OP - sounds like you are completely on board with your kids needs. I would focus on providing lots of positive opportunities for play - swim classes, soccer, t-ball...
If you kids is getting a couple of hours a day of real play, adequate sleep and adequate nutrition - and is still extra challenging then you might want to try to work on behavioral strategies to teach patience and good social skills. finally, try and make sure he has an opportunity to have playtime with a peer who has very high social skills.

Some kids just need more - more intuition from parents, more care in developing good sleep habits, more structure and thoughtful behavioral approaches where impluse control is an issue....

Also - what about media content. I was always very cautious on media and friends thought I was nuts. Then they started having issues with their 4, 5 or 6 year old boys and realized that tv time was not good for them. that it was stimulating when the kids brain really needed time for free play, or outdoor time, or quiet time reading books...

You sound like a very mindful parent and your kid will be fine cause you will figure out what he needs and give it to him. Even if all he needs is time and space to mature.

One of the PPs here... OP, if there are no issues with friends or school, and your child seems to be developing normally, then I think it is fair to wait and see what happens once the school work and social situations become more demanding. Still, I do think a family therapist/psychologist could be very helpful, both in teaching your child how to cope with frustration and helping you the parents anticipate outbursts and defuse them, as well as possibly spotting an issues you may have missed. There are also many good books out there which might help you (The Explosive Child, Effective Parenting for the Hard to Manage Child, The Challenging Child, and others).

Of course you want to just make sure your kid eats and sleeps well and gets lots of exercise. And you might want to introduce something like yoga or tae kown do.

OP here. Thanks for all of your responses. My child is a young 6. We have seen a development ped. ASD is out. I think ADHD could be a possibility, but there are no problems in school (so far - I'm waiting to see when homework and academics pick up) and none of the professionals (OT, ped, dev. ped) or teachers think it is there. There could be anxiety (I don't see depression), though at this age how to tell? If it is there, it is certainly internalized as I don't hear looping, ruminations, worries expressed like I hear from adults who have anxiety. We've been waiting on the neurospych to see how things progress - again, there aren't problems in school or with friends, and I feel like we need to see how maturity will change things.

How old is your son?

I am trying to say this nicely...I have known several families with similar profiles who were initially told that their dc's behavior stemmed from sensory issues and all of them ended up with other diagnoses: mood disorders/ADHD/HFA, etc.

I don't know any families who just had stand alone sensory issues that went away with OT.

If your ds is school age, I really think you need a thorough neuropsych exam (at least get on the waiting list for an appointment-it can be a long wait for someone who takes insurance). If your ds is younger, I think you need a thorough evaluation from a developmental pediatrician.

Also, a psychologist or therapist who can help your son and you with strategies for dealing with his behavioral issues.

Don't know how old your DS is or how long you stuck it out with OT, but your child will mature, however, he will still need tools to help him regulate. Therapy of any kind isn't a quick fix but rather a long term plan.

Depending on the age, talk therapy may not be helpful. You might want to seek out a developmental pediatrician to make sure you aren't missing true issues.

My sister ignored and rationalized her son's ADHD behaviors--mega tantrums during preschool, sensory issues. He's started middle school, has no friends, and got suspended at the end of the last school year. Please don't live in denial.

I don't think this is something for talk therapy. if he had emotional issues like anxiety, it would be one thing. But your problem is that he isn't behaving, because he can't behave. This is a big red flag for an organic brain issue. It sounds like he needs a full evaluation from a developmental pediatrician. It could be a lot of things -- ADHD, ASD, depression, anxiety, or something else entirely. But since he can't control his behavior, talking about it to a therapist isn't going to help.

How old is your child? I think age makes a difference in many different ways. A lot of times the sensory stuff is obvious early on but in later years other issues develop or become more apparent--or don't at all. Not trying to say that your child will definitely have other issues. But if he is 3 1/2, say, I think it is a totally different situation from eight.

That said, yes, our play therapist has been invaluable to us. She has really helped us understand our child and learn to parent him better. She has also helped him develop an emotional language and learn some calming strategies. She has also observed him at school, talked to teachers, etc--she is our go-to person and a person I trust and rely on. OT, on the other hand, didn't do a lot for us.

I think the important thing is to find SOMEONE you trust and who understands your kid, whether it is a developmental ped, a psychologist, psychiatrist or other therapist.

I'm wondering if anyone has any sage advice. I have one of those kids who has issues but doesn't really have issues - there is definitely sensory stuff going on (definitely seeking - he recently said the pressure of a blood pressure cuff felt good, likes to roughhouse, etc.), we've done OT and I'm not sure how much it helped, and now we're looking at therapy to help with emotional disregulation (tantrums and quick mood changes, hitting and kicking, not seeming to have a good understanding of emotions). But I wonder, if these issues stems from sensory problems, how much is a therapist going to help? And how much of this is a matter of maturity (maturing more slowly, but maturing nonetheless)? On one hand, I want to make sure he becomes an emotionally mature adult, on the other I don't want to keep spending money on therapies that may not have an effect.