Does My Child Need Occupational Therapy?

Words by Amanda Danaher

A Roanoke Valley pediatric occupational therapist explains what OT really is — and when it’s time to reach out. 

When a child struggles with the same transition day after day, or has difficulty with tasks like buttoning a shirt beyond what parents expect, many families across the Roanoke Valley start to wonder: Is this something they will grow out of, or do I need to give my child a little extra support?

For many, that question leads to occupational therapy (OT), a field far broader than most parents realize. To better understand what OT looks like for your child and when it may help, we spoke with a Roanoke pediatric occupational therapist about what parents should know and when it’s time to ask for help. 

Important: This is a resource to help you understand OT and recognize the signs, not a diagnosis, so if something here resonates, the next right step is talking with your pediatrician or reaching out to an OT directly. 

What Is Occupational Therapy and How Can It Help?

Most people associate OT with handwriting practice or fine motor development. But its scope is much wider than that.

Allie Newton, MS, OTR/L, founder and CEO of Hands On Play Pediatric Therapy in Roanoke, explains that occupational therapy focuses on how a child functions across all areas of daily life, including how they manage emotions, move through routines, learn, play, and connect with others. At Hands On Play, therapists are trained to support children across a wide range of skill areas, including: 

• Motor skills — fine motor, gross motor, and coordination
• Sensory processing — how a child’s nervous system receives and responds to the world
• Emotional and behavioral regulation — managing big feelings, transitions, and impulse control
• Executive function — planning, organization, and attention
• Social skills — play, peer relationships, and communication
• Self-care — dressing, feeding, hygiene, and daily independence
• Visual skills — tracking, perception, and visual-motor integration
• Feeding skills — food aversions, textures, and mealtime routines
• Sleep — sensory and regulation factors that affect rest
• School readiness and performance — handwriting, focus, classroom participation

“Our goal is not to fix children,” Newton says. “It’s to understand their unique strengths and challenges, help them build the skills and confidence they need, and provide families with practical tools that make everyday life feel easier and more successful.”

Signs Your Child May Benefit from Occupational Therapy

Every child develops differently, but some patterns are worth a closer look. Newton notes that concerns can emerge at any age from infancy through high school. Here are among the most common signs families notice first:

Frequent emotional outbursts or difficulty managing feelings: When meltdowns happen regularly and seem disproportionate to the situation, it may signal that a child’s regulation system is overwhelmed. OT can help them build the internal tools to recognize and respond to their emotions more effectively.

Struggles with transitions or changes in routine: Difficulty shifting from one activity to the next, especially when it causes significant distress, can point to sensory or executive function challenges that an OT is trained to address. 

Difficulty sitting still, focusing, or completing tasks: This is a common concern for children with ADHD, but it can also stem from sensory processing differences or other developmental factors. OT looks at the why behind the behavior, not just the behavior itself.

Sensitivity to or avoidance of certain sounds, textures, foods, or clothing: Children with sensory processing differences aren’t being difficult. Their nervous system is genuinely responding to input in an intensified way. An OT can help identify patterns and develop strategies that make daily life more manageable.

Delays in self-care such as dressing, feeding, or hygiene: If a child is significantly behind peers in tasks like getting dressed independently or tolerating certain foods, OT can break those skills into achievable steps and address any underlying barriers.

Challenges with handwriting or fine motor tasks: Difficulty holding a pencil, cutting with scissors, or forming letters can affect a child’s confidence and school performance. These are very common and treatable reasons for referral.

Coordination or balance concerns: Clumsiness, frequent falls, or difficulty with physical activities like riding a bike can indicate your child may need some support. 

Difficulty with peer relationships or play: Social participation is an occupational skill, too. Children who struggle to engage in imaginative play, read social cues, or maintain friendships can benefit from OT’s play-based, relational approach.

“Parents are often the first people to notice when something feels difficult for their child, even if they can’t quite put their finger on why,” Newton says. “The good news is that families don’t need to wait until challenges become severe. Early support can often make a significant difference.”

A Child Does Not Need a Diagnosis to Start OT

One of the most common misconceptions about occupational therapy is that a child needs a formal diagnosis, such as  autism or a developmental delay, before they can receive services.

That’s not the case.

At Hands On Play, therapists work with children across a wide range of presentations, including those with autism, ADHD, oppositional defiant disorder (ODD), sensory processing differences, anxiety, and developmental delays, as well as children who simply need a little extra support in one or more areas of development.

“A child does not need a formal diagnosis to benefit from occupational therapy,” Newton says. “If a child is struggling to participate successfully in everyday life, OT may be helpful.”

Knowing When It’s Time to Reach Out

Many parents worry they’re overreacting, or that their child will grow out of whatever is making daily life hard. Newton’s perspective is direct:

“If your child is struggling with age-expected developmental milestones or behaviors that are impacting their daily life — and the whole family’s daily life — it is definitely time to seek out help. Whether that’s getting ready in the morning, participating in school, mealtimes, sleep, friendships, or family routines, it is worth exploring,” Newton says.

Consider a child who has a meltdown every morning getting dressed. A parent might chalk this up to stubbornness or a difficult phase. But an OT evaluation might reveal that certain fabric textures are genuinely overwhelming to that child’s sensory system, and that with the right strategies, mornings can look completely different within a few months. That kind of shift doesn’t just change a child’s day. It changes the whole family.

Early support matters. The longer a child struggles without intervention, the more those struggles can ripple into a child’s confidence, school performance, and family relationships.

What to Expect at Your First OT Evaluation

At Hands On Play, an OT evaluation is designed to feel relaxed and play-based, not clinical or intimidating. Therapists will talk with you about your concerns, observe your child during play and structured activities, learn about their strengths and daily routines, and complete any assessments that are needed.

By the end, families should have a clearer picture of what may be contributing to their child’s challenges, a better understanding of their child’s unique needs, and a recommendation for whether therapy is a good fit.

Newton is clear that this is a partnership from day one. Therapists bring specialized training in child development, sensory processing, regulation, and evidence-based therapeutic approaches, including DIR/Floortime, Zones of Regulation, Whole-Brain Child concepts, and other techniques. Parents bring something irreplaceable: a deep, lived knowledge of who their child is.

“Children don’t exist in isolation, and neither should therapy,” Newton says. “The best outcomes happen when we work together as a team.”

Ready to Take the Next Step?

If something about your child’s daily experience feels consistently difficult for them or for your whole family, it is worth a conversation. Hands On Play Pediatric Therapy offers evaluations for children across Southwest Virginia, with flexible scheduling, in-home services, and a clinic location in Roanoke to fit your family’s needs. 

If you’re still on the fence, Newton’s advice is simple: “Trust your gut as a parent.”

Frequently Asked Questions

What is the difference between occupational therapy and physical therapy for kids? Physical therapy primarily focuses on large muscle groups, movement, and physical rehabilitation. Occupational therapy focuses on a child’s ability to participate in the everyday “occupations” of childhood, such as play, learning, self-care, and social connection, and addresses the motor, sensory, cognitive, and emotional factors that support or hinder that participation.

Does my child need a diagnosis to start occupational therapy? No. A formal diagnosis is not required to receive OT services. If your child is having difficulty with daily tasks, routines, emotions, or development, an evaluation can help determine whether OT would be beneficial.

At what age can a child start occupational therapy? OT can begin as early as infancy. Hands On Play works with children from birth through high school, and early intervention is often one of the most effective windows for support.

What conditions does pediatric OT treat? Pediatric OT supports children with a wide range of needs, including autism, ADHD, sensory processing disorder, ODD, developmental delays, anxiety, fine motor delays, feeding challenges, as well as children without a formal diagnosis who are struggling in daily life.

How long does pediatric occupational therapy last? The length of therapy varies based on each child’s goals and progress. Some children benefit from a short-term targeted approach; others receive ongoing support. A good therapist will revisit goals regularly and involve parents in those conversations throughout.

Does insurance cover pediatric occupational therapy? Many practices accept Medicaid and most major insurance plans, as well as cash pay. It’s always worth contacting your insurance provider directly to confirm your specific benefits.

About Hands On Play Pediatric Therapy

Hands On Play is a locally owned, purpose-driven pediatric OT practice serving children from birth through high school across Southwest Virginia. Named 2025’s Best OT in Roanoke by the CommunityVotes Awards, they offer a child-centered, play-based approach rooted in compassion and clinical specialization.

Services are available in the home, school, or daycare setting because children learn best in the environments where they actually live and grow. Families who prefer a clinic setting can visit Hands On Play’s Hollins Clinic, offering both daytime and after-school session times to work with your busy schedule.

AMANDA DANAHER is a busy mom of five and publisher and editor of RoanokeFamily Magazine. She is also a contributor to sister publications, VirginiaSummerCamp.com and CharlottesvilleFamily Magazine. For over 17 years, she has focused her work on parent and family magazines, where she draws on her journalism degree to help local families thrive in every season.