08/20/2026
As I observe in different environments, and think about back to school the thought of autonomy has been heavily on my mind.
As an OT, we have to have goals. We evaluate and create treatment plans and skills we're supposed to address.
Sometimes, we can get too focused on getting a child to perform the skill in that treatment plan that we stop asking a much more important question:
What is the actual goal here?
If a child is sitting at a table and their entire body is telling us they need to get away by crying, trying to leave, pushing materials away and we have to physically position ourselves so they cannot run away just to make sure they match a few colors or make a mark on a piece of paperâŚ
What is the emergency?
Seriously. What happens if that child doesn't match the colors today? What happens if they don't make the mark? What are we teaching that is so important that it requires overriding everything their nervous system is communicating to us?
Not only that, but what might we be teaching instead? That their ânoâ doesn't work? That adults get to decide when their body can leave? That therapy is something done to them? That the adults who are supposed to help them will continue making demands even when they are very clearly communicating, âI can't do this right nowâ?
Then we wonder why schools or therapies start to not feel like itâs not âthe right fit.â
Yesterday I worked with a child at my clinic.
She had creative freedom to build an obstacle course. I couldâve made it prior, told her the steps, all wrappped up in a perfect package to perfectly address all my goals and check all the boxes. But I also understand the importance of allowing her to have ownership over what happens.
By allowing her just a bit of autonomy during an activity I already wanted her to do she created an obstacle course that: naturally stretched a tight Achilles related to toe walking, the obstacles she designed elicited heel striking, she incorporated the jumping and crashing her nervous system seeks for regulation, she challenged her visual skills by adding a hidden treasure challenge, she worked on strengthening, balance, motor planning and coordination.
Most importantly, because she had this control, she also let me in.
As I gave ideas along the way she was receptive to them because they werenât demands. We were working alongside each other to make the best obstacle course this room has ever seen.
I didnât need to dangle a reward over head in order for her to comply. I wasnât physically holding her hostage. I didnât need to give a thousand verbal prompts to remind her of my expectations.
She was receptive because the demand didn't feel threatening. During the entire session she had agency. She could say no. She trusted that I wasnât going to take over and ruin something she created.
That is therapy, too.
I would argue that autonomy itself can be therapeutic, especially for children who spend enormous portions of their lives being directed by adults.
Sit here. Come here.
Put this on.Take that off.
Look at me.Answer this.
Write this. Try again.
Hands down.Quiet body.
First this, and THEN you can have what you actually want.
Autonomy is often a reward for the âwork,â after all child has complied. This may ruffle some feathers but it feels like an approach created to make things work for the adults in the situations⌠not to actually help the children at any fundamental level.
I think itâs completely backward.
Autonomy is part of how children learn to trust their bodies. It's how they learn that their communication has meaning. It's how they develop self-advocacy. It's how they experience themselves as active participants in their own lives rather than passive recipients of whatever adults decide is best for them.
I want to be clear that none of this means children should never experience challenge.
It also doesn't mean therapy is child-led chaos where clinicians have no goals and children never encounter something difficult.
It means challenge and coercion are not the same thing.
It means I can know exactly what skills I'm targeting while giving a child meaningful choices about how we get there.
It means I can grade an activity, modify an environment, create opportunities, model, invite, wonder, collaborate and sometimes gently challenge without making my âsuccessâ dependent on whether a child obeys me.
Sometimes children will absolutely need support doing things they don't want to do. Life contains nonpreferred tasks. Safety sometimes requires adults to intervene.
But my point here is things like matching colors at a therapy table is not an emergency. Making a mark on a piece of paper is not an emergency. Completing the activity I planned simply because I planned it is not an emergency.
The goal cannot be compliance for compliance's sake.
Because I don't want the children I work with to leave my therapy room having learned that I can make them do things.
I want them to leave knowing something about themselves.
I can do hard things.
I can listen to my body.
I can ask for help.
I can change the plan.
I can say no.
I can trust this adult enough to try.
My ideas have value.
My body belongs to me.
And sometimes, when we stop spending the entire session trying to get a child to do exactly what we planned, we discover that they will show us another way to reach the very same goals.
Maybe even a better one.
Our clinical knowledge matters.
Our goals matter.
Our expertise matters.
But so does the human being standing in front of us.
The question isn't just, âDid they complete the task?â
It's also: What did they have to override in themselves in order to complete it?
I think we owe it to the children we serve to keep asking that question.
