A Multisensory Approach to Learning and Carry Over

“But they can do it at OT!”

It's a phrase many of us have heard (or said).

A child might successfully complete a task during a therapy session, follow the steps, use the strategy and even demonstrate a new skill. Then they return to the classroom or home environment and… it's as though the skill never happened.

So what happened?

Learning a skill in one situation doesn't automatically mean a child will use it somewhere else. The people, environment, sensory demands, task expectations and level of support can all change. Even presenting the same task in a different way can cause some children to stumble. Tying a different set of shoelaces on a different pair of shoes can feel like a completely new task!

Children learn through seeing, hearing, touching, moving, thinking, using working memory, doing and practising. When we deliberately draw on these different ways of experiencing information, we can provide more opportunities for a child to understand, practise and remember a skill.

What is multisensory learning?
A multisensory approach involves using more than one form of sensory input or prompt to support learning.
This might include:

• Visual information – seeing a demonstration, picture, symbol or written cue
• Auditory information – hearing an instruction, rhythm, rhyme or verbal cue
• Tactile information – touching or manipulating materials
• Kinaesthetic information – learning through hands-on movement and physical experience
• Proprioceptive and vestibular information – receiving information from muscles, joints and movement to develop body awareness

For example, when teaching a child how to form a letter, we might demonstrate the movement, talk through the sequence, have the child experience the movement with their finger and then practise writing the letter. We might layer sensory input by changing the body position, such as sitting on a gym ball, or adding a tactile component such as sandpaper underneath the paper.

The multisensory experience provides useful information and feedback that can help the child understand, experience, practise or remember the skill.
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My previous article, “Draw with me: A three step multisensory approach,” explores how I have used music, movement and repetition when teaching drawing skills.

Individualising multisensory learning
A multisensory approach can also take account of individual differences in sensory processing. Winnie Dunn's Sensory Profile framework provides one way of understanding how people notice and respond to sensory information. The framework considers the interaction between neurological thresholds and self-regulatory responses. It describes four broad patterns: Bystander, Sensor, Seeker and Avoider. Read more about the Sensory Profile framework here.

These patterns aren't fixed categories. A child's responses can vary depending on the sensory system, activity, environment and context. Children can also demonstrate different patterns across different situations. This has important implications for multisensory learning.

A child who tends to miss sensory information may benefit from information being made more noticeable. Another child may notice sensory information very quickly and need input reduced so they can focus on what is relevant. A child who actively seeks sensory experiences may benefit from appropriate opportunities for movement and interaction, while a child who avoids particular sensory experiences may need increased predictability, choice or adaptation.
The same sensory strategy won't necessarily work for every child.

Adding a cognitive strategy
The Cognitive Orientation to daily Occupational Performance (CO-OP) approach provides another useful way of thinking about learning and carryover. CO-OP is a goal-directed, problem-solving approach that actively involves the child in developing strategies to improve their occupational performance.

A central feature is the Goal–Plan–Do–Check process:
GOAL – identify what the child wants to achieve.
PLAN – develop a strategy for achieving it.
DO – put the plan into action.
CHECK – evaluate how it worked and make adjustments.

This changes the role of the child from someone who just follows an adult's instructions to someone who is engaged with participation.

When we combine multisensory learning with a cognitive strategy such as CO-OP, we can support children to notice what they are experiencing, develop strategies, test them and make adjustments. This can also support the development of executive functioning skills such as planning, monitoring, problem-solving and cognitive flexibility. We can build habits and affect memory. Repeating actions creates automatic routines, and these routines physically change and strengthen the brain systems responsible for storing and recalling information.

Prompts can support learning and carryover
Children need different levels of prompting to learn and carry over their skills. In my article Prompt Hierarchy Explained!, I discuss different levels of prompting and considerations for moving from “most to least” or “least to most” support.
Prompts might include:

• verbal instructions
• visual cues
• demonstrations
• physical assistance
• gestures
• reminders
• environmental modifications
• encouragement

These supports can be valuable, particularly when a skill is new. They can also change as the child's skills develop and carry over into more settings.

Prompts can form part of multisensory teaching. A child might receive a visual cue alongside a verbal instruction, or a physical cue alongside a demonstration.

Over time, the aim is for the child to require less adult input and become increasingly able to initiate, monitor and adjust their own performance. The child may respond to natural cues. 

Generalisation (carryover) is more than repetition
Carryover isn't simply about practising a skill many times. A child might practise a skill repeatedly in a therapy room but have difficulty using it in the classroom because the environment, task demands or level of support are different.

Meaningful practice helps bridge the gap.

• If the goal is independent dressing, practising with real clothing is important.
• If the goal is using cutlery, practising during mealtimes provides the functional context.
• If the goal is handwriting, writing needs to be part of the intervention.
• If the goal is participating in a classroom activity, opportunities to practise within classroom routines can help support transfer.

The occupation itself provides a meaningful reason to learn the skill.
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Pencil grasp as an example
Pencil grasp provides a useful example of how these ideas can come together. My co-author Jaime Spencer has written specifically about How Kids Learn Pencil Grasp. Her article explores the learning process and teaching supports specific to pencil grasp. Spoiler alert but songs, posters and visual cues actually work!

A child learning about pencil grasp might first need to see what an efficient grasp looks like. A poster or visual reminder can provide that information without an adult having to repeat the instruction every time.

They can then feel and experience the grasp while using a pencil, receive feedback from their fingers and hand, and practise it during meaningful drawing and writing activities.

The visual information can remain available in the classroom or at home, providing a consistent reminder when the therapist isn't there. This is one of the reasons we included visual posters in Gripipedia.

The posters aren't intended to replace teaching or become another checklist of “correct” pencil grasps. Instead, they are designed to provide accessible visual information that can support teaching, discussion and carryover. Teachers and parents can use the same visual language as the therapist, helping to create consistency across environments. The poster can become a prompt that the child eventually uses independently.
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That is the shift we are looking for: from adult prompt → to visual cue → to self-monitoring → to independent use.

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