Occupational Therapy For Twice Exceptional (2e) Children

Written 27th of May, 2025 by Claire Britton (Director of Neuroinclusion)

When we think of gifted children, we often imagine young people with exceptional talents, advanced thinking skills, or an insatiable curiosity. But what happens when those same children also experience challenges with emotional regulation, sensory processing, executive functioning, or social interaction? This is the reality for many gifted and twice-exceptional (2e) children—individuals who are both intellectually gifted and neurodivergent.

As an occupational therapist, I have the privilege of supporting 2e children in ways that celebrate their strengths and accommodate their needs. My approach is neurodiversity-affirming, meaning I don't seek to "fix" differences but rather to empower children to participate in daily life in ways that feel authentic and sustainable for them.

Understanding Twice-Exceptionality

Twice-exceptional children may be Autistic, have ADHD, dyslexia, anxiety, or other neurodevelopmental differences, alongside high intellectual potential. Unfortunately, their support needs are often misunderstood or masked by their abilities. They might be labelled as "lazy," "too sensitive," or "non-compliant," when in reality, they are navigating a world that doesn’t accommodate their way of thinking, feeling, or being.

This mismatch between internal experience and external expectations can lead to burnout, school refusal, or poor self-esteem. Occupational therapy plays a key role in bridging this gap.

How OT Can Help

🌱 Emotional Regulation and Sensory Support

Many 2e children experience heightened emotions and sensory sensitivities. They may feel things deeply, notice subtle sensory input others miss, or become easily overwhelmed by noise, clothing textures, or transitions. As OTs, we work with children to build their interoceptive awareness (understanding what’s happening in their body), co-regulate with trusted adults, and use sensory strategies to feel more comfortable in their environments.

🧠 Executive Functioning and Practical Independence on Daily Tasks

A child might be able to discuss astrophysics but struggle to remember to pack their school bag. This isn’t a contradiction—it’s a hallmark of asynchronous development. We support 2e children by developing external systems (like visual schedules or checklists), building routines, and supporting transitions in a way that promotes agency, not compliance.

✍️ Fine and Gross Motor Development Impacting on Daily Tasks

Some gifted children have motor challenges that impact handwriting, posture, or coordination. These difficulties can be a source of frustration, especially if expectations don’t align with their motor development. Through strength-based activities, we help children develop confidence and skills in a safe, engaging way.

🫂 Social Participation and Authentic Connection

2e children might experience difficulty to "fit in" socially, not because they lack social skills, but because they may prefer deep conversations over small talk or need more downtime between interactions. We help children build awareness of their social energy, find like-minded peers, and advocate for the kind of relationships that feel fulfilling to them.

🛑 Demand Avoidance and Burnout

Many 2e children experience demand avoidance—not as defiance, but as a protective response to overwhelm, anxiety, or trauma. As OTs, we listen carefully, reduce unnecessary demands, and support autonomy through collaborative approaches. We work with schools and families to create environments that are respectful, flexible, and safe.

A Strengths-Based Lens

Above all, occupational therapy for 2e children must be grounded in respect. We look beyond checklists and diagnostic criteria to truly understand the child—what brings them joy, what helps them feel safe, and how they want to engage in the world. Strengths are not just “nice extras”; they’re essential to building a sense of identity and self-worth.

Collaboration Is Key

We work alongside parents, educators, and allied health professionals to ensure consistent, compassionate support. Advocacy is a big part of our role—making sure the child’s needs are seen, heard, and valued in every setting.

Final Thoughts

Giftedness and disability are not mutually exclusive. When we recognise and embrace both, we open the door to meaningful, individualised support. Occupational therapy, when done through a neurodiversity-affirming lens, doesn’t just help children "cope"—it helps them thrive.

If you're supporting a 2e child and wondering how OT might help, reach out. We’d love to walk alongside you.