Colleen Beck OTR/L

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:

Executive Function Tests

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Executive Function tests

There are many executive function tests out there, but which are the best when it comes to assessing executive functioning skills? Many times, parents and educators ask about testing children for executive functioning skills. Today, we’re discussing how an executive dysfunction test can provide the mental dexterity information needed to support students. Each test covers a range of cognitive skills as part of an executive functioning assessment. Let’s get started!

Executive function tests by age

Executive Function Tests

These executive functioning assessment tools can be used as part of a formal assessment, or used in part as an informal executive function assessment of critical thinking skills. These testing tools can also be included in a full OT assessment.

Assessment tools analyze dysfunction in various EF areas:

When determining a child’s need for skilled occupational therapy services, it is important to collect data through an occupational profile, formal and informal assessment tools, observation, and client/caregiver interview. However, there are a lot of different executive functioning assessment tools available, so it can be hard to determine the best one for you!

Related, check out this blog post on executive function coaching as a way to support individuals through a coaching model.

Executive function tests for therapists, including formal and informal executive functioning assessments.

Executive Dysfunction Test

There are a multitude of different executive functioning assessment tools that vary in their applicable ages, administration type (questionnaire vs. participation-based), and standardization. Each has its own strengths and weaknesses, but check out a few favorites to see if one might fit your needs!

The following executive dysfunction tests cover various areas. We’re covering these assessments:

  • Children’s Kitchen Task Assessment (CKTA)
  • The Executive Function Performance Test (EFPT)
  • Behavior Rating Inventory of Executive Functioning- 2nd Edition (BREIF-2)
  • Informal Executive Function Tests

Other assessments for analyzing executive functioning skills (these are not covered in detail here) include:

  • Trail Making Test (TMT) Form B
  • Verbal Fluency Test (VFT) – F, A and S
  • FT Animals category
  • Clock Drawing Test (CDT)
  • Digits Forward and Backward subtests (WAIS-R or WAIS-III)
  • Stroop Test
  • Wisconsin Card Sorting Test (WCST)
  • D-REF. There is also the D-REF, which is free if you are on the Q-Global for Pearson. The “D” is the Delis Executive Function Assessment.  It is free and they have six computerized versions. 
  • Brown Scales
  • Trail Making-  This is an app used on an iPad to screen for working memory challenges 
  • Card sorting

The Children’s Kitchen Task Assessment (CKTA)

The Children’s Kitchen Task Assessment (CKTA) is a fantastic non-standardized assessment of executive functioning skills.

  • The CKTA is geared toward children ages 8-12.

Let’s dissect this particular executive functioning test.

The CKTA asks children to make play dough from a recipe with both words and pictures. The CKTA itself is free, though you do need to make a kit of materials out of common household items. Children are rated based on the level of assistance they require, rather than their quality of performance.

Prior to starting the activity, the child is asked to respond to a few questions, including predicting how much help they will need to perform the activity. The child also responds to questions after participating, including their perceived level of assistance and performance, as well as how they could have done better. This is a great opportunity to develop self-reflection!

Try this executive function assessment using kitchen tasks: Children’s Kitchen Task Assessment.

The Executive Function Performance Test (EFPT)

The Executive Function Performance Test (EFPT) is another non-standardized assessment of executive functioning skills.

  • The EFPT does not have a specified age range, though with the nature of the tasks, it is best suited for use with ages 14 and up.

During the EFPT, participants are asked to cook stovetop oatmeal, make a phone call, take a pretend medication, and pay pretend bills. Much like the CKTA, the participant is rated on their level of assistance and the participant also completes self-reflection components. Executive functioning skills become even more critical as a child grows up—executive functioning is critical in adulthood!

Try this executive function test, the Executive Function Performance Test.

Behavior Rating Inventory of Executive Functioning- 2nd Edition (BREIF-2)

The BRIEF-2 is a standardized, questionnaire-based executive functioning assessment.

  • There are multiple options for the BRIEF-2: teacher report, parent report, and self-report (ages 11+). The general BRIEF-2 is for ages 5-18, though preschool and adult versions are available for an additional cost.

In completing the BRIEF-2, raters are asked to respond to statements relating to a wide variety of executive functioning skills. In order to increase validity, there are 3 subscales to determine any responses that would decrease validity: infrequency, inconsistency, and negativity.

To view or purchase: BRIEF-2.

Informal Executive Function Tests

There are several nontraditional and informal assessment methods for testing executive function skills.

  • An informal executive function test can be used for any age. You’ll need an age-appropriate activity that is meaningful and motivating.

Executive functioning is important for nearly every task we complete each day. As a result, it can have an enormous impact on a child’s ability to participate in age-appropriate activities. However, these skills can also be easily assessed through many everyday activities!

Daily tasks such as self-care routines, learning tasks, chores, kitchen tasks, games, or problem-solving tasks, consider these aspects of executive function listed below. These are informal executive performance tests in a very functional strategy, taking into consideration the environment in which the task actually is performed.

  • Forming ideas to do an action (planning)
  • Starting an action (task initiation)
  • Using organization of tools and materials
  • Maintaining an action until the step is finished and knowing when a step is done (task completion, processing speed, impulse control, attention)
  • Switching behaviors or strategies to do the next step needed (prioritization, foresight)
  • Regulating, controlling, and adjusting body actions to deal with changes and new information along the way (working memory, strategizing)
  • Planning a tactic down the road to deal with a new issue or new direction (planning, cognitive flexibility)
  • Holding details in the working memory (working memory)
  • Controlling emotions (self-monitoring, emotional control, emotional regulation)
  • Thinking abstractly (problem solving, persistence, shift)
  • Knowing when the whole task is finished, stopping that task, and moving onto a different task or activity (hindsight)

Some simple tasks to assess these skills can be cooking a simple recipe, completing a chore, making a daily “to-do” list, preparing for a party or event, or other tasks that require several steps and a process of planning out tasks.

Executive Dysfunction Tests in Everyday Tasks

The thing about using a non-standardized assessment of executive functioning abilities is that this is where you may see some of the functional performance factors. These are the aspects of daily tasks that look like “struggle”. Some of these skills are very obvious and others are more inconspicuous.

These areas of executive dysfunction are tested and observed in everyday tasks:

  • Distraction levels
  • Keeping track of materials
  • Emotional control
  • Response inhibition
  • Sustained attention
  • Task initiation
  • Flexibility in task
  • Rational thinking
  • Future considerations (Use this letter to future self as an activity idea)
  • Flexibility
  • Mindfulness– Ability to manage and be aware of internal thoughts, feelings, emotions
  • Interoception – including ability to manage mood (to reduce intrusive thoughts), ability to manage fatigue (knowing how to pace oneself and take regular breaks), and ability to manage physical comfort and needs (pain, hunger, thirst)

When in doubt, select an activity and see if you can assess multiple executive functioning skills within the activity! Whether an obstacle course, board game, or a craft, there are so many options to gather “real-time” data on how these skills are impacting a child!  

Informal executive dysfunction tests can be anything that is multi-step and a functional, meaningful part of one’s day. Some ideas include:

  • Cooking a recipe
  • Folding clothes/towels
  • Sorting objects
  • Starting homework (including getting materials from the backpack and returning them when complete)
  • Making plans in a planner
  • Making an appointment (doctors visit, dentist, etc.)
  • Watering plants
  • Dusting
  • Shopping
  • Managing bills

Things to look at include ability to stay on task, managing all of the needed materials, planning out and following through with a task to completion. Take note of things such as:

  • How much help or assistance is needed?
  • Do visual prompts help?
  • Do verbal cues help?
  • Are one-step directions needed or can you move to two-step directions?
  • Can several steps be accomplished while thinking of other information?
  • How long can information be held (working memory)?

Executive Function Tests in the School Setting

Some of these tests that we described above will be used in school based occupational therapy and others will not. For therapists working in school settings, testing for executive functioning skills isn’t always necessary.

Instead, skilled observation or teacher referral (checklists and screening tools) can provide the input needed for the part that executive functioning skills play in completing school tasks.

I know that I have had many consults with educators as part of a collaborative model with executive functioning needs are mentioned. Sometimes simply having the discussion and then trying a few accommodations can support the needs of the student.

Supporting EF needs that impact learning might start with requesting a school based OT evaluation because, while the OT won’t specifically address only executive functioning skills, they will target the functional areas that the student struggles in:

  • Managing papers
  • Keeping track of assignments
  • Organizing a locker or desk
  • Managing materials and belongings
  • So many other areas of learning throughout the school day!

It’s really important to remember, and this is something that I find myself reminding parents all the time…that kids are very much in the developmental phase of executive functioning skills during their school years. They are at the toddler or baby phase of working memory, planning, prioritization, organization, and the main thing about this stage is repetition!

Following up the Executive Function Assessment with strategies

Looking for applicable resources to informally test executive functioning skills as well as incorporate executive function activities into daily tasks? The Impulse Control Journal is your printable guide to working through tasks, multi-step activities, and daily issues that impact executive function. Not only does it address impulse control, the journal is a resource in organization, establishing habits and mindset, working through goals, and getting things accomplished.

Click here to access the Impulse Control Journal.

Impulse Control Journal the OT Toolbox

The Impulse Control Journal…a printable resource for helping kids strategize executive functioning skill development. When saying “calm down” just isn’t enough…

When a child is easily “triggered” and seems to melt down at any sign of loud noises or excitement…

When you need help or a starting point to teach kids self-regulation strategies…

When you are struggling to motivate or redirect a child without causing a meltdown…

When you’re struggling to help kids explore their emotions, develop self-regulation and coping skills, manage and reflect on their emotions, identify their emotions, and more as they grow…

Grab the Impulse Control Journal to build organizational strategies, planning, prioritization, habits, and mindset in kids.

Oral Motor Problems and Feeding

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oral motor problems

Many times, OT professionals receive referrals for oral motor problems and feeding. It’s through oral motor occupational therapy interventions that kids can move from challenges biting, chewing, and moving food around inside the mouth, to success with eating and trying new foods. Let’s get started!

Oral motor problems lead to difficulty biting, chewing, and manipulating foods. They can cause difficulties with textures of foods, and can be a cause of extremely picky eating! A good place to start is with understanding the development of oral motor skills. Be sure to check out our resource on infant feeding therapy too, because we cover how to support food intake in infants and babies in practical ways that can help the caregiver or parent.

Oral Motor problems

One thing is for sure; individuals can have a huge spectrum of considerations when it comes to oral motor issues. No two kiddos will be alike. That’s why it’s so important to discuss oral motor issues with a professional.

The process of eating is a complex collection of movements patterns with physical and sensory components.

When feeding is a challenge, many times individual oral structures and sensory-motor patterns are a cause. 

If you are questioning whether an eating issue is sensory or oral motor, be sure to take time to explore each consideration. There can be different interventions and strategies depending on the underlying cause of eating difficulties. For example, there are specifics when it comes to issues with sensory food aversions and sensory food issues.

What are Oral Motor Problems Occupational Therapy Addresses?

The oral motor problems listed below are just some of the issues that can impact function in feeding.  

In a small series of blog posts, I have broken down each oral motor problem that occupational therapists typically address. Each blog post includes information about the specific oral motor concern, the reasoning or underlying influences that relate to each oral motor issue, and feeding issues related to the specific oral motor problem.   

This series of blog posts should be a resource for you to find more information relating to how feeding issues are related to specific oral motor problems and how these feeding issues can be addressed in treatment.   

Click on the links below for more information on each oral motor problem area as they relate to feeding. 

  • Mouth Clamped Shut when eating- Consider the child who clamps their mouth shut during meals.  This is usually the biggest sign to a parent that the child is all done eating, is full, or is refusing to eat.  However, it might be an oral motor problem that is actually the cause of the clamped shut mouth.  The child falls back on this technique because it’s worked for them in the past in some way to provide stability, move out of the difficult oral motor exercises, or has resulted in a response from the parent.   

Other oral motor problems include:

  • Tooth Grinding
  • Tonic Bite
  • Jaw Retraction
  • Tongue Retraction  
  • Tongue Protrusion
  • Tongue Thrust      

Kids can have trouble with picky eating and difficultities in feeding when there are oral motor problems. Different types of oral motor problems.

Occupational Therapy for Oral Motor

Oral motor interventions in occupational therapy can cover a variety of intervention techniques. It is essential to begin with an evaluation and individualized assessment by a feeding professional. Occupational therapists are trained in this area, but some OTs have additional certifications.

The list of occupational therapy oral motor strategies listed below is for educational purposes only and not a replacement for therapy of any kind.

Some occupational therapy oral motor strategies that can be used are:

  1. Oral motor assessment- It is essential to start with the assessment process for safety of the individual. Addressed in more detail below.
  2. Oral motor stimulation- In occupational therapy, strategies include brushing to the lips or cheeks, towel stimulation, feeding swab, tongue mobility exercises, etc. These are explained in greater detail below.
  3. Oral Motor Exercises– We’ve listed a larger list of specific exercises to use in play and in therapy sessions.
  4. Oral motor coordination exercises– Use the oral motor cards in the deep breathing kit to improve oral motor coordination skills. Try mimicking the movements by using a mirror and visual modeling.

Oral Motor Assessment Occupational Therapy

Assessment occurs by a pediatric occupational therapist, but there are many things to be considered.

Feeding is developmental and it’s essential to consider the level, age, and abilities of the individual as this will impact all aspects of feeding and oral motor considerations.

Oral motor assessment and infants-

In infancy, oral motor skills are both a means for self-regulation (nurturing through sucking) and nutritive. Things to consider in an occupational therapy oral motor assessment for infants and babies at this age and stage:

  • Is the infant able to suck in exploration for nipple of bottle or breast?
  • Does the infant suck in bursts and have pauses to allow for breathing while eating?
  • Assessment of the physical mechanics of swallow
  • Timing of sucking and pauses- sucking should occur at a rate of about one suck per second with pausing to swallow the liquid and breathing. This should occur in a coordinated manner.
  • Lip closure
  • Jaw movements to draw liquid into the mouth and to swallow (infants)
  • Anterior tongue movement during the sucking, along with cheek movement and jaw movement as the tongue draws milk or formula to the rear of the mouth to swallow (older babies)
  • Oral reflexes and whole body primitive reflexes (root reflex, a suck reflex, a swallow reflex and then protective reflexes like gag and coughing)
  • Liquid leaking from the mouth during eating
  • Anatomy of the mouth, tongue, lips, neck, etc.
  • Positioning during feeding
  • Family educational needs
  • Sleep and timing considerations

Oral motor assessment in babies–

In older babies, you begin to see certain developments. Missing these milestones can indicate oral motor problems. These considerations should be addressed in occupational therapy oral motor assessments as babies grow:

  • Hands in the mouth in exploration and play- this is normal part of exploration and supports development of tongue, lips, cheek mobility
  • Positioning and seating (high chair positioning)
  • Neck, head, and upper body control against gravity
  • Motor coordination at age appropriate levels
  • Bite reflex
  • Mouthing toys, teethers, etc.
  • Making sounds with a variety of oral motor movements
  • Mimic facial expressions (open mouth, tongue out, etc.)
  • Gag reflex present
  • Accepting variety of baby food textures, flavors
  • Accepts foods from a baby spoon
  • Lip closure
  • Tongue mobility (thrusting tongue after initial spoon offerings is normal)
  • Transverse tongue reflex- The baby/child feels stimulation on the side that tongue and the tongue moves in that lateral direction- needed for swiping foods
  • Attempts or tries a variety of flavors, textures, and softer, larger foods

Oral motor assessment in toddlers-

During the toddler years, oral motor issues can present in drinking, feeding, and other areas. Consider these aspects in OT assessments:

  • Drinking from sippy cup/open cup
  • Drinking from a straw
  • Drinking a variety of textures and thicknesses (water, juice, thick or thin smoothies
  • Eating a variety of textures and thicknesses
  • Eating fluids mixed with solids (cereal, soups)
  • Biting foods from a larger piece of food
  • Moving food around within the mouth
  • Swiping the mouth with the tongue to clear the mouth
  • Chewing with rotational movements of the jaw
  • Begins to remove food from the lips with the tongue

Oral motor stimulation

We cover specific oral motor exercises designed to support the oral motor stimulation to move the lips, tongue, and jaw to bite, move, swipe, clear the mouth of food, and swallow food in our resource on oral motor exercises. However, below you will find strategies to provide oral motor stimulation to the mouth, lips, gums, and tongue.

Oral motor stimulation in occupational therapy centers around play in order to enable function. This focuses on independence with feeding with safe ability to bite food, clear food from the mouth with the tongue so that food can be swallowed.

Tongue Stimulation-

  • Use a mouth swab– to touch, swipe, tap and swab the tongue on the sides, at the tip, and along the length, avoiding the back of the tongue to avoid activating a gag reflex.
  • Use a vibrating toothbrush- to stimulate tongue movement on the sides. This can help the tongue with lateral movements.
  • Use a gloved finger- Put on a latex or non-latex glove and use a finger to tap the sides of the tongue. The glove can be worn by either the occupational therapist or the individual themselves.
  • Use a mirror- Move the tongue by mimicking movements and watching them in a mirror. You can even have the individual touch their tongue to a clean mirror surface. Play in front of a mirror alongside the child or in front of the child above the mirror so the child can look at the therapist’s face and check their movements in the mirror at the same time.
  • Tongue movement exercises- Use the tongue and mouth exercises included in our Deep Breathing Exercise pack for ideas.
  • Tongue sounds- Make clicking sounds with the tongue on the roof of the mouth. As the child/individual to copy the sounds.
  • Push the tongue into the cheeks of the mouth to copy motions. This can help with lateral sweep of the tongue to clear foods by increasing tongue range of motion.

Lip and Cheek Stimulation–

  • Washcloth oral motor simulation- this occurs with a dry wash cloth and then a wet wash cloth by rubbing the lips and cheeks. Each area can be separated so they are addressed in isolation. Use a dry washcloth or wet washcloth to wipe the face, without food use. Use a warm or cold washcloth to wipe the face.
  • Making faces- Cheeks and lips can obtain heavy work, or proprioception by puffing up the cheeks, making fish lips, sealing the lips and blowing, blowing raspberries, copying facial expressions, etc. Play “Simon Says” with facial expressions. We have oral motor Simon Says Commands to share!
  • Food stimulation- Some foods (sweet, sour) are very alerting. These can be used as a frozen pop in the form of a lemonade pop, smoothie, or popsicle. Or, add fruits and frozen foods to a mesh bag that is sucked on.
  • Ice pops- Freeze an ice cube on a popsicle stick and use it as an alerting and stimulating tool to “wake up” the lips and cheeks.
  • Vibrating tools- Play with vibrating mouth toys and touch the face, mouth, lips, teeth in the way of a vibrating toothbrush (offering input through the jaw).
  • Wilbarger Brushing Protocol– Use prior to eating foods (contact a trained therapy professional)

Jaw Stimulation-

  • Vibrating toys- vibrating toys, chewing tools, or a vibrating toothbrush can offer oral motor stimulation through the jaw. This can be very alerting, so use with caution.
  • Chewing tools- biting on “chew toys” (described as heavy chewing therapy tools) or chewing tools that add heavy work through the teeth and jaws. This offers feedback to “wake up” the jaws.
Oral motor issues related to feeding in kids

    As you can see there is a lot of different areas that need to be assessed and addressed when it comes to oral motor concerns related to eating and drinking.       

  

 
 
 
 
 
 
 

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.

What you Need to Know About a Thumb Wrap Grasp?

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thumb wrap grasp

If you’ve worked with kids on handwriting skills, then you’ve probably seen a thumb wrap grasp at one time or another. Also known as a crossover grasp, a cross thumb grasp, a thumb wrap grasp, (or other descriptive names), a thumb wrap grasp is just that: a holding the pencil with the thumb wrapped around the pencil shaft. Here we are talking about what this type of pencil grasp looks like and what to do about it. Let’s discuss!

Thumb wrap grasp information

Thumb Wrap Grasp

Kids can use some pretty interesting grasps on pencils.  You can see the thumb squashed up against the pencil, the pointer finger wrapped around the pencil, or the thumb wrapped around the fingers.

Very often, the pencil grasp that a child is using is not one of stability and rather, is a demonstration of instability as weakness in the muscles of the hand is compensating during handwriting. This thumb wrap pencil grasp exercise is an easy one to put together and one that will help kids gain strength in the muscles that make up a functional grasp.  Read on to find out how to work the muscles of the hand to improve the “dreaded” thumb wrap grasp!

I’ve had a few questions from readers about the thumb wrap grasp.  It seems like this pencil grasp is becoming more prominent in classrooms.

So, what does a thumb wrap grasp look like?

The thumb wrap grasp is what you see when you the end of the thumb is wrapped around the pointer finger.  The pencil is supported with the tip of the pointer finger, and supported by the middle finger. The end of the thumb wraps around the pencil to support and stabilize the pencil. With a thumb wrap grasp, typically mobility of the pencil strokes are limited by the thumbs positioning on the pencil.

However, a thumb wrap grasp can be functional as well. While it’s not a completely horrible pencil grasp, it isn’t a great grasp for speed and efficiency in writing.

Several anatomical components are involved with a thumb wrap grasp:

  • Opponens Pollicis
  • Flexor Pollicis Longus
  • Interphalnageal Joint (IP Joint) of the thumb
  • Intrinsic muscles

An open thumb web space is a skill that can help to fix the thumb wrap grasp. Try these fine motor activities to promote an open thumb web space.

A thumb wrap or thumb tuck grasp can be a part of developmental progress of pencil grasps, but might be one to address during this progression. Read more about pencil grasp development for more information.

A thumb wrap grasp can also be called different names:

  • Thumb wrap grasp
  • Thumb tuck grasp (pencil is tucked under the pencil, but similar anatomical positioning exists and strengthening can be used to address a thumb tuck)
  • Crossover grasp
  • Cross thumb grasp

A thumb wrap can also exist in combination with other grasp patterns:

  • Tripod grasp with thumb wrap
  • Lateral thumb wrap grasp
  • Quadrupod grasp with thumb wrap
Pencil grasp exercise to work on an open web space and flexed thumb needed to remedy the thumb wrap grasp.

Is the THumb Wrap Grasp Functional?

*Note* I am one who takes pencil grasps in stride.  So, when I say “dreaded” thumb wrap grasp, I am not completely serious in that this grasp is dreadful or something to fear.  Many (many) of us have unique and very functional pencil grasps.  The issue is when a quirky grip on the pencil becomes a cause for illegibility, fatigue, joint strain, or other concern.  In those cases, a grasp should be addressed. Read more about functional pencil grasp and how a functional grasp can exist even if it doesn’t look like they typical tripod grasp.

Remember that a functional pencil grasp is the one we want to see. A functional pencil grasp might look like various things. Every child may have different tendencies when it comes to “functional” 

Functional means the student can hold the pencil, write with legible handwriting, and doesn’t have joints that are hyperextended or otherwise inefficient in joint positioning. Fatigue and endurance play a part in a functional pencil grasp.

This resource on what therapists want parents to know about pencil grasp is a great read.


Pencil grasp exercise to work on an open web space and flexed thumb needed to remedy the thumb wrap grasp.
 

What is happening when a child uses the Thumb Wrap Grasp?

Full disclosure: This post contains affiliate links.

The tip of the thumb bends over the pencil and pointer finger, providing stability to the grasp.  Instead of using the opposition muscle of the thumb to grasp the pencil, the child is using the adductor muscle.  The thumb wrap grasp provides stability but it does not allow for quick pencil movements.

As a child is required to write faster to take notes, the legibility of their handwriting will be sacrificed. Rather than moving the pencil with the tips of their thumb and index finger, the child is manipulating pencil motions with their wrist and forearm.

In order to improve this grasp, a child needs to strengthen the opposition muscle, Opponens Pollicis, along with Flexor Pollicis Longus to bend the tip of the thumb or the Interphalnageal Joint (IP Joint) of the thumb. Strengthening the intrinsic muscles along with addressing an open web space will improve IP flexion in pencil grasp. 

Working on precision skills will also help with a thumb wrap grasp.

Pencil grasp exercise to work on an open web space and flexed thumb needed to remedy the thumb wrap grasp.

 

Exercise to Work on a Thumb Wrap Grasp

Pencil grasp exercise to work on an open web space and flexed thumb needed to remedy the thumb wrap grasp.

This is such an easy activity.  Use store bought Play Dough or homemade sensory dough.

Press flower beads into the play dough with a bent thumb. Encourage your child to press the flowers into the dough using a their their thumb in a bent position on the edge of the flowers.  This is important, because it works the muscles needed to oppose with an open web space and flex the tip of the thumb.  This is the mobility needed to advance the pencil fluently.  These flower beads are perfect for this exercise because of the length of the flower that can press into the Play Dough.

Pencil grasp exercise to work on an open web space and flexed thumb needed to remedy the thumb wrap grasp.

 

Next, ask your child to pull out all of the flower beads by using the tips of their pointer finger and the tip of the thumb, while ensuring that your child maintains a slightly flexed (bent) thumb IP joint.

Encourage learning and playful math by counting as your child pulls out the flowers.  If your kiddo is like my preschooler, those flower beads will be hidden pretty far into the play dough.  The search and find is a great overall hand exercise and a fun math activity as you add up the beads!

ONE Simple Trick to Help Kids With Their Pencil Grasp

SO? How can you use this info to help kids with their pencil grasp? Make them aware of that little bent thumb joint.  Point it out as they are doing the play dough activity and then again when they are holding a pencil.  Remind them of that bent knuckle when they write.  Too much for your kiddo?  Don’t fret. 
 
Another tip is to use the pencil grip needed for a thumb wrap grasp. This blog post includes pencil grips for each type of grasp.

Pencil Grasp Tricks and TIps

Working on the underlying skills of a functional pencil grasp? Battling a thumb wrap grasp that slows down handwriting so much that the kiddo you are seeing on your caseload falls behind in writing speed? Know a child who has hyper-extended joints when holding the pencil?

Here are some pencil grasp tricks that can help to improve functional grasp. These strategies can address pencil grasp issues such as thumb wrap, inefficient joint positioning, a closed thumb web space, poor separation of the sides of the hand, and other pencil grasp concerns.  

Use this pencil grasp tricks to help kids improve pencil grasp when writing.
human hands with pencil and erase rubber writting something

Pencil Grasp Exercise

  • Try this trick: Ask the child to hold and manipulate a small item such as a kneadable eraser in the non-dominant (non-writing) hand while holding the pencil with the dominant hand. Ask them to manipulate the object with just the thumb, pointer finger, and middle finger. Sometimes that symmetrical movement makes a big difference!
  • This pencil grasp trick uses an item you probably already have in your therapy bag: a clothes pin!
  • This pencil grasp trick helps to work on thumb IP joint flexion…and requires only a marker.

The pencil grasp exercise and tricks above will help with many kids that need to work on an open web space, not just the thumb wrap grasp.  Try it and let me know how it goes!

MORE PENCIL GRASP HELP

Working on a functional pencil grasp with your child or occupational therapy caseload? Need activities to improve pencil grasp that kids WANT to do? These games that improve pencil grasp through fine motor activities are activities that boost the skills kids need for pencil grasp and games that strengthen the hands. Working on pencil grip to make and efficient and functional pencil grasp can be as easy as adding a few fine motor games to your therapy toolbox!

  • Want to know how to fix a problem with pencil grasps?
  • Need help knowing where to start when it comes to immature pencil grasps or a child hating to write because their hand hurts?
  • Need help with carryover of pencil grasps?

The Pencil Grasp Challenge in open for you! In this free, 5 day email series, you’ll gain information, resources, specific activities designed to promote a functional, efficient pencil grasp.

know about the skills that make up a functional pencil grasp. You’ll learn what’s going on behind the inefficient and just plain terrible pencil grasps you see everyday in the classroom, clinic, or home. Along with loads of information, you’ll gain quick, daily activities that you can do today with a kiddo you know and love. These are easy activities that use items you probably already have in your home right now.

Besides learning and gaining a handful (pun intended) of fun ideas to make quick wins in pencil grasp work, you’ll gain:

  • 5 days of information related to pencil grasp, so you know how to help kids fix an immature pencil grasp.
  • Specific activities designed to build a functional pencil grasp.
  • Free printable handouts that you can use to share with your team or with a parent/fellow teachers.
  • You’ll get access to printable challenge sheets, and a few other fun surprises.
  • And, possibly the best of all, you’ll get access to a secret challengers Facebook group, where you can share wins, chat about all things pencil grasp, and join a community of other therapists, parents and teachers working on pencil grasp issues.

Click here to join the Pencil Grasp Challenge.

free pencil grasp challenge
Pencil grasp exercise to work on an open web space and flexed thumb needed to remedy the thumb wrap grasp.

More fine motor activities you will love:   

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.

The Handwriting Book is a comprehensive resource created by experienced pediatric OTs and PTs.

The Handwriting Book covers everything you need to know about handwriting, guided by development and focused on function. This digital resource is is the ultimate resource for tips, strategies, suggestions, and information to support handwriting development in kids.

The Handwriting Book breaks down the functional skill of handwriting into developmental areas. These include developmental progression of pre-writing strokes, fine motor skills, gross motor development, sensory considerations, and visual perceptual skills. Each section includes strategies and tips to improve these underlying areas.

  • Strategies to address letter and number formation and reversals
  • Ideas for combining handwriting and play
  • Activities to practice handwriting skills at home
  • Tips and strategies for the reluctant writer
  • Tips to improve pencil grip
  • Tips for sizing, spacing, and alignment with overall improved legibility

Click here to grab your copy of The Handwriting Book today.

Easy Fine Motor Precision Activities

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Precision activities

Helping kids develop and strengthen fine motor skills is essential for functional tasks, and this resource on fine motor precision activities supports that development. Here, we are addressing what fine motor precision means and specific activities to do with kids to help with grasp manipulation, dexterity, and graded movements like managing a zipper, buttons, and adjusting a pencil within the fingers to write and erase. These are just a few examples of how grasp and release activities support fine motor skill development. Let’s break this down…

Fine Motor Precision Activities

Before we get to the fun stuff…the actual fine motor activities that support graded grasp and release, manipulation of objects within the hand, and various amounts of pressure and precision needed to perform functional tasks, let’s cover exactly what precision skills look like, what the term means, and why this area of development is so important.

At the bottom of this post, you’ll find specific strategies to support precision development so that kids can complete these tasks and not fumble with objects in the hands.

A good place to start is with our resource listing games with paper clips as a tool to support precision and refined dexterity.


This post is part of my 31 Days of Occupational Therapy series where you can find 30 more ideas like this one with easy treatment materials.

Easy precision in grasp, release, and rotation in fine motor skills for kids. Precision is so important in dexterity in many skills like handwriting, cutting with scissors, and everything done with the hands!

What is Fine Motor Precision?

Fine Motor Precision refers to the ultra-fine motor skills in the hand, broken down into areas: grasp and release, fine motor rotation, in-hand manipulation, and proprioception. Together, these precision skills enable us to pick up an object with the right amount of pressure and motor dexterity so you can grasp the object accurately taking eye-hand coordination skills into consideration. After grasping the object without overshooting or missing the item, it is necessary to position or rotate the object within the hand

Let’s cover each of those areas in greater detail below.

But first, it’s important to note that a child’s ultra fine motor dexterity is dependent on bigger things.  And by that, I mean that in order for a child to use their hands super fine motor tasks, they first must demonstrate strength and control of their core, shoulder, and arm.  If any of these areas are not fully developed in stability or control, then the child will show compensatory strategies as they try to use their hands in handwriting or cutting with scissors. Gross motor coordination is a great place to start if precision skills seem to be “off” or delayed. Related to that is the key input of body awareness and the impact of heavy work on more distal motor coordination skills.

One way to remember this is this:

“Proximal stability allows for distal mobility.”

Colleen Beck, OTR/L

Before a child can manipulate and move an object with dexterity and refined motor skills, there needs to be a base of support in stability in the core and upper extremity, mobility and coordination in the proximal joints (shoulder before elbow…elbow before wrist…and wrist before hand).

Breaking it down further, arch development and strengthening of the intrinsic muscles in the hands are both areas that are essential for precision in the fingertips.

The following resources will be a great way to break these areas of development down:

Fine Motor Precision

Kids and fine motor skills go hand-in-hand. (That is my funny-OT attempt at a fine motor skills joke!) But really, fine motor skills are a staple of a child’s development and are essential to function.

Precision occurs with development of grasp when child to use the pads of the index finger, middle finger, and thumb to manipulate objects with opposition.  I talked a little about strengthening these types of grasp patterns.  

Today, I’m sharing ways to work on the controlled use of these fine motor patterns in controlled dexterity tasks.  The precision of grasp and release is essential for very small motor movements in activities like picking up beads and releasing items like blocks with precision. This is broken down into areas of dexterity that all work together:

  • Grasp and release (we’ll break these two areas down even further)
  • Fine motor rotation
  • In-hand manipulation
  • Muscular force, or the amount of force applied through the muscles in small motor use, also referring to proprioceptive input through the hands and fingers.

What is precision of grasp and release?

Precision in grasp, manipulation, and release of small objects makes the difference between fumbling with zippers and buttons and efficiently grading movements in very small dexterity patterns like threading a string through a needle (kid-friendly, of course!) 

Precision in grasp is related to the picking up of items.  A graded lateral grasp is needed to cut with scissors and only squeeze the scissors halfway shut for accurate cutting lines in some situations.  Around 3-4 years, a preschool aged child typically develops a greater variety of grasping patterns, including precision.  They begin to grade their scissor strokes so that they can cut a line or shape without opening and closing the scissors completely.  Grasps in babies typically begin with a raking motion and work towards a pincer grasp.  Precision in this skill occurs when the child is able to pick up very small items like beads with accuracy and graded movements.  

Precision release is needed for stacking blocks without toppling them over, placing cards on a pile, opening scissors just a small amount, or placing small beads into a bowl.  Precision is needed for a child to let go of an item in a controlled manner.  If they are not exercising precision in release, you might see them rolling or tossing an object as they let go.  They will knock over a stack of blocks, or over open the scissors when cutting lines, making their accuracy very choppy.   

Precision in rotation is another task that children develop around age 5. Rotation is a portion of in-hand manipulation and seen when turning a coin on the edges and the child rotates it in a circular motion.  Precision in rotation also occurs when holding a pencil between the fingers and the child rotates it over and over. 

Easy precision in grasp, release, and rotation in fine motor skills for kids. Precision is so important in dexterity in many skills like handwriting, cutting with scissors, and everything done with the hands!

One way to develop these skills is through practice! One precision grasp and release activity I love is using popsicle sticks in various colors. You can stack the popsicle sticks so they build a wall without toppling over. Using the different colors allows kids to see how the sticks are aligned by offering contrasting colors. If they see a bit of yellow stick under the green stick, then they need to adjust the top stick with refined motor movements.

Grade this activity for younger kids or those developing skills:

  • Simply place a single popsicle stick down on a table surface. Then pick it up.
  • Younger kids can stack just one stick on top of another.
  • Match colors.
  • Make a wall of popsicle sticks to develop more refined precision skills.
  • Place and sort popsicle sticks into a container on the vertical position (shown below)

To practice precision in grasp and release, I showed my preschooler how to pick up and stack Popsicle sticks.  Picking up the sticks required a tip-to-tip grasp.  We used different colored Popsicle sticks for my 4 year old and my 17 month old.  

The preschooler was able to pick up the sticks accurately without pushing other sticks around.  She could grasp the specific stick she wanted by an end or middle accurately.  

The toddler grabbed the sticks with a pincer grasp, but showed much less accuracy.  

Easy precision in grasp, release, and rotation in fine motor skills for kids. Precision is so important in dexterity in many skills like handwriting, cutting with scissors, and everything done with the hands!

To advance this popsicle stick sorting, the next step is precision in rotation. This can be addressed by asking the individual to sort popsicle sticks into containers.

Different small cups (Dixie cups would work) but we used a popsicle mold to encourage a single hand to hold the mold as the assisting hand.

We used an empty Popsicle mold to place the sticks into the cups.  What a great way to practice grasp precision!  We worked on sorting the craft sticks by color and had to hold the mold with one hand to work on bilateral hand coordination.  For the activity, we placed the mold on the floor and sorted the colored sticks without knocking the Popsicle mold over. Both the preschooler and the Toddler loved this simple activity.  

Easy precision in grasp, release, and rotation in fine motor skills for kids. Precision is so important in dexterity in many skills like handwriting, cutting with scissors, and everything done with the hands!

 Another precision in release activity was simply stacking the craft sticks.  The four year old could do this, but used her non-dominant hand to stabilize. 

Precision in in-hand manipulation- In hand manipulation skills include different components as well. In our blog post, we cover rotation, refined movements within the hand, and how to actually move objects from the fingertips to the palm and ice versa. These are precision skills at work!

Muscular force- This refers to knowing how much force to use to pick something up. When it comes to muscular force in fine motor skills this can mean the difference between overshooting an object when picking something up, fumbling with small objects, pinching things with too much force, or dropping items because not enough force is applied.

As described above, muscular force also refers to the amount of force applied through the muscles in small motor use, also referring to proprioceptive input through the hands and fingers. Another term for this concept is force modulation, or graded force.

Muscular force is a must for picking objects up, putting them back down, manipulating them within the hand, and rotation.

We go into greater detail on the proprioceptive input in our blog post on proprioception. In summary, muscular force means the ability to inherently know how much force is needed to pick up and hold and manipulate a ladybug as opposed to a heavier rock. Too much force and the bug is squashed. Not enough force, and the rock slips through the fingers. Another example is pressing too hard when writing and holding a pencil. This experience and muscle knowledge happens through play!

As you can see, all of these concepts work together to enable precision skills in functional tasks!

Precision Activities

We’ve covered a couple of precision activities related to grasp and release and rotation, but let’s go over a few more that include all aspects of precision, including muscular force activities and how these are related to functional participation.

Easy precision in grasp, release, and rotation in fine motor skills for kids. Precision is so important in dexterity in many skills like handwriting, cutting with scissors, and everything done with the hands!

This post contains affiliate links.

Looking for more ways to practice precision in grasp, release, and rotation with Occupational Therapy students or your kids?  Try some of these ideas.  While they are not all free (going with our series this month!), they are creative ways to practice precision.  

  • Precision engineering activities that use play dough and blocks to work on force modulation in the hands as well as eye-hand coordination.
  • Small motor pegboards like this precision pegboard activity combining crafts with fine motor skills
  • Perler beads- Try manipulating Perler Fuse Beads with Pegboards (affiliate link) for precision in grasp and release. These pegboards are very small and work on very fine dexterity with precision. 
  • Stamp sets (affiliate link)- Playing with stamps is a good way to practice graded grasp and release. Use these stamp blocks to accurately stamp within a specific area on a page. Draw squares or circles and the child needs to stamp in those areas. 
  • Tweezer games and activities like this Bed Bugs Game (affiliate link) encourage a precise and graded grasp and release of the small game pieces using tweezers. This game is on my must-buy list for Christmas this year! 
  • This Avalanche Fruit Stand (affiliate link) for another fun way to practice precision with a pair of tweezers. Stack the fruit with precision of grasp and release in a fun and colorful way! 
  • The Perfection Game (affiliate link) is another game that is great for precise grasp and release. Encourage kids to rotate the pieces by twirling the peg of the game pieces to work on precision in rotation as well. 
  • Jenga (affiliate link) is a precision work out in grasp and release of the blocks. My kids love this game!
  • Stacking blocks is a precision pattern activity that is perfect for working on graded grasp and release. 
  • This Tobbles stacking toy (affiliate link) is a version of that, with bright and bold colors. Try stacking and taking these balls down without knocking them over! 
  • Sometimes, simple is best! These Wooden Color Cubes (affiliate link) are perfect for simple block building and stacking while working on precision of grasp and release. 
  • Kids need precision of the thumb, too. These Slide Puzzles (affiliate link) are not only fun, they work on small motor skills needed for graded movements in cutting and pencil control.
Easy precision in grasp, release, and rotation in fine motor skills for kids. Precision is so important in dexterity in many skills like handwriting, cutting with scissors, and everything done with the hands!

It’s my hope that this post and ideas were helpful and a resource for you!  Looking for more fine motor activities for functional grasp?  Try these: 

Working on fine motor skills, visual perception, visual motor skills, sensory tolerance, handwriting, or scissor skills? Our Fine Motor Kits cover all of these areas and more.

Check out the seasonal Fine Motor Kits that kids love:

Letters Fine Motor Kit
Kit de motricidad fina de verano
Summer Fine Motor Kit
Outer Space Fine Motor Kit
Space Fine Motor Kit
Spring fine motor kit
Valentines Day fine motor kit
winter fine motor kit
Winter Fine Motor Kit

Or, grab one of our themed Fine Motor Kits to target skills with fun themes:

Want access to all of these kits…and more being added each month? Join The OT Toolbox Member’s 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.



Acorn Activity for Learning Vocabulary Words

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Acorn activity for learning vocabulary words

This acorn activity is an old one on our website, but it’s still so much fun! In the Fall months, acorns can be found all over in many forests and lawns, and here we are showing a creative way to use acorns to support learning vocabulary words…BUT, you could apply this idea to use acorns in learning letters, spelling words, or any aspect of elementary learning and preschool development!

Pair this with Fall fine motor activities or a Fall leaves therapy theme for fall OT sessions!

Acorn Activity

Do you remember reading over vocab lists, memorizing as much as you can the night before a test?

If you are a hands-on learner, you have a lot of trouble with memorizing lists.   


At best, you recall the words for the morning of the test.  But a week later?  A day later?  That afternoon?  It’s all gone.  As soon as the teacher says, “Ok, turn in your test!”, it all wooshes out of your head.


This Acorn Vocabulary Activity is perfect for hands-on learners that just don’t do memorizing and lists.  And we’re not talking about acorn terms, acorn parts, or acorn types.  This fun Fall activity is perfect for vocab fords of any kind!

Kids can practice and learn vocabulary words and definitions with a hands-on learning activity using acorns and a Fall theme tree. It's a fun way to learn vocab words without just memorizing a list! Perfect for second grade ELA!

This was a fun activity to make with my oldest daughter.  Second grader with a vocab list in her hands + pile of acorns in the backyard = fun, hands-on learning activity!


To practice vocab words, you’ll need just a few materials:
(Affiliate links are included in this post.)

One way to gather the acorns is on a family nature walk. Once you’ve gathered a bucket or basket full of acorns, you are ready to go!

Acorn Activity for Learning Vocabulary Words

This is a great vocabulary activity for elementary students. The adult or the child can try to write the words right on the acorns. Younger students like preschoolers can use just a letter on the acorns.

To practice vocab words with acorns:


Draw a tree on a paper or cardboard.  Note: This is my tree. My very fingernail-finger-not-treelike-tree.  Not my 2nd grader’s tree.  (She could draw a better looking, less fingernail-y tree.)  But no matter what your tree looks like, it is perfectly tree-ish and will be perfect!


Get the kids involved in drawing a tree.  You’ll want the branches to be wide enough for writing (which is why we did the activity with my tree-like figure).  


Write vocabulary words on acorns, using a black marker.  Washable is great, then you can rinse the acorns and throw them back outside for the squirrels.

Use acorns in vocabulary activities for elementary students

Have your kiddo write out the definitions to vocab words on the tree branches, on the ground of the picture, or anywhere they like.


If you would like a printable tree, I’ve got one here for you.  Simply print and write the definitions along the lines of the branches.

Acorn activity to practice vocabulary words.

Match up the acorns to the definitions. You can tape the acorns on with a ring of tape on the back of the acorns or just place them on the branches to practice over and over again.


Have fun practicing vocabulary words, the hands-on way!

Vocabulary acorns on a cardboard tree

More Acorn Activities

Add these movement and learning ideas to create an acorn theme to develop skills in therapy or at home:

  • Add squirrel themed brain breaks to the mix for nuts and acorn fun. These are great for self-regulation or for transitions between activities
  • Acorn Counting Cards– Cut out the acorn counting cards in the Fall Fine Motor Kit. Use them in sensory bins or to work on number formation and fine motor tasks.
  • Acorn Sensory Bin- Create a sensory bin with real acorns or use the printable materials in the Fall Fine Motor Kit.
  • Work on fine motor skills with an acorn array with this activity. Cut out the acorn images and place them on the mat to work on fine motor skills and visual motor skills.
  • Work on copying skills and handwriting with this acorn copy work activity.
  • Cut out the acorns and squeeze clothes pins for fine motor work and strengthening with this acorn craft and banner activity.
  • Acorn play dough mats- The Fall Fine Motor Kit has printable play dough mats to develop strength and eye-hand coordination by rolling play dough balls onto an acorn printable.

 
You will love these other hands-on learning ideas: 

 

   


 

fall fine motor kit
Fall Fine Motor Kit

Dinosaur Free Printable For Visual Perception

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dinosaur free printable

If you know a kiddo that loves all things dinosaurs, than this dinosaur free printable is for you! It’s a visual perception activity designed to develop and support visual perceptual skills such as visual discrimination, form constancy, visual closure, and other visual processing skills (visual tracking for one!) To grab this free printable dinosaur activity, read on! Add this resource to your dinosaur activities for an OT theme.

Dinosaur free printable page

Dinosaur Free Printable

If you are working on the visual perceptual skills needed for letter formation, handwriting, or reading, then you are probably loving the recent free visual perception printable sheets that we’ve been sharing on the site.  

This visual perception worksheet is great for working on skills like visual motor skills, visual scanning, visual figure ground, visual discrimination, spatial reasoning, and visual memory.  Also, it’s a great way to develop pencil control by moving the pencil around obstacles as kids connect the matching pairs of dinosaurs.

Visual perceptual skills are needed for so many functional skills. You’ll find easy and fun ways to work on visual perceptual skills through play here. 

Kids will love this free visual perception printable sheet with a dinosaur theme

How to use this dinosaur printable

This printable dino activity can be used in many different ways to support hands-on learning.

Print the page and slide it into a plastic page protector.  Kids can then use a dry erase marker to work on the page over and over again.  

Try these tips to use the worksheet in different ways:

  • Connect the dinosaurs with a dry erase marker
  • Place play dough balls on the matching dinosaurs
  • Use finger paints to place a fingerprint on each matching dinosaur
  • Play I Spy: Ask users to find an object that has specific colors or other details

OR, use it right on your tablet.  You won’t be able to draw a line to connect matching dinosaurs, but you will be able to save the ink as kids use their finger to connect the matching dinosaurs.  They will still address those visual perceptual skills by using the freebie on a tablet’s screen.

Then, use this activity along with other dinosaur activities to support development of other skills. Other dinosaur themed ideas to use along with this printable activity include:

Free Dinosaur Printabale

To get your copy of this printable page, enter your email address into the form below. The printable is part of our 24 page free visual perception packet, so you can use all of the items in the packet along with this dinosaur activity. Just print and go!

OR, if you are an OT Toolbox Member, you can log in and go to our toolboxes and access this resource along with every other freebie here on the website. For this particular tool, head to our visual tools page.

Look for more free visual perception worksheets like this one, coming soon to the site.  

You can check out our space theme visual perception free printable, or if you sign up for the freebie below, you’ll be directed to a page with all of the free printables in one place.    

These visual perception apple theme shape stamps are a perfect way to work on visual perceptual skills and fine motor skills with DIY stampers.

Be sure to try some of these pencil control activities to help with the visual motor skills needed for handwriting and to challenge a child you know with more activities just like the dinosaur free printable.  

FREE VISUAL PERCEPTION PRINTABLE PACKET

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

    Container Baby Syndrome

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    container baby syndrome

    If you are a new parent, then you have probably heard that tummy time is important for your baby, but it’s so important to process the concept of container baby syndrome. In this blog post, we are covering container syndrome, what this means, and what you can do to support your most precious little one.

    container baby syndrome

    What is Container syndrome?

    Container Syndrome is a term used to describe the lack of skill in infants who are not allowed ample movement opportunities. Container Baby Syndrome is the result of an infant being placed in a container for an excessive amount of time during the day. 

    Importantly, this is not to shame use of baby containers…or to say that use of these items is to be omitted at all costs. It’s important for the wellbeing of the caretaker to put the baby down sometimes! Things need done around the home. Parents need a shower, or some time to themselves. Other children need cared for.

    The important thing to know here is that we are talking about constant use of baby holders all the time, during the day and night. Moving the baby from one container to another is the issue.

    Constant use of positioners, or devices is what leads to the syndrome known as baby container syndrome, not using some of these items sporadically.

    This extended time leads to structural, movement, and behavioral challenges as a result. 

    Baby containers include baby equipment and items such as:

    • Restrictive playpen that does not allow for movement
    • Crib
    • Car seats
    • Strollers
    • Bumbo seats
    • Bouncy seats and swings
    • Rockers
    • Nursing cushions
    • Vibrating chairs
    • Jumpers
    • Exersaucers
    • positioning pillows
    • Slings
    • Floor seats
    • Infant swings
    • Walkers
    • Jumpers

    The other issue is when the devices are used for nighttime and daytime sleep.

    It’s easy to fall into that trap of the newborn sleeping in the rocker chair or bouncy seat because the reclined position puts the upper body into a reclined position, which can help with reflux that a baby might have. The warmth and close sides allow the baby to fall asleep easily. But when the newborn is sleeping in this positioner all night and then wakes for a short period and then goes back to sleep in the same device, is when we see the issues with constant pressure on one side of the head and neck positioning that can lead to issues.

    For support and help with newborns not sleeping through the night, be sure to check out our blog post on this topic. Occupational therapy professionals can help with sleep during the newborn stage which impacts so many aspects of functional development and family dynamics.

    All of the time spent in these baby containers adds up! When in a positioning device such as the ones listed above, little ones are limited in the motor development that results from stretching, wiggling, turning, reaching, and otherwise moving.

    Why Worry About Container Syndrome?

    As a new parent, you might be wondering “why can’t I just use the wonderful bouncers, baby rockers, and other entertainment devices for infants and toddlers? After all, I got all of these amazing baby chairs, rockers, and positioners for my baby shower…can’t wait to use them!“

    Why should I put my baby on the floor? The biggest reason has to do with the benefits to development. Putting a baby in a container such as a jumper, positioning seat, bouncy seat lead to something called container baby syndrome.

    It’s understandable why the baby seat or jumper seems like a better option than the floor for a baby. Parents and caregivers have shown a great deal of support for baby “containers” like bouncy seats, Bumbo seats, and activity centers. In fact, these baby holders have become so popular over the years, that a term has been coined; “container baby syndrome”. 

    When babies are constantly keep in a space where they cannot freely move, how can they be expected to roll, crawl, or walk, when it is the developmentally appropriate timeframe?

    Furthermore, babies need experiences where they can learn from their world in a physical way.

    They need to discover “what happens when I move my arm and head like this”?’ Babies may fall over, and have some stumbles along the way, but this is how young children learn about gravity and develop postural stability.

    Without those learning opportunities, children will only learn that their seat will catch them from falling, no matter how much they wiggle. 

    With fewer movement opportunities, a delay may be seen in typical development and reflex integration. More serious issues may occur when we keep babies still, like a flattened head from lying down (positional plagiocephaly) or a tight neck that reduces head movement (torticollis). 

    There is the visual component too. When babies are in a positioner such as a bouncy seat, they are positioned on their back with little to no neck movement. The neck, back, spine don’t receive the time (even minutes) to stretch, turn, and move. But the eyes are limited as well.

    When placed on the back in a reclined position, the eyes are not strengthened to look and gaze based on head and neck movements. The eyes may stay in one place and are not challenged to focus on different depths and peripheral stimuli.

    Neck movements are limited to turning from side to side, and they eyes tend to follow the neck. This limited eye movement can later impact other areas of development.

    Where did container syndrome come from?

    In 1992 the “back to sleep” campaign was introduced to lessen the likelihood of sudden infant death syndrome (SIDS).  While the rate of SIDS went down 50%, (yay!) container syndrome rose 600%, to one in seven babies! 

    This is astounding. 

    Parents are so nervous about SIDS, they place their babies in various containers most of the day. While this seems a safe, convenient, and supportive option, the use of too many “containers” can lead to container baby syndrome. 

    Babies who have not had enough tummy time may resist this at first, giving the false impression that the container is the best place for them. 

    What does container syndrome look like?

    • Head Shape Flatness. The back or the side of the head is abnormally flat
    • Facial asymmetry. The sides of the baby’s face may appear unequal as a result of skull deformity and flatness
    • Torticollis. The baby has difficulty turning the head to one side, or keeping the neck and head straight due to muscle tightness on one side of the neck
    • Decreased movement, strength, and coordination -the baby may not be able to roll, sit up, crawl,  lift the head or reach with their arms while on their tummy. 
    • Delayed milestone achievement
    • Speech, sight, hearing, and cognitive problems – Visual skills can be affected such as following moving objects with the eyes and seeing toys from different distances. Hearing can be disordered, as baby does not hear from all angles. Delayed cognitive skills may arise because the infant is not able to problem solve, explore their environment, or develop language skills
    • Attention deficit hyperactivity disorder (ADHD)
    • Increased weight/obesity

    How to prevent container syndrome in babies

    Container baby syndrome is 100% preventable.  If you suspect your baby or a client of yours has symptoms of this syndrome, speak with their pediatrician, get a referral to a physical therapist, and begin working on exercises.

    • Allow baby plenty of supervised free time on a blanket on the floor, or in a large play yard. Encourage tummy time, reaching for toys, exploration.  Some caregivers feel unsure about putting their baby on the floor.  A blanket, sheet, or other floor covering can be placed and washed after usage. Or, use toys such as a baby gym to encourage belly play.
    • Limit baby’s exposure to containers. Use only when transporting the baby, or there is truly no other safe option
    • Increase supervised tummy time during the day.  Your baby may cry and resist at first, as this may be difficult or uncomfortable.  Start slowly and persevere. Colleen from the OT Toolbox has a great article on Tummy Time Myths.
    • Hold your infant in your arms, or in a sling for short periods during the day.  This will encourage movement, increased head control, and socialization
    • Rotate baby through various stations and positions during the day. Holding a baby all of the time is not healthy for a growing child either. 
    • Floor Play for Babies is another great resource from your friends at the OT Toolbox
    • Use gates and other borders to secure a safe place for baby to play, away from wandering pets, or siblings who may step on them
    • EDUCATE caregivers and other people about the danger of container baby syndrome. Encourage caregivers to provide opportunities for the baby to explore their environment freely.  Demonstrate tummy time and other appropriate movement experiences

    Activities to Prevent Container Syndrome

    Now that it is understood that playing on the floor is important, let’s get into the many different ways you can do it! One of the easiest ways to encourage floortime with your baby is to lay a blanket on the floor, preferably with a carpet underneath for comfort, and place a toy or two near the baby.

    Depending on their age and abilities, the baby may be totally independent, rolling and playing happily. If the children are younger, or less comfortable playing by themselves, this is a great opportunity for a caregiver to step in. A fair amount of babies do not like being on their tummy for various reasons, including medical or sensory.

    Babies who have gastrointestinal issues may be hesitant to engage in tummy time, as it is uncomfortable. Work through these difficulties while encouraging floor play.

    How do I keep them safe down there? Prepare a safe and clean environment for movement. This may involve baby gates, barriers, or a large corral to allow freedom of movement, without risking baby falling down the stairs. Lie on the floor yourself and see what is down there at child level. You may be surprised to notice extension cords, small objects, or other unsafe objects while you are down there.

    • 2 months or younger: Talk with your baby, showing them toys, describing them, and giving them to their hand to feel and explore. Sing songs – whatever songs you know! Encourage them to wiggle their arms and kick their legs along with songs, tickles, or kisses. 
    • 3-4 months: Your baby will be able to hold tummy time for a bit longer by now. If they have trouble staying there, lay down with them! Be a part of the team, showing them how fun being on their tummy can be. Babies around this age can reach and bring toys to their mouths, so give them safe opportunities to do so.
    • 5-6 months: Rolling should be part of the baby’s physical development around this time. Encourage this movement by enticing them with something they love. Maybe it’s you, a special toy, the TV remote, or their next bottle. Try singing Five in the Bed. When the song says “Roll over!” show your baby how to roll.  During this time of development, your baby may be moving more than ever. They may even be crawling! Encourage even more floor play with these new skills. As long as the area surrounding them is safe, and you are close by, tons of fun (and important development) can be had! Read here about the types of crawling you might start to see at this age.
    • 7-8 months: Just like rolling, encourage crawling by giving the baby lots of space on the floor (that may mean moving aside some furniture) and placing toys or books in various places. There are so many fun games to be played! Playing “Peek-a-boo” where the baby pulls a blanket or towel off to show what’s underneath, is a classic game and critical to development. This teaches baby object permanence. Scatter toys near and far to encourage looking, stretching, and moving.
    • 9-10 months: Around this age, your baby will really be on the go. Maybe a baby obstacle course is up their alley…crawl over mom’s legs, under the coffee table, around the dog, and up the step into the kitchen! Creative barriers and safety gates will likely come into play around this stage to keep young children safe.
    • 11-12 months: Almost one-year-olds may be walking, which means they will likely not tolerate being in a “container” very well anymore. Now that they are cruising on furniture, squatting to pick up toys, and participating more in play, they may likely lead the way! See what your child’s interests are during floor playtime and follow their lead. 

    Need more tummy time information?  The OT Toolbox has several articles on baby play that support the development of balance and coordination through play.

    Another great resource to read more on how to promote development through play is DIR Floortime as it covers strategies to support development through interest-based play.

    The National Institute for Health also has a great resource on tummy time. 

    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.

    A final note on container syndrome

    While the “back to sleep” campaign has certainly been successful, it is not without pitfalls. The rule of thumb for parenting is;  everything in moderation.  Not too much screen time, sweets, or containers.  Parents do not need to be laden with guilt over container baby syndrome.  Most caregivers are doing the best they can with what knowledge they have.  As they learn more, they will do more.

    NOTE* The term “they” is used instead of he/she to be inclusive.

    Teach Kids How to Blow Their Nose

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    Teach kids to blow their nose

    Want to know how to teach kids to blow their nose so kids can blow their stuffy noses on their own? Many times, we see kiddos with booger-y, runny noses that don’t know how to blow their nose. They might not know how to blow their nose or even how to hold a tissue. Blowing a nose is a functional skill that occupational therapists may see come up in the classroom or at home. Read on for nose blowing tips for kids from an occupational therapist will help kids blow their nose with ease!

    Teaching preschoolers to blow their nose is one of the practical life activities for preschool that impact not only functional performance, but learning, too. A stuffed nose effects hearing and auditory processing, which in turn can impact how letter sounds are perceived, verbal directions are heard, and even safety considerations.

    How to Blow Your Nose

    This time of year, kids get sick.  Sometimes it seems like there are more visits to the pediatrician’s office than there is to the grocery store.  With children back into the routine of school, there are more opportunities for kids to come into contact with germs from friends and teachers.  As parents, one thing we know a lot about is runny noses.  When our babies are born, it is usually not long before a runny nose has us and the sweet little baby up at night with the stuffy, congested breathing.  When kids start to progress in their self care, they can start to become more independent with the task of blowing their own nose.  

    Blowing your nose includes steps that can be hard for kids to master:

    • Knowing that their nose is stuffy or full (interoception, or an awareness of the body)
    • Knowing to blow boogers instead of sniffing them up into the nose (interoception)
    • Holding a tissue at the nose without crumbling it (fine motor skills)
    • Blowing air through the nose and not the mouth (oral motor skills)
    • Pressing on one nostril and then the other (fine motor skills, interoception)
    • Knowing that all of the mucus or boogers are gone from the nose (interoception)
    • Handling a messy tissue without spreading germs (fine motor skills and tactile sensory skills)
    • Throwing away a tissue and washing hands (executive functioning skills, problem solving, sensory processing, fine motor skills)

    And completing all of these tasks WHILE engaging in learning, social events, or performing other tasks. What a challenge for some of the kids we serve!

    How can these steps of nose blowing be mastered by kids who struggle with fine motor skills, sensory processing concerns (including tactile or interoception issues), and executive functioning skills?


    Tips to teach kids to blow their nose

    Today, I’m sharing tips and tricks to help kids learn how to blow their own nose and to develop their ability to perform this portion of personal hygiene and functional skill ability. These are practical tips to teach kids that blowing the nose, wiping runny noses, washing hands when done, and how to use a tissue to blow a nose are all important aspects to take care of your nose.

    For the younger children, you might think it is easier to just wipe a runny nose rather than allowing the young child to attempt nose blowing. You might even have the thought, “does blowing your nose help?” cross your mind. But, yes, it is very important to teach kids to blow their nose. And,

    This is a great resource to add to a Montessori nose blowing lesson, because of the practical life skills that are addressed through nose blowing activities.

    Teaching kids to blow their own nose can be tricky.  Children who are typically developing find blowing their own nose to be difficult and children with special needs may have an especially troubling time with independent nose blowing.


    There are important parts of the development of the child to consider when it comes to nose blowing.  Knowing what a child typically should be able to do in this personal care task can help parents determine if teaching nose blowing is feasible at different ages.  Other kids with sensory, fine motor, cognitive, or other struggles will fit into this developmental breakdown differently.  You can read more on these areas concerns below.

    Tips to teach kids how to blow their own nose. This is great for typically developing kids and special needs kids.

    Nose Blowing Development

    While the runny noses that impact newborns seem to happen right away, as children age, you may wonder “When Can Kids Blow Their Nose?” There is much to think about in the nose blowing process…considerations such as body awareness, social awareness, grasping the tissue, and the actual nose blowing process.

    Blowing a nose doesn’t come naturally. It’s a skill that needs to be taught. Parents that watch their little ones struggle with boogery, wet, runny noses often wonder when their child is old enough to blow their own nose. In fact, there are milestones that go along with this functional skill.

    These are typical age ranges for the breakdown of skills needed for independence in nose care:


    Age 1 –  The child allows his or her nose to be wiped.
    Age 1.5– Attempts to wipe nose without actually completing the task
    Age 2- Wipes nose when asked
    Age 2.5-3.5- Wipes nose without request
    Age 2.5-3.5- Blows nose with request



    It’s important to note that kids don’t always follow these developmental milestones and that every child is different.  They typically developing child may not blow his or her own nose until age 5.  

    Just like any skill that a child completes, there are various ranges of development.  In this post, you will find tricks and tips to help kids develop this skill.


    For the child with special needs, independent nose blowing may develop more slowly as a result of concerns in other areas.  

    How to blow your nose: Fine motor skills needed 

    When blowing one’s own nose, there are fine motor components that are necessary.  Eye-hand coordination, bringing the hands to midline, vision-obstructed motor control, pincer grasp, and pinch grip strength are necessary for managing a tissue. To address these needs, try building the skills needed for each area.

    Here are strategies to build fine motor skills.

    How to blow your nose: Sensory Skills needed

    For a child, the process of blowing his or her own nose can be quite distressing.  

    Children with olfactory sensitivities may breathe primarily through their mouth, making the act of nose blowing difficult.  A sensitivity to scents can cause an overreaction to the tissue that needs to be held near the nose.  

    To accommodate for these sensitivities, try using unscented tissues.  Attempting the nose-breathing activities listed below can help.

    There are tactile and olfactory sensory skills involved with nose blowing and managing a tissue, but also interoceptive skills.

    Interoception is a sensory processing ability that tells us how our body feels and impacts functioning skills. This skills allows kids to understand and feel what’s going on inside their body. When a child struggles with the interoceptive sense, they may have trouble knowing when their nose is full, running, or stuffed. They may not realize they have a booger on their face or when they need to blow their nose. Interoception allows us to know when we are finished blowing our nose and when a child’s  nose is empty or they’ve finished blowing.

    Here is more information on sensory processing.


    How to blow your nose: Cognitive skills needed

    For young children, the process of completing each step of nose blowing can be a difficult process. Children need to maintain lip closure while breathing through their nose, one nostril at a time.  

    This multi-process task can be difficult for older children who demonstrate difficulty with cognition.  To address these problem areas, try using a social story for the steps of nose blowing.  A social story can also help children identify the appropriate time for attempting to blow their nose.

    Executive functioning skills play a part in teaching kids to blow their own nose. The problem solving needed to identify when a stuffy nose impacts functioning is just one concern. Here are more ways that executive functioning impacts nose blowing:

    • Initiation
    • Planning
    • Prioritization
    • Attention
    • Impulse Control
    • Working Memory
    • Cognitive Flexibility
    • Foresight

    If a child has a runny nose when in the classroom, they need to plan out how to get a tissue.

    They need the foresight to know that if they don’t blow their nose, they will have a messy nose, runny boogers, or get an ear infection from sniffing too much.

    They need to prioritize how to stop writing or reading and how to blow their nose in the middle of the classroom, and then what to do with the used tissue.

    They need the impulse control to not sniffle or to throw their tissue in the garbage as opposed to the floor.

    They need the working memory and cognitive flexibility to return to the task at hand once they blow their nose.

    They need the ability to pay attention to the teacher or their assignment while they blow their nose.

    What a lot of executive functioning skills are involved with nose blowing!

    How to Blow your nose: Oral motor skills needed

    In order to blow the nose, a child needs to maintain lip closure.  This can be a very difficult task for children who exhibit oral motor problems.  Oral motor skills impact feeding and breathing through the nose (as opposed to mouth breathing), but blowing the nose is impacted by oral motor skill development as well.

    Here is more information on oral motor skills.

    Use these fun tips to teach kids how to blow their nose.


    Strategies for helping kids learn to blow their own nose: 



    1. First practice nose blowing with the mouth.  

    Teach kids bring a tissue to their nose and practice blowing air out of their mouth.  In this way, kids understand that blowing out air can move the tissue.  They can then progress to closing their mouth and blowing air out through their nose. 


    2. Teach nose blowing when not sick.

    This is an important factor in teaching kids to blow their nose.  Parents typically do not consider nose blowing until there is congestion that interferes with breathing.  

    When kids are trying to learn to blow their nose and they are dealing with a runny or blocked nose, it can be overwhelming and frustrating for kids to breathe while holding their mouth shut.  Try practicing nose blowing when the child is feeling well.


    3. Teach kids to blow their nose by practicing to blow water.

    Teach kids that they can use their nose to blow air through one or both nostrils at a time in order to blow ripples across the surface of water.  Ask them to practice pinching their nose. 


    4. Blow a tissue ball to practice blowing a nose.

    Tear a small piece of facial tissue and crumble it into a very small ball. Place it on the table surface and ask your child to blow the tissue on the table using their nose.


    5. Blow on a mirror to see the fog to practice blowing a nose.  

    Ask your child to pinch one nostril closed and to blow air through their nose onto a mirror.


    6. Teach the child about the spread of germs.  

    Try this children’s book and craft to get started.

    7. Teach the child to hold one nostril with a tissue. 

    Use your hand to push down on one nostril. Kids can try this skill too, by trying to making the tissue dance with just one side of their nose. Call it a “tissue boogie” and get that tissue dancing by blowing it with the air from one nostril at a time.

    8. Teach kids to blow their nose by over-exaggerating.

    Over-exaggerate the breathing, closing mouth, and blowing through the nose without a tissue. Sit across from the child and play a game of “Simon Says” to copy the movements to take a deep breath, hold it in, close the mouth, and blow through the nose. You can find functional and practical Simon Says commands on our site.

    9. Nose Blowing Social Story.

    Try this nose blowing social story to teach kids to blow their own nose.

    Tips from an Occupational Therapist to teach kids how to blow their nose.

    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.

    Sensory Processing Disorder Chart

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    sensory processing disorder chart

    Did you know that sensory processing disorder can be broken down into several aspects of “sensory” based on considerations that you see in sensory challenges? Here, you’ll find a sensory chart covering these sensory processing attributes to better explain the vastness of SPD. You’ll also want to check out our resource containing a sensory processing disorder checklist as it covers sensory red flags that potentially indicate the terms you see below in this sensory chart.

    Printable sensory processing disorder chart for educating on complexities of sensory processing challenges.

    Gaining an understanding sensory processing disorders can have a vast difference in supporting clients, patients, parents, and the entire team involved with children or students who struggle with daily functional tasks as a result of sensory processing differences.

    The neurodiversity make us who we are, but understanding how this all works together is pivotal.

    For more information on sensory integration, please check out our resource on Ayres Sensory Integration as a tool for understanding the theory behind sensory processes. It can make all the difference in gaining a full picture of the nervous system.

    Sensory Processing Disorder Chart

    Let’s cover the sensory breakdown to better understand this complex concept and various attributes of sensory preferences and behaviors. These explanations and sensory information is found in greater detail in our resource, The Sensory Lifestyle Handbook.

    Sensory Processing Disorder as a global umbrella term that includes all forms of this disorder, which includes three primary areas (Sensory Modulation Disorder, Sensory Discrimination Disorder, and Sensory-Based Motor Disorder).

    Let’s look at each of these areas:

    Sensory discrimination disorders– 

    Sensory discrimination is defined as the ability to discriminate (or identify) sensory input, sensory differences, quantities, and qualities of sensory stimuli. When we discriminate sensory input, we use our sensory systems to taste, touch, hear, feel, smell, and perceive sensory information. This discrimination allows for safety and functional participation in everyday tasks. Sensory discrimination can mean smelling smoke from the stove vs. smoke from a backyard firepit, hearing an alarm sounding, tasting spoiled food, knowing when to go to the bathroom, knowing when to stop spinning on the swing, and so many other aspects of daily life!

    Children with sensory discrimination difficulty have problems recognizing or interpreting differences in stimuli. 

    • They will bump and crash into others or objects. 
    • They might eat until they are sick rather than stopping when full.
    • They may write with a heavy or overly light pencil pressure.
    • Individuals with sensory discrimination disorders frequently drop items
    • There might be poor balance
    • Others may be overly afraid of heights
    • You may see balance and coordination challenges.

    It can look like so many different things! Check out this resource on sensory red flags for more descriptions.

    There are so many aspects of daily life that are related to sensory discrimination!

    Sensory modulation disorder

    Sensory modulation disorder is defined as the challenge of interpreting sensory information, either overly responding, under-responding, or specifically seeking out sensory input.

    Sensory Modulation Disorder is further broken down into subtypes, or three categories:

    1. Sensory Over-Responsiveness
    2. Sensory Under-Responsiveness
    3. Sensory Seeking

    Sensory Over-Responsiveness– With one type of sensory modulation disorder, over-responsiveness, sensory input can be irritating, painful, or abrasive and the individual avoids that particular sensory input. The sensory systems are overly responsive in this way. You may see food or texture avoidance, issues with noisy environments, and distractions by light, sounds, textures, etc.

    Sensory Under-Responsiveness- The other end of the spectrum is a under-responsive sensory system. In this case, the individual may not realize or recognize sensory input. They may seek sensory input, but they can also be lethargic or fatigue easily. This is where you will see running into traffic, slow to react, or clumsiness.

    Sensory Seeking- Another type of sensory modulation issue is the seeking out of specific sensory input. Likewise, sensory input can be stimulating and pleasant. The individual will seek out sensory input that they prefer: rubbing a particular texture, jumping, crashing, etc. are some examples of sensory seeking.

    With each of these types, you will see preferences of certain sensory inputs and a withdrawal from other responses. They may become upset by noises and sounds and are easily distracted by stimuli. Each individual will be drastically different.

    These kids have problems regulating response to sensory input. 

    These subcategories are explained in further detail under the sensory systems section. 

    For children who struggle in this area, a sensory diet might help them to modulate sensation in the environment. Children experience a poor compatibility of sensory information and the tasks they need to accomplish.

    Sensory Based Motor Disorder

    Sensory Motor Disorder is another aspect of sensory processing, referring to the motor output as it relates to sensory information. Those with sensory motor disorder challenges have difficulty navigating their world.  Their bodies don’t do what their brains tell them to do. 

    Sensory Based Motor Disorder has two subcategories: Dyspraxia and Postural Disorder.

    1. Dyspraxia– Children with dyspraxia have difficulty planning, timing, organizing, sequencing, or executing unfamiliar actions.  These children may appear awkward and poorly coordinated. Dyspraxia describes developmentally acquired motor planning deficits and includes poor planning of movements.  
    2. Postural-Ocular disorder–  Children with postural-ocular disorder have trouble with controlling movements and posture.  They may have difficulty with coordination of functional vision. Joint instability seen in these children results in controlled motions.  These children may slouch in their seats and exhibit muscle weakness, low tone, or poor balance.  Kids with postural disorders have difficulty keeping up with their peers and may appear as lazy or clumsy.

    Sensory Processing Disorder Considerations

    Each of the areas described in the sensory processing disorder chart may have some or all of the considerations listed below. We cover these areas in greater detail in our book, The Sensory Lifestyle Handbook.

    Emotional regulation– Children with this difficulty have trouble maintaining an emotional state that matches the task or activity.  They may overrespond to emotional situations. Read more on emotional intelligence to determine typically developing emotional regulation skills vs. challenges in this area.

    Somatodyspraxia is a type of sensory-integrative based dyspraxia where there is evidence of poor processing of somatosensory information.  Essentially, somatodyspraxia is a combination of visual and proprioceptive input. The somatosensory system interprets information from the skin and around joints and carries that information to the central nervous system. 

    This includes tactile discrimination or sensory touch which includes heat or temperature awareness, vibration, pain registration, interoception, pressure, proprioception, and position of body in space.  All of this information leads to one’s ability to perceive temporal and spatial organization, develop body scheme and postural response, stabilize the head and body during movement, and interpret touch sensation and pain needed for movements and actions.

    Children with somatodyspraxia often exhibit poor tactile and proprioceptive processing, clumsiness, frequent tripping, falling, and bumping into objects; difficulty with fine motor and manipulation skills, and poor organization (Cermak, 1991).

    Treatment focuses on providing heavy work, deep pressure, and light-touch experiences. Verbal cuing and feedback may also be used (Koomar & Bundy, 1991). The sensory diet/sensory lifestyle and environmental modification ideas for decreased discrimination of tactile and proprioceptive information should be used in addition to the ideas specific to praxis issues.

    Impaired Bilateral Motor Coordination

    Children with impaired bilateral motor coordination often exhibit difficulty with bilateral activities, or tasks that require the two sides of the body to work together in a coordinated manner.

    This includes clapping, hopping, skipping, and jumping jacks.

    Individuals with impaired or delayed motor coordination may have some right–left confusion, avoid midline crossing, and have difficulty developing a hand preference.  Additionally, they appear to have vestibular and proprioceptive difficulties. 

    Treatment generally focuses on providing vestibular and proprioceptive experiences and graded bilateral activities.  Treatment may start with simple crossing midline, rotation, and symmetrical activities and work toward asymmetrical activities and more complex coordination skills (Koomar & Bundy, 1991).

    The sensory diet/sensory lifestyle and environmental modification ideas for decreased discrimination of vestibular and proprioceptive information that address vestibular input should be used in addition to the ideas specific to bilateral motor coordination.

    Tactile Defensiveness

    Children with tactile defensiveness often exhibit an aversive response to a variety of tactile experiences, such as craft materials, food, clothing, bathing, or touch. They will often avoid a variety of activities and may react aggressively at times. They can be easily distracted and have difficulty with attention.

    Therapy generally focuses on providing heavy work and deep pressure input. Slow linear vestibular input may also be helpful.

    Therapy also provides opportunities for participation in graded tactile experiences (Royeen & Lane, 1991). The proprioceptive sensory diet ideas for decreased discrimination of proprioceptive and vestibular information could be used in addition to the ideas specific to tactile defensiveness.

    Gravitational Insecurity

    Children with gravitational insecurity may exhibit limited participation in gross motor play; avoidance or fear of escalators, elevators, cars, or planes; or resistance to being off the ground. Treatment in the clinic environment generally focuses on providing proprioceptive input and graded vestibular input. In treatment, the child is always in control of the amount of vestibular input received and is never pushed beyond his or her limits (Koomar & Bundy, 1991).

    Environmental modifications would focus on helping the child to feel safe in all environments and situations. Sensory diet activities would focus on providing calming proprioceptive input throughout the day. The proprioceptive sensory diet ideas for decreased discrimination of proprioceptive and vestibular information could be used in addition to the ideas specific to gravitational insecurity.

    Individuals with these difficulties may have certain behaviors or characteristics in common.  There are underlying needs that result in adverse reactions to sensory processing. 

    The integration of sensory input leads to poor attention, self-regulation, co-regulation, self-monitoring, self-esteem, anxiety, discrimination, motor skills, communication, or responsiveness.  Incorporating healthy sensory habits within the family lifestyle is critical to success.

    The Sensory Systems

    Most of us learn about the five senses early in our childhood education.  Taste, touch, sight, sound, and scent are ingrained from a very young age.  It might be surprising to find out there are actually more than just five sensory systems.  With a typical Google search, you will learn that there are two more sensory systems that are added on to those five sensory systems. 

    The sensory breakdown includes aspects of each of the sensory systems (listed below):

    The proprioception system and vestibular system are two additional sensory systems.  However, when we consider perception, regulation, movement, interaction, and functioning, there are actually MORE systems that are involved. 

    These important systems are deeply connected to the central nervous system and are essential for perceiving and interpreting our world around us.  While they do not specifically sense input from the environment, they are and always have been an essential part of our existence. 

    Interoception is the sensory system of our inner body.  It includes organs, our heart, blood vessels, etc.  While the receptors to the five commonly known senses are obvious and clear, the receptors to the interoceptive system are inside our bodies.  They may not be seen but they are definitely important for functions such as emotional awareness, hunger, nervousness, fear, and feelings.  Our ability to sense fullness, elimination needs, temperature, thirst, sweat, and all require regulation of the interception system.

    You can see how this system is very much related and a part of other sensory systems in how a person functions.

    Additionally, there are other important systems that we are going to discuss in this book.  The somatosensory system refers to the integration of the visual and proprioceptive systems in order to perceive and respond with temporal and spatial organization, develop body scheme and postural response, stabilize the head and body during movement, and interpret touch sensation and pain needed for movements and actions.

    Finally, praxis, or kinesthesis help us understand how to move our bodies.  The praxic system, or the kinesthetic system essentially “puts it all together” when it comes to motor responses to sensory information that has been perceived by the other senses. 

    Putting it all together

    Let’s look at all of the sensory systems in a list:

    And the systems that are deeply connected to these sensory systems:

    • Somatosensory System (Movement organization)
    • Praxic/Kinesthetic System (How to move)

    Challenges with processing can mean that each of these sensory systems do not functioning adequately as an overall well-oiled machine. It’s then that you’ll see individuals with a poor reaction to the environment.

    Typically, dysfunction within these sensory systems present in many different ways. 

    • You may see withdrawal or over-responsiveness to auditory and visual stimuli.
    • You may see lack of focus on tasks and may feel insecurity in the environment, with poor body perception as a result. 
    • A child with sensory difficulties may be over- or under-responsive to sensory input. 
    • They may operate on an unusually high or unusually low level of activity. 
    • They may fatigue easily during activity or may constantly be in motion. 

    Children may fluctuate between responsiveness, activity levels, and energy levels.

    Additionally, children with sensory processing dysfunctions typically present with other delays.  Development of motor coordination, fine motor skills, gross motor skills, social-emotional skills, behaviors, executive functioning skills, language, and learning are all at risk as a result of impaired sensory processing.

    It is important to note that sensory processing is deeply connected to a combination of the sensory systems working together as well as the impact of environmental stimuli. 

    Sensation from the environment is combined with family life, parent expectations, peer interactions, classroom rules, community expectations, internal states such as feelings, hunger, fatigue, and health to result in behaviors responses.  Looking at the underlying reasons for behavioral responses is absolutely key to identifying strategies to help with “behaviors” or the actions we see. 

    Sensory Chart

    We’ve created a visual, sensory processing diagram to show exactly how these terms break down from an umbrella term of sensory processing disorder into more detailed and nuanced areas. As you can see, there is a lot to the overarching term of “sensory processing”.

    This free printable sheet guide to the breakdown or types of Sensory Processing Disorder is a great addition to your therapy toolbox.

    Print off the sensory chart and hang in on a wall or bulletin board for sensory processing awareness. This occupational therapy chart is a great visual to share with parents or educators when explaining how the whole system relates to behaviors and sensory considerations.  

    Types of sensory processing disorders in a printable sensory processing disorder chart.
    Sensory Processing Disorder Chart- Enter your email address below to get access to a printable version that can be hung on bulletin boards or used as an educational tool.

    Want a printable version of this sensory processing disorder chart? Enter your email address into the form below. You’ll receive the printable chart in your email inbox.

    This sensory chart is also found in our Member’s Club. Members can log in and access the handout under our Sensory Downloads area in the membership. While you’re there, also grab other sensory resources without the hassle of entering your email address for each resource.

    Free Sensory Processing Disorder CHART

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      More Sensory Processing Information

      Want to know more or to add another handy educational handout to your therapy toolbox? Grab a copy of each of the sensory processing tools below.

      1. Sensory processing information handout– It’s a great way to break these complex concepts down into easily digestible and understandable information. Print off the pamphlet and use it to share with educators, parents, caregivers so they can better understand sensory processing disorder.
      2. Sensory Red Flags– Print off this list of sensory red flags to use as a checklist to determine sensory challenges.
      3. Sensory Strategies Toolkit– The Classroom Sensory Strategy Toolkit is a free printable packet of resources and handouts that can be used by teachers, parents, and therapists. Whether you are looking for a handout to explain sensory strategies, or a tool for advocating for your child, the Classroom Sensory Strategy Toolkit has got you covered.
      4. Sensory Lifestyle Handbook– This is a resource for those living with, teaching, or working with children with sensory needs. For the child with sensory processing needs, everything about life can be distressing! Sensory processing challenges can impact a child’s every interaction and environment. Sensory challenges affect behavior, self-regulation, attention, development, learning, social skills, emotional development, and independence. The child who struggles with sensory processing may be challenged daily with rigorous interactions. For these children, sensory input or sensory-based accommodations can make all the difference.