1. Introduction
Think back to a moment in your childhood when you felt truly comfortable, truly at ease in your own skin. Perhaps it was the feeling of warm sand between your toes, the rhythmic sway of a swing, or the soothing sound of your mother's voice. Now, imagine that those same sensations—touch, movement, sound—feel overwhelming, even chaotic.
Imagine that your senses are sending you a constant barrage of information that your brain struggles to process. This is the experience of many children, particularly those on the autism spectrum, who face challenges with sensory processing.
This is the Ananya Child Development Center podcast, and today, we are going beyond the surface. We are exploring the hidden world of sensory integration with a renowned expert who's dedicated her career to helping children navigate the complexities of their sensory experiences. I'm your host, Madhavi Adimulam, and I'm honored to be joined by Sian Wilson, a highly experienced pediatric occupational therapist from the UK who's visiting Ananya CDC here in Hyderabad.
Sian, welcome to the podcast!
Sian Wilson: Thank you so much for inviting me here today. It's been incredible to visit your beautiful therapy center and meet the wonderful people and children who come here. Thank you.
2. A Journey of Passion and Discovery
Madhavi Adimulam: Sian, you’ve had such a rich and diverse career, working in various settings from the NHS to schools and private clinics, and even venturing to India to set up a therapy program for children with autism. What were some of these early experiences that ignited your passion for this work, particularly with children on the autism spectrum?
Sian Wilson: My journey into occupational therapy began while I was traveling and working as a nanny in San Francisco. One of the children I was caring for had severe developmental delays. I was very young at the time, and I had no idea how to help him.
Back in the 1980s, there was an incredible developmental therapy center in California. I took this little boy to the center several times, and I was amazed by the simple, practical things they did that made such a profound difference in his development. When I first started taking him there, he couldn't even sit up. But when I left, he was rolling, crawling, and doing all sorts of things. It felt like a miracle! I knew then that this was the kind of work I wanted to do.
I returned to the UK and trained as an occupational therapist. For many years, I worked in the National Health Service (NHS), initially seeing a lot of children with cerebral palsy and Down syndrome. Gradually, I started encountering more and more children with autism.
At that time, we had diagnostic services for children, but nothing specifically for autism. My boss and I realized that something needed to change. We secured funding for a research project to identify the gaps in autism services in Ealing, a borough in West London.
This project was a turning point for me. We spoke to parents, listened to their concerns, and learned about their needs. That research became the seed for a much larger initiative that eventually led to the development of specialized services for children with autism throughout the UK, including diagnostic services, parent support groups, and training programs for teachers and therapists.
Over the years, I’ve worked with children of all ages, from toddlers to teenagers. And now, I’m starting to explore the needs of adults with autism, as there are still significant gaps in services for this population, even in the UK.
Madhavi Adimulam: Thank you, Sian, for sharing your experience with us. It’s remarkable to hear about your journey and how you’ve been a driving force in expanding services for autistic individuals. And if you think the UK has gaps in its system for supporting children with developmental needs, imagine the challenges we face in India. They are on a different level altogether!
Sian: I can only imagine.
Madhavi Adimulam: Sian, can you please explain what occupational therapy is? Is it different from sensory therapy? Or is there a connection between OT and sensory integration? And how do parents know whether their child needs sensory integration or occupational therapy?
3. Occupational Therapy vs. Sensory Integration: Understanding the Difference
Sian Wilson: That’s a great question, and I’ll try to answer it simply. Occupational therapists (OTs) help children and adults with disabilities develop the skills they need to live independent and fulfilling lives. One of the key things we do is something called activity analysis. We break down any activity, from a baby sucking their thumb to a teenager writing an essay, into its component parts—the sensory, motor, behavioral, cognitive, and social aspects of that skill. Then, we analyze those components to understand why a child might be struggling with a particular task.
Sensory processing is just one aspect of a skill, but it’s a very important one, especially for children with autism. Because sensory processing is part of the diagnostic criteria for autism, we know that these children often have difficulties processing sensory information.
Sensory Integration Therapy is a specific set of techniques and strategies that OTs use to help children improve their sensory processing. It’s one tool in our toolbox, and it’s a very important one.
So, to answer your question, it's not OT versus sensory integration therapy; it's OT *using* sensory integration therapy. It’s part of a broader approach to supporting a child’s development.
Madhavi Adimulam: That’s a helpful clarification, Sian. It’s not either/or; it’s both. The occupational therapist will use their expertise to determine if sensory integration techniques are necessary.
Sian Wilson: Exactly! Let's say a child is having trouble sitting at the dinner table. An occupational therapist wouldn’t just jump to sensory strategies. They would take a step back and analyze the situation: Is the child uncomfortable with the chair? Are they overwhelmed by the social expectations of mealtime? Is there a sensory aspect to the food itself that’s bothering them? It could be a combination of factors, and we need to understand the whole picture before we can develop effective interventions.
Madhavi Adimulam: So, it’s about looking at the whole child, the whole context, and using a variety of tools and strategies to support their needs.
Sian Wilson: Precisely.
4. The Art of Observation and Assessment
Madhavi Adimulam: Sian, you’ve emphasized the importance of observation. So, the first step is to carefully observe the child in their natural environment to understand their strengths, challenges, and how they're interacting with their surroundings, right?
Sian Wilson: Absolutely! Observation is crucial. If the concern is that a child can’t tie their shoelaces, you need to observe them trying to tie their shoelaces. You can’t just rely on what someone tells you; you need to see it for yourself. Once you’ve observed the child, you can then dig deeper to understand what specific aspect of the skill is breaking down.
This is where assessment tools come in. We might use standardized assessments, informal observations, or a combination of both, depending on the child and the situation.
Madhavi Adimulam: So, you gather information through observation, you conduct assessments, and then what? How do you translate all that information into a plan to help the child?
5. Clinical Reasoning: The Heart of Occupational Therapy
Sian Wilson: This is where the real magic of occupational therapy happens—clinical reasoning. We take all that information from the observations, the assessments, the conversations with parents and teachers, and we analyze it, synthesize it, and use our knowledge of child development to figure out what’s going on and how we can help.
It’s not a simple formula. It’s a very complex process of critical thinking, problem-solving, and hypothesis testing. We don’t have one-size-fits-all solutions. Every child is unique, and every intervention needs to be individualized.
Madhavi Adimulam: So, it's not just about ticking boxes on a checklist but about understanding the whole child and their unique needs.
Sian Wilson: Exactly! It’s about seeing the patterns, connecting the dots, and then creating a plan that’s tailored to that specific child.
Madhavi Adimulam: And you always involve the family in that process, right?
6. The Collaborative Approach: Partnering with Families
Madhavi Adimulam: How do you develop a working relationship with parents and make them an active part of the therapy process?
Sian Wilson: It all begins with listening—truly listening—to what parents have to say. It’s about understanding not just their concerns but also their hopes, their dreams for their child, and their vision for the future. It’s about recognizing their expertise as the child’s primary caregiver.
Once I’ve listened and gained a deeper understanding, we sit down together—the parents, the child (if appropriate), and myself—and we collaborate on a plan. We discuss goals, we brainstorm strategies, and we’re realistic about what’s achievable.
It’s important to be honest with parents. Sometimes, we need to gently rein in their expectations, while other times, we need to encourage them to believe in their child’s potential and to push beyond their comfort zone.
And once we have a plan in place, it's crucial to provide ongoing support and encouragement. It’s about working together as a team, celebrating successes, and adjusting the plan as needed.
Madhavi Adimulam: It sounds like open communication, shared decision-making, and mutual respect are at the heart of your approach.
Sian Wilson: They are. And it’s essential to have everything written down—the goals, the strategies, the timelines—so that everyone is on the same page.
Madhavi Adimulam: That makes a lot of sense. Clear documentation can prevent misunderstandings and ensure that everyone involved is working towards the same goals. Now, you mentioned earlier the importance of setting realistic and meaningful goals. I’m curious about how you go about choosing those goals.
Help Your Child Thrive
7. The Art of Goal Setting
Madhavi Adimulam: How do you determine which goals are most important for a child, and how do you ensure that those goals are truly meaningful for the child and their family?
Sian Wilson: It’s a collaborative process. We listen to the parents, we observe the child, and we talk to the child themselves (if they’re able to communicate their preferences). It’s about finding those goals that will have the biggest impact on their daily life, their ability to participate in activities they enjoy, and their overall sense of well-being.
Sometimes, parents might have goals that aren’t realistic or that aren't aligned with the child’s needs or interests. For example, a parent might be focused on their child learning to tie their shoelaces, but the child might have no interest in shoelaces. They might prefer Velcro shoes. It's about finding those practical, achievable goals that will make a real difference for the child.
I remember working with a child during the COVID lockdown. We were doing a session over Zoom, and the parent had set a goal of learning to ride a bike. But when we talked to the child, he said, “I don’t want to ride a bike. I have no interest in it at all.” So, we had to rethink our approach. If the child isn’t motivated, the goal won't be achieved.
Madhavi Adimulam: It’s a great example of how important it is to listen to the child’s voice and to respect their preferences.
Sian Wilson: Absolutely! And goals can change over time, as the child develops and their needs evolve. What’s important is to have that open communication, that flexibility, and that shared commitment to finding solutions that work.
Madhavi Adimulam: Now, we’ve talked a lot about goal setting, but goals are meaningless without action.
8. Taking Action: Translating Goals into Progress
Madhavi Adimulam: Once you’ve identified the goals, how do you translate those goals into an actionable therapy plan? And how do you involve parents in that process?
Sian Wilson: It varies depending on the child, the family, and the setting. But the key is that it’s a collaborative process. We work together—the therapist, the child, the parents, and any other relevant professionals—to create a plan that everyone understands and is invested in.
It might involve direct therapy sessions, home programs, or a combination of both. We might focus on a specific foundational skill, like improving attention or developing motor coordination. Or, we might address a specific challenge, like dressing or mealtime routines.
Sometimes, parents need a lot of guidance and support at the beginning, especially if they’re new to the world of therapy. Other times, they might just need a few specific tips or strategies, and then they’re off and running, doing the work at home with their child.
Madhavi Adimulam: So, there's a range of approaches depending on the situation. But documentation is essential, right?
Sian Wilson: Absolutely! Clear documentation is crucial for tracking progress, ensuring consistency, and providing a record of what's been done. It also helps with accountability, both for the therapist and the family.
I’ve been an OT for over 30 years. When I first started, we didn’t have computers or electronic records. Everything was handwritten! We had stacks of notes, but we always kept meticulous records. Today, things are more streamlined with electronic systems, but the principle remains the same: documentation is essential.
Madhavi Adimulam: And what about those times when goals aren’t met? What happens then?
Sian Wilson: It’s not about achieving every single goal on a checklist. It’s about progress and growth. If a goal isn’t met, we reflect on why. Was it too ambitious? Was the child not motivated? Were there other factors that interfered with their progress? We then revise the plan, adjust our approach, and keep moving forward.
Madhavi Adimulam: It’s a continuous process of evaluation and adjustment.
Sian Wilson: Exactly. And we always document those changes and the reasons behind them.
Madhavi Adimulam: Documentation helps us learn from our experiences and improve our practice. Now, I know from experience that building a strong relationship with parents is key to a successful therapy journey.
9. Building Strong Relationships with Parents
Madhavi Adimulam: How do you develop a strong rapport with parents and make them active participants in the therapy process?
Sian Wilson: It all comes down to listening, active listening. I want to understand what the parents are hoping for, what their concerns are, and what they really need to make their lives easier. It's about acknowledging their expertise as their child's primary caregivers.
Then, we sit down together and collaboratively create a plan. We discuss goals, brainstorm strategies, and are honest about what's achievable. Sometimes, I need to gently guide parents towards more realistic expectations. Other times, I need to encourage them to believe in their child’s potential and to push beyond their comfort zone.
Once we have a plan, it’s about providing ongoing support, celebrating successes, and being flexible enough to adjust the plan as needed. Most importantly, we never give up. We work together as a team, and we stay motivated, knowing that we’re making a difference in the child’s life.
Madhavi Adimulam: It’s about honesty, open communication, shared decision-making, and mutual respect.
Sian Wilson: Exactly! And having everything documented—goals, strategies, timelines—ensures everyone is on the same page.
Madhavi Adimulam: Now, many of the families we work with at Ananya are on a long-term journey with their child’s development. They’re facing challenges that might not have a quick fix.
10. Maintaining Hope and Finding Support
Madhavi Adimulam: How do you help parents stay motivated and engaged throughout their child’s journey?
Sian Wilson: It’s so important to build a supportive network—a community of people who understand the challenges and can offer encouragement, guidance, and a listening ear. This could include other parents, family members, friends, therapists, and support groups.
I’ve also learned so much from the children I’ve worked with. They’ve been my greatest teachers. They remind me to focus on the joys, to celebrate small victories, and to keep things fun and engaging. And it’s important for parents to take care of themselves—to find ways to manage their own stress, to make time for things they enjoy, and to prioritize their own well-being. It’s not selfish; it’s essential.
Madhavi Adimulam: Finding that balance is crucial.
Sian Wilson: It is. And remembering to enjoy the journey, even amidst the challenges, can make a world of difference.
Madhavi Adimulam: I can’t wait to see you in action next week, Sian, during your parent coaching and mentoring sessions here at Ananya. I know our families are eager to learn from you, and I’m confident they’ll leave feeling empowered and hopeful.
Sian Wilson: I’m looking forward to it, Madhavi!
11. Conclusion and Invitation
Madhavi Adimulam: Thank you so much for sharing your expertise and your heart with us today. It’s been a privilege to have you on the podcast.
Sian Wilson: Thank you so much. It's been wonderful to share my experiences.
Madhavi Adimulam: And for those of you in Hyderabad, Sian will be at Ananya CDC from the 16th to the 20th of September, working with parents, coaching, and mentoring them. At Ananya Child Development Center, we are committed to providing personalized support for children with developmental delays, offering a range of therapies, including occupational therapy and speech therapy. We are located in multiple locations across Hyderabad, making quality care accessible to families throughout the city.
I’m Madhavi Adimulam, and this is the Ananya Child Development Center podcast.
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