How to Improve Working Memory

working memory

Working memory is a skill we need for everything we do!  From answering the phone to shopping at the grocery store; working memory is happening at every given moment.  Kids who struggle with executive functioning skills often times have working memory challenges.

working memory activities



working Memory

 Let’s talk about what working memory is and how to improve working memory in kids so they can be successful in those everyday tasks.

Use these strategies to help improve working memory in kids with sensory processing struggles or executive functioning difficulties.

 

What is Working Memory?



Working Memory is the ability to act on past memories and manipulating the information in a new situation.  

Processing short term memories and using it allows us to respond in new situations.  

Working memory allows us to learn. Using working memory skills we can use past information in reading in order to read sight words.  

We can remember math facts, state capitals, mnemonics, phone numbers, addresses, and friends’ names.  We can then use that information to answer questions based on what we know and apply that information in new situations.


Executive functions are heavily dependent on attention.  Read about the attention and executive functioning skill connection and the impact of attention on each of the executive functioning skills that children require and use every day.


In order for working memory to be used in daily tasks, we need a few key items.  Our brain might be considered a memory soup and the key ingredients to working memory are attention, focus, auditory memory and visual-spatial memory.


Read more about visual memory and how to incorporate strategies into play.

Use these strategies to improve working memory skills in kids.

 

Mix all of those ingredients together and you will end up with working memory that can be used to problem solve any given situation.


You can see how children who struggle with the underlying “ingredients” of attention, concentration, auditory processing, and visual processing will be challenged to pull that information into an unrelated event.  The child with sensory processing disorder who is also struggling with social emotional issues might end up in meltdown mode.  The child who can not generalize facts to a new environment might withdrawal.


Read more about attention and how to help kids improve attention with easy strategies for home and school.

 

All of these situations can potentially lead to difficulty with problem solving. Children are developmentally growing every day in relating past information. Yes, we say thank you EVERY time someone holds the door for us, not just that one time last week.  By going through our day, kids learn these things!


The child who is struggling with any of the key ingredients related to working memory, it can be really hard to generalize.

Many parents, teachers, and therapists of kids with executive functioning skills or sensory processing challenges wonder how to improve working memory. These strategies for working memory skills will help.

 

How to Improve Working Memory

Try these working memory strategies to help improve this executive functioning skill:

  1. Take notes
  2. Daily Journal- The Impulse Control Journal is a great tool for keeping track of day to day events
  3. Notebook with times for daily tasks
  4. Practicing the ability to stop and think in practice and in real-life situations. This skill allows one to complete tasks or respond using past experiences.
  5. Writing down information (opposed to typing or tracking on an app)
  6. Setting an alarm for tasks
  7. Second set of school books for home
  8. Dry erase board notes to be used in tasks like cleaning a room
  9. Mnemonics
  10. Guided imagery
  11. Mental rehearsing
  12. Imagine a task in pictures (like a cartoon strip of a day’s event)
  13. Analyzing problem areas
  14. Practice through rehearsal
  15. Routines
  16. Rewards
  17. Reminder messages including verbal, picture, or app-based
  18. To-do lists with physical action (pull off a post-it note when completed)
  19. Task sequencing lists
  20. Play memory games, such as matching games or memory card games.
  21. Use mnemonic devices to help remember information, such as acronyms or visual cues.
  22. Repeat information to yourself multiple times to help solidify it in your memory.
  23. Use visualization techniques to create mental images of information you need to remember.
  24. Break down complex information into smaller chunks to make it more manageable to remember.
  25. Use repetition and rehearsal to help remember important information.
  26. Practice active listening by summarizing and repeating back what someone has said to you.
  27. Write down important information or ideas to help reinforce them in your memory.
  28. Use technology, such as digital reminders or voice memos, to help you remember important information.
  29. Practice mindfulness exercises to improve focus and concentration, which can help with working memory.
  30. Engage in regular aerobic exercise, which has been shown to improve working memory.
  31. Play strategy-based games, such as chess or Sudoku, to help improve working memory skills.
  32. Use self-testing or quizzing techniques to help reinforce information in your memory.
  33. Break tasks down into smaller steps to make them more manageable to remember.
  34. Use different sensory modalities, such as sight and sound, to help reinforce information in your memory.
  35. Practice relaxation techniques, such as deep breathing or meditation, to help reduce stress and improve working memory.
  36. Engage in activities that challenge your working memory, such as learning a new language or musical instrument.
  37. Use context cues or associations to help remember information, such as associating a person’s name with a visual cue or location.
  38. Prioritize and focus on the most important information to remember.
  39. Get enough sleep, as lack of sleep can negatively impact working memory skills.
  40. Repeat complex instructions
  41. Break down complex instructions into step-by-step directions with pictures, such as a more detailed version of a visual schedule

Working Memory Activities

In addition to the working memory strategies listed above, there are specific activities you can do to build working memory. Try these ideas:

Digit Recall Activities- Work on repeating numbers in a series. The individual can repeat back numbers in 2 to 3 digit series in both forward and reverse. Then, you can add on additional digits. Continue to grade the digit activities in greater difficulty by adding digits to the thread of numbers or adding letters. To increase the difficulty of this activity even further, ask the individual to write down the series of numbers and letters, and add time in between the given number and when they are asked to recall the series.

Word Sequences- Similar to the number sequences described above, you can use visual pictures of words, or auditory word sequences. Ask the individual to repeat back the series of words.

Ordering Activities- Another great working memory activity is sequential ordering of images or objects by size. You can target this activity to meet the interests of the individual. Think about ordering animals, sports balls, toys, or other items by size. Offer a specific number of items and challenge the individual to remember all of the objects in the series. Increase the difficulty by asking the individual to order objects by largest to smallest and then by smallest to largest.

Instructional Sequencing Activities- This working memory activity focuses on functional tasks and can target goals of the individual. For example, a child working on brushing their teeth can order the steps of the activity from memory. Then, you can ask the child to list the steps in reverse. 

 

More tools for addressing attention needs in kids

There are so many strategies to address attention in kids and activities that can help address attention needs. One tactic that can be a big help is analyzing precursors to behaviors related to attention and addressing underlying needs. 

The Attention and Sensory Workbook can be a way to do just that. 

The Attention and Sensory Workbook is a free printable resource for parents, teachers, and therapists. It is a printable workbook and includes so much information on the connection between attention and sensory needs. 

Here’s what you can find in the Attention and Sensory Workbook: 

  • Includes information on boosting attention through the senses
  • Discusses how sensory and learning are connected
  • Provides movement and sensory motor activity ideas
  • Includes workbook pages for creating movement and sensory strategies to improve attention


little more about the Attention and Sensory Workbook: 


Sensory processing is the ability to register, screen, organize, and interpret information from our senses and the environment. This process allows us to filter out some unnecessary information so that we can attend to what is important. Kids with sensory challenges often time have difficulty with attention as a result.

It’s been found that there is a co-morbidity of 40-60% of ADHD and Sensory Processing Disorder. This workbook is an actionable guide to help teachers, therapists, and parents to help kids boost attention and focus in the classroom by mastering sensory processing needs. 

You will find information on the sensory system and how it impacts attention and learning. There are step-by-step strategies for improving focus, and sensory-based tips and tricks that will benefit the whole classroom.

The workbook provides tactics to address attention and sensory processing as a combined strategy and overall function. There are charts for activities, forms for assessment of impact, workbook pages for accommodations, and sensory strategy forms.
 
Grab the Attention and Sensory Workbook below.
 
 

 

Attention and sensory workbook activities for improving attention in kids

 

These strategies to improve working memory are helpful tools for addressing short term memory in tasks.

References:
Gentry, T. (2015, September). Mobile technologies as vocational supports for workers with cognitive-behavioral challenges. Technology Special Interest Section Quarterly, 25(3), 1–4.

FREE Attention & Sensory Workbook

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    Colleen Beck, OTR/L has been an occupational therapist since 2000, working in school-based, hand therapy, outpatient peds, EI, and SNF. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. Read her story about going from an OT making $3/hour (after paying for kids’ childcare) to a full-time OT resource creator for millions of readers. Want to collaborate? Send an email to contact@theottoolbox.com.

    Empathy Activities for Kids

    empathy activities for kids

    Many years ago, we made empathy bracelets as one of our favorite empathy activities for kids. Empathy activities like this bracelet craft are easy ways to teach kids about empathy as a foundation for social emotional skills. We made empathy bracelets as a way to develop social-emotional awareness and self-awareness of others and how they feel.  When you use a hands-on activity like this bead activity to teach abstract concepts like empathy, children can stimulate thinking and allow kids to grasp the perspectives of others. Use the empathy beads and the Quick as a Cricket activity idea here to help kids think about others and the world around them.

    empathy activities for kids

    Empathy Activities for Kids

    One fun way to teach kids about empathy is with the children’s book, “Quick as a Cricket”. By using this book about feelings, and a fun activity that can be adjusted to meet the needs of various kids, teaching about feelings and values is meaningful.  

    This book really hits on the self-awareness of a child as they see that each feeling in the book makes up a part of him.  We thought that if this boy is feeling all of these emotions about himself, then others are too! If you are looking for for more activities based on children’s books then we have a lot to share with you!

    Use empathy beads and make an empathy bracelet to teach kids empathy. Its one of many empathy activities to show respect and awareness of other's feelings.  This busy bag activity is based on the book, Quick as a Cricket.

    Activity to teach empathy

    Teaching kids about empathy is important. There are studies that show us that specifically teaching kids about empathy makes a difference. In fact, when we teach kids about empathy in ways that make sense to them (or are meaningful), we may see more positive positive social behaviors, such as sharing. 

    Helping others becomes more meaningful as well. Additionally, research tells us that kids that learn about empathy are less likely to be antisocial  or present with uncontrolled aggressive behaviors.   

    Additionally, it’s been said that empathy and perspective taking serve an important role in what  is called prosocial behavior, or helping others, sharing, taking turns, etc.  

    After reading the book Quick as a Cricket, (just a few dozen times–this is a book you WILL read over and over again!), we talked about how each of us has many feelings that can be seen in animals.  

    Some of our feelings happen daily, and some not for a while.  Other feelings pair together (feeling small and sad).   

    Kids can have a difficult time with learning to be empathetic.  My kids really got an understanding of empathy as we talked about how other people might feel these feelings and we should be aware.  To take the empathy lesson a bit further, we made Empathy Bracelets with our empathy beads!    


    Empathy Activity

    Today, I have a fun friendship activity that uses a classic children’s book. Kids can struggle with the abstract concept of empathy and the perspectives of others.

    This Quick as a Cricket activity will be a hit at your book club play date, or any day!  I loved the simplicity of our activity as it really went well with the simple rhyme of the book’s text.  

    How to teach kids' empathy? Make an empathy bracelet with empathy beads to show respect and awareness of other's feelings.  This busy bag activity is based on the book, Quick as a Cricket.

      This post contains affiliate links.  

    To discuss and learn more about empathy, we used just a few items. First, we read the book, Quick as a Cricket, by Audrey Wood.   If you haven’t read this classic book, it’s one you definitely want to find!  

    The boy in the book discovers the characteristics of animals make up parts of himself.  The book has simple rhyming words and captures children’s attention.  It’s a great book to discuss self-awareness and feelings that make up all of us.  

    Quick as a Cricket activity for kids. Make a bead bracelet and talk about empathy, acceptance, and perspectives of others.


    Empathy Bracelets

    You’ll need just two items to make empathy bracelets with kids:

    1. Pipe cleaners
    2. Beads
    How to teach kids' empathy? Make an empathy bracelet with empathy beads to show respect and awareness of other's feelings.  This busy bag activity is based on the book, Quick as a Cricket.

    We grabbed a handful of colorful pipe cleaners.

    To make our empathy bracelets, we used a bunch of different colored beads.  Some of the beads were different shapes and sizes, and that fit in perfectly with our empathy talks.  

    People come in different shapes and sizes but we all have the same feelings inside!  

    To create the Quick as a Cricket activity, I used our snap and stack containers.  This worked great as a busy bag storage system so the kids could create bead bracelets whenever they wished as a quiet activity.  

    How to teach kids' empathy? Make an empathy bracelet with empathy beads to show respect and awareness of other's feelings.  This busy bag activity is based on the book, Quick as a Cricket.

     

    Before making the empathy bracelets, we read through the book once more.  

    We looked at each of the animals and talked about their color and found a bead that went along with the animal.  

    We discussed the feeling or description of the animal and how we sometimes show those feelings.  

    Then we made our bracelets.  It was fun to see how each of my kids made their bracelets differently.  One just plucked the beads from the bin and said the feeling that went along with that color.  

    Another flipped through the book and matched up beads to the animal.  

    Each empathy bracelet is different as it is made by a different child.  But, they all mean the same thing; they represent the feelings that we all share!  

    When you make these empathy bracelets, you could pull out colors to match the animals or feelings, or you could just let the child create as they wish.  It is completely up to you!    

    You can talk about empathy and kindness in many ways using activities with kids.  Mine loved this Little Blue and Little Yellow book activity to promote kindness, too.   

    Kids will love to wear their bracelets and fiddle with the beads.  As they fidget with the individual beads, they can remember the feeling that is associated with that bead.  They might see someone who is having a bad day and recognize the emotion.    

    Encourage empathetic respect of other’s feelings even when your child is not feeling that same way.  You can explain that not everyone has the same beads or colors of beads on their bracelet (or might not be wearing a bracelet!) but they still have those feelings and emotions inside of them.    

    How to teach kids' empathy? Make an empathy bracelet with empathy beads to show respect and awareness of other's feelings.  This busy bag activity is based on the book, Quick as a Cricket.

    Empathy Activities for Kids

    For fun and hands-on empathy activities for kids, grab our social emotional skills resource, Exploring Books Through Play: 50 Activities based on Books About Friendship, Acceptance, and Empathy, that explores friendship, acceptance, and empathy through popular (and amazing) children’s books!  It’s 50 hands-on activities that use math, fine motor skills, movement, art, crafts, and creativity to support social emotional development.    

    • Use plastic eggs to work on empathy by writing various scenarios on strips of paper. Kids can open an egg and state how they would feel in the scenario. This is a great group activity.
    • Use dolls and puppets. Act out scenarios and record the story on a phone or tablet. Kids can re-watch and describe the various feelings and how the characters felt and acted. 
    • For kids with autism, modeling, prompting, and reinforcement are strategies that can help.
    • Read books! These chapter books that teach empathy are great for the older kids or using as read-aloud books with the whole family. They are great ways to spark conversations about empathy. 
    • Writing about Friendship Slide Deck – writing prompts, writing letters to friends, and handwriting activities to develop friendship skills, all on a free interactive Google slide deck.
    • Create a social story about specific events or tasks that involve other individuals. This can create options for the individual to use during a task and can help when there may be unexpected situations to navigate that lead to feelings of anxiety or worries leading up to a social situation or activity.

    • Children can benefit from perspectives of others, including through personal space. Use this Personal Space Friendship Skills Slide Deck as a tool to address body awareness and personal space among others. Friendship involves allowing personal space, and body awareness and all of this is part of the social skill development that some kids struggle with. Use this free Google slide deck to work on body awareness and personal space.
    • Here are five simple activities to teach empathy to preschoolers.
    • Pretend play is a wonderful way to teach empathy to young children. You can do this as an adult directed activity, through puppets or assigning roles to children during large group times. Encouraging a child child to be sad for a specific reason and having another child take care of them, will help children learn body language of others. 
    • Emotion activities that are available to complete on a daily basis, help children learn how to name different feelings in themselves and identify those feelings in others.
    • Friendship activities such as these friendship activities.
    • Using Book-related play activities- This digital download contains 50 hands-on, multi-sensory play-centered activities for anyone helping kids learn about friendship, acceptance, empathy, compassion, and differences in others. These activities encourage cooperation, negotiation and communication through play.
    Use this Quick as a Cricket activity to teach kids about feelings. It's a fun hands-on empathy activity for kids.

    More Quick as a Cricket Activities

    Expand on the empathy activities with other Quick as a Cricket activities that involve play and movement. First, pick up the book, Quick as a Cricket. Then use the empathy beads activity here along with these functional activities to inspire development:

    Quick as a Cricket Snack from Craftulate can get kids busy in the kitchen building skills like executive functioning and fine motor skills.

    Quick as a Cricket Sensory Play from Still Playing School includes play and sensory based learning.

    Quick as a Cricket Art from Fun-a-Day inspires fine motor skills and motor development.

    hands-on activities to explore social emotional development through children's books.

    References on empathy skills

    Schrandt, J. A., Townsend, D. B., & Poulson, C. L. (2009). Teaching empathy skills to children with autism. Journal of applied behavior analysis42(1), 17–32. doi:10.1901/jaba.2009.42-17  

    What is Empathy?

    Empathy is the development of care for others. When I was young, my mom always told me to say “I’m sorry” when I was in a conflict with my cousin. Sometimes I didn’t feel sorry (after all, he’s the one that took the ninja turtle from me first,) but I did what I was told. After a while, saying “I’m sorry” felt repetitive with no actual meaning behind it. 

    Instead of teaching children to say “I’m sorry,” what would happen if we helped our kids understand how another person is feeling, and respond with care for that person’s feelings. This is called empathy. 

    Empathy Development in Kids

    Did you know the ability to use and practice empathy in everyday situations is not a born skill and that there are actually specific and defined stages of empathy development? It’s true!

    There is real power to the development of empathy in the first five years of a child’s life. Not only do children need to understand who they are as a person, but how others feel. Empathy isn’t something that can be forced on a child, but it is something they can become familiar with and understand through adult support and play based activities. 

    stages of empathy development

    Here, we are covering the stages of empathy development and some activities that preschoolers can participate in, to understand and practice empathy. 

    Empathy is a complex skill that is learned over time.

    From the time a child is born, they open their eyes and notice that they aren’t the only being! There’s mom, dad, nurses and they all do everything possible to get the baby’s needs met. As a child grows, they are introduced to siblings, cousins, peers and other adults. Every interaction a child has, provides them with opportunities to understand social structure and engagement. 

    According to this article by Professor Martin L. Hoffman, the main theorist on the development of empathy in childhood, “there must be parallelism of feelings and affections with thoughts, moral principles, and behavioral tendencies.”

    According to this article in “The Matter of Style” the 4 stages of empathy include the following:

    “ First stage (global empathy)

    It comprises the first year of a person’s life and consists of the fact that the child does not yet perceive others as different from himself. For this reason, the pain that he perceives in the other is confused with his own unpleasant feelings, as if it were happening to himself. For example, the baby who, on seeing his mother crying, dries his own eyes.

    Second stage (egocentric empathy)

    It corresponds to the second year of life, and the child is aware that it is the other person who is going through the unpleasant situation. However, she assumes that the internal states experienced by the other person are being felt by herself.

    Third stage of the child’s development of empathy (empathy for the feelings of others)

    It runs from the second to the third year. The child is aware that the feelings he experiences are different from those of the other person, and is able to respond to them in a non-self-centered way. At this point, she is already in a position to understand that the other person’s intentions and needs differ from her own and, therefore, that person’s emotions may also differ from her own. Thus, for example, she becomes able to console.

    Fourth Stage (empathy for the life condition of others)

    It comprises the final period of childhood. The feelings of others are perceived not only as reactions of the moment, but also as expressions of their general life experience. That is, they respond differently to transitory and chronic states of pain, since they take into consideration the general condition of the other.”

    How to support empathy development in each stage

    Ages 0–12 Months:  Supporting strong, secure attachments in infants, is essential at this age. As children learn that others are understanding how they are feeling, and are supported by getting their needs met, babies learn that their emotions and feelings can be understood by other, even before they can talk. 

    Ages 1–3 years: To help toddlers develop empathy, describe their feelings to them, and the feelings of others around them. This is helpful when they are engaging in play with other kids, as toddlers have a harder time managing their emotions. For example, “When Sandy was sad, it was so nice that you gave her some ice to help her leg feel better.” 

    Ages 3–5 years: In the preschool years, children are learning how to respond to their feelings and the feelings of others. Adults can support empathy development by asking open ended questions and providing concrete ways for children to calm down and express their feelings. Through using emotional tools such as pretend play-based activities, children are able to regulate their feelings and learn how to communicate their needs to others.

    A 6 year old boy recently saw his 3 year old brother become upset because he couldn’t climb as high on the play structure. The 6 year old could use toys to help his brother and asked him if he needed help calming down. Once calm, his brother helped his 3 year old get a step stool so he could reach the rung on the bottom of the play structure. 

    The social and emotional measures in this preschool rating scale, includes empathy goals for children ages 19 months and up. As empathy development becomes a focus in Early Childhood and essential for Kindergarten readiness, teachers and parents are looking for more easy to teach empathy through play. 

    A final note on empathy

    Empathy is something that isn’t taught to children, but a skill developed over time. Starting with strong, positive attachments in early childhood. When children have the opportunities to practice developing their social skills by being provided a variety of opportunities to engage in play throughout early childhood, their empathy grows exponentially. Adults can support the development of empathy in early childhood by asking open ended questions, creating opportunities for children to practice developing friendships through play, and providing children with concrete ways to respond to big feelings in themselves and others. 

    Behavioral Optometrist/Developmental Optometrist

    behavioral optometrist or developmental optometrist

    Do you ever refer your clients to a behavioral optometrist for an evaluation or vision therapy?  This post will explore what a behavioral optometrist, otherwise known as a developmental optometrist. We’ll also cover when individuals see behavioral or developmental optometry, and what the role of the occupational therapist in vision therapy is in working with this type of eye specialist.

    behavioral optometrist or developmental optometrist

    What is a Behavioral Optometrist?

    A behavioral optometrist can also be called a developmental optometrist, or a functional optometrist.

    Behavioral Optometry is a  growing subspecialty of optometry that uses vision therapy to go beyond the usual concerns of vision care. Strong vision is much more than being able to see 20/20.

    Optometrists and ophthalmologists  provide eye exams that evaluate a patient’s overall eye health, visual acuity (20/20, 20/40 etc.), and the need for any corrective measures. They can diagnose various eye diseases, prescribe medication for treatment, and provide prescriptions for eyeglasses or contact lenses.  These tests don’t detect other visual disorders which can impact reading and learning, such as eye teaming (binocular vision), focusing, tracking and visual processing.

    A behavioral optometrist uses a wide array of exams to study your vision. Many of the tests require you to answer verbally because they’re related to how you interpret your vision.  

    Because of the connection between the brain and the eyes, behavioral optometrists do measure your sight, but also your brain’s response to what you see. 

    Behavioral optometry acknowledges the brain’s connection to vision, and the impacts on behavior that poor vision can  have. 

    They are concerned with how your eyes and visual system function, and are interested in how your behavior affects vision or how your vision influences your behavior. 

    The behavioral optometrist, also known as a developmental optometrist, treats functional vision problems, including difficulties with binocular vision, eye movements and depth perception, as well as visual deficits following brain injuries. 

    Developmental optometrists base their work on the principle that vision can be developed and improved, and done so by using prisms, lenses and vision therapy.

    Behaviors Associated with Visual Difficulties

    Behavioral optometrists notice the impact that poor vision is having on learning. They see the behavioral reactions, striving to uncover the reason and treatment.  They tackle getting the eyes and brain to work together. As a recent study noted, over 20 percent of children have vision problems that can impede their ability to reach their potential.

    There are several maladaptive “behaviors”, or resulting actions, associated with visual difficulties:

    • Child gets frustrated with their vision
    • Maybe they struggle with sports and coordination, thus lose motivation to try
    • Your learner doesn’t like to work independently because it is more effective for them to rely on the vision of others
    • They have difficulty with visual tracking, often refusing to try and read
    • In writing/reading there are letter reversals, skipping words, 
    • They compensate for poor skills by using their finger to track words in a book
    • Tilt their head or lean very close to their work
    • Have difficulty with visual perception, especially finding objects and completing puzzles
    • Poor visual attention
    • Poor visual memory
    • Poor visual motor skills

    Behavioral optometrists believe that these kinds of behaviors, as well as poor performance during visual tasks, are a sign of non-optimal visual skills.

    Dr. Stanley Appelbaum, author of Eye Power: A Cutting-edge Report on Vision Therapy, studied the role of vision in children’s behavior. His unique approach to understanding the role of the eyes in learning involved “how eyes work together and move together and process information and store information and do something with the information.”

    What do developmental optometrists work on

    Developmental optometrists (behavioral optometrists) focus on specific areas of vision.  Some of the key vision skills include:

    Many of these skills are targeted through vision therapy.

    Vision therapy is a sequence of eye exercises that are used to improve the quality and visual efficiency. It is also called vision training. Vision therapy helps your eyes work more efficiently so that you can perform daily tasks, like reading and writing more efficiently.

    Vision therapy is often carried out by optometrists, and vision therapists who work under the supervision of an optometrist.

    When to Refer to a Behavioral Optometrist

    As an occupational therapy practitioners, we see a host of vision and visual perceptual difficulties. 

    It is always best to rule out visual acuity and vision difficulties either before beginning therapy interventions, or simultaneously. 

    Imagine spending six months working on visual perception, eye hand coordination, and vision, only to find out your student can not see what is in front of them!

    Below are some symptoms to watch for when considering referring to a specialist for an eye exam:

    • headache
    • eye strain/eye fatigue with close work (e.g. reading, writing, computer work)
    • fluctuating vision
    • blurry distance vision after prolonged close work
    • losing place while reading
    • re-reading lines and/or losing concentration when reading
    • words or letters seem to jump around

    There is a big overlap between vision therapists, behavioral optometrists, and occupational therapists.  OT practitioners are trained to work on the 17 key vision skills outlined above.  It is within our scope of practice to address visual perception, visual tracking, eye movement, and visual motor skills.  

    While OT practitioners can perform more basic visual exercises with children, only an optometrist experienced in vision therapy can prescribe therapeutic lenses, filters and prisms to significantly impact the functioning of their visual skills.

    As a “seasoned therapist” I feel very comfortable addressing the key vision skills. I am quick to refer to an ophthalmologist or optometrist to rule out visual acuity differences, but dig through my OT Toolbox for a long while before jumping to a vision therapist or behavioral ophthalmologist. 

    If after a few sessions I hit a roadblock, or my treatment strategies are not working, I will then consider reaching out to other specialties.  This is not a “rule” or “procedure”, but my own treatment strategy after 30 years of clinical practice. 

    What is the Role of the Occupational Therapist in Vision Therapy

    Occupational therapy practitioners can work in conjunction with vision therapists to provide a great team approach to learning.  

    I have often incorporated the same exercises the vision therapists are using in my treatment sessions in order to have carryover of skills.  Members of the OT Toolbox can find all of the resources associated with vision and visual perception in one convenient location. Click here to sign up, or access this information.

    Behavioral Optometry Exercises

    As with any skill, practice makes things better. Your eyes require exercise like any other body part. The rest of the body gets a lot of work during the day, however the eyes are often open and staring ahead. 

    It’s important to work on their flexibility and agility. This can be done with vision training exercises.

    Here are some vision exercises that might be used by a developmental optometrist:

    The 10-10-10 Rule

    The 10-10-10 rule in behavioral vision therapy is a technique used to reduce eye strain and fatigue when performing near work activities, such as reading or using a computer.

    The rule suggests that after every 10 minutes of near work, you take a 10-second break to look at an object 10 feet away. This technique helps to reduce the strain on the muscles responsible for focusing up close and can prevent the development of symptoms such as headaches, eye strain, and blurred vision.

    By following the 10-10-10 rule, you give your eyes a chance to relax and adjust to a different distance, which can help to reduce the risk of developing vision problems associated with prolonged near work.

    Eye-Finger Exercise

    The eye finger exercise is a technique used in behavioral optometry to improve eye teaming skills, specifically convergence, which is the ability of the eyes to move inward to focus on near objects.

    During the exercise, the patient holds a small object such as a pen or a pencil with both hands, positioning it between their eyes at arm’s length. The patient then slowly moves the object towards their nose, keeping their eyes fixed on it, until the object is about 5 cm away from their nose. They then move the object slowly back to arm’s length while still keeping their eyes focused on it.

    This exercise helps to train the eye muscles responsible for convergence, which can improve eye teaming skills and reduce symptoms such as eye strain, headaches, and double vision.

    Varying Focus Exercise

    The varying focus exercise is a technique used in developmental optometry to improve the ability of the eyes to change focus, also known as accommodation.

    During the exercise, the patient looks at a chart with different sized letters or shapes. The chart is placed at a distance that is comfortable for the patient. The patient then alternates their focus between two points on the chart, one closer and one farther away. This exercise can be done by gradually moving the chart closer or farther away, or by using lenses that change the focus of the chart.

    The varying focus exercise helps to improve the flexibility and responsiveness of the eye’s focusing system, which can improve overall visual function.

    Clock Face Exercise

    The clock face exercise is a technique used in both behavioral and developmental optometry to improve eye movement skills, specifically saccades, which are quick, coordinated movements of the eyes from one point to another.

    During the exercise, the patient is asked to imagine a clock face and to look at each number on the clock in a specific order, such as 12-6-3-9-1-7-2-8-4-10-5-11. The patient is instructed to move their eyes quickly and accurately from one number to the next without moving their head.

    The clock face exercise helps to improve the speed, accuracy, and coordination of saccadic eye movements, which are essential for reading, tracking moving objects, and other daily visual activities.

    Other vision activities:

    Here is a post on the OT Toolbox reviewing books related to vision.  Another interesting post explores whether the problem is visual or attention

    Behavioral optometrists, like chiropractors, operate outside the realm of established medicine and largely rely on their own alternative methods to achieve results.  For this reason, there are people who are resistant to referring to or hiring a behavioral optometrist.  As with any alternative treatment methods, do the research, then provide an unbiased option to inquiring parents, letting them decide their plan of care.  

    Victoria Wood, OTR/L is a contributor to The OT Toolbox and 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.