Occupational therapy for teenagers can look a lot different than OT interventions for preschoolers. Middle school occupational therapy and high school occupational therapy sessions focus more on transitional stages as children age into teenagers and beyond.
Occupational Therapy for Teenagers
In the younger grades, school occupational therapy practitioners go into the school setting armed with playdough, scissors, pencils, crayons, glue, fidgets, and a few games/puzzles.
What about the middle school occupational therapy population…and those years following in the high school OT interventions? These teenagers are not motivated by crayons, Candyland, letter formation exercises, or cut and paste activities. Nor should they be. Unless your middle school caseload is in a self contained classroom functioning at a preschool level, these games and activities are not appropriate or practical. This post will explore the tricky transition from elementary to middle school occupational therapy.
Starting in late elementary school, many therapists transition their caseload from a direct to indirect, or consultative therapy model at this time, especially if they have been working with a particular student for several years.
Reasons OT for teenagers moves to consultation
When a student remains on the OT caseload into the middle school setting, therapy typically does transition to consultation. Why? There are several valid reasons for doing so. There are many reasons why transitioning from direct services to a consultation model is appropriate for teenagers (in middle school and high school). The primary reasons for transitioning to a consultative model are:
- Teenagers are self conscious and do not care for a therapist coming into their general education classroom to sit by them, observe, or ask questions. A consultative model allows the student to take ownership over their therapy recommendations.
- Middle school schedules are busy. It can be difficult to ensure carryover of occupational therapy goals when there are many different teachers on the student’s schedule. Therapists make suggestions but then the recommendations may not be carried over to each class. Additionally, pulling a student for individual therapy weekly means they are missing valuable learning time.
- Handwriting habits are set and unlikely to change at this age. Pencil grasp development and letter formation skills are often formed by the age of eight, making adjustments in middle school difficult. The same is true for Visual perceptual skills.
- Students do not want adaptations that make them stand out from their peers. They will resist noise cancellation headphones, a scribe for written notes, alternative seating, weighted items, or noticeable fidgets.
- Executive function – many middle schools already incorporate these skills into their program through schedules, planners, online classrooms, and reminders.
- Students in the middle school and high school settings are most likely using technology, virtual classrooms, and email to do much of their school work by this point.
- Students have often been receiving services since early elementary school. Changes are less likely to happen at this stage, if they have not already.
Direct interventions Occupational Therapy for teenagers
Middle school occupational therapy is not a one size fits all model.
There are several reasons to keep a student on a direct therapy service model during middle school and the high school years. It’s important to realize that moving from direct services to consultation should not occur simply because the student ages out of the elementary buildings.
Teenagers receiving occupational therapy services may continue on with the direct therapy model for several reasons:
- Self contained students work at a different pace than their mainstreamed counterparts. They may continue to need more intervention.
- Lower level learners will need to be transitioning to a life skills or self help model, if they have not already. This means new objectives and goals to address. Some of these areas to address include: life skills cooking tasks, starting at the beginning with cursive name writing, changing clothing for gym or swimming at school, perineal care to address menstruation needs, or other skills.
- Middle schoolers are a different breed of people. There are new social expectations, hormonal changes, levels of independence, and increased demands for self help skills or self-regulation skills.
- It may take time to educate families and caregivers about this change in service model, and expectations. Automatically moving everyone to an indirect model, or discharging them, may be too abrupt for anxious parents or overwhelmed teachers
The Role of the occupational therapist with teenagers
The teenage years bring many changes that impact functioning abilities that impact the education in middle school or high school.
Seruya and Ellen write about the Role of the Middle School Occupational Therapist. They highlight several important factors or strategies to intervention
- Involve your learner in decision making about goals and objectives. These will be more meaningful and motivating to your students.
- Transition away from typical handwriting goals to more functional goals
- Teach typing and word processing.
- Address motor skills use of calculators, rulers, graph paper, etc.
- Address organization of locker and homework planner.
- Provide adaptations if your learner is not able to complete work in an effective manner. A scribe to write notes for them, word processing versus written documentation, lessen the workload if writing is too labor intensive, preferential seating to improve attention.
- Address any lingering or new sensory concerns. Provide adaptation for these with preferential seating, alternative seating, gum or fidgets for self regulation, ear plugs to reduce incoming sounds, and organizational tools.
- Address important life skills – learners need to know their emergency contact information, effectively groom themselves, take care of feminine hygiene issues, advocate for themselves, and follow a schedule.
- Some interventions may require private therapy to be more appropriate such as meal preparation, laundry, ordering from a menu, shopping, budgeting, or filling out an application. These would be appropriate goals for students in a self contained classroom.
how to improve handwriting for teenagers
There are times when therapists are called to continue to address handwriting in their middle school population. Intervention needs to be functional, beyond basic letter formation. Functional handwriting can mean learning to write the letters in a name in print or cursive, filling in forms, and essential handwriting life skills.
Handwriting help for middle schoolers
One handwriting goal for middle schoolers, or even handwriting in high school may address the letter formation or number formation to write identifying information such as name, address, phone number.
For example, a handwriting goal for teenagers may be:
“This student will be able to independently write identifying information (name, address, phone number) without a model with 80% legibility.”
Another handwriting goal might be:
“The student will be able to write or access information to fill out a form independently.”
The OT Toolbox has a great post about filling out forms. (Coming soon)
Transition to middle school and high school occupational therapy
What can you do to help this transition to middle school occupational therapy and high school occupational therapy?
- Educate – teachers, parents, and other caregivers may not understand the role of the occupational therapist in middle school. It may be time for a little education on the services provided and the therapeutic model.
- Empathy – reducing therapy minutes may feel like the student is not going to improve, or they are being given up on. It is tough for parents to imagine their learner may never write a sentence, read independently, or live alone. This is the time to gently begin this conversation.
- Collaborate – work with educators and families to determine what are appropriate functional goals and needs in the classroom, and how they can be addressed. This blog on collaboration between OT and educators can assist.
- Continue Direct Intervention– There may be a need for direct therapy intervention. Keep your students motivated with relevant and important treatment activities.
- Address life skills. The OT Toolbox has a series of life skills posts including cooking, laundry, filling out forms, and social stories.
Working with teenagers in occupational therapy can be challenging. A few final tips for the OT working in middle schools or high schools:
- Remember teenagers are suddenly big and somewhat awkward.
- Keep goals and objectives focused on relevant and functional skills.
- Educate staff and caregivers about the role of the OT in schools.
- Provide resources, and make adaptations to the educational environment to help students better access their curriculum.
- Try not to be in the hallways when they are transitioning between classes!
NOTE*The term, “learner” is used throughout this post for readability and inclusion. This information is relevant for students, patients, clients, preschoolers, kids/children of all ages and stages or whomever could benefit from these resources. The term “they” is used instead of he/she to be inclusive.
Victoria Wood, OTR/L has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.