1st Edition

Occupational Therapy for Children with DME or Twice Exceptionality A Practical Approach to Support High Learning Potential, Sensory Processing Differences and Self-Regulation

By Mariza Ferreira, Rebecca Howell Copyright 2024
    240 Pages 37 B/W Illustrations
    by Speechmark

    240 Pages 37 B/W Illustrations
    by Speechmark

    Children with high learning potential or giftedness have remarkable potential. Despite this, these children can struggle to participate in everyday life because of a range of needs that are sometimes misunderstood, overlooked or not adequately addressed, leading to underachievement and, in turn, low self-esteem. Needs that, in many cases, paediatric occupational therapists are best suited to address.

    The practical resource offered in the book, the DME-C approach, is a tried-and-tested approach to help children who have challenges relating to their high learning potential, as well as sensory processing differences, unhelpful thought patterns and self-regulation. It draws on the heart of occupational therapy that considers the whole profile of the child, actively caters to the unique profiles of children with dual or multiple exceptionality (DME) or twice exceptionality (2e), and guides therapists towards therapy provision that is strengths-based and achieves favourable outcomes. This book:

    • Includes a clear and comprehensive introduction to high learning potential and DME or twice exceptionality (2e), along with guidance to help identify children with these profiles
    • Covers questions and concerns occupational therapists may have when working with children with DME or 2e
    • Considers the similarities and differences between high learning potential/DME/2e and neurodivergent conditions such as developmental coordination disorder, autism and ADHD, with a focus on sensory processing differences
    • Explains, in easy-to-understand language, the full DME-C therapy approach, with a range of example activities to use in therapy to achieve its principles, and a suggested therapy progression plan
    • Is packed full of real-life case studies to translate theory into practice
    • Empowers therapists and educational professionals further by drawing attention to how they can better relate to children with DME/2e in therapy regardless of the children’s specific needs

    Full of examples and with the voices of parents and children at its heart, this resource is essential reading for occupational therapists, SENCOs, education psychologists and other relevant professionals, who want to improve the lives and wellbeing of children with DME or twice exceptionality and help them reach their full potential.


    1. Introduction

    2. High Learning Potential / Giftedness

    3. Dual or Multiple Exceptionality (DME) / Twice Exceptionality (2e)

    4. DME / Twice Exceptionality and Occupational Therapy

    5. DME / Twice Exceptionality and Sensory Processing Differences

    6. The DME-C Approach Foundation: The 10 Golden Nuggets

    7. The DME-C Approach Four Walls: The 4 Essential Components

    8. Making DME/2e Part of Everyday Occupational Therapy Work

    9. Case Studies

    10. Resources for Further Help




    Mariza Ferreira is passionate about supporting children with DME/2e to reach their full potential. It has become her professional mission to both advocate for these children and highlight the importance of the occupational therapy profession to help them. Mariza provides treatment for children and trains parents and other professionals on child-related topics. She also provides supervision to other occupational therapists. Her motto is to change the world one child at a time. This book is one of the ways she is doing that.

    Rebecca Howell is a consultant in educational leadership specialising in governance, policy, risk and systems. Formerly Director of the DME Trust and senior education consultant at Potential Plus UK, she has supported many children with high learning potential and dual and multiple exceptionality and their families. Rebecca is dedicated to driving system-wide improvement in education through collaborative, values-led leadership.

    "Mariza Ferreira and Rebecca Howell have provided a masterclass in inclusive practice for occupational therapists. Their holistic DME-C approach is endorsed by families for its life-changing impact, particularly for children with ‘spiky profiles’ where it can be difficult to determine the most effective therapeutic interventions. Radiating the spirit of occupational therapy, this book moves beyond labels to focus on practical solutions, such as the Ten Golden Nuggets, helping therapists to identify and support children with DME as a routine part of their professional practice. This book is a must-read for every occupational therapist." - Professor Adam Boddison OBE, Co-author of The School Handbook for DME

    "An essential handbook for occupational therapists working with or interested in working with children who demonstrate characteristics of DME/2e! Written collaboratively by expert DME/2e practitioners, this comprehensive book guides the therapist through clearly structured chapters with detailed information on the identification of DME/2e with easy to use checklists, and tried and tested intervention techniques. Utilising the 10 Golden Nuggets with the 4 Essential Components of the DME-C therapy approach provides the therapist with skills to deliver holistic therapy that embraces the child as an equal partner in the process. I wish this book had been published before I retired!" - Sue Davis, Retired Independent Paediatric Occupational Therapist


    "This is a breakthrough book which offers a practical framework and simple steps to both identify Dual and Multiple Exceptionality and to supplement current professional OT practice to address appropriately the specific issues these children and young people face. Not only that, but I believe that every professional across the practice spectrum, parent/carer and teacher should be aware of the approach outlined in this book. Used in the right way, it could have a major impact on issues ranging from school phobia to behavioural issues at home or in the classroom; mental health challenges to issues related to underachievement and beyond." - Denise Yates, Author of Parenting Dual Exceptional Children and co author of The School Handbook for Dual and Multiple Exceptionality