Beyond the Binary: Reclaiming the Full Scope of Occupational Therapy in a Polarized World

As pediatric occupational therapists, we are living in an era where conversations about neurodiversity, intervention, “harm,” and professional identity have become deeply polarized. On one end, we hear passionate arguments for radically adapting the world to meet neurodivergent needs. On the other end, we hear the call to intervene directly and supporting skill development, promoting nervous system regulation, and helping families navigate daily life with greater ease.

In this tension, many therapists find themselves asking:
What is my role?
What can I do?
What should I do?

The truth is: It’s not a binary. It never has been.

And yet, our profession is feeling the strain of a debate that risks pulling us away from our collective mission which is to support human participation, belonging, and well-being.

The Danger of Polarization in Our Profession

The conversations happening across social media, professional groups, and even continuing education spaces have become increasingly charged. Words like harmful, evidence-based, or outdated are often used as labels and sometimes it seems the intention is to elevate one’s position, sometimes out of genuine concern, and sometimes out of fear.

But when we begin labeling entire approaches, philosophies, or methods as universally “bad” or universally “good,” we risk:

• Shrinking our therapeutic toolbox

• Creating fear and uncertainty among developing clinicians

• Undermining clinical reasoning

• Eroding confidence in our profession’s identity

• Leaving families confused and unsupported

If we aren’t careful, we unintentionally pressure therapists into choosing sides rather than choosing what matters most:
the individual child and family in front of us.

Therapy Is and Always Has Been Individualized

Occupational therapy is grounded in a belief that intervention planning is individualized, contextual, and client-centered. We are trained to consider strengths, needs, environments, cultural values, lived experience, trauma history, sensory and motor foundations, and family goals. There is no single approach that can be universally applied and no single approach that should be universally dismissed.

Of course, we must always avoid interventions that pose true potential for harm.
But caution is different from blanket rejection.

When we label entire frameworks as “never appropriate,” we stop asking essential clinical questions:

• What is the child communicating through their behaviors, nervous system, or patterns of participation?

• What are the family’s goals, values, and stressors?

• What underlying sensory, motor, emotional, or relational factors are impacting participation?

• What does this child need right now and what will they need later?

Our work is not to apply a method. Our work is to apply judgment through clinical reasoning.

One of the Real Issues in Pediatrics: We Need Better Training in Understanding the Nervous System

Many of the debates we see today reflect something beneath the surface:
a profession that has not been universally trained in deep nervous system literacy.

Therapists vary widely in:

• Their ability to assess regulation patterns

• Their comfort treating emotional and sensory dysregulation

• Their understanding of interoception, co-regulation, or the neurobiology of safety

• Their experience & training when addressing underlying motor or sensory foundations

• Their training in therapeutic use of self and responsive intervention planning

When skill sets vary, fear increases.
When fear increases, polarization grows.
When polarization grows, we lose sight of nuance.

This is not a failure of individual therapists.
It’s a call for improved, unified training that brings clarity and not more confusion.

Our Role: Both Adaptation and Intervention

The question of our role is often framed as a choice:

Do we adapt and modify the environment to fit the child?
Or do we intervene to support skill development and lasting change?

The answer is and always has been yes.

We are here to modify, adapt, scaffold, coach, educate, intervene, and build capacity.
We are here to support nervous system stability, functional skill development, and participation.
We are here to help families feel less alone, less ashamed, and more empowered.

Modifying the world is not always possible.
Accepting human differences is always necessary.
Supporting growth is always ethical.
Meeting children where they are is always essential.
Believing in their potential is always part of our mission.

Honoring neurodivergence does not require abandoning intervention.
Intervening does not require erasing identity or forcing conformity.

These ideas are not opposites. They belong together.

The Heart of OT: Being Change-Makers, Not Just Advocates

Occupational therapists do not exist only to point out where systems fall short.
We exist to help children and families do what they want and need to do.

Families come to us seeking connection, understanding, and tools.
They want support, not more restriction.
They want progress, not more polarization.

When we spend our energy debating what is allowed, disallowed, harmful, outdated, or not “neurodiversity-affirming enough,” we risk:

• Becoming passive instead of purposeful

• Losing sight of therapeutic reasoning

• Providing less support instead of more

• Shrinking our profession instead of expanding it

Therapists deserve clarity.
Families deserve clarity.
Children deserve clinicians who bring their whole skill set to the moment.

Moving Forward: A Call to Unity and Shared Purpose

We can honor neurodivergent experiences while also supporting skill development.
We can adapt environments while also strengthening foundations.
We can reject harmful practices without rejecting entire frameworks.
We can hold compassion for all sides of this debate without choosing extremes.

Most importantly, we can return to:

• Listening deeply

• Observing with curiosity

• Responding with intention

• Using our full clinical reasoning

• Honoring the individuality of every human

• Continually growing our skill sets

• Seeking clarity rather than conflict

The world needs pediatric occupational therapists not divided by philosophy, but united by purpose.

Our purpose is participation, belonging, and well-being.
Our power lies in our ability to support change ~ internally, externally, and relationally.
Our responsibility is to avoid polarization and stay connected to the child or human in front of us.

This is how we remain compassionate, effective, and relevant in a changing world.
This is how we support families who feel overwhelmed, unseen, or unsupported.
This is how we reclaim the fullness of our profession.

Thanks for reading and listening to what has been heavy on my heart as of late.

Lisa 🌲

P.S. The image is a recent photo of the Northern Lights from just outside my home. It was a spectacular display of color. It reminded how we can all come together to witness and observe beauty in this natural world.