Adult life · participation · personal priorities
PEAR TREE™ Lens with Adults
A person-first way to explore what supports agency, belonging and meaningful participation in adult life.
Adult life is rarely organised around one sensory system or one setting. Work, study, relationships, parenting, health, caregiving, travel, home life, rest and community participation all ask different things of the body.
The PEAR TREE™ Lens helps keep the adult’s own priorities, experience and choices at the centre while exploring how the person, environment, activity and relational response are working together.
What the lens offers
Understanding the whole situation, not locating everything inside the person
PEAR TREE™ is a practical framework for meaning making, co-production and participation. It helps us notice what is happening around a person as well as what the person is experiencing.
This matters in adult life because support can easily become organised around a diagnosis, a service pathway or somebody else’s priorities. The lens brings the conversation back to the person’s everyday life and what they want to be more possible.
What matters
Begin with the person’s priorities, roles, interests, relationships, identity and hoped-for participation.
What already works
Notice strengths, choices, routines, places, people and strategies that already support access or recovery.
Where effort rises
Explore mismatch, hidden effort, delayed recovery and the points where participation becomes less sustainable.
What can change
Consider environmental, activity and relational changes before assuming the person must adapt or tolerate more.
Adult life and participation
Sensory experience sits inside ordinary occupations
Sensory patterns may become visible through the things a person chooses, avoids, changes, repeats, finds effortful, returns to or uses to feel more comfortable. They may also change with health, fatigue, pain, medication, pregnancy, menopause, ageing, stress, relationships, housing or life transitions.
Work and study
Open-plan spaces, online meetings, travel, lighting, deadlines, movement, concentration, breaks and the social expectations of work.
Home and daily routines
Cooking, cleaning, washing, dressing, sleep, rest, personal space, shared living and recovering after demanding days.
Relationships and belonging
Touch, proximity, conversation, intimacy, social events, communication, trust and how support is offered.
Parenting and caregiving
Noise, interrupted sleep, physical contact, emotional demand, unpredictable routines and balancing another person’s needs with one’s own.
Health and recovery
Appointments, hospital environments, pain, fatigue, body signals, medication, rehabilitation and changes in function.
Community and travel
Public transport, driving, shopping, crowds, exercise, leisure, faith, culture and access to valued places.
PEAR
Four connected places to notice
PEAR invites us to consider Person, Environment, Activity and Relational response together rather than treating an observable response as something that belongs entirely to the individual.
Person
What matters to this person? What do they enjoy, seek, avoid, prefer or find effortful? What strengths, roles, body signals, health factors, communication and previous experiences shape the situation?
- Use the person’s own words and communication.
- Notice choice, identity, autonomy and lived experience.
- Include what already helps, not only what is difficult.
Environment
What changes across places? Consider sound, light, temperature, movement, smell, visual complexity, crowding, layout, access, predictability and opportunities to pause or leave.
- Compare supportive and effortful environments.
- Notice practical barriers as well as sensory qualities.
- Consider whether the environment respects privacy and agency.
Activity
What is the person trying, needing or wanting to do? What sensory, movement, communication, cognitive, emotional and social demands sit inside that activity?
- Begin with meaning and purpose.
- Notice sequence, pace, duration and hidden demands.
- Ask whether support helps participation rather than merely compliance.
Relational response
How do other people’s pace, tone, proximity, expectations, communication and willingness to adjust affect the experience? Is support offered collaboratively and with consent?
- Consider trust, power and previous experiences.
- Make choice and the genuine ability to stop visible.
- Notice when another person’s response increases or reduces effort.
TREE
From noticing towards thoughtful action
TREE supports proportionate, relational and ethical decision making through Triage, Relationship, Embodied evaluation and Ethics.
Triage first
What needs attention now? Consider pain, illness, fatigue, hunger, medication, distress, safeguarding, communication, access and immediate environmental mismatch before reaching for a sensory strategy.
Relationship
Agree how support will be offered. Notice power, consent, predictability, trust and the person’s right to accept, decline, pause or choose another route.
Embodied evaluation
Review comfort, effort, recovery, agency, engagement, belonging and meaningful participation. Ask what the person noticed and whether the change was useful to them.
Ethics
Whose goals are being pursued? Is the support wanted, proportionate and within scope? Does it protect dignity, identity, autonomy and the person’s right to do things differently?
Everyday examples
What the lens may sound like in adult life
These are prompts for exploration, not conclusions about why somebody does something.
Open-plan workplace
An adult works well at home but returns from the office exhausted and unable to prepare an evening meal.
Healthcare appointment
A person misses appointments and is described as “not engaging”.
Cooking and eating
A person wants to cook more often but relies on a small number of familiar meals.
Relationships and touch
An adult sometimes seeks firm pressure but finds light, unexpected touch uncomfortable.
Reflection prompts
Useful questions for the person and those alongside them
Notice
What feels different when participation is easier? What patterns appear across times, places, people and activities?
Meaning
What does this experience mean to the person? Is it chosen, familiar, valued, threatening, exhausting, comforting or necessary?
Effort
What effort is visible and what effort is hidden? What is the recovery cost afterwards?
Choice
Where does the person have meaningful control over timing, intensity, pace, place, support and the option to stop?
Support
What already helps? What can be protected, strengthened, adapted or made more consistently available?
Next step
What small, collaborative change would matter to the person, and how will we know whether it improved participation?
Working together
Support without taking over
PEAR TREE™ can be used independently or collaboratively. The person’s own account remains central, including when they communicate through AAC, movement, behaviour, writing, images or another preferred method.
The adult
Leads the meaning making through lived experience, priorities, consent, communication and what support feels useful or unhelpful.
Family, friends and supporters
May contribute information across time and settings with appropriate consent, while avoiding assumptions or speaking over the person.
Professionals
Bring profession-specific assessment, formulation, coaching and intervention within scope, governance and collaborative goals.
Clear assessment boundaries
A participation lens is not a diagnostic test
PEAR TREE™ supports person-centred information gathering, reflection, co-production and shared understanding. It does not produce a diagnosis or a fixed sensory profile.
- It does not replace medical review where pain, illness, neurological change, medication effects or another health concern may be contributing.
- It does not replace occupational therapy assessment, standardised measures, functional assessment or specialist sensory integration assessment when these are indicated.
- A support idea should not be presented as effective simply because the person became quieter or easier for others to manage.
- Any sensory support involving touch, pressure, movement or restriction requires meaningful consent, appropriate risk consideration and a genuine ability to stop.
- Professional roles, education and scope should be described accurately and transparently.
Earlier publications and practice history
Adult sensory practice has a longer history
PEAR TREE™ is a current participation lens. It sits alongside, rather than replacing, a longer adult practice history involving co-produced tools, handouts, conference presentations, clinical audit and peer-reviewed publication.
Sensory Levels in Learning Disability
Smith, K. Training pack developed within Cornwall Partnership NHS Trust.
Sensory Ladders®
Early co-produced work helping adults recognise, understand and communicate changing sensory and body states.
Be SMART Profile and adult mental health learning
Smith, K. and A, H. Be SMART Profile, published as a handout and learning tool; alongside Sensory and Adult Mental Health training and conference material.
Sensory processing in mental health
Brown, S., Shankar, R., Smith, K., Turner, A. and Wyndham-Smith, T. Occupational Therapy News, 14(5), 28–29.
Personalising Sensory Integration Approaches with Adults
Urwin, R. and Smith, K. Poster and presentation bringing together adult mental health and learning disability practice.
Borderline personality disorder and sensory processing impairment
Brown, S., Shankar, R. and Smith, K. Progress in Neurology and Psychiatry, 13(4), 10–16. DOI 10.1002/pnp.127
Sensory Ladders® webinars
Smith, K., Brown, E., Fisher, J., Fisher, R. and colleagues, ASI Wise and The Sensory Project.
Adult mental health quality improvement
Sensory Ladders® were highlighted within a Cygnet quality improvement study in an acute mental health service.
Learning routes
Develop the lens at the level that fits your role
PEAR TREE™ can support shared reflection across many roles. More comprehensive assessment and Ayres’ Sensory Integration® intervention remain within specialist professional education, competence and governance.
PEAR TREE™ Model
An accessible introduction to person, environment, activity, relational response, embodied evaluation and ethical practice.
Seeing Differently
Flexible online learning, practical Sensory Project tools, lived experience, case-based application and tutor conversation across sensory integration, participation and wellbeing.
Sensory “Espresso” Shots
Focused CPD for busy practitioners and managers, with short sessions on specific assessment, neuroscience and practice themes.
Sensory Integration with Adults
Explore adult sensory integration functions, assessment, participation, specialist learning and the wider evidence and conference history.
ASI Wise Certificate ASI1–ASI3
Postgraduate education in theory and neuroscience, comprehensive assessment and evidence-based ASI intervention across the life span.
PEAR TREE™ and connected resources
Continue through the Sensory Project shop
Choose the resource that fits the purpose of the conversation and the level of professional reasoning required.
PEAR TREE™ Model
A practical introduction to the person-first, contextual and relational framework for participation, belonging and support.
PEAR TREE™ About Me
Includes Home, Baby & Toddler, Child & Teen, Adult and Older Adult versions for person-centred information sharing.
Sensory Choices Checklist
An accessible way to explore sensory choices, preferences and experiences across everyday life.
Sensory Grids™ Workbook
Gather everyday information before interpreting, then explore patterns across sensory systems, occupations and contexts.
Sensory Ladders®
Shared language around changing body states, early cues, support, recovery and participation.
A collaborative next step
Notice patterns, protect agency and keep participation visible
Begin with the person’s priorities. Explore what changes across environments, activities and relationships. Protect what already works, reduce unnecessary mismatch and review whether support makes meaningful participation more possible and sustainable.