Beyond Bottom-Up or Top-Down: Integrating Sensory-Motor and Cognitive Approaches for Children with DCD

Making sense of ASI, CO-OP and individualised intervention planning for children aged 6–9

By Kerry Evetts | Occupational Therapist, Founder of SenseUp

Have you ever worked with a child who struggles with handwriting, dressing, ball skills or playground activities and wondered where to begin?

Perhaps you've identified difficulties with postural control, body awareness or sensory discrimination. You can see how these might influence movement.

But you also know the child needs to learn specific skills to participate more confidently in everyday life.

Do you begin with sensory-motor intervention? Or should you focus directly on practising the activity?

What if the more useful question isn't which approach we prefer, but what this particular child needs?

This is where clinical reasoning becomes so important.

Understanding the intervention dilemma

Developmental Coordination Disorder (DCD) affects the acquisition and execution of coordinated motor skills, with consequences for everyday activities.

Between six and nine years, these challenges often become increasingly visible.

Children are expected to manage school routines, handwriting, dressing, playground games, physical education and more complex social play.

For some, motor difficulties coexist with differences in sensory processing, postural control, attention, emotional regulation or motor learning.

These observations matter. But identifying a possible contributing difficulty doesn't automatically tell us which intervention will improve participation.

Interpretation informs intervention.

What does the evidence tell us?

International clinical practice recommendations for DCD prioritise activity- and participation-oriented interventions, including task-specific training, Neuromotor Task Training and Cognitive Orientation to daily Occupational Performance (CO-OP) (Blank et al., 2019).

These approaches directly address the activities children want or need to perform.

The evidence for interventions focused primarily on underlying body functions is less consistent, particularly when we're interested in whether improvements transfer into everyday occupations.

This doesn't mean underlying sensory-motor differences are irrelevant.

It means we must distinguish between identifying a possible contributing factor and demonstrating that treating it improves functional outcomes.

CO-OP: Helping children become active problem-solvers

CO-OP is an occupation-focused cognitive approach that supports children in developing strategies to achieve meaningful goals.

Using the global strategy Goal–Plan–Do–Check, therapists guide children to discover solutions, evaluate performance and adapt their approach.

Imagine an eight-year-old who wants to learn to ride a bicycle.

Rather than repeatedly correcting their movements, the therapist helps them identify what they're trying to achieve, develop a plan, experiment and reflect.

Specific strategies might involve where to look, how to position their feet or how to organise the starting sequence.

The child's own discoveries are central.

The child's developmental profile, communication, cognitive abilities and readiness for guided problem-solving influence how we use it.

Where does Ayres Sensory Integration® fit?

Ayres Sensory Integration® (ASI) is a distinct, fidelity-based occupational therapy approach addressing sensory integration difficulties through individualised, active, play-based intervention.

It considers how sensory processing and integration contribute to adaptive responses and participation.

For example, a child may demonstrate difficulties with vestibular-proprioceptive processing, postural control or praxis alongside challenges in everyday occupations.

A comprehensive assessment may identify sensory integration difficulties that warrant consideration within intervention planning. And using sensory-motor activities doesn't necessarily mean we're delivering ASI with fidelity.

Blending approaches through clinical reasoning

At SenseUp, I don't believe therapists need to position themselves exclusively as bottom-up or top-down practitioners.

But integration should be purposeful, rather than simply combining activities from different approaches.

Consider Oliver, an eight-year-old who struggles with handwriting and physical education.

Assessment suggests difficulties with postural control, bilateral coordination and aspects of sensory-motor integration. He also has trouble planning and adapting movements during unfamiliar activities.

We might use the SenseUp Model™360  to organise these observations and consider their relationship to Oliver's everyday participation.

Our intervention planning could include:

• Meaningful occupational goals: Identifying the activities Oliver wants to improve.
• Task-specific practice: Directly practising handwriting or selected playground skills in relevant contexts.
• CO-OP strategies: Supporting Oliver to plan, experiment, evaluate and develop his own solutions.
• Sensory-motor support: Addressing postural control and bilateral coordination with clear hypotheses and measurable outcomes.
• Environmental adaptations: Adjusting equipment, expectations or task demands to support immediate participation.

We need to evaluate whether our intervention is making a meaningful difference.

Motor performance isn't always motor learning

A child may successfully complete an activity during therapy but struggle to reproduce it the following week.

Motor learning involves relatively lasting changes in the capacity to perform a skill, demonstrated through retention and, where relevant, transfer to other situations.

Successful performance during a session may reflect immediate support, repetition or familiarity rather than lasting learning.

For children with DCD, we need to consider opportunities for practice, feedback, problem-solving and generalisation.

Are we measuring success in the therapy room? Or are we measuring whether the child can participate more successfully in everyday life?

The child's experience matters too

Motor learning involves uncertainty. Children need opportunities to experiment, make mistakes and discover what works in a safe and predictable environment where they feel understood and supported.

Repeated experiences of difficulty may affect confidence, motivation and willingness to participate.

Being trauma-informed, neuroaffirming and attentive to regulation means respecting the child's communication, preferences, autonomy and emotional experience.

Our role is to create conditions in which meaningful learning and participation become possible.

Bringing it together

For children aged six to nine with DCD, effective intervention begins with understanding the individual child and identifying meaningful occupational goals.

CO-OP and other activity-oriented approaches offer an important evidence-informed foundation.

ASI may be considered for separately identified sensory integration needs, but its effectiveness for DCD-specific outcomes remains uncertain.

The question isn't simply whether we work from the bottom up or the top down.

It's whether our clinical reasoning connects assessment findings, intervention choices and measurable participation outcomes.

We don't begin by choosing an intervention technique. We begin by understanding the child.

Because interpretation informs intervention.

SEEING THIS CLINICAL DILEMMA IN YOUR OWN CASELOAD?

Knowing what the evidence recommends is one thing.

Deciding what it means for the individual child in front of you is where clinical reasoning becomes essential.

In Beyond Coordination: Making Sense of DCD and Praxis, Kerry takes this reasoning further, connecting sensory-motor processing, praxis, motor learning and participation.

WHEN “THEY DID IT IN THERAPY” IS NOT THE END OF THE STORY

Retention, transfer, adaptation and generalisation are central to understanding whether performance is becoming learning.

This is one of the clinical threads Kerry will unpack LIVE in Beyond Coordination: Making Sense of DCD and Praxis. 

If this blog has you thinking about a child on your caseload, bring that clinical picture with you.

24 November 2026
18:00 AEST - 19:30 AEST (Incl 30 LIVE Q&A with Kerry)
1.5 PD/EU Certificate of Attendance
60-day replay access | Workbook Incl | Bonus Resourcesfor Live attendees

Join Kerry LIVE

See what the Masterclass covers

Move beyond simply describing the movement difficulty and strengthen the clinical reasoning behind what you observe, what you explore next and how that informs intervention.

Use PARTICIPATE20 throughout November for 20% off your booking.

References (APA 7th edition)

Acuña, C., Gallegos-Berrios, S., Barfoot, J., Meredith, P., & Hill, J. (2025). Ayres Sensory Integration® with children ages 0 to 12: A systematic review of randomized controlled trials. American Journal of Occupational Therapy, 79(3), Article 7903205180. https://doi.org/10.5014/ajot.2025.051023

Araujo, C. R. S., Cardoso, A. A., Polatajko, H. J., & Magalhães, L. C. (2021). Efficacy of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach with and without parental coaching on activity and participation for children with developmental coordination disorder: A randomized clinical trial. Research in Developmental Disabilities, 110, Article 103862. https://doi.org/10.1016/j.ridd.2021.103862

Blank, R., Barnett, A. L., Cairney, J., Green, D., Kirby, A., Polatajko, H., Rosenblum, S., Smits-Engelsman, B., Sugden, D., Wilson, P., & Vinçon, S. (2019). International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder. Developmental Medicine & Child Neurology, 61(3), 242–285. https://doi.org/10.1111/dmcn.14132

Kishida, Y., Stephenson, J., Kemp, C., & Salisbury, C. (2026). Efficacy of interventions adhering to the revised Ayres Sensory Integration® Fidelity Measure: A systematic review. Journal of Autism and Developmental Disorders. Advance online publication. https://doi.org/10.1007/s10803-026-07283-7

Zengin Yazıcı, G., Yıldırım, K., & Tanrıverdi, M. (2026). Effects of the Cognitive Orientation to Daily Occupational Performance approach on occupational performance and related outcomes in children with disabilities: A systematic review and meta-analysis. Australian Occupational Therapy Journal, 73(5), Article e70129. https://doi.org/10.1111/1440-1630.70129