09/08/2026
A new 2026 scoping review has made us reflect on a question that has quietly shaped Sensory Ladders® for more than 25 years:
Cossart, Thomacos, Bhopti and Fossey’s 2026 review explores how occupational therapists understand self-regulation in mainstream primary schools. Despite self-regulation being widely discussed in occupational therapy, the authors found only 12 papers meeting their criteria, seven peer-reviewed studies and five dissertations. More importantly, they identified considerable uncertainty about how self-regulation is defined, understood and measured.
That conclusion resonates strongly with the history of Sensory Ladders® and with the more recently articulated PEAR TREE™ Lens. The challenge may not simply be to help people become “better regulated”. It may be to understand regulation differently.
Cossart, Thomacos, Bhopti and Fossey found that self regulation remains inconsistently defined in occupational therapy and is often measured through related constructs rather than through occupational performance, engagement and participation. Their conclusion is important: we need a more occupationally grounded understanding of regulation, connected to what people actually need and want to do.
That feels very familiar.
Sensory Ladders® grew from our earlier Sensory Levels work in 1999 and clinical practice in adult mental health. Brown, Shankar and Smith’s 2009 paper explored whether sensory processing could offer another way of understanding experiences that might otherwise be viewed primarily through psychiatric or behavioural lenses.
Twenty five years on, PEAR TREE™ helps us make that thinking more explicit.
A Sensory Ladder helps us notice changing embodied states. PEAR asks us to consider the Person, Environment, Activity and Relational response together. TREE then supports Triage, Relational response, Evaluation and Ethics.
So perhaps the question is not simply:
“How do we help this person regulate?”
It is:
“What is happening for this person, in this environment, during this activity, alongside this relational response, and what could support participation?”
That distinction matters.
The aim is not to teach people to look regulated. It is to understand experience together, strengthen agency, adapt what can be changed and support meaningful participation.
Our fuller research reflection is now on The Sensory Project website:https://sensoryproject.org/from-sensory-ladders-to-pear-tree/
References:
Cossart L, Thomacos N, Bhopti A, Fossey E. (2026). Occupational therapists, self-regulation, and primary schools: A scoping review. Australian Occupational Therapy Journal, 73(4), e70101. DOI: 10.1111/1440-1630.70101.
Brown S, Shankar R, Smith K. (2009). Borderline personality disorder and sensory processing impairment. Progress in Neurology and Psychiatry, 13(4), 10–16. DOI: 10.1002/pnp.127.
