When we have done OT in the past there seem to be 2 types available. The medical type we have gotten through a branch of the local children's hospital and the for profit type we have gotten from a large OT chain in the area. Both require a medical script and take insurance, but otherwise they are pretty dissimilar.
Our dev ped (also with children's hospital) has frequently referred us to the OT department for regulation stuff/alert program. When we go to the OT they say they don't know why the dev peds keep referring people, OT does not do therapy that is focused on regulation/behavior management. They recommend cognitive behavioral therapy.
For years we used a local for profit OT business that assured us they would fix all of DS's troubles through sensory therapy. They put him on swings, forced him to follow direction in a chaotic room, dragged him around on scooters, pushed him through tunnels, made him play in shaving cream, insisted he jump into beanbags, etc. In the end he went for 3.5 years and never saw any improvement in regulation. He did see a drastic decrease in compliance though.
I'd love to know if there is anything out there that helps with regulation. DS has none. Actually, his meds help, but nothing else ever has. It seems a lot of professionals are of the opinion that OT is the solution to just about every problem. I highly recommend a medical based OT if you do see one. They will likely be more honest with you. They also did help us with some sensory issues. Very focused, task specific programs that got my DS brushing his teeth and dressing himself in addition to being less tactilely defensive in general. None of that helped with regulation in any way though.
Compression vests, fidgets, wiggle seats, etc. did nothing for my DS. They might help some kids, but even if they do they aren't going to treat any underlying issues actually causing the problem behavior. For my DS it turned out to be ADHD, but when he was younger we were told autism and pursued the sensory stuff a lot. I also worked for years with kids with autism and honestly never saw a lot of benefit from the OT side of things. Yeah, if you have a kid chewing up shirts the OT can help find a better chewing solution, but they can't change a child's neurology (the child will still need to chew). Anyone claiming they can go into a classroom and fix a kid with OT is lying, IMO. If a special seat or a new light fixture solves all of the child's problems, there probably wasn't a problem to begin with. Not saying these things can't help, just that there is no OT miracle cure out there despite what the current trends might be.
We have also had some experience with OT's from the school district. I have found they know no more about sensory than I have learned reading on the internet. They pretty much say try a sensory diet and buy lots of sensory things and see if they help. I made my own sensory diet that probably didn't help my son, but didn't hurt either. Just some basic exercises that he enjoyed that were designed for certain types of input. We did it twice a day. I also spent a ton on special equipment: compression vest, special inflatable seat thing, noise cancelling headphones, chewelry, etc.
In the end I recommend making sure you aren't using OT just because it's currently the popular choice to treat everything. Find out what's going on and pick something evidence based. OT is obviously a real medical profession that treats real issues. Just don't believe that it treats every behavioral problem for every kid. It doesn't. But professionals and teachers push it and the less honest places are glad to take your money even if they can't help you.
