Colleen Beck, OTR/L is a pediatric occupational therapist and the owner and author of The OT Toolbox website. She manages all of The OT Toolbox social media accounts and runs the popular newsletter.
Read about Colleen's experience and career as an occupational therapist, including how The OT Toolbox began on our About The OT Toolbox page: https://www.theottoolbox.com/about-us/
Colleen created The OT Toolbox in 2011 and since then has written thousands of blog posts designed to support therapy providers, educators, parents, counselors, admin, and caregivers in promoting the healthy development of kids.
Check out Colleen's blog posts below:
One of my favorite ways to work on several skill areas at once is with a sensory bin. Today, I’ve got a really fun and creative sensory bin idea to use during the Fall months, perfect for your occupational therapy sessions. This apple pie sensory bin is not only a cute seasonal apple activity that is great for therapy, but it’s a fantastic tool for working on fine motor and sensory motor skills. The best part is that most of the materials can be found easily, and if not, you can substitute items with things you already have.
All you need is oats, red and green craft pom poms, and a few other materials to make this apple pie sensory bin.
Apple Pie Sensory Bin
How awesome does this apple pie sensory bin look? I bet you’re ready to dive in and play with it yourself!
Let’s explore why this sensory bin is such a great addition to therapy this Fall! Also be sure to check out our Fall occupational therapy activities for more ideas.
We like using silicone cupcake liners to pick up and sort sensory bin materials because it encourages a tripod grasp and intrinsic muscle strength in the hands when putting items into the small container size.
What is an Apple Pie Sensory Bin?
An apple pie sensory bin is a fun, Fall-themed sensory activity for kids. It’s a perfect pretend play opportunity where children can engage their senses while pretending to make an apple pie.
Our apple pie sensory bin incorporates the scents of cinnamon, and the visual appeal of red and green “apples” (pom poms), creating a fun and engaging activity for this time of year! I love this for sensory input with kids!
Benefits of Using an Apple Pie Sensory Bin in OT Sessions
This sensory bin is a fantastic way to bring Fall fun into therapy sessions. You can incorporate various textures, scents, and tools to support sensory processing and fine motor skill development. The apple pie theme can carry you through the Fall season from September through November!
I love using sensory bins because they allow for specific skill targeting. You can easily use this sensory bin with different kids on your caseload, and the materials are inexpensive.
Using oats as a base is a great option because they are affordable, easy to replace, and can be used across multiple sessions. You can add handwashing as an activity before and after therapy, integrating functional life skills into the activity. This sensory bin can even be used with small groups to encourage social interaction.
Sort the craft pom poms into the cupcake liner.
Why this Apple Pie Sensory Bin Works
Sensory bins are great for addressing a variety of skills. You can basically make the sensory bin work for the needs you need to target for the kids on your caseload.
You can also hide objects in the oats to work on visual closure and visual figure ground skills. Kids love the hide and seek aspect of uncovering hidden objects in sensory bins. I love to use letter cards, too. We have apple letter and number cards in The OT Toolbox that are a great tool for this!
Plus, there’s the sensory component. Oats offer a dry tactile experience, which can be either alerting or calming, depending on the child. Playing with this bin can support sensory needs impacting tactile defensiveness while also helping children become more comfortable with textures.
For kids who are sensitive to tactile input, this can be a helpful way to gradually introduce them to new textures. Some children may dive right into the oats, while others will need encouragement to touch them. This can be a wonderful opportunity to work on tactile discrimination and sensory tolerance.
Use tongs to pick up the cinnamon sticks and craft pom poms. Then, use the craft pom poms and felt strips to make a mini apple pie.
Fine Motor Skill Support- How to Use the Apple Pie Sensory Bin
One of the main goals of this apple pie sensory bin is to improve fine motor skills. The activity encourages scooping, pouring, and manipulating small objects like the pom poms and felt strips.
Oats are a great sensory material for practicing pouring, which is a functional life skill needed for tasks like pouring milk or cereal. The act of scooping oats and using tweezers to pick up pom poms is great for eye-hand coordination, too.
You can use the materials and challenge your kids to pick up a certain number of craft pom poms in a given time. Add a timer or roll a dice and ask them to use the tweezers to pick up that number of craft pom poms and place them into the silicone cupcake liner (affiliate link). There’s a lot of ways you can play with this one sensory bin.
When kids are focused on finding and manipulating items in the bin, they tend to calm down and focus. The sensory input helps regulate their bodies while keeping them engaged in play.
This apple pie sensory bin uses just a few materials.
Apple Pie Sensory Bin Materials
Here are the materials we used for our apple pie sensory bin:
Colored silicone cupcake liners (Amazon affiliate link) for sorting. Using the silicone cupcake liners are nice because they are more sturdy and you can reuse them over and over again.
Cinnamon sticks (for scent)
Tweezers or tongs
Felt pieces cut into strips (for pretend pie crust)
Low tray or container
Feel free to adapt or substitute materials to fit what you have on hand or to meet the specific needs of your clients.
I like using a low tray to hold the sensory bin materials because it allows kids to play while keeping the materials inside the bin.
How to Set Up the Apple Pie Sensory Bin
1. Prepare your tray or bin by pouring in the oats. (Kids can help to set this up and work on pouring and scooping skills, too!)
2. Add the red and green pom poms, cinnamon sticks, and felt strips.
3. Provide tools like tweezers or tongs for picking up the pom poms, and silicone cupcake liners (affiliate link) for sorting.
4. Let the children explore the materials, build their “apple pie,” and engage in pretend play.
The setup is simple, but the benefits are extensive!
This is such an easy sensory bin to make, and kids love it during the Fall months.
Tips for Supporting Fine Motor Skills
To target specific fine motor needs, you can adapt the sensory bin by adjusting the tools and materials. For example:
Use different sizes of tweezers or tongs based on the child’s skill level.
Provide smaller or larger pom poms for different levels of difficulty.
Use a variety of scoops to adjust the challenge of picking up and pouring oats.
We like to use an apple pie sensory bin and use it over and over again throughout the Fall.
Variations for the Apple Pie Sensory Bin
You can easily modify this activity for various ages and abilities. For example, larger tweezers or scoops might be appropriate for younger children, while smaller tools could challenge older kids. You can even add letters or numbers hidden in the bin to encourage literacy skills.
Safety Tips when using an Apple Pie Sensory Bin in OT
Always consider the child’s safety and abilities when using a sensory bin. Some kids may try to put small items, like pom poms, in their mouths, or throw materials. For those children, you may need to modify the bin, such as using larger manipulatives or skipping small tools altogether. Supervision is key during sensory play, especially with small or scented items like cinnamon sticks.
Choking Hazard- This, and all sensory bins should be designed with the age of the children in mind. Many items typically used in sensory bins can pose a choking risk for babies and toddlers, and other ages of children who may put things in their mouth due to cognition or sensory need. For children under three and those individuals with cognition or sensory needs, be sure to use larger, safe items that don’t have small parts and are safe if mouthed or chewed on.
Allergies- Some children with allergies may also react to creams or products scented with nut oils. Additionally, children can have allergies to environmental materials like cinnamon, oats, or other common sensory materials like grass or leaves. To avoid any reactions, ensure that none of these allergens are included in your sensory bins. If using this apple sensory bin with your students, double and triple check allergies beforehand.
Apple Pie Sensory Bin FAQ
What age is this sensory bin appropriate for?
This sensory bin can be adapted for a wide range of ages, from toddlers to school-aged children, by modifying the materials and tools used.
How do you minimize the mess with this apple sensory bin? You can minimize the mess by placing the sensory bin on a large plastic bag, shower curtain liner, or mat on a floor that’s easy to clean. Another option is to take the sensory bin outside. Shower curtain liners are an affordable option and can be found at the dollar store.
If you want to give this apple pie sensory bin a try, go ahead and have fun with it! You can use it as part of your Fall therapy toolkit to engage kids in sensory play and support their fine motor skills.
This sensory bin goes really well with our Apple Therapy Kit. You can use the items in the kit in the sensory bin. We also have many other apple themed activates inside The OT Toolbox Membership Club.
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.
This post is all about retained primitive reflexes, what retained reflexes look like, and how they impact child development. You’ll find specific strategies to integrate retained primitive reflexes as well. In a recent blog post, we discussed what are primitive infant reflexes, and why they are so important to infant development. Now, it is time to discuss what can happen if these reflexes hang around for too long.
Remember that every case is unique, and if your child matches these characteristics, that does not necessarily mean that they have retained that reflex. If you are concerned about your child’s abilities and how they may relate to retained reflexes, we recommend talking to your pediatrician.
For more information on primitive reflexes and their impact on child development, be sure to check out some of these books on primitive reflexes.
retained Primitive Reflexes
The term “retained primitive reflexes” might be a phrase you’ve heard before. But what does that mean and what do retained reflexes look like in children? Well, there is a lot to cover.
Basically, as infants develop into toddlers, their primitive reflexes should do what health care professionals call “integration”. The response that comes with the primitive reflex should integrate into a more mature or voluntary movement. When primitive reflexes are retained, those instinctive actions, movements will remain past the typical age range…they continue to exist. They are retained.
If primitive reflexes are still present long after they should have integrated, the child will display certain characteristics specific to the retained reflex, many of which limit their development and academic skills.
Just to add some background information, when we say that primitive reflexes are integrated, that means that the movements (or reflexes) are absorbed and contributing to characteristics, actions and neurological responses. To put it in other words, a reflex moves along a neurologic arc and when integration of those reflexes occurs, a process where specific stimulus results in a predictable response (or lack of that predictable response) so that movements are more efficient. This occurs so the neurologic system is connected and communicating efficiently. It’s all part of the nervous system.
PALMAR REFLEX
The palmar reflex is important for the development of purposeful grasping, something that an infant is learning throughout their first year of life. The palmar reflex can be seen when you place your finger in the palm of an infant’s hand and their reflexive response is to hold on to your finger. What an adorable reflex, right?
This is not something we want to see in an older infant or child, though. While the response is necessary for a newborn to learn how to use their hands, it limits an older infant or child to only using their hands and fingers for a strong grip.
retained palmar reflex
Children with a retained palmer reflex may:
Get fatigued very easily with handwriting or fine motor tasks, like stringing beads.
Have a sensitive or “ticklish” palm
Open and close their mouths while using their hands for tasks like writing or cutting with scissors.
Have difficulty in speech articulation
The mouth and the hands are connected via neural pathways in infancy, and that connection is still strong in those who have the palmar reflex. This is why the movements of the mouth and speech may be involved in the retained palmar reflex.
How to integrate the Palmar Reflex:
Tasks that encourage separate use the fingers
Squeeze a ball with one finger and thumb, alternating fingers to squeeze
Stringing Beads
Playing with small Legos or similar toys
MORO REFLEX
The Moro reflex is also called the startle reflex – it can be seen in a frightened infant up to about 4 to 6 months old. The reflex causes a baby to stretch out their arms and legs, and quickly bring them back in, in jerky movements. This is in response to the feeling of falling, a loud sound, or a drastic change in temperature.
Retained Moro Reflex
Children with retained Moro reflexes are often very sensitive to stimuli – sounds, tags on clothing, lights, etc. They tend to lack emotional and self-regulation skills and have a difficult time paying attention in class. Without an integrated Moro reflex, their fight or flight response can be activated very easily causing them to have deficits in many areas of life.
How to integrate the Moro Reflex:
Starfish Exercise
While seated, open up into a big “X” shape with straight arms and legs.
Cross right ankle over left & Cross right arm over left
Open up to big “X”
Cross left ankle over right & Cross left arm over right
Repeat
This is also how you can test for its presence! If a child has a very difficult time completing these actions, without another known cause, they may have a retained Moro reflex.
TONIC LABYRINTHINE REFLEX
The tonic labyrinthine reflex (TLR) is used for head and postural control. We know that baby has poor control of their head and neck when they are born, and this reflex is part of what helps them gain control over this part of their body.
Retained Tonic LABYRINTHINE reflex
This reflex typically integrates around 4 months old, but if it persists, the following may occur:
Difficulties judging space, speed, depth, and distance.
Toe walking
Discoordination in simultaneous movements, such as walking or swimming.
Avoiding lying on their stomach.
Children with retained TLRs tend to be perceived as clumsy and often have a difficult time sitting upright and still in their chairs. This can decrease their ability to pay attention in the classroom setting. When posture exercises in kids don’t work, sometimes it’s easy for teachers or parents to wonder what is going on, when a look at retained reflexes may be in order. In some cases, integrating the TLR reflex can support posture.
How to integrate TONIC LABYRINTHINE REFLEX
Incorporate activities on their stomachs as much as possible, or for as long as they can manage each day.
Try reading, watching TV, or playing with a toy while on their tummies
Daily practice will strengthen their muscles and correct this response.
ASYMMETRICAL TONIC NECK REFLEX
This reflex is important to the initiation of crawling, as the arms and legs move as a baby turns their head while on their belly. While infants are on their bellies, and while crawling, they are exposed to a ton of visual stimulation by looking at their arms moving, looking and grabbing toys, etc. Tummy time is so important for this reason and more!
The ATNR should disappear around the time an infant is gearing up for crawling, around 6 months old.
Retained ASYMMETRICAL TONIC NECK REFLEX
If asymmetrical tonic neck reflex doesn’t integrate, the following may occur:
Poor Coordination during movements like skipping or riding a bike
Trouble crossing midline
Example: Moving right arm to left side of the body to buckle a seat belt.
A quick test for a retained ANTR starts with having the child stand with both arms directly out in front of them. Ask the child to slowly turn their head all the way to the left. Their left arm will remain straight and their right arm will bend if the reflex is still present.
How to integrate the ATNR
Lizard Crawling Exercise
Start on the stomach
Look to your left, and bend your left elbow and left knee
Look to your right, and bend your right elbow and right knee
There are many more primitive reflexes, as well as postural reflexes, that are important to child development and student success. We have not covered everything here, but we hope to have given you a nice place to start building your understanding of what may happen when primitive reflexes are maintained over time.
Want to learn more about primitive reflexes, what to do when reflexes are retained, and how to know there might be an issue? Check out the primitive reflexes course below. (affiliate link)
In this primitive reflexes course, created by two occupational therapists, you’ll find modules and functional intervention activities for:
Moro reflex
The Tonic Labyrinthine (TLR) & Landau Reflex
The Rooting Reflex
The Asymmetrical Tonic Neck Reflex (ATNR)
The Spinal Galant Reflex
The Palmar Grasp Reflex
The Symmetric Tonic Neck Reflex (STNR)
Support for kids who push back
Printable handouts, screening tools, and checklists
Information on postural reflexes, yoga, sensory diets, and more
Case studies
Research
AOTA continuing education: 1.05 AOTA CEUs
If your child has retained primitive reflexes, learning to integrate them could lead to improved development in many areas:
Social Skills
Learning
Motor Skills
Executive
Functioning
Coordination
Reading & Writing
Primitive Reflexes and Occupational Therapy
This article was originally published in 2021. While reflexes have not changed since then, there is new research and resources available on primitive reflexes. This is important to keep up to date with as an occupational therapist working with children. Inevitably, we will see a child who has retained reflexes impacting daily functional skills.
When it comes to primitive reflexes and occupational therapy, there is a lot of connection because of the motor and sensory components that impact function.
This article talks about the link between retained primitive reflexes and autism spectrum disorder. The authors go on to say that this connection is due to a brain imbalance and connectivity. They offer a specific set of exercises, with EEG testing done at the beginning and end of treatment to show progress.
The research is limited on the efficacy of integrating reflexes thus far, however there is plenty of evidence on reflexes. Reflexes are important for survival in infancy and early childhood. They need to be integrated so we can produce smooth movements, which later might impact motor planning and body awareness. Without this integration we often see uncoordinated movements, an increased startle reflex, difficulty with frontal lobe maturation.
Because the research about the “integration of reflexes” is not there, the AOTA is suggesting using exercises and activities to improve coordination and performance in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), rather than calling it the integration of reflexes.
A Therapist’s Perspective on Reflex Integration in OT
Whenever I have parents or other professionals questioning the validity of certain treatment ideas such as sensory integration, therapeutic listening, vibration, astronaut training, and more, I try the “what can it hurt” approach.
“What can it hurt”, is a worthwhile approach to life and taking risks. I am much more willing to take risks if the reward is greater than the potential drawbacks. This holds true for a lot of what we teach as OTs. This includes primitive reflex “integration” therapy. Whether you believe in integration/retained reflexes or not, think about the treatment methods provided.
Treatment methods for reflex retention include strengthening, coordination, and stretching exercises. Whether the cause of incoordination is reflex retention or something else, practicing strengthening and coordination exercises can help either way. While finding the “why” during treatment is helpful, it is not always available. There are times we may never know the cause of a disorder. In this case we treat the symptoms we see.
According to Samantha Heidenreich, OTD, MOT of occupational therapy .com, There are theories as to the cause of primitive reflex retention including:
the birth method, like Cesarean section versus vaginal delivery
Trauma during pregnancy, birth, or shortly after
exposure to toxins
Anesthetics during pregnancy/birth
medications
Additionally, other possible causes for retained primitive reflexes are decreased tummy time in infancy, a lack of crawling, early walking, head injuries, or chronic ear infections. In the OT world, we are always looking at decreased tummy time and that lack of crawling during our intakes and assessments.
Based on what we do know, the back to sleep program and container baby syndrome, are having an effect on development that needs to be counteracted. When we take a step forward for safety, innovation, and technology, there are often consequences if not used in moderation or with caution. (Being a “tech-wise” family means having an awareness of this from the start. Its something that we as OTs can educate our families on, even when working with children of a very young age.)
Education and early intervention are the keys to success. Whether you are talking about retained primitive reflexes, or another difficulty seen in children, we can do more by letting people know how to care for young children, and intervening early.
How can you add to your OT Toolbox to better educate yourself about reflexes and treatment? Check out some of our resources!
The resources at the OT Toolbox are endless. Want to find an easier way to locate resources instead of clicking and scrolling? Become a member today! One of the perks of being a member is access to restricted content, and easy search categories.
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.
In this blog post, we are covering all things crossing midline activities…but what is crossing midline?? We’ll get into that too, as well as some fun ways to develop midline crossing skills and specific exercises that kids (and all ages) can do to support development of this motor skills task that is huge in the way of gross motor coordination.
Crossing midline is one of those motor skills we do constantly throughout the day, but never really give a second thought. And that automaticity of motor movements is a good thing, too! Imagine processing the action to use one hand to pull a door open. Imagine the time it would take to shower, dress, put on and tie your shoes if you had to process through the action to move your hands fluidly across the middle line of your body.
As therapists, we hear “crossing the midline” all the time. Have you ever wondered what the big deal is? Why is crossing the midline so important? In this post we will delve into what crossing the midline is, what causes issues, and how it impacts daily function, especially schoolwork.
Before we get started, if you are doubting the validity of crossing the midline, tie one hand behind your back and go about your day. How much did you reach across your body to get something? You reached across, diagonal, up and down to interact with your environment. While a two-handed person does not do this much crossing the midline, there is still a fair amount.
What is Crossing Midline?
Crossing midline refers to moving the body (hand/arm/foot/leg across an imaginary line that runs vertically down the center of the body to the other side (and vise versa). Additionally, crossing midline also refers to twisting the body in rotation around this imaginary line, as well as leaning the upper or body across the middle of the body.
Let’s break it down further:
Midline of the body is an imaginary line that drops from the middle of the head, straight down over the nose, to the belly button and divides the body into left and right sides. Imagine a line that starts at the middle part of your hair and runs straight down your forehead and ends at the core of your abdomen. This imaginary line effectively divides your body into a symmetrical (mostly) left side and a right side.
“Crossing the midline” is a simplified way to indicate that part of the body moves over that imaginary line. This can look like 3 different aspects of movement:
Reaching an arm/hand or foot/leg across the middle of the body to the other side of the body (Example: Reaching the right arm across the body for an object placed on a table to the left side)
Rotating the body around the midline in a rotary motion in order to twist at the hips. This can look like putting your hands on your hips and rotating your upper body around at the abdomen (Example: reaching for a seatbelt involves reaching the hand and arm across the midline but it also involves twisting at the hips)
Leaning the upper body over the middle line as in doing a side crunch. The head and shoulders move over the middle of the body (Example: Bending sideways at the waist while getting dressed or reaching while sitting for an object that’s fallen to the floor)
Crossing the midline is a motor skill that requires using both hands together in a coordinated manner (bilateral hand coordination) allows kids to cross midline during tasks. This bilateral coordination ability is deeply connected to crossing midline.
Why is Crossing Midline Important?
Midline crossing is a developmental ability that is important for so many fine motor and gross motor tasks. This relates to functional skills in a major way. When a child has difficulty with crossing midline, they will demonstrate challenges in practically every functional task.
When a child does efficiently cross the midline, they can use their dominant hand in skilled tasks. They develop a dominant hand and the other extremity becomes the assisting hand. They can manipulate objects in the world around them through all planes. They can demonstrate sensory integration by motor skills with vestibular, proprioceptive, and visual input.
In particular, crossing the midline offers vestibular input. Moving the head from center plane shifts position of the inner ears. When bending, twisting, and moving from center, the vestibular system is at work.
When the child does not cross the midline, they tend to use both hands equally in tasks like handwriting, coloring, and cutting with scissors. They may demonstrate awkward movements by moving the body to position itself so they don’t need to cross the middle line.
Challenges with this motor skill impact learning, social skills, play, and self-care.
In particular, we might notice sensory motor challenges at different age levels. For example, for children aged 3-5, we might see specific midline red flags that impact learning and play. We cover this specific age group in our blog post on Crossing Midline Activities for Preschoolers.
Occupational therapy will assess midline crossing skills by observing play and functional tasks.
Crossing Midline Occupational Therapy Asessments
Occupational therapists perform individualized evaluations and assessments of underlying skills as they impact functional performance in every day tasks. Because of this, crossing midline is an essential skill that will be observed and looked for in every OT evaluation.
Occupational therapists can complete a standardized evaluation, but most often, their skilled abilities will enable them to identify when crossing midline is a problem through play and interaction during the evaluation process.
When you are watching for midline crossing, you should observe kids playing in normal situations. A child will demonstrate a tendency to avoid crossing midline in activities or tasks, but if “set up” to cross the midline (i.e. setting items to the left of the body and asking them to reach over the midline with their right hand), they will typically be able to complete the requested movement pattern, but not carry over the action in a normal situation.
If they have difficulty with crossing midline, a child will switch hands during handwriting because both hands get practice with pencil manipulation.
The child might rotate their whole body instead of twisting at the trunk or shift their weight in a task rather than leaning the upper body over the midline.
You can often times observe a tendency to avoid midline crossing in activities such as kicking a ball, throwing beanbags, switching hands in coloring, difficulty with putting on pants and shoes independently, and difficulty with visual tracking and reading.
Crossing Midline Activities
So, what do you do when crossing the midline is an issue? There are many ways to support the development of this skill.
The ideas listed below are fun ways to play and develop motor skills by crossing midline, however they have a sensory component too.
We mentioned above the aspect of vestibular input and proprioceptive input that occurs in crossing the midline. These midline activities have those sensory motor considerations through play.
Toss bean bags -Encourage upper body movement! Bend through the legs, turn sideways, reach back behind you, rotate side to side…encourage vestibular input by bending and rotating.
Slow motion cartwheels- Place both hands on the floor to the side, kick legs over. By doing the cartwheel in slow motion, the body is forced to move sequentially, adding midline crossing at the trunk.
Hit a ball with a bat.
Use pool noodles to hit a ball- think hockey and hitting the ball into a target on the floor
Play catch with rolled socks- Use a bucket or bin to catch the rolled socks. They will fly high, low, left, and right!
Play flashlight tag.
Catch lighting bugs or butterflies.
Show the child how to write their name in the air with large arm movements.
Bend over at the waist and swing the arm side to side, in large circles, and in figure 8 motions.
Play with scarves to music.
Move a ribbon wand to music.
You can use midline crossing activities in OT interventions.
Crossing Midline Treatment Ideas
You can use the ideas above in different ways like in games like Simon Says or the Hokey Pokey. You could add them to obstacle courses or brain breaks. Some other things to consider about crossing midline treatments…
One of the easiest ways to work on midline crossing is to make the opposite side unavailable.
The classic treatment for hemiplegia is to restrict movement of the functioning side, while making the affected side do all the work. You can do this activity yourself, or with your learners. Make the activity rewarding to encourage your learners to want to keep going. Food, stickers, or preferred activities are a great motivator.
Another way to address midline issues is to move objects to the side to encourage reaching. Put a preferred object in different places to encourage your child to stretch to get it.
Sometimes you need to restrict the movement of objects. People will turn and shift their paper or other objects to be able to utilize it without crossing the midline. Fix the paper to the table and encourage your students to sit forward without turning their body.
One of the classic tests, the Bruinicks Oseretsky Test of Motor Proficiency, is a drawing test where learners have to draw inside a narrow path that crosses across the paper. You can quickly see who struggles with this as they quickly turn their paper to make the task easier. The design copy task in this test looks at midline crossing as well. Learners are asked to dot to dot a diamond. They are instructed not to pick up their pencil or shift the paper. This proves to be difficult for many students.
Crossing midline exercises can look like many different things.
Crossing the Midline Exercises
I love this crossing midline exercise below, because it has a ton of different movement options with one fun activity.
We had fun one winter day with a few crossing the midline exercises, including marching, crossing arms over, and stomping out some wiggles.
Our midline march activity was a marching parade with “Stop Stations”. We marched along to music and when I turned off the sound, the kids had to do a midline exercise.
The midline exercises included:
Place left hand on right knee
Place right hand on left knee
Stand and bend to touch the opposite foot
Standing and place right elbow on left knee
Standing and place left elbow on right knee
Crunches with touching right elbow to left knee
Crunches with touching left elbow to right knee
Cherry picker crunches- lay on the back slightly bent forward at the hips so the upper body is off the ground. Move a ball or small toy from the right side to the left side.
Because we were doing these midline exercises to music that quickly stopped and started, the thought process was quick. The kids had to quickly complete the exercise without much forethought.
This quick start and stop activity allowed them to practice crossing midline without over-thinking about the action.
A crossing midline exercise like the ones in the pictures are easy to incorporate into therapy sessions or occupational therapy at home. Make it fun!
Fine Motor Crossing Midline Exercises
Crossing the midline can be done on a small scale, too. This activity is similar to the midline marching activity described above, but it uses paper, pencil, and small colored dots such as stickers or a small circle drawn with markers.
Draw dots on the left margin of a paper using colored markers or colored stickers. There should be one of each color going down the left margin.
Draw dots using the same colors going down the right margin. Use each color only once.
Turn on music. The student can draw to music on the center of the page using their pencil or markers.
Turn off the music. When the music stops, call out a direction: “Left hand, yellow!” The student should put down their marker and touch the yellow dot on the right margin using their left hand.
Turn on the music to draw again and repeat.
This activity is similar to the gross motor midline exercise because it requires the child to think on the spot. They have to listen to several instructions, but also process the motor skills and cross the midline automatically.
You can adjust this activity by numbering the dots, using less colors, or less dots, and reducing the amount of instructions. This activity can be used with any level by grading the activity.
This post is part of the Gross Motor A-Z series hosted by Still Playing School. You can see all of the gross motor activities here.
Occupational Therapy and Crossing Midline
Now, let’s talk about what an occupational therapy practitioner will assess and why they look so closely at midline crossing during OT evaluations.
As a parent/caregiver you probably do not give “crossing midline” much thought, until you see your little one painting the left side of their picture with the left hand, and the right with the right hand. Difficulty crossing the midline can be caused by several different factors:
Neurological impact – caused by a stroke, brain bleed, or cerebral palsy
Visual deficit – sometimes after having a stroke the visual field is impacted. Persons can see only one side of their visual field, or each side is treated as a separate side, rather than a fluid spectrum. There are other vision disorders that impair the visual scanning field
Low tone and muscle weakness. People with low tone or core weakness may feel unbalanced when they reach across their midline. They might topple over, or feel like they are going to. There are various diagnoses that exhibit low tone, like Down Syndrome and others. It’s important to assess midline crossing skills that might be delayed because of tone or weakness.
Sensory processing – the sensory system is critical in determining position in space, feedback on the muscles and joints, and body awareness. Without this, a person may not notice where their body parts are, or that they are using inefficient movements to complete tasks.
Here is a good hint for new grad OTs or occupational therapy students working in a fieldwork position: Uncovering the “why” is important, in case there is a medical cause that can be corrected. We do want to know the why and that can solve some of the questions that we might have during the evaluation or interventions. However, try not to spend too much time worrying once you have determined the “why”. It is important to get started with treatment.
Pediatric occupational therapists will evaluate midline crossing skills in OT evals.
Evaluating Midline Crossing
Pediatric occupational therapists will note midline crossing in practically every evaluation they do. It might only be a one liner in the eval that you’ll see: “Child crosses midline independently during play.” Or, the description of the midline crossing skills might go more into depth, covering the dominant and the non-dominant hand, various self care skills, whether weighted items were used that triggered more tone during movement, etc. There can be many variances to crossing midline and a skilled eye is key.
Things to look for when assessing crossing midline:
Some symptoms of difficulty crossing the midline will be obvious. Seeing your child eat each side of their plate with a different hand will be hard to miss. In young babies using both hands interchangeably is typical. Movements are not coordinated in young children, neither is hand dominance.
Other signs of not crossing midline might not be as obvious. Watch someone paint a wall. You will probably notice they cross the midline of their body as they reach for different parts of the wall. Someone who does not cross midline will constantly move their body to reach the next part. This type of obvious non-use of the midline might be observed in the child that colors one side of the page with one hand and then complains that they are getting tired and they pick up another crayon with their other hand to color the opposite side of the page. Or, you might see a child struggling to put on a seatbelt in a car. They might pull the seatbelt with their hand closest to the belt, get it to the middle of their body, and then continue to pull the seatbelt with their other hand. They might struggle to engage the buckle of the seatbelt because they only use one hand. Or, they might turn in their seat so the buckle is in the center of their body and midline crossing is taken out of the equation.
Other things to look at when assessing midline crossing:
Hand dominance
Foot dominance
Vision dominance
Hand preference in tasks
Strength, bilaterally
Muscle tone
Motor planning skills
Proprioceptive input and tolerance
Cognition and direction following
How the individual moves when holding items
Different environments (when alone, when in front of peers, confidence in movements, etc.)
Something to consider that isn’t always thought about when you think about midline…vision skills!
Crossing Midline and Vision
Crossing the midline can involve vision also. This means that your eyes scan over the middle of the imaginary line running down the middle of your body. For example, you can move your eyes visually from the far left of your view to the far right. Both eyes should move steadily and together. If there is difficulty with visual midline skills, then you will see a lot of head movement as the individual compensates.
If you can not cross midline visually, you might have difficulty scanning a document, reading fluidly across a page, or doing visual perceptual tasks like word searches, and hidden pictures.
Crossing Midline and Fatigue- Something to Consider
There are times when I fail to cross the midline, even though I am perfectly able. When I am doing strenuous tasks like a large painting, cleaning, or carrying something heavy, I tend to switch hands to alleviate some of the stress on my joints. This does not make me ambidextrous, just tired. Sometimes it takes considerable effort to reach way across my body, when my right hand is already there.
If you have ever broken an arm, you can relate. If you can only use one arm, you have to become adept at reaching across the midline. You may get used to this new movement pattern quickly, while others get off balance, often moving their body to compensate.
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.
Here, you will find tools and information for adults with executive function disorder and executive functioning issues that impact day to day tasks in adulthood. For adults, executive functioning skills are a part of everything we do. The ability to use these skills with mental dexterity impacts the way we pay attention, focus, plan, and prioritize. Here, you’ll find strategies that can impact executive functioning needs so that organization, impulse control, planning, time management, and other executive functioning skills are improved and regulated in daily life tasks.
Adults with Executive Function Disorder
Now you might be thinking, “Executive function disorder?! I don’t have a disorder!” And that is probably the case in most instances for those reading this article. However, there are many of us who struggle on a day to day basis with things like getting started on chores or problems (task initiation), staying focused (attention), losing things constantly (organization), getting out of the house on time on a regular basis (task completion), and a variety of other challenges that impact our lives and generally stress us out. These are not the components that define a disorder, but they are executive functioning challenges that impact day to day life. It’s my hope that this resource offers tools to make the overall wellbeing better, and to offer tools for adults with executive function challenges easier!
Let’s break down executive functioning skills in adults and take a look at how things like focus, attention, organization impact life skills in adulthood.
My daughter has battled Executive Function Disorder all of her life, but right now, it is really preventing her from moving forward with her life. Things like completing a task, making decisions, time management, and projecting ahead are SO HARD. Is there anything that can help my adult daughter struggling with executive functioning disorder?
Does this sound at all familiar? So often, executive functioning challenges are present in adults but we don’t stop and think, this isn’t how things have to be. In fact, there are everyday challenges that are very difficult for adults with executive functioning needs. Things like organization, planning, and flexible thinking can be a real struggle that impacts family life, work life, personal relationships, and the things we need to do every day.
As kids with these challenges move into adulthood, some areas that we might expect to develop just never seem to change. It’s not uncommon; the fact is that executive functioning skills are a very broad set of skills. Forgetting things, difficulty with inhibiting behaviors or actions, trouble with planning big projects, or staying organized in the daily life of an adult…everyone deals with these challenges at one time or another.
The challenges become a problem when social, emotional, intellectual, or organizational aspects are disrupted. A person’s career/job/family life/etc. can be devastated by difficulties with executive functioning skills.
Difficulties with the higher-level cognitive skills that make up executive function can impact adults by limiting one’s ability to “connect the dots” and can impact other areas of executive functioning as well.
For the adult with executive function disorder, challenges can present in many different ways. There may be no trouble with impulsivity or attention struggles, however other mental skills can be quite difficulty. Sometimes, seeing the “big picture” is the problem. For others, it’s just making decisions. Still others lack time management and have difficulty with multi-tasking.
Executive Function in Adults
Here’s the thing: There is a lot of information out there for kids who are struggling with these areas. However, for most of us, executive functioning skills are still developing well into the adult years.
Executive function in adults is developmental. In fact, executive function skills don’t typically develop until the early 20s. Development of executive functioning skills occurs up through the college years (and beyond), making that transition from the home setting of high-school into a college dorm very difficult for many.
So, for some adults who are challenged in these areas, there can be simply a few accommodations or strategies put into place. Simply using a few set of tools designed to address these needs can allow for improved skills like organization and time management which are then carried over to other areas.
Making changes to executive function in adults can mean looking at the big picture.
Adults need to do adult things, right? Areas of life skills where executive functioning skills impact “getting things done” include:
Obtaining a job
Maintaining a job
Creating personal relationships
Maintaining personal relationships
Sustaining a clean and safe home
Completing large home projects (inside the home and outside the home)
Shopping
Paying bills
Transporting oneself to work, the community
Making healthy choices
Cooking and cleaning up food
Taking medications
Contributing to the community
Caring for children
When you think about the life changes that happen between high school graduation to accomplishing all of these high-level executive functioning skills, you can see how there is a developmental change that occurs between the ages of 18-25.
Executive Functioning Skill Components
In order to complete high-level thinking and planning tasks, adults require development of several executive functioning areas:
Planning
Prioritization
Attention
Organization
Task Completion
Task Initiation
Problem Solving
Working Memory
Self-control
Flexibility
Self-awareness
For other adults who may have always struggled with seeing the big picture, planning tasks, or staying focused on a task, this is the typical development for that individual. In other words, some adults may be gaining improvements and strengthening the skills they’ve got, just at a lower level than another adult. In these cases, strategies and tools can make a difference here, too.
Adults and distractibility
We are distracted by many things, and that level of distractibility is impacted by advances in screens, stimuli around us, faster lifestyles, more options, and increasing availability of information.
Some good resources to check out on adults and distractibility include:
Below, you will find curated information from around the web that will be instrumental in making an effortful improvement in executive functioning needs. Read through this information and use it as best fits the needs you or an adult with executive functioning challenges might be experiencing.
Remember that everyone is different in their strengths, weaknesses, needs, interests, and experiences. This information is not intended to treat or address specific needs, but rather, as educational material. Seek professional help when needed.
Adult Executive Functioning Disorder
The is fact that adult executive functioning impacts everything we do as adults. Take a look at this adult executive functioning skill checklist.
We all have busy lives. We have kids’ schedules, constant email reminders, to-do lists, deadlines, work needs, social lives, appointments, family, friends…the list goes on and on. It can be easy to feel overwhelmed. Missed appointments happen. The real issue is that when executive function problems in adulthood leads to safety or daily functional skill issues.
Another thing to consider is that you can have comorbidities that lead to executive functioning problems in adulthood. By this, I mean that there is typical aging happening. The level of distractions that we could deal with at a younger age might be more difficult. Ever see the meme that says something like, “I need to turn down the radio volume so I can drive better”? A younger driver might have that radio up full blast and be holding a conversation, and navigating a busy intersection. As we age, there is normal executive functioning skill declines and this is just one example.
Then, there are diagnoses that we receive as aging adults that can have executive functioning challenges that go along with the process. Consider pain. When we are in pain or sick, it’s hard to think, right? It’s hard to remember what’s on your calendar for next week and what work deadlines you have coming up. There are cognitive processes in place that make it harder to focus or attend because our body is trying to heal.
Other diagnoses might have brain fog, cognitive decline, or other medical reasons that make executive functioning skills a challenge. We can put supports in place to help.
Let’s take a look at some of the examples of executive functioning problems in adults…
executive function problems in adults
Some of these problem areas for adult executive functioning issues may include:
Difficulty making plans
Difficulty making decisions
Time management
Trouble with organization
Difficulty keeping important papers organized
Trouble prioritizing
Poor emotional control
Difficulty with flexible thinking
Trouble thinking “on the spot”
Trouble using a schedule
Trouble getting out of the house on time
Trouble with impulsive buys
Difficulty paying bills on time
Difficulty with losing keys or important items
Trouble following through with plans
Trouble picking the most important tasks
Trouble doing the important parts of tasks first
Trying to do too much at once
Constantly running late
Difficulty listening to a person talking without thinking of other things
Easily frustrated
Forget the last step/steps in a multi-step task
It’s easy to see how the list above can look so different for different people, especially when considering aspects such as job requirements, family obligations, outside situations or other issues that may make a difference in the occupational performance of an individual.
These structures and their hormones control functions such as emotions, behavior, motivation, sleep, appetite, olfaction, stress response. In adults, the role of the limbic system impacts household tasks completed, grocery shopping, paying bills, getting to work on time, caring for children and other daily life tasks.
This is really interesting, because you may connect the dots with this list and see that social emotional skills, executive functioning, inner drives, and sensory processing (including the sense of smell and interoception) all centered in one place in the brain! (This is not to say that these are the only places in the brain that operate these functions as well.) All of this can be considered when addressing needs using a specific sensory diet for adults that center on the areas of needs for the individual struggling with executive functioning skills.
You can see how the role of emotions and regulating daily stressors impacts attention, organization, task initiation, task completion, and problem solving.
Generally speaking, the limbic system is the emotional brain but this piece of the EF puzzle has a huge role for adults who are expected to act…like adults!
Tips for adult executive functioning
Some easy to apply tools can impact executive functioning challenges in adults. These strategies include low-tech or high-tech strategies such as:
Use a paper planner or calendar to keep track of obligations
Set up a filing system to keep track of and manage mail and important papers
Use highlighters and colorful sticky notes to make a visual organization system
Set up calendar reminders on a phone or smartwatch
Set up automatic payment plans for bills
Brainstorm routines and weekly/daily tasks and strategies to make decision-making less stressful and easier
Think through and visualize the day or week ahead and predict any challenge that may arise
Create routines and calendars for ongoing tasks
Create brain dumping lists for big tasks and set goals with specific dates and timelines
Use a daily journal to track each day’s events. The Impulse Control Journal can be used by adults as well as kids. The “look” of the journal is not childish, and has many components that can translate to an adult’s needs in promoting organizational, time management, etc.
Resources for Adults with Executive Function Disorder
Here are some symptoms of executive function disorder in adults. Some of the symptoms include time blindness, self-motivation, and an inability to keep future events in mind. Do these symptoms sound familiar?
One symptom that is mentioned is the regulation of one’s non-verbal working memory, or our inner critic. This is an area that can be detrimental to some, especially when self-conscious of weaknesses that impact life choices or struggles. Here is one simple strategy for self-talk in kids, but can be morphed into an age-appropriate version for adults.
If an adult or someone who is trying to help an adult with executive function needs would like to look into testing, here is a self-test that may help with self-awareness of the problems that can easily be addressed through strategies and tools. Use this information to move forward with professional help if necessary.
Another article that can “bring to light” some of the concerns with executive functioning needs is this article about the day in the life of an adult with EFD. It really highlights the challenge of managing other people’s schedules, the workplace juggling act, and managing relationships.
Time management tools, including simple planners and time management apps can be helpful. Here are more tools for addressing time management and other tools such as motivation, scheduling, prioritization, and other challenges.
This article discusses ADHD, but a lot of the tips and strategies can carryover to any need with planning ahead.
Often time, completing household chores is a huge problem for those wiht executive functioning skill challenges. Check out our resource on how to support executive functioning skills with chore tasks.
Finally, remember that many of the executive functioning strategies that are out there and presented in books can be used just as easily and seamlessly by adults. The same strategies that work for keeping track of homework tasks by a child can be used by an adult who needs to manage bills and important papers.
How to plan and prioritize tasks
The Impulse Control Journal is your guide to addressing the underlying skills that play into trouble with planning and prioritization.
The journal is an 80 page collection of worksheets and prompts to discover what’s really going on behind executive functioning skills like planning, organization, prioritization, working memory, and of course, impulse control.
While the guide was developed for students of all ages, this printable workbook is perfect for adults, too. It can help you discover strategies that make a real impact for all of the skills needed to get things done.
Here’s the thing; Everyone is SO different when it comes to struggles related to executive functioning and everyone’s interests, needs, challenges, strengths, and weaknesses are different too. All of these areas play into the challenges we see on the surface. And, this is where the Impulse Control Journal really hits those strengths, weaknesses, and challenges where it matters…in creating a plan that really works for kids of all ages (and adults, too!)
Check out the Impulse Control Journal, and grab it before the end of February, because you’ll get a bonus packet of Coping Cards while the journal is at it’s lowest price.
Read more about The Impulse Control Journal HERE. The Impulse Control Journal has been totally revamped to include 79 pages of tools to address the habits, mindset, routines, and strategies to address impulse control in kids. More about the Impulse Control Journal:
30 Drawing Journal Pages to reflect and pinpoint individual strategies
28 Journal Lists so kids can write quick checklists regarding strengths, qualities, supports, areas of need, and insights
8 Journaling worksheets to pinpoint coping skills, feelings, emotions, and strategies that work for the individual
Daily and Weekly tracking sheets for keeping track of tasks and goals
Mindset,Vision, and Habit pages for helping kids make an impact
Self-evaluation sheets to self-reflect and identify when inhibition is hard and what choices look like
Daily tracker pages so your child can keep track of their day
Task lists to monitor chores and daily tasks so it gets done everyday
Journal pages to help improve new habits
Charts and guides for monitoring impulse control so your child can improve their self confidence
Strategy journal pages to help kids use self-reflection and self-regulation so they can succeed at home and in the classroom
Goal sheets for setting goals and working to meet those goals while improving persistence
Tools for improving mindset to help kids create a set of coping strategies that work for their needs
This is a HUGE digital resource that you can print to use over and over again.
What does executive function disorder look like in adults?
Things like distraction, time blindness, distractibility, and attention or organization issues can be common in adults with executive function disorder. Here are other signs of EF issues in adults:
Time blindness– being unaware of the passing of time (see below for more information)
Trouble remembering names
Losing or misplacing everyday items such as purse, wallet, keys, phone
Difficulty completing multi-step tasks such as laundry
Late for appointments consistently
Difficulty breaking tasks down into steps
Trouble completing tasks that need done daily such as hygiene, grooming, making the bed, etc.
Forgetting to pay bills month after month
Consistently forgetting to take out the trash on trash day
Misplacing items
Unable to multitask
Can executive function be improved in adults?
This can be a difficult question to answer because of the multitude of way’s that an executive functioning difficulties present themselves in adults. There are just so many functional tasks that can be broken down into functional participating.
When taking into consideration the skill areas that make up executive functioning skills, addressing the areas of working memory, attention, organization, prioritization, planning, self-motivation, emotional regulation, problem solving, inhibition…there are many areas to work on when it comes to improving executive functioning skills in adults.
This is to say, however, that it is possible to make habit changes, adaptations, and cognitive, behavioral changes that improve the ability to complete tasks. In the ault with executive functioning disorder, working on small steps and through tools such as lists, organizational changes, executive function coaching, apps, or progress planners, it is possible to make positive changes in the tasks that are impacted by executive functioning issues.
Here are some action plans that can be used to improve executive functioning skills in adults:
Use lists
Work on one task for the day
Use colored markers and a planner to organize how time is spent
Create a morning, evening, and study routine
Have clear goals
Plan ahead for the day by working off an organizer and checklists
Write a letter to future self as a strategy to visualize a future you would like to achieve
Identify strategies to cope and regulate moods better
What is time blindness?
Time blindness refers to the concept of being unaware of time passing.
In most cases, adults and teens (as they develop) are aware of time and have the ability to track its passing. This allows us to move through the morning routine to get out the door on time. It allows us to complete tasks and make it to appointments. It allows us to complete each step of a meal preparation so that dinner is on the table at a reasonable time.
You may recognize time blindness by recognizing that “time got away from you”. We all have felt the impact of time blindness when we say “time flies”.
However, some individuals have a difficult time with time awareness, and “time blindness”.
Time blindness becomes an issue for some individuals when they are consistently late leaving the house for appointment, or when late from returning from a break. Time blindness, when severe, can impact health, social participation, responsibilities, or safety.
Some examples of time blindness include:
Missing appointments
Taking too long to get started on a task
Taking too long to get ready in the morning
Sitting on a phone or device without realizing how much time has passed (This is a BIG one!)
Not realizing how much time a task will take to complete (such as meal preparation)
Getting “sucked into” a leisure activity such as watching Netflix, playing a game on a device, watching YouTube, or talking with friends
How to Deal with Time Blindness
If you know someone who struggles with executive function, it can be frustrating to watch. I am organized, a planner, and get things done. I love checklists. My friend struggles with all of these things. Instead of pushing through and getting tasks done, she shuts down. Things do not get done. She doesn’t feel the pressure or get anxious about her list. She experiences what we call “time blindness.”
Time blindness is an unawareness of the passage of time. I worked with one young adult who said she could spend five hours drawing, thinking only an hour had passed. Try this experiment. Set a stopwatch. Sit idle and see if you can guess when one minute has passed. Do not count the seconds. See how close you get to 60 seconds. When I did this activity it seemed time crawled. My client let the timer go past three minutes before she felt a minute had passed.
While time certainly does fly, we can make some simple changes that deal with time blindness that might impact function, safety, and participation in daily tasks and responsibilities.
Use a timer. The timer app on your phone can be used for a simple task or to use during recreational tasks such as watching YouTube videos. When the timer goes off, turn off the videos and move on to what you need to get done.
Keep track of how long things take and write it down in a planner or journal. Refer back to that time tracker when planning a day.
Use a planner with time slots for the day. Mark down appointment times and mark off how much time it takes you to drive to the location, get ready, eat meals. Be sure to add a small cushion time in your time planner for things like gathering a purse, putting on shoes, or gathering your keys and phone.
Use a clock- wear a wrist band so that the time is always on you. There are smart watches available that offer a vibration as a physical notification.
Make the clock app on your phone show up on the screensaver face of your smart phone.
Break a larger task such as laundry or meal prep into smaller tasks.
Create a system. Tasks such as shopping for groceries can fall into the time blindness category. Set up a shopping system and then a putting away the groceries system. Use what works for you.
Use a Pomodoro app to keep track of how long you are working on a particular task. Use the break period, and then get back to the task.
Addressing skill areas such as organizational skills, time-management skills, focus, memory, goal-setting abilities, and general well-being can have a huge impact on adults struggling with executive function challenges.
Hopefully this video on executive functioning skills helps in some way.
Executive function problems in adults can be normal, but there are signs that it is something more, too.
occupational therapy executive functioning activities for adults
In recent years more adults are getting diagnosed with attention deficit disorder. One of the main difficulties adults experience that lead them to a diagnosis of ADD is executive function disorder. Over 90% of adults with ADD/ADHD struggle with executive function. At some point in your life, you have probably experienced difficulty with executive functioning. You may have struggled to get tasks done, be organized, or remember things. This is normal.
SO when do we intervene with the tactics listed above? How do we know when executive functioning challenges are beyond what is normal aging and normal chaos of everyday life as an adult with full schedules, busy lives, and amongst all of the input we receive on a daily basis?
This might be where occupational therapy comes in. Luckily, there is a lot of information out there on social media to give you some starting points to try.
I know as a mom, business owner, OT, wife, friend, family member, and all of the other roles that I hold, there is a lot of input. I’m bombarded on a daily basis with information, deadlines, schedules, grocery lists, and more. It’s hard to keep it all straight.
When we see real challenges, however, is when there is functional life consequences. There might be safety issues. There might be missed appointments that are beyond the every once in a while occurrence.
Adults with executive function disorder, suffer significant life consequences due to their inability to initiate and complete tasks. They struggle to get or keep a job, maintain healthy relationships, manage money, stay on a budget, or properly care for children.
Are you a procrastinator? Procrastination is the intentional delaying of tasks. People who struggle with executive function tend to be procrastinators, but not intentionally. They delay tasks by their inability to “get it together.” True procrastinators get an exhilarating feeling when rushing to complete a task at the last minute. This feeling reinforces the behavior to delay tasks.
I used to say my oldest daughter and step son have two speeds; slow and stop. They do not feel the pressure to get things done on time. It gets done, but at their speed. They are chronically late for appointments or project deadlines. They are not procrastinating, but working very slowly on tasks. No amount of pressure makes them work faster. They are consistently working on the job, at a snail’s pace. Is this executive function disorder? It certainly might have some roots in it, but both of these young people lead productive lives with great jobs, successful relationships, and happy homes.
Adult Executive Functioning Skill Tips
Do you compensate for executive function difficulties without realizing it? Perhaps you have a calendar on your phone, to do lists, color coded schedules, auto payments for bills, and reminders set on your phone. This is a healthy way to approach organization. People with executive function disorder may need help getting these things set up. It is not in their wheelhouse to make lists and schedules.
Young children build executive functioning skills as they mature. They learn from experience, or being taught. Adults who continue to struggle with their executive function may not have learned these strategies, or can not independently implement them.
Realizing this is a disorder, rather than an annoyance, is a great way to support your loved one who struggles with EF skills. When going anywhere, we know to give my step-son plenty of extra time and warnings before he has to go anywhere. I have learned over time that my daughter will get things done, just not on my timeline. No amount of nagging is going to stress her out, or make her work faster. She does not exhibit the sense of urgency that I do. I just offer to help out, and try to be patient.
Did you know that the prefrontal cortex does not fully develop until age 25 (mid to late 20’s). The prefrontal cortex is responsible for planning, prioritizing, and decision making, otherwise known as executive functioning. It is the last part of the brain to mature. 20 years ago the prefrontal cortex matured much faster, a sign of slowed development in recent years. Therefore we should expect difficulties with our teens and young adults with higher level processing skills. That is a great time to start teaching compensation and organizational strategies.
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.
This apple activity is a fine motor activity for occupational therapy sessions with kids that builds many skill areas. I love this fine motor apple activity because you can make it work for the needs of each child. There is power to using hole punch activities with kids! Working on hand strength? Use the hole punch to build skills. Working on dexterity? Pick up the small red circles to place them on the felt apple tree. You can even incorporate it into a vertical plane activity or add apple brain breaks to the session. The sky is the limit!
I love this apple tree activity because you can use dice to work on hand mobility, small apple dots that are precision work, and you can incorporate other skills into the activity.
Pair this apple tree activity with our apple tweezer activity for even more apple themed fine motor fun.
Fine motor strengthening is a hot topic when it comes to back-to-school time. Kids go back into the classroom and need to get back up to speed on all of the fine motor requirements in the classroom. What better way to work on fine motor strength than with a Fall apple theme? This apple themed fine motor activity adds a bit of math, too and it’s super easy to create for hands-on play, learning, and fine motor work.
Fine Motor Strengthening Activity
This apple tree activity is a fun way to build the intrinsic muscle strength of the hands as well as gross grasp strength. It’s an easy activity to throw together, and the steps of the activity help to build strength of the hands, too.
Materials needed to make this apple tree activity:
Scissors (Here are my favorite scissors and why to use each type of scissors for different needs)
To create the apple tree, cut the green felt into a tree-ish shape. Cutting felt is a complex scissor task, so older kids can help with this part. If you are able to use stiff felt, cutting through the material is a strengthening exercise in itself.
Next, cut the brown felt into a trunk shape, by simply cutting strait lines. Consider allowing the child to cut the trunk shape as cutting strait lines on a material such as felt is easier, yet the flimsy material makes it difficult to cut. A stiffer material would work well for this part as well.
Next, cut the red cardstock into small, thin strips of paper. This is not necessary for the end result of the activity, however there is a fine motor benefit to the extra step. Kids can hold the thin strips of paper with a pincer grasp using their non-dominant, helper hand. Using the small strips of paper requires precision. Kids will then be required to slow down while using the hole punch so that they don’t cut the holes over the edge of the strip of the paper.
Need a hole punch that requires less effort for younger kids or those who need to build their gross muscle grip strength? Try this one.
Hole Punch Activity
Before we move on, I want to take a moment to talk about this portion of the activity.
Cutting paper strips and using a hole punch along the strip is an easy fine motor activity that you can set up with items you probably have on hand….Cut strips of paper. Use different grades and remember that cutting thicker paper means more resistance which is good for strengthening the hands.
Use the brown cardstock to make a small apple barrel shape. This can be used in the math part of this activity.
A slower cut with the hole punch allows for the muscles of the hands to exercise with prolonged tension and increases blood flow. Using the hole punch with slow repetitions builds gross grasp strength.
Once the apple tree and apples are created, kids can place them on the tree. The cardstock will not stick permanently to the felt, but they will stay in place for temporary play. Scatter the red cardstock circles, (those are your apples!) onto the table. Show your child or student how to pick up the apples and place them onto the apple tree. Picking up the small cardstock circles is a real workout for the intrinsic muscles of the hand.
To make this activity easier, place the cardstock circles on a piece of felt.
Apple Fine Motor Activity
Add a bit of math to this activity with a pair of dice. Show your child how to roll the dice and then count the number of dots on the dice. They can then add and count the number of apples and place them on the tree.
There are several ways to build on this activity:
Use the dice to add apples.
Subtract by taking away apples from the tree.
Create multiple step math problems by adding and them subtracting the numbers on the dice to put on and then remove apples.
The Apple Therapy Kit is full of fine motor, visual motor, and sensory motor tools to support fine motor skill development needed for handwriting and other functional tasks.
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.
There are many reasons to incorporate oral motor exercises into your therapy plan. Here, we are covering the reasoning behind several oral motor exercises and strategies to work on mobility and functioning in the mouth, tongue, lips, and jaw.
Eating is a functional skill we all do. When there are oral motor issues, occupational therapists will address this area.
Why Oral motor Exercises?
When we talk about oral motor exercises, it’s important to know why we are considering specific exercises. When it comes to oral motor exercises, we are striving to improve the functioning of the mouth, jaw, lips, cheeks, and tongue so that the child can demonstrate coordination needed for sound production and articulation. Other issues can arise in manipulation (chewing, movement of foods and liquids, tolerance of various textures, and swallowing food and liquids).
When it comes to feeding issues, there can be a question of whether the feeding problems are a result of sensory processing challenges and/or oral motor considerations. Check out this resource for more information on pediatric feeding and oral motor issues or sensory issues that impact feeding abilities.
Kids who struggle with feeding may be impacted by oral awareness and oral discrimination. These skills enable us to both be aware of the motions of the muscles and joints of the mouth to enable positioning for oral sound creation as well as movements to control and mobilize the chewing and manipulation of foods and drinks of various textures.
Oral discrimination is essential for safety, efficiency, and function when eating. When oral discrimination is a challenge, children can have resulting food aversions, be unaware of food in their mouth, or not be able to tolerate certain types of foods because of food texture issues, tastes, or temperatures. They may have difficulty with managing various textures and end up with messy eating during meals. Oral discrimination also effects skills like speech and tooth brushing.
Start here by reading more about the development of oral motor skills. Typical development of oral motor skills is an important consideration when it comes to self-feeding and movements of the mouth, tongue, and lips in tolerating new foods or textures in feeding.
Specific reasons for incorporating oral motor exercises into a therapy program may include issues with the following movements:
The oral motor exercises listed below can offer additional opportunities for strength and coordination of oral motor skills, as well as heavy work proprioception through the mouth as calming input to organize the body.
Let’s take a look at some of the oral motor exercises that we might use with kids…
Oral Motor Exercises
These activities are not the only ones that can be done to address oral discrimination issues. Additionally, it’s important to know that therapists understand that oral discrimination is just one piece of the feeding puzzle. Considerations such as tone, sensory processing, and oral-sensory exploration as well as many other components make up feeding.
Tips for Oral Motor Exercises
These specific oral motor exercises can be selected based on the specific needs of the child. Each exercise many not work for all individuals. And, the exercises should be modified as needed to grade up or down (make them easier or harder) based on the needs of the individual.
For each exercise listed below, add a repetition to complete the task. Add in a specific number of repetitions.
Add the number of days these exercises should be completed each week.
Incorporate function whenever possible. Working on feeding? Add real foods of interest. Use utensils or cups when possible. Incorporate the occupation of play to make the exercises motivating and fun.
Consult with a pediatric occupational therapist!
Oral Motor Exercise Ideas
Remember that not all of these exercises are needed for every child’s specific needs. Pick and choose the exercises that meet the needs of the child you are working with.
Bring their hands and fingers to his or her mouth and lips.
Play tongue Simon Says with a mirror. We have many oral motor Simon Says commands that can be printed off to target specific motor skills with the lips, jaw, cheeks, and tongue.
Play the “hokey pokey” with your tongue and cheeks.
Encourage tolerance of a spoon or other feeding utensil in different parts of the mouth.
Open and close your mouth.
Move your tongue from side to side.
Press your lips together and then smack your lips apart.
Explore different types of utensil textures (plastic, metal, plastic covered, etc.)
Hold and play with a toothbrush, bringing the brush to their mouth and face.
Encourage mirror play, identifying parts of the mouth.
Add rhythmical, whole- body play with therapy balls, uneven surfaces such as trampolines or crash pads to improve proprioceptive input. (Great for core strengthening and stability needed for feeding, teeth brushing, etc.)
Explore mouth play with teething toys and tools.
Explore use of teething toys and tools in different positioning (prone, supine, side lying, etc.)
Use rhythmical music along with tapping the cheeks or lips.
Offer frozen fruit on a tongue depressor. Try this recipe for frozen fruit skewers.
Chew a straw.
Pucker your lips in a pretend kiss.
Blow a party noise maker.
Blow a kazoo.
Use a straw to pick up squares of paper and drop them into a bowl.
Make fish lips.
Apply Chapstick (scented or unscented) and press your lips together as you move your lips from side to side.
Puff up your cheeks.
Smack your lips.
Whisper the sounds the letters of the alphabet make from A-Z. Notice how your mouth moves. Or, spell out your name or other words by whispering the sounds the letters make.
Blow bubbles
Blow through a straw to move a cotton ball or small craft pom pom along a line. Can you move it through a maze?
Freeze water to a popsicle stick and lick or suck until the ice melts.
You may want to check out these themed oral motor exercises for development of motor skills in various points throughout the year. These themed exercise can be added to weekly therapy themes to increase motivation and carry through. Here are several themed oral motor exercises for kids:
Want printable oral motor exercises? Grab the Deep Breathing Exercise Cards. The pack of deep breathing cards includes oral motor exercises for heavy proprioceptive input through the mouth, tongue, and lips, and oral motor activities using different themes, totaling 113 different exercises.
The Oral Motor Exercises can be done anytime, using just the mouth. These strategies offer exceptional proprioceptive input through the lips, tongue, and cheeks, making a calming heavy work activity that can be used in sensory diets to help children achieve a calm and ready state of regulation.
Today, like many other days, I evaluated the cutest little boy. When I asked the mother her main concern, she replied that he does not eat anything. While he definitely had other difficulties, the core of her worries was eating. Why? In the hierarchy of needs, basic ones like food and sleep build the foundation of higher learning. Not only this, these are the worry triggers every parent feels on a daily basis!
Feeding and eating are an important part of our lives. Not only for survival, but there is a social component relating to food. Think of all the major celebrations each year; birthdays, Christmas, Thanksgiving, Easter. What is one of the things families gather for? A meal. Meal times come around at least three times a day.
Imagine the stress on the child and their caregivers each and every meal involving a problem feeder. When I say “problem feeder” I am not talking about your average picky eater who does not like vegetables. I am speaking of the children like the one I evaluated today. The only foods he will eat by mouth are corn chips and Doritos. He will drink water and juice from a bottle. This is it. He now has a g-tube for supplemental feedings to take some of the stress off of nutrition for the moment.
There are a lot of components involved in eating. Did you know there are 27 steps between having the food in the room with you, and eating a regular meal? This is a ton of stages to navigate each and every new food that is added, especially to a picky eater or problem feeder. Add to this the oral motor difficulties that may be interfering with good eating skills.
Oral Motor Challenges That we work on in OT Sessions
As pediatric occupational therapists, we focus on function, right? This means we assess the areas of daily living skills that are a challenge. Then we can work on those areas by addressing the underlying skills and development. So, when it comes to oral motor challenges, these are some of the things we hear parents relay to us in the OT evals.
With oral motor struggles your child might experience the food:
sliding down their throat before they are ready to swallow
getting stuck in their mouth and they can not move it to the back
falling apart in their mouth, with bits of food in different spaces rather than creating a bolus.
Causing their mouth to be so tired after just a few chews
Taking forever to chew and swallow
Falling out of their mouth in the front or sides
Getting all over their lips and not being able to clean it
After a few trials of this, either your child accepts that they are a messy eater, or they become selective about what passes through their lips.
Tongue Exercises
My step-son has significant fatigue when eating. The first few bites go down quite easily. After a few bites, he slows down significantly. I see him chewing and chewing the same bite for several minutes. I counted his chews once and he was chomping up to 50 times for one bite! This means meal times last forever, or he gives up before getting adequate intake.
In this situation, it might be appropriate to use some tongue exercises. This can help with clearing food from the cheeks or the mouth in order to swallow food. Of course, you’ll want to have a full evaluation completed to make sure this is the most appropriate step.
Tongue exercises to try:
Tongue Push-Ups- Press their tongue against the roof of their mouth as if trying to push it upwards. Hold for a few seconds and release. This helps with awareness of how their tongue moves in their mouth.
Tongue Lateralization– Have them move their tongue from side to side, touching the corners of their mouth. This helps with moving food from the cheek pockets.
Tongue Circles: Have them move their tongue in a circular motion inside their mouth, touching the roof, sides, and bottom of the mouth. This helps with clearing food as it’s being chewed and helps with clearing the teeth when eating.
You can work on these tongue exercises while trying different foods. Offer different consistencies like chewy licorice or bagels.
Another chewing exercise to try is using gum to work on the chewing ability while managing saliva and holding the gum in the mouth (not allowing it to fall out when chewing). This is a fun exercise because kids may not get a chance to chew gum that often.
Oral Motor Exercises for Gagging
Now imagine having sensory issues in and around your mouth. If you have low awareness in your mouth, you may not notice the food in there. You may tend to stuff your mouth in order to feel the food in there.
This can lead to gagging and choking, a major safety concern. If you have high sensitivity or awareness in your mouth, the smallest bite can feel like a mouthful. You take teeny tiny bites, making meal time last forever.
When it comes to gagging, the first step would be to monitor and address the food consistency. Because we don’t want to see any risk of aspiration, you want to address this first when there is gagging happening.
Try these things:
Food consistency– Make sure you’re using the best consistency and start with soft foods. Do they gag with easy-to-manage textures, like purees or mashed foods? Gradually introduce more challenging textures as tolerance improves.
Encourage small bites- Offer smaller bites of food to reduce the chance of triggering the gag reflex. Small, manageable portions are less likely to overwhelm the individual.
Temperature– Sometimes gagging has to do with the food temperature because of sensory considerations. Try different food temperatures. Some individuals might tolerate warm or cold foods better, which can reduce gagging.
Other ways your mouth can be sensitive can be texture, temperature, and taste. This does not take into account the smell of food either. There have been children I work with who know how hot they like their food, down to the second in the microwave. Two seconds too much, and it gets rejected. If this does not sound that bad, imagine this same child liked her food to stay at the same temperature. Once the food cooled down, she needed it reheated a few more seconds, otherwise she would not continue. This is exhausting!
If food feels, tastes, or smells noxious, how many times are you going to keep trying? If you feel as if you are choking each time you eat certain foods, how often are you going to eat them? Every meal time feels like an attack. Eventually the brain stops responding to calls for hunger.
Luckily there are treatments for both oral motor and sensory processing difficulties regarding eating. The first step is to take a step back. I can almost guarantee there has been some stress felt by either you or your child around meal times. Breathe and take a second to realize your child is not likely starving. They are likely getting something by mouth (or tube). It may not be adequate calories or nutrition, but that will come.
Start with the expectation that your child will join you at meal times. They may not eat, but just sit and see/smell the food. This is a big step. If your child truly has oral motor or problem feeding issues, you will benefit from help by a trained therapist. Not all occupational and speech therapists deal with feeding disorders. The wrong training CAN make things worse.
Below are some tricks and techniques to begin working on easing some of the stress around mealtimes and eating.
have a supportive approach.
Have a routine in place. Establish a predictable mealtime routine with regular times and familiar settings.
Praise even small efforts.
Introduce new foods slowly.
Involve the child in meal preparation, such as washing vegetables, stirring ingredients. Here are ideas for getting kids involved in cooking tasks.
Use small portions so the child isn’t overwhelmed or stressed out by what’s on their plate.
Give the child choices about what they eat.
Before meals, engage the child in oral motor exercises, such as blowing bubbles or chewing on a chewy tube, or use our oral motor exercise cards.
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.
Looking for a Halloween sensory bin that inspires mess, sensory tactile play? This spooky sensory bin has purple water beads, plastic spiders, Halloween toys, and is a fun fine motor and sensory activity for developing skills this time of year. Add this idea to your Halloween occupational therapy ideas. Sensory bins are such a fun way to learn and play!
As a pediatric occupational therapist, I’ve found that creating easy Halloween sensory bin ideas for toddlers and preschoolers can celebrate the holiday and sneak in therapy interventions that support development.
I love putting together non-spooky sensory bins for preschoolers because it’s a fantastic way to introduce them to Halloween themes in a playful, non-scary way. You can use materials that are fun to explore like tongs and plastic spider rings, and you can use sensory bin fillers like orange and green shredded paper.
It’s especially easy to make Halloween sensory bins using materials you have on hand, with just one added material like googly eyes.
Halloween Sensory Bin
We made this Halloween sensory bin many years ago, and it was a huge hit. We used purple water beads, however if water beads aren’t appropriate for the clients on your therapy caseload, that’s ok.
Use the spooky (or not spooky) sensory bin activity to target specific skills:
Fine motor skills– pincer grasp, separation of the sides of the hand, thumb opposition
Scissor skills by cutting paper in the sensory bin
There are many items that you can use as a sensory base in a Halloween sensory bin.
Over the years, I’ve shared many DIY Halloween sensory activities for kids using simple items I already had at home. When working with children who have special needs, I’ve tailored Halloween sensory bins to provide just the right amount of sensory input, ensuring that every child can enjoy the experience.
For example, you can work on sensory motor skills like bilateral coordination, motor planning, fine motor work, heavy work, vestibular input, and gross motor strengthening with this giant spider web activity. An activity like this one can include a Halloween sensory bin…add picture cards or an example of the things students should find in the sensory bin within the spider web. They can climb through the strings and then go to the sensory bin, where they need to look for the matching item.
You can use the Halloween sensory bin cards that we have inside The OT Toolbox Membership Club in your sensory bin and in the gross motor spider web task.
Halloween Sensory Bin Fillers
We have many sensory bin ideas here on The OT Toolbox, but to make this one pumpkin, ghosts, or spider themed, you can pull out any Halloween decoration or party supply.
I often look for ways to save money, so I’ve put together some cheap Halloween sensory bins with household items that I can repurpose.
This is nice because I love to re-use those materials, when possible, to make other holiday sensory bins. If you use a tool like tweezers or tongs, you can definitely reuse the sensory bin materials.
Some of the small items you can use to fill a Halloween sensory bin include (a lot of these items can be found at the dollar store):
Googly eyes
Black and orange dyed rice
Plastic spiders and bugs
Eyeball bouncy balls
Plastic bats
Miniature pumpkins- these are good for sorting items into
Foam ghost shapes
Halloween-themed mini-erasers
Plastic witch’s cauldrons- also use these to sort different small objects into
Plastic vampire teeth- I like to use these like mini-tongs. Kids can put them on their fingers to pick items up.
Glow-in-the-dark stars and moons
Black and orange craft pom-poms
Plastic candy corn shapes
Orange and black feathers
Miniature witch hats
Plastic skulls
Plastic snakes
Black and orange beads
Many of these Halloween sensory bin ideas would be a great addition to a Halloween party.
One tip is to save party favors that kids get from Halloween parties at school. Because most schools don’t allow edible party treats, some parents will purchase small items like the plastic spider rings. I like to save these and add them to my sensory bin stash! Then you can make a Halloween toy I Spy game with those same items.
When I create these bins, I like to use things like rice, pasta, or homemade playdough, which makes these activities accessible for everyone. Here is how we used colored rice in a sensory writing table.
Another good idea is to use cooked pasta like we did in our messy sensory play activity. This is especially “spooky” for a Halloween bin.
How to use a Halloween sensory bin
Once you fill your bin with sensory play materials, there is more to it than just playing. The occupational therapy provider will probably think about all of the skills being targeted.
You can support learning and skills like executive functioning using a sensory bin, too.
Textures: Add materials with different textures to encourage tactile exploration. Consider including items like sand, kinetic sand, rice, dry beans, cotton balls, or foam pieces. Or, add wet and dry ingredients to mix things up. For kids with tactile defensiveness, this can be a real challenge.
STEM and Math Skills: Incorporate items that promote Halloween math skills. Use small toys or objects that children can count, sort, or group. You can also add numbers or counting cards for math-related activities. In The OT Toolbox Members Club, we have counting cards with pumpkin numbers that are perfect for this.
Sensory Words: I like to work on self confidence in kids when playing in sensory bins. You can introduce themed books, flashcards, or word cards related to the sensory bin theme. Encourage children to describe what they see, hear, and feel in the bin, which enhances vocabulary and language development. This is important for self-regulation skills.
Fine Motor Skills: Include tools like tweezers, tongs, or small scoops for activities that develop fine motor skills. Children can use these tools to pick up, transfer, or manipulate items within the sensory bin.
Creativity: Add materials that inspire creativity, such as colored paper, markers, or crayons. Children can use these supplies to draw, write, or create art based on the sensory bin’s theme.
Science Exploration: Incorporate items related to the scientific aspects of the theme. For example, if it’s an ocean-themed bin, include shells, plastic marine animals, and magnifying glasses for observing and learning about sea life.
Problem-Solving: Include puzzles, mazes, or objects that require problem-solving skills. These can be used to create challenges or games within the sensory bin.
Social Skills: Encourage group play and social interaction by providing enough materials for multiple children. Promote sharing, cooperation, and communication during sensory play.
Music and Sounds: Play background music or use sound-making objects to stimulate the auditory sense. This can enhance the sensory experience and create a multisensory environment.
Sensory Storytelling: Use the sensory bin as a storytelling tool. Create or find a story related to the theme and use items in the bin to act out the narrative. This combines sensory play with imaginative storytelling.
Color Recognition: Choose items in different colors to promote color recognition. Have children sort or group items by color.
Seasonal Themes: Align your sensory bin with seasonal or holiday themes. This keeps the sensory experience fresh and engaging throughout the year.
Emotion Exploration: Introduce items that represent emotions or facial expressions. Use this opportunity to discuss and explore feelings and emotions.
Using a Halloween Sensory Bin in Occupational Therapy
In my practice as a pediatric OT, I often focus on using Halloween sensory bins to develop fine motor skills. Activities like scooping, pouring, and sorting small items are perfect for helping kids strengthen these skills in a fun way. You can use tweezers, tongs, scoops, or just fingers to work on fine motor coordination and strength.
You can also use image cards like the ones in The OT Toolbox Membership to work on visual memory, visual attention, and visual motor skills.
I’ve also seen how Halloween sensory play ideas like a themed bin are beneficial for children who need help with sensory processing.
Budget-Friendly Halloween Sensory Bins with Everyday Items
They then peeled stickers (there are SO many reasons to play with stickers!) and placed on on each piece. We added another paper square to match so that it was a DIY memory game type of activity. Memory card games are a powerful too, too, so this is another reason to add this game to the sensory bin.
We then scattered the cut paper squares into the sensory bin and hid the stickers.
I had this kiddo seek and find the stickers to match the pictures on the squares. It was such a great way to work on so many skill areas!
Then, after we did that activity, we hid Halloween mini erasers like bats and spiders. The child used fingers and then tongs to pick up erasers.
Feed Me Sensory Bins
One activity that I really love is using a “Feed Me” sensory bin. You might have seen this before…it’s usually a large face with a hole cut in the mouth area. I like to tape the face cut out to a container like an empty tissue box or a container of some type. You put small objects like mini erasers or letter cards into the mouth.
We have several “feed me” activities in The OT Toolbox Membership Club. Plus, letter cards to go along with the theme to add in handwriting and letter identification.
Another Halloween Sensory Bin
With Our Trick Or treating postponed until this weekend (due to Hurricane Sandy weather), we have been continuing with the Halloween activities for a few extra days.
This Halloween Sensory bin was very much needed this morning!
Sometimes, you can tell that all-out chaos is about to let loose in the house, unless Mom comes in to rescue the littlest (babies who can not-quite run) from out of harms way…flying couch cushions anyone??
I brought out this sensory bin and the couches were saved from three bouncing (catapulting?) children.
This skeleton guy had a lot of fun too 😉 For more fun with bones, check out this bone identification activity. It’s a great learning activity to use with a Halloween sensory bin.
All it took were googly eyes, plastic spiders, orange beads, rings, and other random Halloween stuff all mixed in with the (still squishy-hydrated-awesome) water beads!
Grab the Pumpkin Fine Motor Kit for more coloring, cutting, and eye-hand coordination activities with a Pumpkin theme! It includes:
7 digital products that can be used any time of year- has a “pumpkins” theme
5 pumpkin scissor skills cutting strips
Pumpkin scissor skills shapes- use in sensory bins, math, sorting, pattern activities
2 pumpkin visual perception mazes with writing activity
Pumpkin “I Spy” sheet – color in the outline shapes to build pencil control and fine motor strength
Pumpkin Lacing cards – print, color, and hole punch to build bilateral coordination skills
2 Pumpkin theme handwriting pages – single and double rule bold lined paper for handwriting practice
Work on underlying fine motor and visual motor integration skills so you can help students excel in handwriting, learning, and motor skill development.
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.
This Halloween cutting craft is an old one that’s been on our site since October, 2018. We love this activity for so many reasons, and wanted to share it again. The ghost cutting activity that we did all those years ago supports development of hand and grip strength, bilateral coordination, eye hand coordination, and more. This is a Halloween occupational therapy activity you’ll want to add to your therapy plan this Fall! Check out all of our hole punch activities for more fine motor fun.
We made these fine motor ghosts years ago, but still love to use them to work on fine motor and visual motor skills.
This Ghost Craft is a fun Halloween cutting craft idea that kids can do while boosting the skills they need for scissor skills and other fine motor skills. Use this ghost craft idea to work on occupational therapy activities and OT goal areas in a fun and festive way, perfect for Fall activities and ghost theme therapy ideas!
For more ways to build skills, try our other quick and fun ghost craft that will boost those fine motor skills.
This ghost cutting craft can be modified to meet the levels of various student skills.
Ghost Craft to Work on Scissor Skills
This scissor skills craft is an easy craft to set up and one that you can pull together in in no time, making it a nice craft for on-the-go school based OTs looking for a ghost themed craft that addresses OT goal areas.
Kiddos will love this ghost craft as it’s a cute craft idea that is motivating. In fact, kids won’t even realize they are working on skills like hand strength, separation of the sides of the hand, arch development, scissor use, or bilateral coordination.
Kids love this ghost cutting craft because you can add different facial expressions.
Ghost Craft for Kids
To create this ghost craft and work on scissor skills as well as fine motor skills, you will need only a few materials (affiliate links are included below):
First, it’s important to talk about where to start with know what a child can benefit from when it comes to paper type (construction paper, printer paper, cardstock, and other paper types all play important parts in addressing needs in scissor skills. Read about the various paper choices in addressing scissor skills in our scissor skills crash course.
In that crash course, you’ll also find information related to line thickness when it comes to teaching kids to move through the stages of scissor skills.
Steps to Make a Ghost Craft and Work on Scissor Skills
To make this ghost craft (and boost those scissor skills), simply draw a semi circle on the edge of a piece of paper.
Ask kids to cut out out the ghost craft along the curved line. You can draw visual cues on the paper to cue kids on where to hold the paper as they turn the paper while cutting.
Next, draw or ask the child to draw circles for the mouth and two eyes. They can then use the hole punch to punch holes inside the circles of the eyes and mouth.
Graded Scissor Skills Craft
There are several ways to grade this ghost craft to make the craft easier or more difficult depending on the child’s needs:
Use lighter or heavier paper grades. Some ideas are tissue paper, newspaper, wrapping paper, paper towels, or coffee filters to make the craft more difficult. Some ideas to make the ghost craft easier include cardstock, manilla folders, poster board, or thin cardboard.
Add more details to the ghost craft such as a bottom that the child needs to cut along a 90 degree angle to cut the bottom of the ghost.
Add a wavy line to the bottom to require more details and scissor movement.
Make larger or smaller ghosts.
Looking for more scissor skills crafts? Try these:
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.
This Fall leaf activity is a fine motor task that supports development of so many skill areas. I love that you can gather a handful of colorful leaves from your lawn and work on areas like scissor skills, fine motor skills, line awareness, and bilateral coordination. Then, you can use the snippings as leaf mulch in a compost bin or right back in the lawn. This is a fun activity that kids love! It would be a great addition to a Fall sensory bin, too. This is a powerful hole punch activity for kids.
Use colorful fall leaves to work on scissor skills with kids this Fall.
Leaf Cutting Activity
This simple leaf cutting activity can be modified to meet a variety of skill needs. You can make the lines thicker or thinner, or make curved lines or angled lines. You can cut smaller leaves or bigger leaves. It’s easy to adapt to the needs of the student.
I have a small obsession with helping kids learn how to use scissors. It was one of my favorite areas to work on in the school-based Occupational Therapy setting. (And I’ve got a few scissor skills activities to show for it!)
Add this leaf cutting activity to our other Fall leaves activities:
Leaf Handwriting– These Fall writing prompts include leaf writing prompts, among other fall themed prompts. Includes sentence prompts and single words, all with a Fall and leaf theme.
Pre-Writing Lines Activity- Work on Pre-writing activity with real leaves. Use real leaves to work on eye-hand coordination, visual motor skills, and pre-writing lines with hands on fine motor work.
Bilateral Coordination Activity: Use this Leaf Craft to address bilateral coordination skills. Use real leaves to make a craft that builds bilateral coordination, heavy work proprioceptive input, and scissor skills.
Cut Real Leaves for Scissor Skills
Let’s get on with the Fall leaves cutting activity…
Today’s activity is all about scissors, cutting on lines, and leaves. This Fall, use those pretty leaves before they are covered with snow and practice cutting on lines.
This scissor skills activity is completely easy.
Go outside and gather some pretty fall leaves. Like our leaf hole punch activity (also very good for working on scissor skills), you want leaves that are not crunchy and are freshly fallen.
You might want to gather leaves that are still on the tree for easier cutting of lines. If you are working simply on the snipping of scissors, totally go for those crunchy leaves. They provide a fun auditory feedback to the snipping of scissors and fun Fall confetti!
Cutting the leaves gets you whiffs of the leaves, too. What a great way to incorporate the sense of smell into a scissor activity.
All you need are colorful leaves for this activity!
Practice line awareness with scissors using Fall leaves
I drew lines on the leaves for the kids to practice cutting along, but you can use just the lines of the leaves for older kids. Holding the small leaf and snipping along the veins is a fantastic bilateral hand coordination activity for kids. When cutting with scissors, bilateral hand coordination is essential for the assisting hand to move the paper accordingly as the dominant hand snips with scissors.
Cutting along lines in simple and complex shapes is an issue when visual perceptual skills are difficult for a child.
They might demonstrate difficulties with cutting within a line. Cutting choppy lines is apparent when a child has poor scissor control or visual motor skills with tools like scissors.
Cutting leaves is a creative scissor activity (Find a ton more creative scissor activities here!) and will be a hit with your kids this Fall. Save it for spring and cut those green leaves, too!
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.
