NHS Occupational Therapy Assessment for an Autistic Child: What to Expect in Leeds

This is a parent-to-parent guide based on our experience of getting an NHS occupational therapy assessment in Leeds for an autistic child. It is not medical advice, and it will not be the same in every NHS trust or Integrated Care Board area. But if you are in Leeds, one thing is worth knowing early: you may need to be very specific about the daily living tasks your child is struggling with.

When we first asked for sensory help, the referral was not getting anywhere. What eventually moved it forward was describing practical activities of daily living: things like putting on shoes, managing clothing, fastenings, cutlery, opening packets, and other everyday tasks.

That matters because Leeds Community Healthcare's ICAN occupational therapy service says it supports children whose needs affect everyday functioning and participation. It also says referrals need to include two activities of daily living that the child finds difficult, and that the service does not offer sensory integration where sensory differences are the main barrier. You can read the Leeds ICAN OT page here: Occupational therapy (ICAN) - Leeds Community Healthcare.

The key lesson from our referral

If you only write "my child needs sensory help", you may not be giving the OT service what it needs to accept the referral.

A more useful referral is specific and functional:

My child cannot reliably put shoes on or manage clothing without adult help.
My child struggles with buttons, zips, socks, or getting clothes the right way round.
My child finds cutlery difficult and needs support to cut food safely.
My child struggles with fine motor tasks such as opening packets, using door handles, or using both hands together.
These difficulties affect school mornings, mealtimes, independence, safety, family routines, or participation.
We have already tried particular strategies, but the difficulty is still affecting daily life.

That does not mean sensory needs are irrelevant. For many autistic children, sensory differences affect eating, dressing, washing, sleep, school, and behaviour. But in our experience, the NHS OT route was much more practical when the request was framed around daily functioning.

Stage one: the long form

After the referral was accepted, we were sent a long form to complete.

The questions were not just about the immediate problem. They asked about the child as a whole, including:

What is going well.
What we wanted from the appointment.
What could be better for the child.
Medical history.
Activities of daily living.
General wellbeing.
Birth history.
Developmental history.
Family history.
Who lives at home.

My advice is to treat this form as evidence, not admin. Give examples. Explain the real-life impact. Do not just say "struggles with dressing". Say what happens, how often, what support is needed, what you have already tried, and what it stops your child or family doing.

For example:

Dressing is difficult because my child cannot consistently identify the front and back of clothing, needs adult support to sequence the task, and becomes distressed or stuck during school mornings. We have tried laying clothes out in order and using verbal prompts, but she still needs adult support most days.

Stage two: the phone call

The next stage for us was a phone call.

This is where it can feel like the service is trying to decide whether advice leaflets or websites are enough. In our case, there was an attempt to avoid a home visit and send resources instead.

Be ready for that possibility. Before the call, write down:

The two or three daily living tasks that matter most.
Why advice alone has not solved it.
What has already been tried.
What happens at home or school that a professional needs to understand.
Whether your child performs differently with unfamiliar adults, in clinic, at school, or at home.
Whether the difficulty needs to be observed in the real environment.

A helpful phrase is:

We have tried general advice, but the difficulty is still affecting daily living. We need assessment and individualised recommendations because the problem is happening in context and we need to understand what support is appropriate.

Stage three: the home visit

We eventually got a home visit.

The OT saw our child at home, with a familiar therapist present. That helped because the OT could see real tasks, not just hear a description of them.

The assessment was practical. The main areas covered were:

Dressing.
Fine motor skills.
Movement skills.
Cutlery and daily living tasks.
Thera-putty and hand strengthening exercises.
Practice through normal activities rather than abstract exercises.

The recommendations were also practical. They included ideas like making the front and back of clothes easier to identify, building checking into the dressing routine, practising fine motor strength through play and daily tasks, using appropriate cutlery and seating, breaking activities into steps, modelling, and using hand-over-hand support where appropriate.

This matched what Leeds ICAN says families may experience: telephone consultations, face-to-face appointments, identifying specific functional goals, and sometimes watching the child doing real-life tasks at home, school, or clinic.

What surprised me

The biggest surprise was how little sensory-specific input we received from the NHS OT assessment.

That may not be the same everywhere, and another child may have a different experience. But for us, the NHS assessment was not like a sensory integration assessment. It was much more focused on functional skills and practical strategies.

That is important if you are thinking about EHCP evidence. Our private sensory integration OT report was over 20 pages and went into much more detail about how our child's sensory system was working. That was the report I attached for EHCP purposes because it answered a different question.

The NHS OT report was useful, but in a different way. It documented functional needs, observed abilities, practical goals, recommendations, and the plan. It was not a full sensory integration report.

NHS OT and private sensory OT are not the same thing

This is how I now think about the difference.

NHS OT may help with:

Daily living skills.
Dressing.
Cutlery.
Toileting, bathing, seating, sleep, or equipment where relevant.
Fine motor and movement skills.
Practical recommendations for home and school.
Functional goals and participation.

A private sensory integration OT report may be more useful when you need:

A detailed sensory profile.
Analysis of sensory modulation, discrimination, praxis, posture, or regulation.
Specific sensory recommendations for school.
Detailed evidence for an EHCP, tribunal, or specialist provision argument.

That does not mean every family needs a private report. It means you should be clear about what question you need answered.

How to word a referral

Instead of writing:

My child is autistic and needs sensory help.

Try something like:

My child is autistic and has significant difficulty with activities of daily living. She needs adult support with dressing, especially putting clothes on the right way round and managing fastenings. She also struggles to use cutlery safely and to open packets or doors independently. These difficulties affect school mornings, mealtimes, independence and participation. We have tried verbal prompts, laying clothing out, and practising at home, but she continues to need support. We are requesting OT assessment and individualised advice around functional daily living goals.

If sensory differences are part of the picture, link them to function:

Sensory differences appear to affect dressing and eating because certain textures, movement demands or task sequences cause distress or avoidance. We need advice on how to support participation in these daily living activities.

What to prepare before the appointment

Before the call or visit, make a short list of examples:

What your child can do independently.
What they can do with prompts.
What they cannot yet do safely or consistently.
What support adults provide.
What happens on a bad day.
What strategies have helped a little.
What strategies have not worked.
What you want from OT.

Video examples can sometimes help, if appropriate and if the service is willing to consider them. School or nursery examples can also help, especially if the difficulty affects participation outside home.

Questions to ask the OT

Useful questions include:

What functional goals are we working towards?
What should we practise first?
How often should we practise?
What adaptations should home or school use now?
Should these recommendations be shared with school?
Can the report describe the impact on daily living and participation?
If sensory needs are outside this service, where should we get help for them?
Can we be referred back if the strategies do not work?

Useful Leeds links

Final thought

If you are trying to get an NHS OT assessment, be specific. Ask yourself: what daily activity is my child struggling to do, what support do they need, and how is it affecting real life?

In our case, that was the difference between a referral going nowhere and finally getting an assessment.