Jan 3 / Guest blogger and occupational therapist, Joanna Blanchard MOTR/L

Using Observation in Sensory Evaluation

Welcome to guest blogger and OT Joanna Blanchard MOTR/L

Sensory-based evaluation and assessment can be tricky. Standardized assessments can give us an idea but not always a holistic view of complex nervous systems trying to regulate. 

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Keep reading to learn:
  • Why observing subtle nervous system cues is important
  • Examples of signs that can be misinterpreted as behavior and how to consider a sensory-based perspective
  • What the best observation environment and what types of information you can gather from the observation
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As a longtime pediatric practitioner and a parent of autistic sons, I’ve spent countless hours living and working with people who can’t explain or intuit why they feel dysregulated, triggered or upset. My experience in observation of subtle nervous system cues comes from day-to-day experience with a (now adult) non-speaking person, in the clinic, community and classroom and collaborating with the caregivers who know our clients best. 

The problem-solving dilemma 

As empathetic therapists we often want to go straight into problem-solving mode when we see a client struggle. I have to remind myself to recognize my own state of regulation, sit back and subtly and respectfully watch the client’s interactions with task, peers and physical spaces. I am positive that to many it appears as if I just hang out and do nothing sometimes!

Watching for cues

The nervous system gives clues to regulatory issues in natural environments and can give a picture beyond evaluation with traditional means. When just observing, (not analyzing or problem solving) We can pick up on sometimes fleeting, subtle and unconscious nervous system cues such as:
• Restlessness, difficulty staying with a task
• Sweaty hands
• Fast, shallow breathing or breath holding
• Self-harming, picking
• Averted or fixed gaze
• Ear color changes/cheeks flushed/nose red
• Hyper alert/wide eyed/trembling/fast talking
• Coughing, yawning, sighing
• Grimacing or out of control giggling
Some of these are often interpreted as behavioral, work avoidance or other disorders, but viewing through a sensory based lens can give a different perspective. What information, paired with task and environmental demands, telling us?

Environment matters

Observation in natural environments also gives you the chance to gather information on other impacts on regulation such as trauma, triggers or different cultural experiences that the client may be navigating. Moving forward you will have a clearer picture to pair with standardized assessment tools and begin building rapport as you start out with a client who feels truly seen.


Guest Writer

Joanna has been an Occupational Therapist in Washington State for over 20 years with experience in both clinical and educational settings (k-21). While her practice has had special focus on Autism, high-support needs, sensorimotor, behavior and inclusion, her most influential teachers have been her sons and other families experiencing disability. She is an advocate and ally with day-to-day experience in navigation of educational, healthcare, legal and crisis systems both personally and professionally. As a member of Washington’s Special Education Support Center and Inclusionary Practices Technical Network, she develops trainings on sensory processing, inclusive practices, UDL, trauma Informed care, teaming with families, behavioral health and related neurology. Recently becoming a Clark County Master Gardener, she lives in Vancouver, Washington with her family, dog, chickens and a little Christmas tree farm of 600 baby firs. 

Dive into senosory!

Join Joanna in her course that invites occupational therapy practitioners to reflect on their own experiences with self-regulation, modulation, and sensory processing to enhance their ability to assess and support pediatric clients in everyday functional activities

Sensory Processing & Neurology in Pediatrics: A Self-Assessment Approach
debuts Tuesday, January 7, 2025 at 8 pm Eastern
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