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  • Writer's pictureDr. Lisa Marnell, OTD, MBA

The Very Excited Autistic Child

Updated: Nov 26, 2023

When it comes to supporting autistic children, one question I am often asked by occupational therapists is this:

“How do I work with an autistic child who can’t seem to focus on anything?”

This is the child who comes into the OT clinic very excited, absolutely on the go. They may hop on and off a swing, pull toys from a shelf, then spin in a circle, with arms outstretched.

Ensure from the start that the child is safe. Some children, for example, may not be safe in an environment with a large trampoline where they may engage in an unsafe manner.

But what can you do as the therapist who is supposed to be addressing this child’s skills? Here are my thoughts, and I welcome your thoughts! We learn more together.

First, step back and consider the big picture.

Think of the big picture in regard to these three things:




So, first , arousal . . . an autistic child or any child naturally finds it exciting to enter a therapy space.

Through studies of autistic neurology, we know that there are differences in an autistic person’s ability to tune out input. This means that so much visual information may be coming to them all at once. And they respond by having a heightened arousal level - this is to be expected, this is okay.

Second, co-regulation . . . this child coming to see you is, well, a child.

So, they may not have figured out how to downshift out of this heightened arousal. But we can show them how to do just this. How? Through co-regulation.

Co-regulation is a term that is used often, but what might it mean in this situation, with

this autistic child?

I define co-regulation as a connection between a joyful adult who may be energetic or calm who intentionally communicates respect, acceptance, and support and a child who is allowed to be their true selves.

In other words, co-regulate with a child by accepting a child where they are, what they are doing, and simply be there with them in a way that values their presence in the world and ensures they feel safe and loved.

On the OT clinic, co-regulation may look like this:

Imagine a child is running about the clinic, but pauses a moment to stare at a dartboard covered in Velcro balls. He starts to read the numbers. Instead of our knee jerk reaction which might be to show the child how to throw a ball so it sticks to the dartboard, follow his lead and think about numbers, maybe pick up a ball and place it on the number he reads.

Don’t talk. Do nothing more. Sit. Wait.

Allow the child to move about the room more if he wants, ensuring of course that he is safe. Will he come back? If he does, see if he states another number. Or think about saying a number yourself. Place a ball on the number that you or he states.

Third, attention . . . through your co-regulation (your calm and your respect for his actions), you are promoting his attention. But what is key here and what makes this neurodiversity-affirming is that your are joining your attention with this child in a task which is meaningful to him.

This has become a game now. A connection. An activity that you can engage in and share together.

So, my answer when an OT asks me how to support and connect with an on-the-go, curious, autistic child, I explain it this way:

First, accept their heightened arousal level.

Second, co-regulate through following their lead and joining them in an activity that is meaningful to them.

Third, embrace simple shared attention to the same task.

Through this process, you are validating them, their energy and their great ideas.

You are developing your relationship with them, but more importantly, you are supporting their realization that connecting with others can be fun and doesn’t have to mean complying to another person’s will.

And you are supporting their attention to engage with an activity that honors them and what they find meaningful.

More from Dr. Lisa Marnell and Kids Master Skills . . .

If you want to learn more ways to support your autistic students, watch my FREE MasterClass that offers you proactive supports for sensory sensitive children and teens.

Register and watch it HERE:

Also, do you have my 10 Neurodiversity-Affirming posters? Download them HERE!

Join my Autism Facebook group for Occupational Therapists and learn more about strengths-based and neurodiversity-affirming practice!

Are you following Kids Master Skills on Facebook, Instagram, or YouTube?

As always, feel welcome to touch base with me by e-mail at

I would love to hear about your successes, your struggles, your feedback, and any questions or comments you have! Let me know if this post was helpful.

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