend to differ from those set by parents or teachers, so acknowledging and addressing children’s own goals implements genuine client-centred practice. This aligns with Aisling Ryan’s work on child goal setting I pretend in episode 9.

The theme around persistence and emotional well-being deserves particular attention. Long exposure to an occupation without experiencing improved ability despite persistent practice led to withdrawal, hopelessness, and despair in some children. This highlights an important connection between participation problems and emotional well-being that we need to be vigilant about in practice.

The significance of social aspects—friendship and sense of belonging—emerged as strongly linked to children’s emotional well-being. Therefore, play participation with others and belonging should be embraced as aims in our practice, not just addressed incidentally and be something that we should be making parents and educators acutely aware of as protective factors for these children.

The researchers suggest that future studies could employ longitudinal designs to hear from children with sensory processing challenges at various stages in their lives. Additionally, research exploring links between occupational competence and engagement in children with sensory processing challenges could help understand mechanisms that hinder or promote engagement in daily occupations.

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