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:

Fun Activities to Improve Visual Saccades

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scanning exercise for visual saccades

We’ve shared much information on visual processing over the last few months. You’ve seen tips for addressing convergence insufficiency, visual tracking concerns, and other visual skill areas. Today we are talking about saccades and activities to improve saccades. These are the eye movements that allow the tracking skills necessary for reading comprehension, handwriting, and so many other areas. The saccade activities listed below are eye exercises that can help enhance visual processing skills. These visual tracking exercises can help with smooth pursuit of vision, in order to improve learning problems and other visual therapy concerns.

Use these visual saccades activities to help kids with visual tracking skills needed for reading and writing, and other learning skills.

Visual Saccades Activities


You’ve identified impaired saccadic movements, the child has seen a developmental optometrist and maybe has corrective lenses, but is still struggling. Now what? Check out the activities below to incorporate into therapy and home programs that address poor saccadic movements directly.


Related Read: Check out this article to learn more about how saccades impact learning skills.

Activities to Improve Saccades

Here are Saccade Exercises presented in fun ways:


Wall Ball Visual Saccade Activity

This activity addresses saccadic movements on a large scale and challenges the child to stretch their eye muscles into the peripherals and back again. The objective is to hit the first target, catch the ball and hit the second target while moving only your eyes. This pattern is completed for as many times in row the kiddo can without dropping the ball or missing the target.


The larger the distance between the targets, the harder the challenge is. Wall Ball also doubles as a dissociation activity of the eyes from head movements.


All you need for Wall Ball is a ball, two targets and a wall or solid structure to bounce the ball off of. The ball can be any size as long as it bounces back directly to the child. Tennis balls and kick balls work the best. The smaller the ball, the more challenging the task is. Grade the activity to meet the kiddo’s needs and abilities as he/she progresses.


How to Play Wall Ball

Begin with the target approximately four feet apart at eye level on the wall. Start with a horizontal line progressing to vertical, and then diagonal.


The kiddo should be standing approximately 3 feet from the wall so that they can see both targets without having to turn their head. This part is important as we want to work only the eye muscles. If the child cannot see both targets without moving their head, adjust the distance of the targets first and then the position of the child as needed.


Increase the challenge by adding paired colored targets and calling out what pair to hit one at a time or in a sequence. As the kiddo’s saccadic patterns become better and smoother, the time needed to complete the task will be shorter.

This activity to improve visual saccades uses a word search to help kids with visual tracking skills.


Read Word Searches to work on Saccades 



Reading requires very precise and accurate eye movements. When these patterns and muscle movements are not natural, they have to be taught and can be a significant challenge for children with impaired saccadic movements.


The objective of Word Search Reading is to have the kiddo read the letters or symbols of the word search out loud without deviating from the line, or skipping a line once back at the beginning of the pattern.


Word Search Reading Directions:

Begin with a simple word search to establish the child’s abilities. A 4×4 line word search is usually a good place to start. As the child’s skills increase or this is too easy, increase the size of the word search. The larger the word search, the harder the child has to work to move their eyes in a smooth movement across the page and back to the next line.


Word search reading can be completed as a table top task, or a vertical surface. It is good to practice both skills as saccadic movements are needed in a variety of settings, not just for reading and writing.


Word Search Reading patterns can be left to right/top to bottom, or top to bottom/ left to right. There should be an emphasis on left to right patterns initially as this is the way that we read and write. As the child’s skills increase, patterns can be reversed right to left/top to bottom and top to bottom/right to left. The more patterns that the child’s eyes are exposed to, the easier fluid movements between any given set of points will become.


While I have listed very set patterns for this activity, it is important to remember that saccades is the fluid, coordinated movement of both eyes between ANY given set of points in ANY plane or position.


Modifications for Word Search Reading to Address Visual Tracking Needs



Word Search Reading activities can be very difficult and result in the kiddo being frustrated as it is making their eyes work in ways that they are not used to. However, there are a few modifications outside of the size of the word search that you can utilize to develop the just right challenge for each kiddo.


The first modification is blocking out lines they are not supposed to be looking at. A ruler or a sheet of paper is a great place to start with this modification. If this is still not enough support and they are skipping letters in the line or reversing letters, try having them track with their finger or a special “tracking tool” (pencil with topper, fun pen, etc.).


Here is a DIY Visual Tracking Tool that can be used as an exercise, too.


Sometimes, even utilizing a finger or tracking tool is not enough and there is still too much visual input and their eyes are trying to jump ahead. In this case, an index card with a slot cut to fit one to five letters at a time can help keep their eyes moving in a nice line.


While word searches are great, if you have a child that is struggling with letter recognition, this task can be completed with numbers or symbols. The main premise is that whatever items you use, are in a grid pattern.


Adjust the challenge and supports as the kiddo gets better at reading the letters in the given pattern to create the just right challenge.

Saccadic Eye Movement exercises

Below are some scanning exercises to work on visual saccadic eye movements.

letter popsicle stick scanning exercise for visual saccades

1. Letter Stick Scanning

Materials: Craft sticks, marker
How-to: Write random letters or numbers down a craft stick. Hold two sticks up and have the child call out each letter as they jump their eyes back and forth between sticks. You can also use colored dots or shapes to make this easier.
Goal: Promotes left-right eye jumping and visual accuracy.

wall sticker scanning exercise for visual saccades

2. Wall Sticker Walk

Materials: Stickers, index cards, masking tape, flashlight
How-to: Place one sticker on each index card. Tape the index cards to the wall. Use a flashlight to highlight a letter or word for the child to find. Have them “jump” their eyes from one target to the next while standing or walking between the cards.
Goal: Combines gross motor and eye movement coordination.

visual scanning pyramid exercise scanning exercise for visual saccades

3. Pyramid Saccade Challenge

Materials: Printed saccade pyramid (e.g., letter A to D, F to G, etc.)
How-to: Print a saccadic pyramid with non-linear letter patterns. Call out letter pairs and have the child find and track them quickly across the page.
Goal: Strengthens diagonal and complex saccade patterns.

masking tape scanning exercise for visual saccades

4. Visual Scanning Tape Lines

Materials: Masking tape, wall space, marker
How-to: Create two vertical tape lines on a wall with random letters spaced down each line. Call out letter pairs and have the child visually scan between them without moving their head. This is a larger version of the craft stick scanning activity mentioned above. You can also position the tape strips in different planes. Try putting one on a slight diagonal. Or place both in a horizontal line. Mix it up.
Goal: Encourages head stability and horizontal saccades.

letter ball toss scanning exercise for visual saccades

5. Letter Ball Toss

Materials: Ball, marker
How-to: Write letters or shapes on a ball. Toss it to the child and ask them to name two shapes or letters as their eyes land on them.
Goal: Engages saccades under dynamic, moving conditions.

word search scanning exercise for visual saccades

6.Word Search Scan

Materials: Word search page, pen
How-to: Circle random letters on a word search page. Ask the child to scan from circle to circle and name the letters.
Goal: Boosts scanning, attention, and accuracy.

dot art letter scanning exercise for visual saccades

9. Paint Dot Tracker

Materials: Dot art worksheet page, paint daubers or dot markers, pencil
How-to: On a dot art worksheet, use a pencil or pen to write in letters of the alphabet in random order. Kids must scan and name the alphabet letters in order as they jump from dot to dot to fill in the worksheet.
Goal: Adds a visual discrimination and color recognition element.

Emoji eye movements scanning exercise for visual saccades

10. Emoji Eye Movements

Materials: Printable eye emoji picture, mirror
How-to: Have the child copy different eye directions or mimic eye movements while watching themselves in a mirror.
Goal: Increases awareness of eye position and movement range.


Visual Saccades Activity: Timed Copying Tasks



One of the best activities to work on saccades is to complete table top activities. This simulates what kids do in school the best, and allows you to find where the breakdown is, and provide supports as needed.


Start with a small activity like a spelling list or site words on table next to the child and have them copy the words onto a piece of paper. Once they are able to do this in a reasonable amount of time increase the challenge to 3-4 words in sequence or short sentences, and then eventually a whole paragraph or short story. This set of activities is referred to as near point copying and is the foundation block for other copying tasks.


When they have mastered near point copying, it is time to move onto far point copying. This is when the items that are being copied are more than 18 inches from the child. Examples include copying from a SmartBoard or whiteboard, or off posters around the classroom. Eventually, this translates into taking notes in higher level education.


The same premise of starting small and building into larger tasks applies to far point copying as well. Utilize a timer to challenge the child to beat their best time and also to track progress. As they become stronger at looking between the two points without losing their spot, the faster the activity will go.



Visual Saccade Exercise: Speed Popsicle Sticks

Like Word Search Reading, this activity challenges the precise movements needed for efficient saccadic movements. Speed Popsicle Sticks is more exercise based then the other activities presented in this post and should be monitored for fatigue and strain like other exercise based activities. This activity is challenging and should be done with children who are able to follow directions and verbalize feelings of discomfort in their eye muscles.

The premise of this activity is to have the child look as quickly as they can between two points without losing focus or deviating from the path in a given amount of time. Popsicle sticks with stickers at the end of them work great at points to focus on.

1. Begin with the child sitting in front of you with their feet grounded.

2. Hold the popsicle sticks approximately 12-15 inches apart, and 15-18 inches away from the child’s face.

3. Then instruct them to look at first one sticker, bring it into focus, and look at the next sticker bringing it into focus before moving back to the first sticker.

Start with a short amount of time, such as 10 seconds to begin, and 2-3 repetitions with a break in between each repetition. Increase the amount of time to complete the activity as the kiddo’s eyes get stronger and they are not complaining of fatigue. Set a cap on time around 45 seconds for this exercise, and keep repetitions low.


Be sure that you listen to the child if they are complaining or are requesting a break. You do not want to cause eye fatigue or strain accidently.

Working on visual tracking skills? These visual saccades activities will help.


Games to Encourage Saccades

There are some great ready-made games on the market these days that challenge saccadic movements. Below is a list of a few of my favorites to utilize in therapy or for gift ideas for parents and home programs.

Amazon affiliate links are included in this list:

Frequently Asked Questions About Saccadic Eye Movements

Here are some of the most common questions that come up about visual saccades:

What is a visual saccade?
A saccade is a quick movement of the eyes that allows us to shift our gaze from one point to another. These precise eye movements are essential for reading, scanning, and daily tasks that require eye tracking and visual perception. Poor saccadic control can impact coordination, reading fluency, and attention.

What controls saccadic eye movements?
Saccadic movements are controlled by the visual system and areas of the brain responsible for motor planning and cognitive skills. Healthy saccades rely on the integration of proprioception, oculomotor skills, and central processing.

Can saccades be trained or improved?
Yes! Vision therapy guided by an eye care professional or vision therapist can strengthen saccadic movements. Training exercises improve accuracy of eye movements, hand-eye coordination, and overall visual perception.

 How do you treat saccadic eye movement problems?
Treatment may include a comprehensive approach using vision training, toys, and puzzles to target eye tracking. Activities like flashlight tag, reading grids, or even scanning games help retrain saccades with professional guidance.

What are saccadic and smooth pursuits exercises?
Saccadic exercises involve shifting the gaze quickly between two or more targets—like reading alternating letters or tracking flashing lights. Smooth pursuit exercises help eyes glide smoothly to follow a moving object. Together, they build strong oculomotor coordination and support academic and daily activities.

How to perform saccades at home?
Try holding two targets (like stickers or pencils) about 12 inches apart. Have your child move their eyes back and forth quickly without turning their head. Keep sessions short and fun, and include activities in their daily routine for consistency.

What causes poor saccadic eye movements?
Issues like delayed oculomotor development, concussion, or visual perception disorders can lead to poor control of tracking. Children with reading difficulties or attention issues may struggle with saccades, often needing professional evaluation and support.

What do saccadic eye movements indicate?
They reflect how well the brain and visual system are working together. Inaccurate or jerky saccades may signal challenges in coordination, attention, or underlying visual field concerns.

Are there recommended tools or toys to improve saccades?
Yes! Activities like flashlight tag, puzzles, and tracking games help. You can also use printables, reading strips, or worksheets that guide the eyes between targets. Some families benefit from apps or computer-based vision training programs.

How can I get more guidance on this topic?
Talk to a qualified vision therapist or eye care professional for individualized support. You can also sign up for our newsletter to get related resources, exclusive offers, and in-depth information on topics like saccades, smooth pursuits, and the future of eyewear.


Final Note on Activities to Improve Saccades

Practice, practice, practice! That is one of the biggest parts in helping a child develop motor patterns, and saccades are no different. With the just right challenge in place and encouragement, the kiddo’s saccadic patterns should become stronger and more fluid leading to increased success with visual tasks.

Looking for more information on vision deficits? Check out my OT Vision Screening Packet for useful handouts, checklists and a screener tool.


This visual screening tool was created by an occupational therapist and provides information on visual terms, frequently asked questions regarding visual problems, a variety of visual screening techniques, and other tools that therapists will find valuable in visual screenings. 
Click here to read more about the Visual Screening Packet.   This is a digital file. Upon purchase, you will be able to print the 10 page file and print off to use over and over again in vision screenings and in educating therapists, teachers, parents, and other child advocates or caregivers.  

More visual Processing Articles you will love: 

 
How do vision problems affect learning in kids and underlying visual processing problems that impact learning in kids. Saccades and learning, read more to find out what are saccades, how to screen for visual saccades, and what saccadic impairments look like. Visual processing, visual efficiency, and learning including how vision is related to reading and writing.
 
Wondering about convergence insufficiency? This article explains what is convergence insufficiency, the definition of convergence, how convergence is used in vision tasks like handwriting, reading, catching a ball, and learning as well as red flags for convergence and visual processing skills and screening tools for convergence insufficiency.  Use a visual screening tool like this occupational therapy screening tool to address visual processing skills like visual convergence and to guide visual convergence activities in therapy. These visual tracking games are a helpful tool in addressig visual tracking goals that kids may have interfering with handwriting, reading, and learning.
 
How Vision Problems Impact Learning
 
What are Saccades: Saccades and Learning
 
Visual Problems You Can Not “See”
 
What is Convergence Insufficiency?
 
Visual Screening Tool
 
Visual Tracking Games
 
 
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This article was written by The OT Toolbox Contributor, Kaylee:
 
 
A little about Kaylee: 
Hi Everyone! I am originally from Upstate N.Y., but now live in Texas, and am the Lead OTR in a pediatric clinic. I have a bachelors in Health Science from Syracuse University at Utica College, and a Masters in Occupational Therapy from Utica College. I have been working with children with special needs for 8 years, and practicing occupational therapy for 4 years. I practice primarily in a private clinic, but have experience with Medicaid and home health settings also. Feeding is a skill that I learned by default in my current position and have come to love and be knowledgeable in. Visual development and motor integration is another area of practice that I frequently address and see with my current population. Looking forward to sharing my knowledge with you all! ~Kaylee Goodrich, OTR


These activities to help with visual saccades are fun ways to work on visual tracking with kids.

Therapy for Picky Eaters

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food therapy for extremely picky eaters

In this blog post, we are covering therapy for picky eaters. Occupational therapists and speech therapy practitioners often cover extremely picky eating in therapy sessions, but how do they know where to begin with food therapy? Let’s cover specifically how to help extremely picky eaters, food for picky eaters, and therapy suggestions for extremely picky picky eating disorder.

Therapy for Picky Eaters

Fifty years ago, feeding therapy this would not have been a popular topic. Children ate what was provided, like it or not.  Sometimes parents would spare the child and leave the offending objects off of the plate. More often than not, children over the age of four were expected to eat what everyone else was eating.

Fast forward to 2022. There has been a huge rise in allergies, picky eaters, and problem feeders. How to help extremely picky eaters  has become the forefront of many occupational therapy sessions and referrals.

There has been a marked rise in food sensitivity (gluten intolerance, lactose intolerance) or allergies to certain foods.  This goes hand in hand with the rise of anxiety, illness, ADHD, autism, and poor immune response. 

Understanding Picky Eating in Young Children

Picky eating is a common concern among parents of picky eaters, especially during early childhood. It’s not unusual for a toddler to reject unfamiliar foods or stick to a very limited range of favorites. While many children outgrow picky eating, others may need additional support from professionals such as pediatricians or psychologists to ensure they’re receiving the right treatment and nutritional balance.

Picky Eater List

There is a difference between oral motor skills that impact feeding abilities and a child’s picky eating. Foods that make the “picky eater’s list” might include certain food texture issues, food mixtures, food sensory issues like crunchy foods, and even foods that require utensils. 

A short list of some foods that are not on the plate of extremely picky eaters might include:

  • Sandwiches
  • Rice
  • Chicken breast or other meats
  • Carrots
  • Cheese
  • Sauces
  • Vegetables
  • Fruits

Obviously this is a short list and any number of foods, food types can be on a picky eater list. Any other number of foods or food combinations

Looking at this list, you can see the limitations in nutrients, vitamins, proteins, and brain-building foods that are missing from the plate of an extremely picky eater.

It is not productive to get stuck in the “why is my child a picky eater”, but move forward to “what can I do about picky eating”.  I am not just an experienced feeding therapist, I too had two picky eaters who survived on 3-4 different foods in their second and third year of development.  

In order to help my daughters, I had to remove my thoughts impacting how I approached tackling that picky eater list for each child. That includes putting aside parenting/worry/anxiety/they’re starving persona, and put on my therapist hat.  I am happy to report they are thriving adults who eat a huge variety of foods!

 NOTE*The term, “learner” is used throughout this post for readability and inclusion. Not all picky eaters are children. This information is relevant for students, patients, clients, preschoolers, kids/children of all ages and stages or whomever could benefit from these resources. The term “they” is used instead of he/she to be inclusive.

When to Seek Support

If picky eating interferes with a child’s diet over an extended period or leads to issues like constipation or significant weight loss, it’s important to consult a pediatrician.

In some cases, psychologists can help address the sensory, behavioral, or emotional components of picky eating. These professionals may work alongside occupational therapists to explore strategies that support healthy eating habits in young children.

 How to help extremely picky eaters 

To learn how to help extremely picky eaters, it is important to define it first.  

Picky eating is different from problem feeding.  Often, but not always, extremely picky eating is actually a problem feeding disorder. This has recently been renamed Avoidant Restrictive Food Intake Disorder ARFID.  ARFID is not classified with eating disorders such as anorexia and bulimia, as persons with ARFID or problem feeding do not restrict their intake due to body image.

The term picky eating includes:

  • Selective eating habits
  • Eats 10-20 different foods (preferred foods)
  • Will often eat more if hungry
  • Not missing entire food groups
  • Can often be bribed or rewarded for good eating
  • Can be distracted into eating
  • Adds new foods to their diet

Problem feeding (extremely picky eating) refers to:

  • Refusal to eat
  • Rigid eating habits (no food touching, specific brand, same plate, cut a certain way)
  • Eats less than 10 different foods
  • Will starve before they eat unwanted foods
  • Missing entire food groups 
  • Behavioral reactions: gagging, vomiting, crying, anxiety, refusal to sit at the table
  • Increased sensitivity to the taste and/or texture of foods
  • No amount of rewards, bribing, punishing will magically make this go away
  • Does not recognize hunger
  • Food jags, will lose foods once eaten regularly

What is the difference between picky eating and problem feeding?                

The picky eater will survive.  They are likely to consume at least one meat, fruit, and vegetable and a bunch of carbs.  

Continue to put out expected foods on the plate and encourage tasting of new foods.  The problem feeder on the other hand, is not consuming enough calories, or getting the right nutrition.  

A person surviving on four foods often gets tired of one of them, eating only three foods now.  This is more of a dire situation and the treatment is complicated.

If you have a problem feeder, seek treatment from a therapist who is certified or has attended classes in feeding therapy.  There is a lot that can go wrong working with problem feeders.

The Sequential Oral Sensory course, Beckman Oral Motor Therapy, and Mealtime Miseries are popular courses. Having this information can help in identifying whether extremely picky eating is related to sensory or oral motor difficulties.

Therapy for Extremely Picky Eating

After viewing the list, if you feel the learner is more of a picky eater, there are several strategies that can help.

Following a feeding evaluation, feeding therapy can begin. Start a structured feeding problem including the following:

1. Feeding Therapy Interview

Interview the caregiver to determine the following:       

  • What foods the learner eats – a specific list will determine texture, variety, color, or patterns. Are all the foods crunchy? Are they all brown?
  • How many foods the learner eats – less than 10 is a problem, 10-15 is picky, and above 20 is average. Count two different cookies as two items, two cereals as two items.
  • Medical history – Is there a history of reflux, G-tube, or NG-tube, swallowing issues?
  • Time frame for eating – A typical meal should last 20-30 minutes for a child.
  • Where the learner eats – Does the learner eat at the table or in front of the television? Do they run around the room catching a bite here and there?
  • Behavioral reactions during meal times – Does the child flee the table? Turn their whole body away from the food, vomit, cry, refuse to open their mouth, gag, spit out food?

Record information from caregivers and look for clues to feeding issues, other than the exhibited behavior. The person may have a history of reflux that makes eating very uncomfortable.  They may have been verbally abused and shamed during mealtime, making eating an unpleasant experience. Perhaps the child has never had structure or routine during meal time, thus not making eating a priority. 

2. Planning for Feeding therapy

Start treatment planning                

Begin with the provided list of preferred foods to determine what foods to try first.  A Food Inventory Questionnaire can be used for this step.

If the learner eats: crackers, pancakes, waffles, bread, and dry cereal, they may have a preference for white/brown foods that are dry. Some are crunchy foods and some are soft foods, but all are dry. 

The next in order would be another dry brown food such as toast, bagel, cookie, or different type of cracker. 

Once the child tolerates more brown dry foods the next texture in the same color family would be a banana or plain macaroni. 

For the learner who eats only purees or smooth foods like pudding, yogurt, and baby food, the next step would be to try different flavors of yogurt or pudding. For a learner who only eats smooth foods, it is important not to vary the texture yet. After the child tolerates this texture, then a trial of applesauce may work.

Adding flavor choices and additional nutrients can be found in sauces or dips. While this can be a source of refusal for some kids, others prefer dips such as ketchup or ranch dressing.

Take a look at what the individual is gaining from these dips. Both can be high in sodium and that salt intake is preferred. Can you offer other foods to dip into the preferred choices?

Think about other similar options that may offer a similar sensory input through texture or taste:

  • butter for pasta rather than sauces
  • pizza sauce in place of ketchup

3. Feeding Therapy Treatment session              

Ask the learner or their caregiver to provide two favored foods and 2-3 non favored foods. Having preferred foods decreases anxiety as  the child is not presented with a plate of non favored foods.  

It is important for the learner/caregiver to provide the food.  Possible allergic reactions are diminished, as the caregiver is more aware of the learner’s diet. There may be cultural or dietary foods that the family prefers.

It doesn’t do any good for the therapist to work for weeks on waffles and applesauce, if the family does not offer these foods.

Food presentation – Present all foods on the plate in small portions, or a choice of two options with small bites of each. Avoid huge piles of non-preferred food, as it increases anxiety or sensory aversion.

Divided plates help ease anxiety, as do small portions. It can help to present the food as snacks, using a snack plate or small tea plate.

Food exploration- Start to encourage eating, or at least food exploration.  Have the learner look at the food, touch the food, touch it to their face, give a kiss, give a lick, take a bite, chew, and swallow. This resource on sensory touch can offer more information and strategies to support tactile exploration.

There are 27 steps to eating from being in the same room as the food, to chewing and swallowing it.  This makes learning to eat new foods challenging. 

Offer food options- Allow the child to touch foods or use their fingertips to pick up and eat or taste the foods. In some cases, muscles and coordination are not appropriate for utensil use, limiting options.

Read about suggestions to improve how to hold a spoon and fork.

Offer various food temperatures. Consider the sensory input offered by cooked carrots vs. raw carrots. 

Offer various food cuts. Consider the amount of force needed to bite baby carrots vs. shredded carrots.

Food Therapy Progression

Food therapy interventions are about progressing through with small incremental changes to food offerings with observation and food challenges. Some food therapy goal banks are included below.

Learner is able to:

  1. Be in the same room as the food, then in the same area as the food.
  2. Sit near the food, then in front of the food without turning away.
  3. Look at food, touch the non preferred item, smell the food.
  4. Touch  the food to face, then lips, then give it a kiss.
  5. Lick the food, take a bite and spit it out, chew the food with the option to take it out.

While presenting and working on the feeding portion, observe for signs of oral motor issues that might indicate oral motor development considerations.

  • Does the learner chew from side to side or munch up and down?
  • Do they have good lip closure?
  • Do they have an intense gag reflex?
  • Can they move the food around effectively?
  • Can they bite into the food?

4. Carryover of Therapy for Picky Eaters

The ultimate goal is to carryover skills achieved in therapy sessions into a functional environment. Discuss techniques with caregivers and encourage them to try the same foods later in the day.

Remind them to be calm and not emotional during feeding time. The goal is to have fun with food and find mealtime enjoyable.

For more information on how to help extremely picky eaters, I have also published a helpful resource book (Amazon affiliate link) Seeing your Home and Community with Sensory Eyes for to understand different environments that may be impacting the eating habits of your child/clients, including the cafeteria, kitchen, restaurants, and more.  

Feeding and toileting are two of the most frustrating, anxiety producing stages of childhood. Children start to exert their free will at this stage and can no longer be forced to do certain things.

Encourage parents, educate yourself on this topic, and spread the word, so problem feeding does not continue to rise along with other scary diagnoses. 

This post is part of a series on feeding disorders/picky eating. Other resources you will find helpful include:

Safety and Health Concerns

Parents should also be aware of the risk of choking, particularly if children avoid certain textures or refuse to chew foods properly. Offering bite-sized pieces and observing during meals is key to safety, especially when introducing new items into the rotation. Constipation can also become a problem for children with limited diets, making fiber and hydration critical areas to monitor.

Building Confidence at the Table

Support from parents of picky eaters is essential. Offer a consistent routine around mealtime, serve familiar and unfamiliar foods together, and avoid pressuring your child to eat. Sometimes the stress of focusing on the “next meal” can escalate picky eating behaviors. Patience and gentle encouragement go a long way in helping children gradually expand their food preferences.

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.

What is Convergence Insufficiency?

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As therapists, we often times see clients with vision needs that impact functional skills. Visual processing is a complex topic and convergence insufficiency is just one area. Read below to find out more about convergence in kids, to understand exactly what is convergence insufficiency, and how convergence plays into functional skills and learning.

**DISCLAIMER** I am not an optometrist, ophthalmologist or vision therapist. All information in this post is informational in nature only and should not be utilized in place of the appropriate professionals treatment and evaluations.

 
 
Convergence insufficiency is a vision problem that many kids experience when struggling with learning or reading. This article explains OTs role in vision problems and also what is convergence insufficiency, screening tools for convergence, how to identify convergence.

What is Convergence Insufficiency?

Vision is a hot topic among therapists these days. It’s a foundational skill that we often overlook, or don’t have a clue where to start even if we know that we need to address it. When our vision is impaired, so is our learning.

Need help addressing visual problems in the classroom? Here are classroom accommodations for visual impairments. 

Vision screenings done in the school nurses or pediatricians office only addresses acuity, resulting in other underlying vision concerns being missed.

These concerns can go unaddressed for long periods of time until the child has received remediation services, OT and other services to address the child’s deficits. By the time we realize that vision needs to be re-addressed the child is struggling and does not find academic work enjoyable.

Underlying vision concerns are often hard to detect, with convergence insufficiencies being one of the most common issues.

What is Convergence

Before we can talk about convergence insufficiencies, we need to address what typical, intact convergence patterns look like.  Simply put, convergence is our eyes ability to smoothly follow a moving target as a team, from a distance to a very near point, such as the tip of our nose.

Convergence is not only an active motor pattern, it is also a sustained motor pattern. Sustained convergence is utilized for the completion of near point work tasks. Intact convergence skills allow us to read, write, draw and catch a ball, and similar tasks with relative ease. When the system experiences difficulties, it can result in a convergence insufficiency.

Convergence insufficiency (CI) is an eye condition where the eyes have difficulty working together to focus on nearby objects. This can result in blurred or double vision, headaches, or eye strain—especially during near work like reading or using smartphone screens. In childhood, this condition may impact school performance and is sometimes mistaken for ADHD due to shared attention and visual symptoms.

Convergence Insufficiency

A convergence insufficiency is caused when the dynamic system of convergence/divergence is impaired or experiences stress. The impairment hinders the child’s ability to move their eyes in synchronized, coordinated, and smooth movements from a far point to a near point or near point to far point.

The ability to assume, and maintain sustained convergence patterns may also be significantly affected.

Causes of Convergence Insufficiency

Impairments to this system can stem from several different causes, with the most common reason being an eye muscle imbalance or weakness. Muscle imbalance and weakness can occur in one or both eyes. It is very dependent upon the child.

Other causes of a convergence insufficiency may be due to congenital neurological reasons, traumatic events, or other physical impairments that affect the eye. These are ​NOT​ the usual suspect for why a child experiences a convergence insufficiency and  should be ruled out by an optometrist or ophthalmologist if there is a reason to believe this is the case.

Contributing Factors

Convergence insufficiency may be linked to eye muscles not coordinating properly. In some cases, nerves sending the proper message to the muscles may be delayed, especially after illness, lack of sleep, or a brain injury. Constant exposure to smartphones, tablets, and digital devices can also strain the eyes. Tasks requiring focusing at different distances, like switching between a board and a notebook, can further challenge a child’s visual system.

Screening for a Convergence Insufficiency

The most recognizable form of a convergence insufficiency found during a vision screening, is when the child is unable to follow the tracking item to within one half inch of their nose. When this happens, the child’s eyes may appear to “bounce” or “snap” back to a midline position despite the child’s best effort to find the item. This can happen with one or both eyes, and it is important to note in your screening what happened. In more severe cases, the child is unable to move their eyes to follow the tracking item to their nose.

More commonly, the child may be able to complete the convergence/divergence patterns, but experiences headaches, complains about their eyes hurting or frequently rubs their eyes with sustained convergence activities such as reading and writing.

It is also important to note, if the child is unable to sustain convergence at the end of the convergence/divergence pattern screening for more than a few seconds. This can also be an indicator that the child has a convergence insufficiency. This is one of the hardest skill deficits to identify as it is very subtle and difficult to see at times. If you suspect a convergence insufficiency, look for other red flags to support your observations.

Diagnosing Convergence Insufficiency

A standard eye exam may not be enough to detect convergence insufficiency. Instead, specific testing performed by an eye doctor trained in binocular vision assessments is needed. This can include evaluating eye movements, testing convergence ability, and reviewing the history of the patient, especially after a concussion or brain injury. Diagnosis often involves identifying the symptoms of CI and determining whether there is a result of true convergence weakness.

Red Flags of Convergence Insufficiency

A convergence insufficiency is often hard to identify in screenings alone. Below are a list of skills that may be affected if a child is experiencing difficulties with convergence.

● Frequent headaches
● Rubbing of the eyes
● Covering one eye consistently
● Red or bloodshot eyes
● Distress with reading tasks
● Distress with near and far point copying tasks such as copying from the board
● Difficulty with catching a ball
● Use of a finger to track their place when reading
● Sleepiness or fatigue during near point work
● Motion sickness
● Blurred and/or double vision
● Words appearing to “jump” or “move” on the page

If the child is experiencing any of these signs, have their vision checked by an optometrist to rule out an eye muscle imbalance that may be causing a convergence insufficiency.

Symptoms of Convergence Insufficiency

Some of the most common symptoms of convergence insufficiency include eye fatigue, double vision (diplopia), headaches, and poor depth perception.

Children may demonstrate frequent mishaps, like tripping on uneven surfaces, frequent spilling, or a misjudgment of physical distances like missing stairs. They may also struggle with eye contact or seem to lose focus during tasks. In more rare cases, issues like vertigo and suppression of vision may occur.

Treatment of Convergence Insufficiency

Convergence insufficiencies are diagnosed by an optometrist or ophthalmologist. It is important to note that an OT cannot diagnose a convergence insufficiency. She/He can only report their observations and recommend follow up with the appropriate health care provider.

Upon seeing an optometrist, corrective lenses or vision therapy may be recommended based on the child’s needs. It is ​VERY​ important that the child wear his/her glasses and complete vision therapy if recommended as prolonged convergence insufficiencies can result in permanent eye strain and damage.

Once the child has received their corrective lenses, and if vision therapy has not been recommended, OT can help provide foundational skill remediation and exercises to promote the development of the child’s convergence skills.

One way to identify any convergence issues is with a screening tool like the Visual Screening Packet. This resource contains tools for occupational therapy practitioners to identify visual convergence challenges. The therapy provider can then offer activities and supports for any issues that are identified. The screening resource can then be used to assess improvements following therapy sessions.

Be on the lookout for my next post, ​Activities to Improve Convergence Skills​ to further fill your vision tool box. Also be sure to check out my OT Vision Screening Packet for useful forms and handouts to help you identify convergence insufficiencies and other vision concerns.

Treatment Options for Convergence Insufficiency

Convergence insufficiency treatment may involve active treatment methods such as pencil push-ups, computer programs, or in some passive treatment plans, prism glasses or prism lenses. In rare cases, surgery may be required, such as for intermittent exotropia.

However, most treatment is non-invasive and focuses on improving convergence ability over time. Getting enough sleep and reducing screen time can also support recovery. Therapy may be customized depending on whether the individual struggles with stationary objects, close object focus, or near work tasks.

Supporting Children with Convergence Insufficiency

When working with children in therapy or classroom settings, it’s important to recognize symptoms of CI and consider how they affect academic and physical performance. Poor posture, stumbles, and struggles with stairs may indicate visual difficulties.

Classroom accommodations, proper lighting, and breaks from screen time can reduce symptoms. Collaboration with caregivers and vision professionals ensures a comprehensive approach to care.

Occupational Therapy Vision Screening Tool

Occupational Therapists screen for visual problems in order to determine how they may impact functional tasks. Visual screening can occur in the classroom setting, in inpatient settings, in outpatient therapy, and in early intervention or home care.

This visual screening tool was created by an occupational therapist and provides information on visual terms, frequently asked questions regarding visual problems, a variety of visual screening techniques, and other tools that therapists will find valuable in visual screenings.

 
This is a digital file. Upon purchase, you will be able to access the 10 page file and print off to use over and over again in vision screenings and in educating therapists, teachers, parents, and other child advocates or caregivers.
 
 
 
 
 
 
Wondering about convergence insufficiency? This article explains what is convergence insufficiency, the definition of convergence, how convergence is used in vision tasks like handwriting, reading, catching a ball, and learning as well as red flags for convergence and visual processing skills and screening tools for convergence insufficiency.

Spaceman Writing Tool

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Spacing tool for spacing between words in handwriting

This spacing tool is an alien craft that kids can make and use as a spacing tool for handwriting. A spaceman writing tool is a powerful device to help kids with spacing in handwriting, specifically space between letters and words when writing. We’ve come up with a few different spacing tools in the past, and this space themed spacing tool helps kids better understand the concepts of spatial awareness for better legibility in written work.

Teaching proper letter spacing in handwriting doesn’t have to be boring—meet your new writing sidekick: the Spaceman Writing Tool! This fun, kid-made spaceman for writing helps children visually and physically separate words on the page. Whether you call it a word spacer tool, spaceman spacer, or star spacer handwriting tool, this simple craft stick Martian is a fun and effective way to improve spacing between words.

Perfect for occupational therapy for writing, classroom handwriting instruction, or home use, this DIY spacing tool for writing gives students a concrete visual cue to help keep their words from crowding together. It’s a space-themed handwriting exercise that brings structure, independence, and just the right amount of fun to writing practice.

This space martian spacing tool goes really well with our block light saber spacing tool!

Sometimes, a child’s handwriting doesn’t improve given time and practice in the classroom. You might see a child copying words or sentences and squishing all of the words and letters together in a long string. There might be no space or inconsistent spacing between letters and words. It can be frustrating for the child and their parent or teacher.

Spacing Tool

This spacing tool will help with spacing in handwriting in a fun way.  My second grader and I had fun creating this Space Martian Spacing Tool and using it to practice spacing between words.

Spacing tool for spatial awareness in handwriting, using a space theme

Spacing Tool for poor spacing in handwriting

  This post contains affiliate links.  

Poor spacing in handwriting can be a visual tracking problem.  It could be visual inattention or poor hand eye coordination.  Sometimes, spacing is just something that needs more practice and a visual prompt like this space alien can help.  

We’ve shared other versions of spacing tools to support these needs:

What Is a Spaceman Writing Tool?

The spaceman writing tool that we made is a small, craft-based object (like a decorated popsicle stick) used to teach word spacing in handwriting. It’s commonly used in classrooms and occupational therapy for writing sessions to give students a consistent way to mark space between words.

Benefits of Using a Word Spacer Tool

I love using a visual tool like this one for several reasons.

  • Encourages consistent spacing
  • Improves legibility
  • Builds independence
  • Supports spatial awareness (important in OT)
  • Engages young writers in a multisensory way
    Include how this tool supports distal finger exercises by giving physical feedback between words.

Try this easy DIY version is actually a spaceman spacer for writing…but the alien version!

Make a spacing tool with this space martian craft, and work on visual tracking, visual perceptual skills, and visual attention in handwriting.

Make a Spaceman Writing Tool

You can easily make this spacing tool with just a few materials:

  1. To make the spacing tool, ask students to use glue to add a small dot of glue to the back of the googly eye. What a great fine motor precision and eye-hand coordination job.

2. Next, stick the googly eye onto one end of the green craft stick.

3. Cut the letter C foam sticker in half. Glue each piece to the craft stick above the googly eye.

And that’s it! If you don’t have foam letter stickers, you could use small pieces of pipe cleaners or scraps of paper.

Here’s a video showing how to make this space alien spacing tool:

Work on spacing in handwriting with a spacing tool craft kids can make.

 Use this handwriting spacing tool between letters and words.  Encourage your child to move the spacer over between words.  Sometimes, just that visual cue is enough to help.  The physical act of moving the craft stick to space between words can provide enough input to a child that they become more aware of the need to space, and are able to carryover the skill without using the physical reminder for spacing.  

Visual Perception and spatial awareness in kids. What is Spatial awareness and why do kids have trouble with spacing between letters and words, reversing letters, and all things vision. Great tips here from an Occupational Therapist, including tips and tools to help kids with spacing in handwriting.

HANDWRITING SPACING TOOL

Another easy way to make a handwriting spacing tool involves materials you have around the home, like buttons. The main thing to address with a handwriting spacing tool is a spatial awareness and using a craft that kids can make adds meaning and motivation to work on spacing between letters and words.  

When kids learn to write, it can be difficult to work on all of the parts of handwriting.  There is holding the pencil, and using muscles to maintain a grasp while writing sentences. Then there is letter formation.  Putting it all together can be challenging.  

In Kindergarten, children really work on letter formation, and especially lower case letter formation. When you throw in the lines and spacing to writing, it can be a real frustration for a new writer!  That’s where using a fun spacing tool comes into play. It allows for appropriate spatial awareness in handwriting is accurately spacing letters within words and spacing words correctly within a sentence.      

For another spacing tool idea, try this easy (and inexpensive!) way to create a Spacing tool using buttons. This spacing tool can be used in handwriting tasks, as a tool for spacing between letters and words.  

Visual Perception and spatial awareness in kids. What is Spatial awareness and why do kids have trouble with spacing between letters and words, reversing letters, and all things vision. Great tips here from an Occupational Therapist, including tips and tools to help kids with spacing in handwriting.

How to make a spacing tool with buttons

Spacing between words and letters can be easy with this button spacing tool.  It’s easy to make and can be created using items you already have.  The cost of this activity should be very inexpensive, especially if you use items you already have.  

To make spacing tool you’ll need just a couple of items: (This post contains Amazon affiliate links.)

  • Craft stick
  • Glue
  • Buttons

We used a colored craft stick and brightly colored button that we received from www.craftprojectideas, but you could use any material you have in your home.  Have a bin of beads or crafting pom poms in your craft supplies?  Use beads instead of buttons. Other ideas include craft pom poms or pipe cleaners.

  1. First, glue one button to the end of a popsicle stick or even a pipe cleaner.  
  2. Let it dry.
  3. Then, use the spacing tool while your child is writing words and sentences.  Show them how to place the button spacing tool between words and sideways between letters. 

This post is part of our 31 Days of Occupational Therapy where I’m sharing tips and tools for many developmental areas using free or inexpensive materials.     For more spatial relations related to handwriting, check out our Visual Tracking activities. 

RELATED READ: Spatial Awareness Tips and Tools

Spacing tool with an alien craft.

   

Visit our Visual Motor Skills page for more ideas in all thing visual perception and kids!      

Occupational Therapy Tips for Teaching Spacing with a Hands-On Approach

In occupational therapy sessions, teaching proper spacing between words often involves visual cues, as well as other areas in a multisensory learning experience. We need to see motor planning, spatial awareness, and self-monitoring during written tasks.

The spaceman writing tool is an excellent way to incorporate proprioceptive feedback and tactile input into handwriting instruction. Here’s how to make it more hands-on:

1. Physically Move the Pencil with Intention

After completing a word, instruct the child to set their pencil down briefly, pick up the spaceman tool, and place it against the end of the word. This pause gives their body and brain time to reset before starting the next word.

Then, the child uses their dominant hand to hold the pencil and their non-dominant hand to hold the spacer in place, which promotes bilateral coordination and fine motor precision. As they slide the pencil to the other side of the spacer, they get a physical sense of space, which helps internalize how much room to leave between words.

2. Add a Cueing Routine

Teach a routine like “Write-Stop-Space-Slide-Write” to support sequencing and executive function during written tasks. These verbal prompts paired with physical actions help students self-monitor spacing over time.

3. Use Heavy Work and Movement Breaks

Incorporate heavy work before writing (e.g., wall push-ups, towel wringing, or chair pushes) to activate proprioceptive input and support postural stability, which improves writing control and precision.

4. Encourage Consistency Across Settings

Have students take their spaceman spacer tool between home and school (or OT sessions and class) as part of their self-regulation and academic routines. This builds confidence and consistency in their handwriting performance, especially for children working on functional school-based goals.

More Spacial Awareness Activities

Know a kiddo that loves all things space, astronauts, and planets? The Outer Space Fine Motor Kit is your chance to develop fine motor strength, dexterity, and coordination skills.

Addressing hand strength, endurance, and precision is out of this world fun! The Outer Space Fine Motor Kit includes:

  • Fine Motor Mazes
  • Fine Motor Ten Frames for motor activities
  • 1-20 Star Counting Cards
  • Bead Copying Strips
  • Space Alien Directed Drawing Sheets

This fine motor kit includes 24 pages of printable resources. Included in this printable pack are:

  1. Two pages of color coded bead copying strips
  2. Two pages of blank bead copying strips
  3. Four pages of “draw and write” directed drawing activities with a space theme (Includes 3 styles of handwriting lines: highlighted lines, single rule, and double rule)
  4. Nine pages of fine motor mazes
  5. 1-20 Outer Space Counting Cards
  6. Four pages of fine motor ten frames activities

These printable activities extend to work on a variety of other functional areas, too: handwriting skills, numbers, math, adding, subtracting, one-to-one correspondence, scissor skills, coloring, and more.

Click HERE to grab the Outer Space Fine Motor Mini-Kit.

Outer Space Fine Motor Kit
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.

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.

Child in therapy? Start Here

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Have a child in therapy? This resource for parents of kids in occupational therapy is a great starting point for OT resources parents need.

Understanding therapy for kids can be overwhelming for the parents. Now especially, with distancing requirements, hybrid learning, or teletherapy, occupational therapy services might look different than you expected. Let’s break down pediatric occupational therapy so your questions and concerns are answered and the overwhelm dissipates a little. If you have a need for some sort of child therapy, then you are in the right place.

Ok, so you’ve received a recommendation to have your child screened or evaluated by occupational therapy. So what next? What does that mean? When there is an apparent need to take your child to therapy, it can be helpful to know what to expect. You might have a lot of questions about getting started with your child in therapy. I want to create a space where your questions are answered when it comes to occupational therapy. So, sit back, relax, and read on…

Have a child in therapy? This resource for parents of kids in occupational therapy is a great starting point for OT resources parents need.

What is occupational therapy?

Occupational therapy is a service that helps people achieve function and independence in the things that are important to them…in the things that occupy one’s day. OTs do this by offering adaptations, modifications, and by addressing underlying factors that impact independence.

Let’s take it a step further; Think about what you do in a single day: getting out of bed, brushing your teeth, getting dressed, making the bed, making and eating breakfast, getting out the door on time and with everything you need for the day, doing your job at work and everything that entails, driving, shopping for groceries, setting the table, balancing your checkbook. This list could go on and on and on!

All of these skills are your daily occupations, or things that occupational therapists can help one accomplish so they are as independent and functional as possible. But there’s more to it than just the daily tasks. There’s also the ability to physically accomplish these jobs. There’s the ability to staying focused on the task at hand, prioritize what’s important, and to stay organized. There’s safety and higher level thinking involved. There’s tolerance to one’s senses and the world around you. There’s balance, vision, coordination, and endurance involved. Essentially, every system in your body needs to be working optimally so that you can be as functional as possible during each and every task that you accomplish during the day.

Kids in therapy can accomplish so much! Occupational therapy works on all of these things!

Occupational therapy is the climb quote.

What do occupational therapists work on with kids?

Occupational therapists can work on many different things with kids.

Occupational Therapy In Schools:

  • Any need that impacts education or learning
  • Fine motor skills
  • Cutting with scissors
  • Handwriting
  • Assistive technology to improve education or learning
  • Managing containers in the lunch room
  • Keyboarding or typing as an accommodation to learning
  • Sensory needs that impact education
  • Staying organized
  • Cognitive processing
  • Attention
  • Visual processing
  • Executive functioning
  • Motor abilities
  • Self-regulation
  • Participation in the classroom

Occupational therapy In the Home or Outpatient Settings:

  • Play
  • Self-care skills- getting dressed, grooming, bathing, caring for oneself and the tasks associated with self-care
  • Leisure activities
  • Sleep
  • Toileting and potty training
  • Safety in the community
  • Feeding and oral motor skills
  • Addressing food texture issues or picky eating
  • Sensory processing
  • Self-regulation
  • Emotional-regulation
  • Social participation
  • Executive functioning skills- organization, attention, working memory, planning, prioritization, impulse control, and other skills
  • Fine and gross motor skills
  • Eye-hand coordination
  • Balance and gross motor coordination

Occupational therapy can also work with children in early intervention or birth though 3 years of age on development of skills. This can occur as a result of a disability or difficulty in developing certain skills. Still other aspects of care can be related to autism, sensory integration needs, mental health, and specific diagnoses.

Who Needs occupational therapy?

The above lists might help explain the question of who OTs service, but it can be helpful to have a list of those who benefit from occupational therapy. This diagnosis list should give you a starting point, but know that OT works with anyone struggling to achieve functional skills or independence in an aspect of any task! This page is referring to pediatric occupational therapy interventions.

  • Autism Spectrum, Asperger’s syndrome
  • Sensory processing disorders
  • Auditory processing disorders
  • Visual processing impairments
  • PANDAs
  • Birth injuries or birth defects
  • ADHD/ADD
  • Behavioral or mental health impairments
  • Visually impaired
  • Traumatic injuries to the brain or spinal cord
  • Traumatic injuries to the body- amputation’s, etc.
  • Learning disabilities or learning problems
  • Developmental delays
  • Brachial plexus injuries
  • Down Syndrome
  • Rett’s Syndrome
  • Spina Bifida
  • Cerebral palsy
  • Childhood stroke
  • Pediatric rheumatoid arthritis
  • Cognitive disorders
  • Broken bones, injuries, surgical impairments, or other orthopedic injuries
  • Post-surgical impairments or conditions
  • Motor or coordination impairments
  • MUCH, much more!

How does occupational therapy work?

When it comes to occupational therapy, one thing is for certain. There are no two treatment plans that are alike. That’s because OT is so specialized! What is important for one child may be goals for them in occupational therapy while another child with similar needs will have completely different goals to address.

Parents can work closely with occupational therapists and occupational therapy assistants to implement strategies and home programs in the home.

Identifying specific needs and progress toward goals requires contact between parents, caregivers, and the occupational therapist professional.

Many times, OTs work with the family as a whole to address challenges faced by the family of a child with needs.

In most states, occupational therapists require a doctor’s order in order to administer evaluation and intervention services. In the schools, typically, the child’s educational recommends a need for occupational therapy evaluation.

How will my child receive teletherapy?

If your child has received occupational therapy services in the past, you might be wondering how teletherapy works. Or, maybe your child is new to therapy and the thought of having a child in therapy via a computer screen seems impossible. You have valid concerns! Occupational therapy is very much centered on hands-on interaction with the therapist who strives to help your child build skills and accommodate for adjustments needed in positioning, motor skills, etc. and that service is very much an in-person skilled service.

Ask any occupational therapist and they will say they WANT to be face-to-face with your child, physically playing with your sweet kiddo, and interactiving in a hands-on ways.

However, occupational therapists are skilled at problem solving, adjusting to needs and the environment, and pivoting on a dime. OTs have got the requirements of social distancing as a result of a global pandemic in the bag!

Therapists are excelling at providing fun, engaging, and skill-building services through digital, virtual therapy, and through motivating and encouraging hybrid versions of therapy that needs to be done during these strange times.

Teletherapy is just one more hat that occupational therapists have had to wear and they are excelling at it! Here is more information on teletherapy and what it looks like.

How to Explain Occupational Therapy to a Child

Starting occupational therapy (OT) can feel like a big unknown, not only for kids, but for parents, too. One of the first questions many families have is: How do I explain occupational therapy to my child in a way that makes sense, and doesn’t feel scary? If you’re wondering where to begin, you’re not alone.

Occupational therapy for kids is all about helping them do the things they need and want to do in daily life, from brushing teeth to holding a pencil, from joining recess games with peers to managing big emotions. OT helps kids build the skills they need for success in daily activities, school tasks, and social participation.

Here’s how to explain it in kid-friendly terms:

“Your OT helps you get better at things that are tricky for you. They do this through games, crafts, obstacle courses, and sometimes even using swings or tools that make your muscles stronger. It’s kind of like having a helper-coach who makes hard things easier, and a lot of fun, too!”

What Is Occupational Therapy for Kids?

When parents ask “What is OT for kids?” the short answer is: OT helps children become more independent in their daily activities, also called activities of daily living (ADLs). These may include getting dressed, using utensils, writing at school, or following instructions in a classroom.

Children might see an occupational therapist if they struggle with:

  • Sensory overload in busy environments
  • Trouble with fine motor skills (like holding a pencil or tying shoes)
  • Delays in gross motor skills, like balance and coordination
  • Difficulties with social skills, emotional regulation, or attention
  • Using adaptive equipment or tools that support independence

In a typical OT session, your child might climb through an obstacle course, squeeze putty to build hand strength, or practice zipping their coat. An OT session is often play-based, but every part is working toward a goal outlined in your child’s treatment plan.

What Does an Occupational Therapist Do for a Child?

An occupational therapist (or OTD, if they hold a doctorate) helps children with different needs improve their ability to participate in their daily lives. OTs evaluate how your child plays, learns, moves, and connects with others, and then create a plan to support skill development across those areas.

Here are some things an OT might help with:

  • Using utensils at lunch
  • Putting on socks or managing fasteners
  • Writing neatly and following classroom instructions
  • Playing with peers and navigating social interactions
  • Managing textures, sensory input, or emotions

An OT may work in different settings, like a school environment, home, or OT clinic, and may collaborate with other providers like physical therapists, teachers, and speech-language pathologists to support your child’s quality of life.

What Should Parents Expect from OT for Their Child?

Parents play a huge role in the success of OT for kids. Whether your child receives OT services at school or in a clinic, you can expect collaboration, check-ins, and ideas to carry over into home routines.

Here’s what to expect:

  • A treatment plan based on your child’s strengths and challenges
  • A blend of structured tasks and play-based activities
  • Support for tasks like getting dressed, focusing during class, or calming down after a meltdown
  • Strategies for siblings, family routines, or school tasks

You may notice changes in your child’s confidence, independence, and even how they interact with siblings or new people. OT is designed to support the whole child, emotionally, socially, and physically.

How to Help Your Child Feel Comfortable with OT

Starting something new can cause anxiety for some children, especially if they’ve struggled in other settings. Here are some ways to ease that transition:

  • Explain OT in positive, simple terms: “It’s a place where you get to work on things you want to be better at, with fun games and friendly helpers.”
  • Practice visiting the OT clinic or look at photos of what it looks like
  • Role-play the first session so your child knows what to expect
  • Involve siblings or peers in supportive conversations
  • Let your child bring a comfort item if they feel nervous (like a fidget or stuffed animal)

OT Is a Team Effort

Every child deserves support that meets their unique needs, and that’s what occupational therapy for kids is all about. Whether your child is working on handwriting, managing emotions, or tolerating textures, OT helps build a foundation that supports success across their day.

If you’re starting this journey, know that collaboration between your family, the OT, teachers, and the school team will be key. And most importantly, OT is often a place where your child will feel seen, supported, and celebrated, while having a lot of fun along the way.

Frequently Asked Questions About Explaining Occupational Therapy to Kids

What is occupational therapy in simple terms?
Occupational therapy helps people do everyday things more easily. For kids, that might mean learning to hold a pencil, get dressed, follow directions, or feel calmer in busy places. OT helps children build skills so they can succeed at home, school, and play.

What is the best way to explain occupational therapy?
You can tell your child, “An occupational therapist helps you get better at things that are tricky, like using scissors, sitting still, or making friends. They do it with fun games and tools that help your body and brain work together.”

What is the definition of occupational therapy for kids?
Occupational therapy for kids is a health service that supports children’s development by improving how they move, think, feel, and take part in daily life. It addresses everything from fine motor skills to emotional regulation, attention, and independence.

How do you explain therapy to a child?
Try saying, “Therapy is a special time where someone helps you practice things that are hard. You’ll play games and do fun activities that make your muscles stronger, your thinking faster, and your feelings easier to handle.”

How do you describe occupational therapy to a child?
Say something like, “Your OT helps you learn new skills through play, art, movement, and fun tools. They’re like a coach who helps your body and brain work better together.”

What are age-appropriate ways to explain the evaluation process to kids?
You can say, “We’re going to meet someone who will play games and do fun activities with you to see what you’re really good at and what might be a little tricky. They want to learn how to help you feel stronger, calmer, and more confident.” For older kids, add: “It’s like a check-up for how your body and brain are working together.”

How do I prepare my child for OT?
Talk positively about the experience. Explain that OT is a fun and helpful place where they get to move, play, and try new things. You might say, “You’ll meet someone kind who helps kids practice things like getting dressed, using their hands, or staying focused.” Let them know you’ll be nearby and that it’s a safe, supportive space.

How to explain OT to a 4-year-old?
Use very simple language: “We’re going to see someone who helps kids get better at things like using their hands, staying calm, and having fun doing crafts or games.” Emphasize play and familiarity: “They have swings, toys, and games to help you grow strong and smart.”

How to explain therapy to a child?
Therapy helps your body and brain learn new things. Say, “Therapy is where you go to practice stuff that’s hard for you, like using scissors or tying your shoes. You’ll play, move, and do fun activities that help make those things easier.”

What does therapy mean for kids?
Therapy is a way to help kids feel better, learn new skills, and handle things that might feel hard. It might involve movement, games, crafts, or practicing everyday routines with a helper.

What is therapy in simple terms?
Therapy is when someone helps you get better at something. For kids, it often looks like playtime with a purpose, building strength, focus, or emotional skills in a fun and safe way.

How to explain treatment to a child?
You can say, “Treatment is something we do to help your body or brain feel stronger or work better. It might mean playing games, using cool tools, or learning ways to stay calm or move more easily.”

What is the main purpose of occupational therapy?
The main goal of occupational therapy is to help kids become more independent and successful in their daily lives. That means building the skills they need for school, home, play, and relationships, all while supporting their development in a personalized and engaging way.

Resources for parents of a child in therapy

Your child’s occupational therapist will be the biggest advocate on your child’s team. Use them as a resource! However, I wanted to offer resources here as well. These are great places to start when it comes to discovering tools, strategies, and specific activities that can help your child. I’ve had many parents of kids receiving therapy tell me that they’ve passed information and resources from this site onto their therapists. I’ve also had many therapists tell me that they’ve found this site because of a parent’s recommendation or request to work on specific areas of need. This is your starting space to find the resources and tools that will best serve your child.

Occupational Therapy Home Programs– START HERE for activities to work on occupational therapy goals or specific skills at home, so kids can do the very activities that your child’s OT might suggest to supplement or support therapy services.

Executive Function Resources for Parents

Executive Functioning Resources– START HERE for resources, activities, and strategies to address attention, impulse control, planning, prioritization, organization, problem solving, and other brain-related challenges that impact learning and accomplishing chores or daily tasks at home.

Fine Motor Resources for parents

Fine Motor Skills– START HERE for specific activities designed to help kids develop stronger hands so they can manipulate toys and clothing fasteners…or have enough endurance to color a picture without complaining their hands are tired…or have strong fingers that can hold the pencil so they can write neatly and so you can read their handwriting.

Occupations of Kids…resources for Parents to Help Kids Become More Independent

Occupations– START HERE to help your child build independence in their daily tasks like getting themselves dressed, tying their shoes, learning to type, potty training, staying safe in the community, and all of the exact ways that parents want their children to grow and learn.

Handwriting– START HERE to understand what’s going on behind sloppy handwriting. You’ll find resources and specific strategies to help kids write on the lines, space between words, form letters accurately, learn cursive writing, so they can write independency and so you and others can read their writing.

Sensory Resources for parents

Sensory– START HERE to help your child manage their behaviors, emotions, and all things “sensory”. OTs help kids tolerate and accommodate for sensory input like that scratchy tag on their clothes or their hatred for the sock seam on their feet. They can help kids with the tools they need for picky eating, specific sounds, or other sensory issues. Therapists can help you create a sensory diet that works and that kids actually want to do. There is so much to sensory and you can find activities and tools to help.

Vision– START HERE for information on what’s going on behind trouble with reading, coordination troubles, or even math. Did you know that vision is related to all of these things? It’s true! Here, you’ll find your way on how to help your child with visual perceptual skills, visual motor skills, eye-hand coordination, and even motor planning! Wondering what these words even mean and how they relate to your kiddo? We’ve got you covered!

A final note to parents of a child in therapy

There is a lot to consider when it comes to occupational therapy for your child. One thing is for certain, though: in occupational therapy, dreams and that far-reaching goal does become possible. Whether it’s getting your child to follow morning routines, banishing picky eating, or helping your kiddo to regulate their emotions, occupational therapy can help.

Occupational therapists use play, activities, and strategies that address underlying areas so that your child can accomplish the goals they have for themselves, too. From learning to ride a bike, learning cartwheels, or mastering climbing that tree.

One thing is for certain; having a child in therapy that is led by an occupational therapist will lead to organizing, motivating, and fun play that drives independence in your child!

Be sure to reach out to your child’s occupational therapist with specific questions!

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.

Middle School Occupational Therapy

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middle school occupational therapy

Occupational therapy in middle school can bring about a lot of questions. When is OT appropriate for middle school students? What should OT focus on in middle school? And how can occupational therapy services support transition to middle school and further levels of education? This post will explore the tricky transition from elementary to middle school occupational therapy. We’ve previously covered occupational therapy for teens, but this article goes deeper into the middle school years.

Occupational therapy in middle school

Prior to the middle school years, occupational therapy in schools is pretty straight forward. In the younger grades, school based OT practitioners go into the school setting armed with playdough, scissors, pencils, crayons, glue, fidgets, and a few games/puzzles. 

What about the middle school occupational therapy population? These teenagers are not motivated by crayons, Candyland, letter formation exercises, or cut and paste activities.  Nor should they be. 

Unless your middle school caseload is in a self contained classroom functioning at a preschool level, these games and activities are not appropriate or practical.

One thing that comes up a lot at the middle school age is that we might need to use our creative thinking cap as OT practitioners. There might be a little push back from the middle school student. They think they are too old for the therapy session, especially if they had OT in primary school. You can find some strategies and our experience in supporting middle schoolers and tips for how to engage a resistant child in therapy.

Middle School Occupational Therapy 

Many therapists assist with transitions for children as their caseload moves from a direct to indirect, or consultative therapy model at this time, especially if they have been working with a particular student for several years.

Why? There are several valid reasons for doing so.  According to APEX occupational therapy, the primary reasons for transitioning to a consultative model are:

  • Teenagers are self conscious and do not care for a therapist coming into their general education classroom to sit by them, observe, or ask questions
  • Middle school schedules are busy.  Pulling a student for individual therapy weekly means they are missing valuable learning time
  • Handwriting habits are set and unlikely to change at this age.  Pencil grasp and letter formation skills are often formed by the age of eight, making adjustments in middle school difficult
  • Visual perceptual skills are often developed by age 11
  • Students do not want adaptations that make them stand out from their peers. They will resist noise cancellation headphones, a scribe for written notes, alternative seating, weighted items, or noticeable fidgets
  • Executive function – many middle schools already incorporate these skills into their program through schedules, planners, online classrooms, and reminders
  • Students at this age are most likely using technology to do much of their school work by this point, or accommodations have been made in their IEP already
  • Students have often been receiving services since early elementary school.  Changes are less likely to happen at this stage, if they have not already

Middle school occupational therapy is not a one size fits all model

There are several reasons to keep a student on a direct therapy service model during middle school:

  • Self contained students work at a different pace than their mainstreamed counterparts. They may continue to need more intervention
  • Lower level learners will need to be transitioning to a life skills or self help model, if they have not already. This means new objectives and goals to address
  • Middle schoolers are a different breed of people. There are new social expectations, hormonal changes, levels of independence, and increased demands for self help skills
  • It may take time to educate families and caregivers about this change in service model, and expectations. Automatically moving everyone to an indirect model, or discharging them, may be too abrupt for anxious parents or overwhelmed teachers

Barrier of Participation in therapy

One thing to consider in the role of occupational therapy in the middle school setting is the barrier of participation that occurs during the middle school years.

During school-based therapy in the younger school settings (early intervention, primary school years, elementary school years), students enjoy occupational therapy sessions. They are fun and exciting. Kids typically love to participate in therapy during these years.

In the middle school years, the school-based OT can start to see a barrier to participation that impact therapy sessions.

Barriers to participation in middle school occupational therapy can vary depending on individual circumstances and individual needs. These barriers can impact the middle school student’s goal achievement.

Specifically, middle schoolers may experience a social barrier to using the tools OT practitioners promote to support their needs.

The student might experience a social stigma and cultural barriers. surrounding their peers and the middle school culture. They may not want to participate in therapy sessions and this can impact the use of therapeutic supports.

Another barrier to participation in the middle school setting may be the issue of time constraints and scheduling conflicts. Middle school students participate in a full schedule, busy hallways, academic and activity commitments, and other responsibilities can make it challenging for students to participate in therapy sessions.

The Role of the middle school occupational therapist

Seruya and Ellen write about the Role of the Middle School Occupational Therapist.  They highlight several important factors or strategies to intervention.

  • Involve your learner in decision making about goals and objectives. These will be more meaningful and motivating to your students
  • Transition away from typical handwriting goals to more functional goals
  • Teach typing and word processing using a typing program
  • Provide adaptations if your learner is not able to complete work in an effective manner. A scribe to write notes for them, word processing versus written documentation, lessen the workload if writing is too labor intensive, preferential seating to improve attention
  • Address any lingering or new sensory concerns.  Provide adaptation for these with preferential seating, alternative seating, gum or fidgets for self regulation, ear plugs to reduce incoming sounds, and organizational tools
  • Address important life skills – learners need to know their emergency contact information, effectively groom themselves, take care of feminine hygiene issues, advocate for themselves, and follow a schedule
  • Some interventions may require private therapy to be more appropriate such as meal preparation, laundry, ordering from a menu, shopping, budgeting, or filling out an application. These would be appropriate goals for students in a self contained classroom
  • Incorporating brain breaks into a natural and functional movement needs. We talk about this more in our article on middle school brain breaks.

Some additional ways that occupational therapy can support students in grades 6, 7, and 8 include:

  • Working on organization, particularly when it comes to using different books, folders, and materials for each class
  • Managing a schedule with classroom changes, including hallway navigation and reading the schedule as well as sensory needs in a busy hallway
  • Lunch considerations-making meal selections, using money to purchase various meal options, and other mealtime considerations
  • Locker use including use of a combination lock, locker organization for obtaining needed materials for different times of day
  • Self-care including clothing management for gym class or swimming
  • Educate middle school teachers, parents, and other caregivers may not understand the role of the occupational therapist in middle school.  It may be time for a little education on the services provided and the therapeutic model. 
  • Empathy – reducing therapy minutes may feel like the student is not going to improve, or they are being given up on.  It is tough for parents to imagine their learner may never write a sentence, read independently, or live alone.  This is the time to gently begin this conversation.
  • Tool use including: rulers, protractors, calculators, graph paper, three ring binders, smaller desks, etc.
  • Social awareness and behavioral challenges as a result of sensory, self-regulation, or emotional needs
  • Changes in schedules, including bell ringing between classes, navigating between classrooms, short or lack of recess times, larger cafeteria, assemblies, etc.
  • Supporting sensory needs in the cafeteria due to the larger sized room and more students in the area
  • Collaborate with middle school teachers- work with educators and families to determine what are appropriate ADLs or functional goals and needs in the classroom, and how they can be addressed
  • Communicate with family of middle school students on appropriate occupational therapy goals and interventions.
  • Motivate middle school students- There may be a need for direct therapy intervention. Keep your students motivated with relevant and important treatment activities. 
  • Life skills in middle school occupational therapy- This may be the time to address life skills, depending on the needs of the student.  The OT Toolbox has a series of life skills posts including cooking, laundry, filling out forms, and social stories.
  • Keep goals and objectives focused on relevant and functional skills.
  • Educate staff and caregivers about the role of the OT in schools.
  • Provide resources, and make adaptations to the educational environment to help students better access their curriculum. 

Still working on handwriting in middle school occupational therapy?

There are times when therapists are called to continue to address handwriting in their middle school population.  Intervention needs to be functional, beyond basic letter formation. One tool is to use these middle school journal prompts to target handwriting skills, executive functioning skills, social emotional skills, and more.

Miss Jamie, a school based OT, has written a post about Addressing Handwriting in Middle Schoolers.  She has gone so far as to write a second post here.   One goal may be; this student will be able to independently write identifying information (name, address, phone number) without a model with 80% legibility. 

Or;  the student will be able to write or access information to fill out a form independently.  In The Member’s Club, we have several form practicing pages to work on the life skill of filling out forms.

Middle School Occupational Therapy Activities that Build Skills & Confidence

Middle school brings a whirlwind of changes: more complex academics, shifting social groups, growing independence, and rising expectations. Occupational therapy in middle school plays an essential role in helping students successfully navigate these challenges. OT supports students through both direct services and consultation with teachers, staff, and families. These middle school occupational therapy activities are designed to help students with disabilities, including autism, ADHD, and other learning differences stay engaged in daily activities and grow their independence.

As part of special education, OT is considered a related service, meaning it supports the educational goals identified by the IEP team. 

The role of OT at this level also often includes collaboration with other professionals, including occupational therapy assistants, teachers, and school counselors. Whether supporting mental health, developing organizational skills, or promoting social participation, the school OT helps students succeed in both academics and life skills. These strategies and recommendations are tailored to each student’s unique needs, goals, and disability profile.

Middle School OT Goals

These middle school OT goals target key areas often addressed in school-based services and can be adjusted depending on the student’s level of support. They’re designed to align with IEP objectives, classroom expectations, and real-world success.

Executive Functioning & Organizational Skills for Middle School OT

  • Student will use a planner to record assignments with 90% accuracy across 3 consecutive weeks.
  • Student will organize materials for each subject using a color-coded system or binder labels with visual prompts.
  • Student will initiate class routines (like unpacking, turning in homework) with fewer than 2 verbal cues per day.

These skills are especially important for students with ADHD or executive function challenges, and are often addressed through both direct and consultation-based OT services.

Self-Regulation & Mental Health for Middle School OT

  • Student will use a self-selected coping tool during transitions to remain calm in 4 out of 5 observed opportunities.
  • Student will identify emotional triggers and demonstrate appropriate regulation strategies in the classroom.
  • Student will participate in a sensory strategy routine to support emotional regulation and reduce stress during work tasks.

Many students with autism, sensory differences, or mental health challenges benefit from personalized routines that support their self-awareness and self-control in the school setting.

Fine Motor Skills, Writing & Daily Activities for Middle School OT

  • Student will demonstrate correct pencil grasp and maintain legibility during a 10-minute writing task.
  • Student will complete scissor-based assignments (cutting, folding) with accuracy in 3 out of 4 trials.
  • Student will complete locker organization or classroom prep tasks using checklists or visual cues.

Fine motor skill development directly supports academics, note-taking, and participation in school-based routines.

Visual Motor & Sensory Processing

  • Student will accurately complete copying tasks from the board or screen using appropriate spacing and alignment.
  • Student will participate in visual perceptual games or strategies to improve attention to detail in worksheets and tests.
  • Student will recognize sensory overload and use pre-taught calming strategies to re-engage in classwork.

These modifications often support visual processing, spatial awareness, and focus, especially important for students with sensory processing differences or visual stress.

Social Participation & Life Skills for Middle School OT

  • Student will participate in 1:1 or group-based activities to build peer interaction and conversation skills.
  • Student will follow social problem-solving steps with visual prompts during role-play or real scenarios.
  • Student will demonstrate responsibility for personal belongings (e.g., backpack, lunchbox, planner) with 80% independence.

These school OT goals promote confidence, peer connection, and independence—all crucial for the middle school years and beyond.

Frequently Asked Questions about Occupational Therapy in Middle School

Next, let’s cover some of the FAQ about occupational therapy in middle school.

What is the role of occupational therapy in middle school?

In middle school, occupational therapy (OT) supports students as they navigate increased academic demands, growing independence, and complex social expectations. 

The role of OT includes helping students participate in daily routines, improve organizational skills, develop executive functioning, and support emotional regulation. OT can address challenges related to handwriting, sensory needs, transitions between classes, or even managing materials like lockers and binders. Services may be delivered through direct OT sessions, consultation, or a collaborative approach with teachers and other school professionals.

Why would a child need occupational therapy in school?

A student may need occupational therapy in school if difficulties in areas like fine motor skills, attention, self-regulation, or sensory processing interfere with their ability to access the curriculum or participate in school routines. 

Students with autism, ADHD, or other disabilities may benefit from OT support. The IEP team, which includes special education staff and related service providers, determines eligibility and appropriate OT services based on the student’s educational needs—not just their diagnosis.

How do I move from 1:1 OT to a consultation model for middle school students?

Transitioning from 1:1 OT to a consultation model is common in middle school. This shift reflects the student’s growing independence and the increased need for support in natural classroom settings. To make this change:

  • Start by reviewing IEP goals and assessing progress.
  • Collaborate with the IEP team to determine readiness for consultation.
  • Set up a plan to fade direct services while increasing teacher support and classroom strategies.
  • Provide visual supports, checklists, and recommendations the student can use across their day.
    This model emphasizes real-time problem-solving, supports carryover of strategies, and encourages student self-advocacy.

What does an OT consult on with middle school teachers?

An OT consultation with middle school teachers might include:

  • Strategies for improving executive functioning (e.g., managing binders, using planners)
  • Classroom modifications for students with sensory processing needs
  • Tools to support handwriting and note-taking
  • Promoting self-regulation with movement breaks, sensory strategies, or calming routines
  • Helping students navigate transitions, such as changing classes or participating in group projects
  • Addressing mental health concerns with structured supports that build confidence
    Consultation ensures that strategies are integrated across classes and aligned with student goals.

How can OT help with self-regulation in middle school students?

Middle schoolers experience an explosion of emotional, cognitive, and physical changes, which can challenge self-regulation. 

Occupational therapy can support students by teaching sensory strategies, creating regulation toolkits, building awareness of emotions, and integrating movement or sensory activities into the day. 

OTs may also provide visual supports or check-in systems that help students recognize and respond to their internal states. This is especially helpful for students with ADHD, autism, or mental health diagnoses.

How does OT help with transition services in middle school settings?

OT plays an important role in transition planning, especially in the middle school years, when students begin preparing for high school and future independence. OT support may focus on:

  • Building daily living skills (e.g., organizing materials, self-advocacy)
  • Teaching self-determination and participation in IEP meetings
  • Supporting the development of routines at school and home
  • Collaborating with transition coordinators, special education teams, and related service providers
    By addressing barriers early, OT helps students build the foundational skills they’ll need for success in high school and beyond.

transition from elementary to middle school

Students that attend occupational therapy services in the elementary grades may move on through their school career with a continued need for occupational therapy support.

What can you do to help this transition to middle school occupational therapy? This article on AOTA covers transitions to middle school and includes ideas for groups in the middle school transition period.

Ideas include:

  • Consulting with various teachers throughout the day
  • Consult with parents
  • Meeting with students in a small group setting to cover transition issues that are similar for several students
  • Working with students in a group in life skills or support rooms for group therapy interventions.
  • Consulting with student aides (if the individual has this level of support)
  • Creating small groups as extracurricular activities to address areas such as social skills, emotional needs, worries, or intermural types of heavy work activity

Depending on the needs of the individual, therapy interventions for the above areas may move to a consult basis.

Working with middle schoolers can be challenging. They are suddenly big and somewhat awkward as they navigate the changes of adolescence. There is a lot more going on than just navigating a bigger school!

One last tip as an occupational therapy provider in the middle school setting: Try not to be in the hallways when they are transitioning between classes…it can be like walking through a stampede!

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.

What It Means to Be Neurodiversity Affirming: Therapy, Teaching, and Everyday Practices

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neurodiversity affirming practices

The term neurodiversity affirming has gained momentum in education, therapy, and parenting spaces. But what does it really mean? Being neurodiversity affirming means recognizing that neurological differences like ADHD, autism, dyslexia, and more are natural variations in the human brain, not deficits to be fixed.

neurodiversity affirming with picture of hands making a heart.

This perspective promotes respect, understanding, and supportive practices that empower individuals across environments, including the classroom, social media, and in therapy sessions.

What Does Neurodiverse Mean?

Neurodiverse refers to the broad diversity of human brains and minds. The term includes individuals with diagnoses like:

  • Autism Spectrum Disorder (ASD)
  • Attention Deficit Hyperactivity Disorder (ADHD)
  • Sensory Processing Disorder
  • Dyslexia, Dysgraphia, Dyscalculia
  • Tourette Syndrome
  • Intellectual or learning disabilities

The term neurodiversity covers many, many more diagnoses (and non-diagnoses) too.

A person is considered neurodivergent if their brain functions in ways that diverge from the neurological norm (often referred to as “neurotypical”). Importantly, neurodivergence isn’t something to “fix” a person. It’s a way to be, and our job is to to understand and support.

What neurodiverse mean? Picture of brain and rainbow tangled strings

What Does Neurodiversity Affirming Look Like?

Next, I want to cover what it means to be neuro-affirming, especially in different environments. Not because the environment makes a difference, per say, but because in different environments, we support individuals in different ways.

On social media, we share posts or comment. When you are neuro-affirming on social media, you have that awareness. It’s good to look at each environment through it’s own lens.

Why Neurodiversity Matters

Recognizing and respecting neurodiversity helps create a world where everyone is welcome as they are. When we affirm neurodivergent individuals:

  • We promote mental health and self-worth
  • We reduce burnout from masking and conformity
  • We build inclusive systems in education, healthcare, and beyond
  • We raise future adults who feel seen, valued, and supported

How You Think Matters

  • See neurodiversity as a natural part of the human experience, not something broken or pathological.
  • Expect variation. We are all different and we all have differences in learning styles, sensory needs, communication, and behavior. Differences are the norm.
  • Reject the “fix-it” mindset. The goal is not conformity. Support individuals to thrive as they are.
  • Recognize disability is not a bad word. Needs are valid, and support is a right. Everyone deserves support and it’s not always the same.
  • Presume competence. Always assume the child is capable, even if their abilities show up in unexpected ways.
neurodiversity affirming practices, picture of brain

How to Support Neurodiversity

Supporting neurodiversity means removing barriers to participation and not changing the person. That includes:

  • Offering sensory-friendly environments
  • Advocating for accessible communication (visuals, plain language, AAC)
  • Using strength-based approaches rather than focusing on deficits
  • Validating that “hard things” might just be different, not wrong

Here are ways be neurodiversity-affirming in day to day situations.

Neurodiversity Affirming Classroom

Being neurodiversity affirming in the classroom might include:

It’s about creating inclusive environments where all students can thrive.

FBA (Functional Behavioral Assessment) with Neuroaffirming Approach

As occupational therapy practitioners we hear a lot about FBA, or Functional Behavioral Assessments and how these are not neuroaffirming in supporting children. A neuroaffirming Functional Behavioral Assessment shifts the question from: “What is wrong with this child?”

to “What is this child communicating through their nervous system and environment?”

When you suspect patterns related to overwhelm, sensory processing differences, or impulse control challenges, a neuroaffirming FBA becomes less about compliance and more about identifying unmet needs, environmental triggers, and lagging regulation skills.

Traditional FBAs often focus on:

  • Reducing problem behavior
  • Increasing compliance
  • Identifying consequences that maintain behavior

A neuroaffirming FBA focuses on:

  • Understanding nervous system regulation
  • Identifying sensory and environmental load
  • Recognizing executive functioning demands
  • Supporting autonomy and dignity
  • Proactive accommodation

To move to a neuroaffirming approach, we want education and assessment or documentation of actions to describe what the nervous system is doing. This might look like assessing the sensory or regulation needs related to the actions we see.

We describe what the nervous system is doing.

When reviewing patterns, examine:

Arousal Level

  • Is the child overactivated (fast, loud, impulsive)?
  • Underactivated (withdrawn, slow, disengaged)?
  • Rapidly shifting?

Sensory Triggers

  • Noise
  • Visual clutter
  • Touch proximity
  • Movement demands
  • Unexpected transitions

Executive Load

  • Multi-step directions
  • Writing volume
  • Time pressure
  • Social interpretation demands

Often, what appears as “behavior” correlates with peaks in cognitive or sensory load.

Neuro-affirming Social Media

On platforms like Instagram, TikTok, and Pinterest, being neurodiversity affirming includes:

  • Sharing content that avoids ableist language
  • Listening to lived experiences of neurodivergent individuals
  • Promoting resources created by neurodivergent voices
  • Avoiding “fix-it” narratives or “how to make your child look normal” posts

Neurodiversity affirming when In Person

In daily interactions, affirming practices might include:

  • Accepting stimming behaviors like fidgeting, rocking, or repeating words
  • Using identity-first language (e.g., “autistic person”) when preferred
  • Asking for consent before giving help or offering feedback
  • Respecting different communication styles and energy levels

Neurodiversity Affirming Practices in Therapy

In neurodiversity affirming therapy, professionals work with (not against) the client’s natural neurology. This might include:

  • Focusing on self-advocacy and autonomy
  • Using co-regulation before demanding self-regulation
  • Collaborating with families to support real-life participation (not “normalcy”)
  • Avoiding masking-based strategies or compliance-focused therapy models
  • Offering choice, consent, and flexibility in every session

Neurodiversity affirming therapy shifts the goal from “normalizing” to empowering.

neuro affirming Evaluation Strategies

  • Focus on the whole person, not just deficits. Assess strengths, interests, and support needs with equal weight.
  • Select tools thoughtfully. Use assessments that reflect real-world function and honor neurodivergent ways of thinking and communicating.
  • Think about the individual. Are you grouping people together instead of treating them as individuals?
  • Prioritize lived experience. Spend time observing and talking to the individual, not just evaluating behaviors on paper.
  • Collaborate with the child or client. They are the expert in their own experience. Let their input shape your goals.

Neuro affirming Communication

  • Honor all communication types. Whether it’s gestures, AAC, scripts, echolalia, or silence. Every kind of communication counts.
  • Never force eye contact. True connection doesn’t require direct gaze. Respect each person’s comfort and culture.
  • Provide choices often. Choice empowers and communicates respect. It builds autonomy and trust.
  • Listen actively. Especially to autistic and neurodivergent voices. They’re your most valuable teachers.

Neurodiversity affirming Sensory & Environmental Supports

  • Support stimming. It can be a self-regulation strategy that is a need. Stimming is not something to suppress.
  • Create flexible environments. Adapt lighting, noise levels, seating, and activity structures to reduce stress and increase access.
  • Adjust the surroundings, not the student. Don’t ask kids to “tough it out” when the sensory environment is overwhelming.

Strengths-Based & Student-Led Approaches

While a strengths-based approach is different, it’s important that we cover this aspect also.

  • Celebrate deep interests. Use them as tools for connection, engagement, and learning.
  • Take a strengths-first perspective. Build on what the child does well, and teach through their existing skills and passions.
  • Stay flexible and responsive. There is no one-size-fits-all approach. Let your strategies evolve with the learner.
  • Stay curious. Be willing to rethink your systems, goals, and teaching methods as you learn more.

Final Thoughts

Being neurodiversity affirming can be a much-needed shift in mindset. Embracing neurodiversity means creating spaces where different doesn’t mean broken.

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.

Jack Be Nimble Nursery Rhyme Craft

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Fine motor skills nursery rhyme craft. child squeezing a glue bottle and picture of cut shapes and torn tissue paper.

Looking for a fun way to bring movement into your circle time? This Jack Be Nimble craft pairs perfectly with nursery rhyme activities that get kids up and moving! Traditional rhymes like this one offer the perfect opportunity to build coordination, balance, and listening skills through gross motor rhymes. Add in a simple hands-on kids crafts, and you’ve got a meaningful activity that supports early learning in a playful way. Whether you’re working with a preschool class or doing OT sessions, this circle time movement idea brings the classic rhyme to life with jumping, crafting, and lots of giggles.

Fine motor skills nursery rhyme craft. child squeezing a glue bottle and picture of cut shapes and torn tissue paper.

Today’s craft is a Jack Be Nimble craft based on the nursery rhyme, Jack be nimble, Jack be quick. If you are looking for an easy nursery rhyme crafts based on development, this craft supports fine motor skills and scissor skills.

Jack Be Nimble Craft

I love this Jack be Nimble craft because it has so many components that are the building blocks for developing motor skills in kids. You’ll find:

  • Cutting simple shapes
  • Cutting straight lines and curved lines
  • Tearing paper
  • Crumbling paper
  • Gluing the craft pieces in order (direction following)

This craft is one of those kids crafts that is project based, but there are components that can be created by the child with a process-based format. You can have the child add their own spin on things and offer art and craft materials and just let the process go.

 
The Nursery Rhyme craft and activities series is in full swing and we’ve had some great ideas shared for some classic nursery rhyme favorites.  
 
Today’s kids craft is one of our favorite Nursery Rhymes.  We’ve loved this short little rhyme since we started book babies at the library years back.
 
It is a fun rhyme to recite and always brings a smile to my kids’ faces. 
 
Jack be nimble
Jack be quick
Jack jump over the candlestick.

 

 
Jack Be Nimble Jack Be Quick, Jack jumped over the candle stick craft for nursery rhyme loving toddlers and preschoolers.
 
 

Jack Be Nimble Jack Be Quick Craft for Toddlers and Preschoolers

This post contains affiliate links for your convenience.
 

 

To make a Jack Be Nimble craft, you’ll need:

  • cardstock in white, another color (we used blue) and a background sheet (we used green)
  • glue
  • tissue paper (in red, yellow, and orange)

This craft is a nice one because you can work on cutting simple shapes. Here is a scissor skills crash course that talks about how to modify cutting tasks to make it easier or harder for kids at different skill levels.

Use Squeeze Glue Bottles Instead of Glue Sticks 

Here’s an occupational therapy fine motor tip: Use squeeze glue bottles for crafts. This is a strengthening tool that also works on graded precision, wrist stability, bilateral coordination, crossing midline, and visual motor skills! 

tip for using glue bottles to work on hand strength

These are skills that kids need for a wider variety of functional tasks and the squeeze glue bottle builds these skills with instant feedback. 

Squeeze too hard and too much glue comes out of the glue bottle. Squeeze too softly and you won’t get any glue. The nice thing is you can modify the amount of pressure needed by opening or closing the cap slightly. 

Wrist stability with fine motor tasks like using scissors and writing is huge. That’s why I love using the glue bottle task as a way to work on this. If the wrists are bent, or flexed when squeezing the glue bottle, the child won’t have stability and strength. It’s easy to point out this concept to them while they are using the glue bottle because it’s right there in front of them with both hands together on the glue bottle. 

This is a great way to make the nursery rhyme craft even more functional and effective! 


To make the Jack be Nimble Jack be Quick craft:

  1. Start by cutting the simple shapes you’ll need to make the candlestick craft.  Older kids can work on scissor skills to cut these simple shapes.  
  2. Cutting from card stock is a great way to work on scissor accuracy because the resistance is greater than regular printer paper.  This allows children to slow their snipping speed and better accuracy when cutting along lines.
  3. Cut a semi-circle from colored paper and a rectangle from white paper.  
  4. Tear a square of each color of tissue paper.

5. Glue the semi-circle onto the paper.  This is a great opportunity to talk about shapes with your toddler or preschooler.



6. Glue the rectangle on top of the semicircle.


7. Draw a flame shape with the glue.

8. Have your child tear small pieces of the tissue paper.  

Tearing paper and crumbling tissue paper is a great way to work on fine motor hand strength, opening of the web space (area between the thumb and index finger), and defining of the arches of the hand.  

All of these areas are important for pencil grasp and endurance in handwriting and coloring.  

Tearing tissue paper is such a great fine motor strengthening activity and one of my favorites!

 
Glue the tissue paper onto the top of the candle stick.  You’re done!  So much fun for little ones who love Jack be nimble!
 
 
Be sure to stop by and see all of the Nursery Rhyme crafts and activities from this week and next week!
 
 
 

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.

For more craft ideas, including templates and printable crafts that allow for data collection, be sure to get our resources inside The OT Toolbox Membership.

Easy Shapes School Bus Craft

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School Bus craft for screening skills during back to school time

We love this easy bus craft as back to school crafts for kindergarten! School buses and the back-to-school season is the perfect time for a fun, low-prep bus craft that supports creativity and fine motor skills. We love using back to school themed activities in occupational therapy sessions for a reason…This paper bus activity is ideal for young kids, toddlers, kindergartners, and even older kids. Using simple materials like cardstock, glue, markers, and printables, this craft is a great option for the first day of school, a classroom display, or a back-to-school school activity.

School Bus craft for screening skills during back to school time

An easy school bus craft is just what kids need before back to school, along with a little crafting fun!


I don’t want to even think about the end of summer and the start of school.  The summer fun is quickly passing by with long days of outdoor play and water activities.   We’ve got a few of the cousins heading back to school this fall.  A couple on the school bus and a few that will be starting up preschool for the first time. 

New classes, new book bags, and new school shoes happen before the summer fun has even ended.  With all of the newness happening, this mama wanted to touch on an old familiar theme with the start of school quickly approaching.  


This school bus craft was a fun way to create while we explored easy shapes.  This was a great craft for my two year old as we talked about the start of school and some easy shapes.

Kids will love to make this school bus craft as a back to school craft that helps kids learn shapes.

Back to School Craft

 
 
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Easy shapes school bus craft
 
 

School Bus Craft

For this craft, all you need is a few items.
 
I cut a few simple shapes from the paper.  An older child who is working on scissor skills could cut these shapes.
 
Building our school bus was fun!  We moved our shapes around until we liked the bus.  This was fun for Big Sister (age 6) as she helped us build the bus and made sure the windows were where she liked them. 
 
Baby Girl (age 2 and half) worked on her shape identification with this craft.  Big Sister and I would hold up a shape and ask her what it was.  She was loving the shape test!
 

We glued the shapes in place on our bus when we got it looking like we wanted.  Big Sister used some scrap paper to draw bus stops for our bus.  I love the “baby stop”!

school bus craft for learning shapes and preparing for back to school

 

Easy Bus Craft for Kids of All Ages

As an OT in schools, I love this craft to start off the school year because you can get a quick look at scissor skills, fine motor skills, planning and executive function, and much more. It’s a wonderful way to welcome the new school year with hands-on learning.

Simple Steps and Creative Add-Ons

This paper plate school bus craft (or use cardstock to make a more structured paper bus) is great for easy crafting in small groups or as part of a station activity. Add a black line for the road, draw headlights on the front, or invite kids to sketch their own child’s face in the windows for a personalized touch.

Need a quick solution for class? Provide step-by-step instructions with a visual example, or print out bus shapes with cut-and-paste parts to make this a preschool craft that’s both fun and functional.

Make It a Wheels on the Bus Craft!

Turn your bus project into a Wheels on the Bus craft by adding interactive features to go along with the classic bus song. Use paper brads to make spinning wheels, or glue on circles cut from black construction paper. Attach craft sticks to act out the song as a puppet or prop during circle time. You can also label parts of the bus (“doors go open and shut,” “wipers go swish swish swish”) to reinforce early learning concepts while you craft.

This is a fun idea that pairs perfectly with music, group time, and creative movement!

Turn It Into a Pigeon Rides the Bus Craft

We have many preschool book activities here on The OT Toolbox. This paper bus craft is a perfect way to extend the craft into the book, Pigeon Rides the Bus!

Turn this craft into a Pigeon Rides the Bus craft inspired by Mo Willems’ beloved character. Simply add a drawing or cut-out of Pigeon riding in or driving the bus. Kids can glue Pigeon onto the driver’s seat or draw him peeking out the window using a marker or crayon. Pair the craft with a read-aloud and follow-up discussion to build on literacy and comprehension skills.

This is a great way to tie in book-based learning with preschool crafts or kindergarten art projects.

Why This Craft Works for Young Children

This school bus art project uses simple crafts and easy paper crafts to build important early skills:

  • Promotes fine motor skills through cutting, gluing, and coloring
  • Encourages creativity and storytelling
  • Supports classroom community with a shared fun activity
  • Perfect for first week of school routines

It’s one of those easy craft ideas that is great for building connection and confidence in your preschool class or at home.

School Bus craft for screening skills during back to school time

With one cutting craft, you can assess many areas:

Fine Motor Skills

  • Cutting: Children cut squares, rectangles, and circles, which targets hand strength, bilateral coordination, and scissor skills.
  • Pasting/Glue Control: Squeezing glue bottles or using glue sticks promotes hand strength and precision.
  • Grasp Patterns: Encourages tripod grasp and refined finger movements when handling small shapes.

Visual Motor & Perceptual Skills

  • Visual Discrimination: Identifying and matching shapes (square windows, rectangular bus body).
  • Figure-Ground: Picking out shapes from a group of cut pieces or worksheet.
  • Visual Closure: Recognizing the bus even if parts are missing or partially hidden.
  • Visual-Spatial Awareness: Placing parts of the bus (windows, wheels, stripes) in correct orientation and location.

Bilateral Coordination

  • Cutting with Stabilization: Requires use of one hand to stabilize the paper while cutting with the other.
  • Assembly Tasks: Holding the bus body with one hand while placing and pressing shapes with the other.

Executive Functioning Skills

  • Planning and Sequencing: Following steps in order (e.g., bus body → windows → wheels).
  • Working Memory: Remembering shape placement and order from visual or verbal instruction.
  • Inhibition: Waiting to glue or cut at the appropriate time within the task.

Language and Cognitive Skills

  • Shape & Color Identification: Naming shapes and colors while assembling.
  • Following Directions: Completing a multi-step task with adult guidance or peer modeling.
  • Concept Development: Understanding positional concepts like “on top,” “next to,” “under.”

Postural Control & Endurance

  • Seated Tolerance: Sitting upright to complete a tabletop activity from start to finish.
  • Core Engagement: Maintaining posture while using both hands in front of the body.

Sensory Processing

  • Tactile Input: Handling paper, glue, and possibly stickers or markers.
  • Proprioceptive Input: Using controlled hand pressure for cutting and gluing.
  • Visual Input: Tracking lines while cutting and scanning for shape placement.

Social and Emotional Skills

  • Turn-Taking and Sharing: During group crafts, materials may be shared.
  • Task Completion: Builds confidence by following through on a start-to-finish task.
  • Self-Expression: Decorating the bus with additional details or personalization (child’s name, colors).

For more ways to focus on scissor skills, and the WHY behind development of cutting with scissors, check out our resource, The Scissor Skills Book.

Check out The Scissor Skills Book for tips and strategies based on development from school based occupational therapists and physical therapists.

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.