Neurobiology, Neuroplasticity, Neurodiversity: An OT Perspective

I almost failed. 

Importantly, I didn't fail. I tried again. I succeeded. 

I wish I had paid more attention in that first semester of OT school. ​

Neurobiology.

Ironically, the study of the brain and how it works  - was hard on my brain! The fact that I could learn new things, make mistakes and try again is so important for life-long learning.  It is the neuroplasticity of our brains that helps us to keep growing (developing skills, resilience and knowledge) and keep going (adjusting to challenges, recovering from difficulties, and maintaining function over time). 

I have been reflecting on this recently with the neurodivergent children that I see. Why are some aspects of learning so hard? What if neurobiology helps us to explain why? What are the links to brain structure? What is the impact on every day activities?  Does OT really help when it seems like an uphill struggle sometimes? 

Now, these questions could form the basis of a Phd ...and sorry I don't have the time or know-how for that...  but I thought I would do a little digging into the research to find a (simplified) answer for myself.  I hope this brief dive is helpful for some of you too - making connections between neurobiology, neuroplasticity and neurodiversity! 

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Neurobiology: The Foundation

Neurobiology is the study of how the brain and nervous system are structured and how they function. It provides the foundation for understanding sensory processing, motor control, attention, memory, and emotional regulation (see, I knew I should have paid more attention in OT school!).

The brain is divided into two hemispheres, each with specialized roles:

• The left hemisphere is generally associated with language, sequencing, logic, and fine motor control.
• The right hemisphere plays a stronger role in visual-spatial processing, creativity, emotional understanding, and holistic thinking.

For everyday activities, both hemispheres need to work together. For example, writing requires the left hemisphere for sequencing letters and words, while the right hemisphere manages spatial awareness on the page. 

The corpus callosum is a thick band of nerve fibers that connects the left and right hemispheres, enabling communication between them. When the corpus callosum is underactive or not fully developed, children may struggle with coordination, problem-solving, or transferring information between sides of the body (Hinkley et al., 2016).  Research has shown that individuals with autism may present with differences in corpus callosum size and connectivity, which can influence how information is processed across hemispheres and contribute to the diversity of learning and developmental profiles. These neurobiological variations highlight the importance of understanding neurodiversity not as a deficit, but as a spectrum of brain-based differences that shape how skills are acquired and expressed. By acknowledging and supporting these unique neurological pathways, therapists, educators, and families can foster meaningful skill development in ways that are affirming and individualized (Prigge et al., 2013).​

OT activities that use both sides of the body—like clapping games, ball throwing, or bilateral drawing—help strengthen these inter-hemispheric connections.

Crossing the midline refers to moving a hand, foot, or eye across the invisible line dividing the body into left and right halves. This seemingly simple action is vital for building neural pathways between the hemispheres through the corpus callosum.

In OT, we are often encouraging midline crossing through posture and positioning.  We ask the child to sit or stand in a certain position, separating the upper body from the lower body but also crossing from one side to other. 

For example:

• A child sits cross legged on the floor and reaches across their body to grab puzzle pieces.
• A child standing at a whiteboard, without moving their feet, they draw a “figure 8” (infinity symbol) repeatedly.
• A child sits at a table, with trunk rotation, plays with  items to move from one side to other. 

These activities strengthen communication between brain hemispheres and lay the foundation for skills like handwriting, reading, dressing, and sports. Repetition of cross-lateral movements has been shown to support neuroplastic changes that enhance interhemispheric integration and higher-order learning (Ocklenburg S, Guo ZV., 2024).

Neuroplasticity: The Brain's Capacity for Change

Neuroplasticity is the brain’s ability to reorganize and create new neural connections in response to experiences, learning, or injury. This is the reason therapy works—the brain is not fixed, but adaptable, flexible ... learning.
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From an OT perspective:

• Every therapy session provides opportunities for practice and repetition that strengthen new skills.
• Engaging in meaningful, motivating activities enhances neuroplastic changes because the brain is more likely to “rewire” when tasks are purposeful.
• Early intervention harnesses neuroplasticity during critical developmental periods, but change remains possible across the lifespan (Kolb & Gibb, 2014). So even when say that habits are formed or things are "locked in", there is still the potential for change and learning. (You can teach an old dog new tricks). 

We use strategies such as multi-sensory learning, task analysis, finding the "just right challenge", appropriate grading and support.  We encourage embedding learning in every-day activities, hands on learning, learning through play and "making learning fun"! 

The CO-OP approach (Cognitive Orientation to daily Occupational Performance) empowers children to set their own goals, problem-solve strategies, and practice until skills become automatic. This process strengthens the brain through neuroplasticity. Goal setting, practice, strategy, and reflection drive neuroplasticity. Skills carry over best when they are meaningful to the child and practiced in real-life contexts.
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Neurodiversity: Embracing differences

Neurodiversity is the concept that natural variations in the human brain—such as autism, ADHD, dyslexia, and dyspraxia—are not deficits but differences that bring both strengths and challenges (Armstrong, 2010).
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From an OT perspective:

• Neurodiversity shifts the focus from “fixing” a child to supporting participation and promoting self-advocacy.
• Therapy emphasizes strength-based approaches, recognizing creativity, problem-solving, and unique perspectives (Dwyer. P. et al, 2024).
• Environmental modifications and accommodations are just as important as skill development.
• Neurodiversity-affirming practice means respecting stimming, sensory needs, and alternative communication, and avoiding interventions that push masking or compliance.
• “How can we adapt the environment or activity so this child can thrive? How can we support the child?

These three concepts are not separate—they overlap in ways that shape occupational therapy practice:

• Neurobiology helps us understand the mechanisms behind skill development and challenges.
• Neuroplasticity gives hope and evidence that change is possible through meaningful practice.
• Neurodiversity ensures we affirm individuality, valuing strengths while supporting challenges.

Together, they guide OT practice toward more compassionate, effective, and empowering therapy.

​As therapists we can consider to: 

• Use neurobiology to understand sensory, motor, and cognitive foundations, and design activities that cross midline to support interhemispheric integration.
• Build neuroplasticity with meaningful and goal directed  tasks.
• Practice neurodiversity-affirming care: value differences, avoid compliance-based goals, and prioritize participation, autonomy, and strengths.

As parents we can remember:

• Your child’s brain can change! With practice, problem-solving, and support, new skills can grow over time.
• Focus on what matters to your child—skills are more likely to  carry over when they are meaningful.
• Celebrate your child’s strengths and differences. Being neurodivergent is not something to “fix”—therapy is about helping them thrive in their own way.
• Partner with your OT: share your child’s goals, celebrate progress, and advocate for approaches that respect your child’s individuality.

​Do you have more questions about neurobiology, neuroplasticity and neurodiversity? I do! Let's keep learning together!  Let me know your reflections and questions!

Cindy is a registered occupational therapist practising in Sydney, Australia.  She has two growing children who are a constant source of inspiration and learning.  Cindy loves working creatively to help children to reach their potential, finding opportunities in everyday living and making learning fun. She is also addicted to making printables (even when they take a long time to complete).  Cindy is the author of the Occupational Therapy blog Your Kids OT.  Read more articles from Your Kids OT at https://www.yourkidsot.com/blog

Cindy is a contributing author of the Functional Skills for Kids Therapy Team.  They have together published THE HANDWRITING BOOK, THE SCISSORS SKILLS BOOK and THE TOILETING BOOK.

​The information on this site is general in nature. The activities are safe for most children, however, you should consult an Occupational Therapist or health professional to address specific movement, sensory or other medical conditions. Affiliate links are used throughout this website to promote recommended products. Your Kids OT receives a small commission if any purchases are made through these links. Please see my disclosure policy for more details. ​​​
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References

• Armstrong, T. (2010). The Power of Neurodiversity: Unleashing the Advantages of Your Differently Wired Brain. Da Capo Press.
• Dwyer, P., Gurba, A. N., Kapp, S. K., Kilgallon, E., Hersh, L. H., Chang, D. S., Rivera, S. M., & Gillespie-Lynch, K. (2024). Community views of neurodiversity, models of disability and autism intervention: Mixed methods reveal shared goals and key tensions. Autism, 29(9), 2297-2314. https://doi.org/10.1177/13623613241273029 (Original work published 2025)​
• Hinkley LBN, Marco EJ, Findlay AM, Honma S, Jeremy RJ, et al. (2012) The Role of Corpus Callosum Development in Functional Connectivity and Cognitive Processing. PLOS ONE 7(8): e39804. https://doi.org/10.1371/journal.pone.0039804
• Kolb, B., & Gibb, R. (2014). Searching for the principles of brain plasticity and behavior. Cortex, 58, 251–260. https://doi.org/10.1016/j.cortex.2013.11.012
• Prigge, M. B. D., Lange, N., Bigler, E. D., Merkley, T. L., Neeley, E. S., Abildskov, T. J., Froehlich, A. L., Nielsen, J. A., Cooperrider, J. R., Cariello, A. N., Ravichandran, C., Alexander, A. L., & Lainhart, J. E. (2013). Corpus callosum area in children and adults with autism. Research in Autism Spectrum Disorders, 7(2), 221–234. https://doi.org/10.1016/j.rasd.2012.09.007
• Ocklenburg S, Guo ZV. Cross-hemispheric communication: Insights on lateralized brain functions. Neuron. (2024 Apr 17);112(8):1222-1234. doi: 10.1016/j.neuron.2024.02.010. Epub 2024 Mar 7. PMID: 38458199.