Anxiety in children is far more common than many people realize, and it doesn’t always look like worry or fear. For some children, anxiety shows up as meltdowns, avoidance, perfectionism, difficulty separating from parents, or physical complaints like stomach-aches. And while “calm corners” and “breathing techniques” have become standard tools in schools and therapy rooms, Occupational Therapy (OT) offers so much more.
Occupational therapists are uniquely positioned to support children with anxiety—not just by helping them calm down, but by empowering them to engage meaningfully in their everyday occupations: play, learning, social interaction, self-care, and participation in family and community life.
This blog post explores the complex relationship between anxiety and occupational performance, outlines OT’s role in supporting anxious children, and discusses practical, trauma-informed, and neurodiversity-affirming strategies that go beyond the calm corner.
Table of Contents
Understanding Anxiety in Children
Anxiety is part of the human experience—it keeps us safe, alerts us to danger, and helps us prepare for challenges. But when anxiety becomes persistent, overwhelming, or out of proportion to the situation, it can interfere with a child’s ability to participate in daily activities.
Common signs of anxiety in children include:
- Avoiding new or challenging tasks
- Clinginess or difficulty with separation
- Perfectionism and fear of making mistakes
- Frequent stomach-aches, headaches, or other somatic symptoms
- Difficulty sleeping or frequent nightmares
- Anger, irritability, or emotional outbursts
- Withdrawing from peers or refusing school
For neurodivergent children—such as those with autism, ADHD, or sensory processing differences—anxiety often coexists with other challenges and may be misinterpreted as behaviour problems, defiance, or lack of motivation.
Occupational Therapy and Anxiety: A Holistic Approach
Occupational therapy is grounded in the belief that all people have the right to participate in meaningful activities (or “occupations”). For children, this means playing, learning, creating, socialising, and growing.
When anxiety disrupts a child’s ability to engage in these activities, occupational therapists can help by:
- Identifying and addressing environmental, sensory, and task-related stressors
- Building regulation and coping skills through play and daily routines
- Supporting a sense of safety, predictability, and control
- Empowering children with tools to understand and advocate for their needs
Unlike more directive, talk-based approaches, OT uses activity-based, body-first, and strengths-based strategies that work particularly well for young and neurodivergent children.
Anxiety as a Sensory and Nervous System Experience
Anxiety isn’t just “in the mind.” It’s a full-body experience shaped by the autonomic nervous system. Many children with anxiety live in a state of chronic hyper-arousal—easily startled, on edge, and always anticipating threat. Others experience hypo-arousal, appearing shut down, lethargic, or hard to engage.
Occupational therapists use knowledge from polyvagal theory, interoception, and sensory integration to support children in identifying and regulating their internal states. This might include:
- Activities that provide calming proprioceptive or vestibular input
- Helping children notice body signals (e.g., heart racing, tight tummy)
- Teaching children to “match” their energy to the demands of the task
- Building routines that include movement, rest, and sensory nourishment
Understanding a child’s sensory and regulation profile is crucial to addressing anxiety—not just managing its symptoms, but supporting the child to feel safe in their body and environment.
The Limitations of the “Calm Corner”
Calm corners—spaces with soft cushions, sensory tools, and visuals—have become a popular regulation strategy in classrooms and therapy rooms. While they can be a helpful start, they are not a solution to the complex and layered experience of anxiety.
Here’s why:
- Not all children know how or when to use a calm space. Some children may need help noticing they are dysregulated or permission to step away without shame.
- Some calm corners are used as punishment. When children are sent away for “bad behaviour,” it undermines the sense of safety and support the space is supposed to offer.
- Calm corners are reactive, not proactive. They are most effective when part of a broader regulation and connection plan, not a stand-alone strategy.
- Sensory needs are not one-size-fits-all. For a child in a shutdown or freeze state, lying on a beanbag might make things worse. Others might need movement, music, or deep pressure input instead.
OT can guide parents and educators to move beyond a generic calm-down space and toward co-regulation, proactive sensory supports, and collaborative safety plans that actually work.
Trauma-Informed and Neurodiversity-Affirming Practice
When supporting children with anxiety, it’s essential to consider both trauma-informed care and neurodiversity-affirming practice—not just because it’s ethical, but because it’s more effective.
Trauma-Informed OT Principles
- Safety first: Children who feel unsafe will struggle to learn or regulate.
- Relationship matters: Trust and co-regulation with a safe adult is the foundation.
- Behaviours are messages: Avoid shaming or punishing dysregulation.
- Empowerment and choice: Anxiety often stems from a lack of control.
Neurodiversity-Affirming Practice
- Respect sensory and social differences rather than trying to “normalise” the child
- Support self-advocacy rather than compliance
- Avoid masking pressure—focus on helping the child feel safe to be themselves
- Celebrate strengths and special interests as pathways to growth and connection
When OT moves from “fixing” children to supporting their nervous systems, identities, and participation, the results are deeper and longer-lasting.
What Does OT for Anxiety Look Like in Practice?
Occupational therapy for anxiety doesn’t follow a single template. It’s dynamic, relationship-based, and tailored to each child’s nervous system, needs, and goals. But here are some common areas of focus:
1. Sensory Strategies and Environmental Adjustments
- Creating sensory diets with movement breaks, heavy work, or calming input
- Adjusting lighting, noise, or seating in classrooms
- Using noise-cancelling headphones, chew tools, or fidget options
- Supporting transitions with visual schedules and timers
2. Body Awareness and Interoception
- Games and activities that help children name and notice body signals
- Using mirrors, yoga, or body scanning exercises
- Creating personalised “energy zones” or “feelings maps”
- Linking physical sensations to emotions and needs
3. Executive Function and Predictability
- Helping children organise tasks and routines to reduce uncertainty
- Creating visual checklists and choice boards
- Teaching planning and problem-solving through play
- Supporting transitions and flexibility through role play and stories
4. Co-regulation and Social Connection
- Modelling calm behaviour and narrating your own regulation strategies
- Practicing “cozy time,” shared activities, and joint regulation routines
- Helping children repair relationships after outbursts
- Supporting safe peer interactions through supported play
5. Empowerment and Confidence
- Setting achievable goals and celebrating small wins
- Creating “brave plans” for anxiety-provoking tasks
- Using social stories or comic strip conversations
- Building on the child’s interests and strengths
Real-World Example: Amelia, Age 9
Amelia is a 9-year-old with inattentive ADHD and anxiety. She often refuses to go to school, complains of headaches, and melts down over homework. Traditional counselling didn’t seem to help.
With OT, the therapist discovered that Amelia was overwhelmed by sensory input in the classroom, confused by multi-step instructions, and terrified of making mistakes. Together, they:
- Created a “start small” homework routine using checklists and breaks
- Used interoception cards to help Amelia recognise her early anxiety signs
- Built sensory supports into her school day (a wobble stool, quiet corner, visual schedule)
- Co-developed a “bravery badge” system for small wins (e.g., entering the classroom, asking for help)
- Worked with her teacher to reduce pressure and provide consistent reassurance
Within two months, Amelia began attending school more regularly and expressing pride in her efforts—even when things weren’t perfect.
Tips for Parents and Educators
If you’re supporting a child with anxiety, here are some practical OT-informed strategies:
- Prevention over reaction. Anticipate stressors and create structure before anxiety peaks.
- Name it to tame it. Help the child give their feelings names: “It sounds like your worry brain is talking.”
- Don’t aim for ‘calm’—aim for connection. Before problem-solving, help the child feel heard and safe.
- Use body-based tools. Movement, pressure, breathing, and rhythm regulate the nervous system.
- Let go of perfection. Encourage bravery, flexibility, and good-enough efforts.
- Offer choice and control. This reduces anxiety’s grip and builds autonomy.
And perhaps most importantly: Believe the child. Anxiety isn’t a behaviour problem—it’s a signal.
Conclusion: More Than a Calm Corner
Occupational therapy for children with anxiety is not about compliance, control, or quiet corners. It’s about understanding the child’s experience, supporting their nervous system, and helping them build the confidence and skills to show up fully in their world.
When we meet anxious children with curiosity, compassion, and creativity, we do more than help them calm down—we help them rise up.
Because children are not meant to be calm all the time. They are meant to be regulated enough to explore, create, love, learn, and live. And that is what occupational therapy is really about.
Want to learn more about how OT can support your anxious child?
Reach out to our team to explore options that are right for your family or school.
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