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:
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.
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.
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.
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 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:
This Writing Spacer Craft uses just a pipe cleaner to space between letters and words.
This pointer stick spacer uses a craft stick to create a spacing tool pointer stick, perfect for visual perceptual needs.
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 Spaceman Writing Tool
You can easily make this spacing tool with just a few materials:
sticky back foam letter sticker “C” are all you need.
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:
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.
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.
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.
First, glue one button to the end of a popsicle stick or even a pipe cleaner.
Let it dry.
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.
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.
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:
Two pages of color coded bead copying strips
Two pages of blank bead copying strips
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)
Nine pages of fine motor mazes
1-20 Outer Space Counting Cards
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.
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
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.
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…
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!
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
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.
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 Skills– START HEREfor 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– 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!
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.
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.
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.
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
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.
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.
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.
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 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.
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:
Respecting communication differences (AAC devices, scripting, or echolalia)
Avoiding token economy behavior systems that penalize neurodivergent traits
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:
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.
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.
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 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)
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!
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:
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.
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.
Cut a semi-circle from colored paper and a rectangle from white paper.
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.
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.
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.
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.
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”!
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.
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.
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.
As occupational therapy professionals, we see firsthand how tightly woven sensory processing, executive functioning, and emotional regulation are in a child’s daily life. While each of these systems has its own role, they don’t operate in isolation. Instead, they constantly interact, either supporting or interfering with one another depending on the child’s sensory experience and environment.
Here are some helpful resources to support your understanding and practice:
When a child struggles with loud noises (sensory processing), it can be harder to focus (executive functioning) and manage frustration (emotions). These systems work together to support self-regulation.
Sensory Processing and the “Traffic Jam” Effect
When a child’s sensory system becomes overwhelmed by input (like loud noises, bright lights, or scratchy clothing) or under-stimulated by an environment that lacks movement or tactile input, it’s like a traffic jam in the brain. The neural pathways are working overtime to manage the incoming data, but there’s no clear flow. As a result, the child may appear distracted, impulsive, emotional, or even shut down entirely.
This reaction isn’t always a behavior like it might seem. It can actually be sensory overload. The brain is busy trying to process sounds, movement, balance, touch, and other inputs, leaving little bandwidth for higher-level thinking or regulation.
How Executive Functioning Is Impacted
Executive functioning refers to the set of mental skills that help us plan, organize, focus, remember, and manage emotions. These skills are crucial for things like following instructions, transitioning between tasks, or problem-solving in social situations.
But when a child is stuck in a sensory jam, their ability to access those executive functioning skills becomes impaired. Imagine trying to solve a puzzle while someone is shining a flashlight in your eyes, playing loud music, and tugging on your shirt. That’s what it can feel like for kids with sensory processing challenges trying to focus in a busy classroom or crowded lunchroom.
Research published in the American Journal of Occupational Therapy highlights these relationships, showing that sensory processing behaviors are significantly correlated with executive function and emotional regulation difficulties, especially in children who have underlying developmental concerns. Source: AJOT.
Emotional Regulation and Sensory Needs
When a child doesn’t have the sensory support they need, frustration builds quickly. A small demand can feel insurmountable. This is why we often see sensory dysregulation manifest as big emotions: meltdowns, tears, yelling, or complete withdrawal. These aren’t bad behaviors; they’re signs the child needs support.
When we support a child’s sensory needs, we’re helping their nervous system return to a regulated state. And when the sensory system is regulated, the emotional brain can calm down, and the thinking brain can take over. This is where the real magic happens in occupational therapy.
Occupational therapy can get a reputation in the school environment as the “handwriting teacher”, but we support the student in a much wider way. We’re supporting the foundation of a child’s ability to learn and grow. Through sensory strategies, routines, movement breaks, environmental adaptations, and regulation tools, we build a bridge from sensory stability to emotional and cognitive growth.
Additional supports we offer as pediatric occupational therapists include:
By recognizing the connection between sensory processing, executive function, and emotions, we can better support children in a compassionate, whole-child-centered way.
What This Looks Like in the Real World
Use real-life classroom or home examples to illustrate how these three areas show up:
In the classroom: A child distracted by hallway noise may struggle to start tasks and become frustrated quickly.
At home: A child who can’t tolerate the feeling of clothing tags may resist getting dressed and have emotional outbursts.
Creating a lifestyle that supports sensory needs will support executive functioning. The Sensory Lifestyle Handbook covers this.
Think about a child you know: Do you notice signs of sensory overload, executive function challenges, or big emotions? What small adjustment could support their self-regulation 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.
Today, we have a couple of separation anxiety activities that can support kids who struggle with school drop off. Many times, kindergarten or preschool drop off is full of tears, especially those first few weeks of school. Here, you’ll find a great connection activity to help preschoolers and parents find a way to make preschool drop off easier by connecting through the book, Owl Babies. Use this Owl Babies activity to help with that preschool separation stage. This post shares movement based separation anxiety activities that can help kids who are experiencing separation anxiety in preschool drop off, with ideas based on the children’s book.
Separation anxiety can occur at various ages and stages, including toddler, preschool, kindergarten, and school-aged.
For example, in the toddler years, separation anxiety is quite common. However, if there is extreme separation anxiety, this might be a toddler behavior red flag or something to look into.
Separation Anxiety in Preschool or Kindergarten
Step into a preschool classroom on the first day of school and you will likely see a few tears here an there (possibly some of those tears coming from the parents dropping off their child for the first time!).
Separation anxiety in preschool age is normal! But here’s what you need to know about that visible preschool behavior that may be fueled by something besides getting used to leaving mom/dad/caregiver for the first time…and how to help with a simple preschool self-regulation strategy.
The movement-based, sensory activity we share below can actually be used with preschool through kindergarten:
the 3 year old preschooler who is just being dropped off for the first time
the 4 year old preschool student
pre-k kids
kindergarten students
older, grade school students who are sad or upset on the first day of school
preschool anxiety
So, what is happening with preschool anxiety that causes tears, meltdowns, and clinging to mom or dad at the day care or preschool drop off?
You have probably seen it before:
Every Monday, Wednesday, and Friday, it’s time for preschool. The routine at home is the same: excitement, packing the bag, and gearing up for a day of learning colors, songs, preschool activities, and nursery rhymes. Getting into the car and driving to preschool is no problem.
But then you pull into the parking lot and the worries begin.
Tears, crying, clinging to Mom, negotiations, promises of seeing the little one in just 2 short hours.
Two minutes later, she is happy, playing with play dough, and dry of all nose drips.
It might even seem as if the preschool separation meltdown is just part of the morning routine.
As a momma of four, I’ve seen plenty of tear-filled drop-offs.
And it just never stops breaking your heart.
Separation anxiety is actually considered a normal process that occurs in early childhood, as a result of a maturing physical, cognitive, and emotional development. Specifically, the areas of development that lead to a period of separation anxiety in young children include:
Visual processing system (visual memory, visual closure)
Social-emotional maturation (emotional connections, attachment, and feeling safe with certain individuals)
Despite the normal development that results in fears, worries, or flat out meltdowns following or leading up to a period of separation, severe separation anxieties do have the potential to negatively impact a child’s social and emotional functioning and this is especially true when the young child then avoids certain places, activities, and experiences that are necessary for healthy development.
Separation Anxiety Disorder
Sometimes, the family, parents, or caregivers also avoid these places, experiences, and activities. This can lead to even more negative experiences. When the family supports avoiding certain places or situations because of the young child’s separation, we can have situations where separation anxiety “hangs around” longer than is part of typical development.
Officially, Separation Anxiety Disorder (SAD) is defined as “developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached” (American Psychiatric Association, 2000). However, for the young child, separation angst does not mean a disorder is present. It is only when the anxiety levels are so severe that they are not appropriate for developmental age that the official diagnosis of Separation Anxiety Disorder should be investigated.
For those with severe symptoms, Separation Anxiety Disorder may result in school refusal and a disruption in educational attainment, refusal to attend doctor’s appointments, dentist visits, or other situations where a child is separated, no matter the physical distance, from the parent or caregiver.
What causes Separation Anxiety Disorder?
There are many developmental areas that enable to progression of separation anxiety in toddlers and preschoolers from levels of worry and age-appropriate anxiety at separation to an inefficient and “disorder” level of worry.
Studies show us that some of these considerations may include:
Parenting behavior
Low parental warmth
Poor attachment
Trauma to the parent during the baby’s young years (death in the family, environmental, or other big situation)
Trauma to the child (Adverse childhood experiences, both large and small)
Insecure or anxious attachment styles
Diminished sense of control over one’s environment
Overprotective and over involved parenting behaviors
Parental intrusiveness- including extreme decision making on the part of the parent
Parental intrusiveness- including providing excessive assistance in the child’s daily activities (beyond age-appropriate ability)
Common signs of separation anxiety in kids
The natural and developmental stage of separation anxiety occurs from around age 6 months when the baby is able to notice that something is missing from their field of vision. This skill requires development of several areas:
Visual perception
Attention
Working memory (executive function)
Sensory motor
Separation anxiety typically continues from around 6 months of age to about 5 years of age, however signs of separation anxiety can persist after age 5 and through age 6.
However, the cognitive and emotional development that occurs during this age allows for kindergarten and younger elementary aged individuals to separate from their loved ones and know that they will be there even when the are not in view.
Once the underlying areas noted above develop (around 6 months of age), you may see some common signs of separation anxiety:
Crying when the parent leaves the room or home
Upset and crying when a babysitter or caregiver comes into view
Tantrums
Avoidance behaviors (refusing to participate in activities that require separation)
Clinging to parents
Refuse to attend certain situations
Apprehension about harm coming to parents
Fears the parent will leave and not return
Running from the classroom/school bus/appointment setting
Today, I’m sharing a simple trick for helping kids with separation anxiety at kindergarten, preschool, or other drop-off situations like day care, a caregiver’s home, nursery school, or a church Sunday school room. These separation anxiety strategies can be addressed in occupational therapy sessions, used in cognitive therapy, or simply trialed at home or at school. Each of the separation anxiety activities listed below may be helpful in any situation where there is anxiety and stress as a result of separation from a parent or caregiver.
separation anxiety activities
One tool that can support separation anxiety in the classroom is starting each day with a feelings check in. This can help to get a handle on how emotions are impacting behaviors.
This post contains affiliate links.
Social Stories- Use social stories to create a visual narrative about how drop offs go and that parents will be back to get the child. Social stories can offer a verbal narrative for the child to use during these situations. Some of our social stories include:
Self-Regulation Strategies- Practice the regulation tools that support the individual’s emotional status with self-regulation strategies. Select a set of calming or heavy work strategies that can be used in preparation for the separation situation, whether that be using at the school bus stop (like this deep breathing school bus exercise) or while driving into school. Having those set of strategies readily available and discussing how the child feels will go a long way.
Movement-based separation activity – One fun way to work on separation anxiety in preschoolers that becomes part of the routine…here we are talking about the preschooler or kindergarten aged child that cries, clings to Mom or Dad, but then warms up to the classroom activities.
Practice routines- Do the same thing every day during the week in preparation for school, including bed times, morning routines, and transportation routines. These visual schedules can help with some individuals.
Wearable Charm- Another similar strategy is to create a DIY separation anxiety charm. Kids can make this along with the family adding heavy work through the hands. then, wear the charm to know that parents and caregivers still love and miss them even when not in view.
Get enough sleep– Practicing good sleep hygiene is important for the child as well as the parent or caregiver. This has an impact on behavioral response and self-regulation. Read a related blog post on supporting newborns not sleeping as sleep in young ones in the home can impact sibling and parent sleep.
Books about Separation- The activity listed below uses the book Owl Babies. But we added a heavy work goodbye sign that parents and children can use at school drop offs to ease separation anxiety. Or, this activity could work for kids that struggle with the transition to the classroom, because they are missing Mom and Dad or other caregiver.
Use the book, Owl Babies by Martin Waddell!
Use a magic number- In some cases, it can be hard for children to separate for even a very short period of time, and even in an environment such as the home. One strategy is the magic number technique. In this activity, the child and parent/caregiver can practice away time for short periods of time. Select a “magic number”. Then, move away from each other by going into a different room of the house. Use a timer or a watch to count up to that magic number. Try increasing the magic number up by a few minutes at a time until it’s less difficult to spend time apart.
Create a plan- Having a plan or set of coping strategies prepared for time apart can help. For the kindergarten separation anxiety issues, maybe looking at a picture of the family that is stashed inside a pencil box would help. For another student in kindergarten, maybe touching a special keychain attached to the shoe or belt loop would work. Having this plan prepared before heading into the kindergarten room or daycare setting is key.
Owl Babies Activity
We read the book, Owl Babies (affiliate link- As an Amazon Influencer, I earn from qualifying purchases) and fell in love.
The sweet little Owl Babies in the book wake up from a nap to find their mother gone from the nest. The owl siblings go through a series of concerns and thoughts about where their mom might be with a little almost-tears.
My older kids thought the book was pretty awesome and decided that each of the owl babies in the book were one of the girls in our family. There were a few similar personality traits that aligned with the owls in the book and the sisters in our house.
The idea of knowing that mom comes back when she leaves is a lesson we’re going through at Sunday School each week and one that happens so often with kids. Just like the Owl Babies (affiliate link), it can be hard to stay calm and not worry when mom goes away.
We decided to come up with an owl themed movement activity that kids could do when they are feeling anxious after leaving mom or dad.
School Drop Off Anxiety
This activity would be perfect for preschool kids or kindergarten students who are experiencing separation anxiety at the start of school or in a new classroom situation. For kids that cry at school drop off, or really struggle with missing Mom or Dad, this school drop off anxiety activity can help.
To do the activity, first read Owl Babies (affiliate link) together. Then, talk about how the owls in the book must feel when they see their mother has gone out of the nest. Finally, talk about how when the mom or dad in your family has to go away for a little while, they always come back and that they are thinking of the little one in your home while they are gone.
One easy way to help with separation anxiety is to come up with a hand signal. We decided that making a bird wing sign would be a lot like an owl in flight. Hook your thumbs together and spread your fingers out to create the wings of an owl.
Then, wrap both hands around your thumbs to create a little owl baby of your own. Now, squeeze your hands tight to give them a hug. Your child can do this motion when the are feeling sad or nervous at school. Tell them to think about the owl babies in the book (affiliate link) and how they felt when their mom came back.
Squeezing the hands tightly can provide a bit of proprioceptive input that is calming in a stressful situation like the preschool drop-off. A simple hand hug might be just the thing that can help! It’s a self regulation activity that supports the whole body as a mechanism to address emotional regulation needs that show up as crying, clinging, and bolting “behaviors”.
Then, when you pick up your little baby, be sure to swoop them up in a big hug!
This activity would work with preschoolers who are a little older than my two year old. She really enjoyed the book, Owl Babies (affiliate link), though and we have read it again and again!
Let me know how this tip to help with separation anxiety works with your preschooler!
This Owl Babies activity is a fun and interactive book for kids of all ages!
Let’s go a bit further with kindergarten separation anxiety and how to support this need.
Kindergarten Separation Anxiety
One thing about kindergarten separation anxiety is that it may not rear it’s head until after school has started. Typically (in many cases, not all cases), young children and parents are very excited for their little ones to head off to kindergarten. There are a lot of new things to experience as a new kindergartener!
However, one new consideration may end up being a case of worries and anxieties after the school year has begun!
What’s going on here?
At the start of a school year, after school has been in session for a few days or weeks, things start to get old, quick. The young child has to wake up early every day. They have to spend 8 or more hours in school, paying attention, and on high alert, every day, Monday through Friday. There are new routines, new peers, new rules, new learning, new transportation, and they can be on high alert all day.
Sometimes we see kindergarten students who experience a separation anxiety from their parents or guardians as a result. This involves stress and worries that might be brought up during the night, before bed, before school, at school, or even during slow times at home.
The kindergarten child who is attached to their special parent, guardian, sibling, etc. are now spending many hours away from their person, people, and routines.
Kindergarten separation anxiety may include fears as well:
they are going to miss out on something at home
their special person will become sick or have an accident while they are not together
they, the kindergartener, may worry that they will become sick, lost, or hurt while away at school
they may worry that they will become lost in the school or on the way to school
Some things that we see with kindergarten separation anxiety may include:
Outbursts at home before school
Refusing to get ready for school
Outbursts or meltdowns before bed or on Sunday night
Refusing to go to school
Refusing to go on the bus
Refusing to sleep alone
Being afraid or fearful when they weren’t before
Refusing to do things they used to like to do like playing with friends
Refusing to leave the home or be away from their parent/guardian
Feelings of intense fear or helplessness
Agitated behavior
Anxiety that presents as crying, tantrums, shrinking away, or running away from unfamiliar people or situations
Excessive fear about other situations
Trouble falling asleep or staying asleep
Reverting to younger habits such as sucking their thumb or talking in a “baby voice”
Restlessness
Trouble concentrating or paying attention
Worry during other times of day or night
There may be other things going on too. With the kindergarten age, it might be hard for the child to express all that they are experiencing. We can however, support separation anxiety in kindergarten students.
How to support Kindergarten Separation Anxiety
One of the most important ways to help a kindergarten student who is experiencing separation anxiety is by giving them words for what they are experiencing.
Talk about separation anxiety- It’s important for the child to realize and understand that we all have worries and anxiety. We all experience stress at some point or another. We can come up with tools to support and work on these worries, however, so they don’t become all that we think about. What we don’t want is for the worries to prevent participation in all of the fun activities that comes along with kindergarten!
Give words to the feelings that the child is feeling. This involves interoception (the sensory system that allows us to recognize internal sensations). One of these aspects is headaches that come because of worries or anxiety. Other feelings might be rapid heartbeat, stomach ache, dry mouth, sweating, cold hands, tingly fingers, etc.
Read books about separation anxiety in kindergarten. There are a lot of great books out there about kindergarten separation anxiety in particular. That tells us that this is a very common issue!
Some of our favorites include: (Amazon affiliate links below)
Focus on Kindergarten Friendships- One of the fun things about kindergarten is meeting new friends. But being worried and over-thinking might mean that there is less time to talk to friends and do all of the fun kindergarten things! Try helping your kindgergartener to focus on friends when they are feeling very anxious about going to school.
Enlist a friend to help walk them to the classroom
Have a buddy to get started during the day
Check in with a friend when they feel the worries
Create a social support system with a small group of friends by having playgroups on the weekends or after school.
Make a Clock- Using paper, make or draw a clock with the time that the child will reunite with their adult. This visual cue can help them to see that they will return to their loved ones. Include “grace” time for a window of time to allow for the school bus, traffic, etc. Plus this is a good clock activity too!
Separation Anxiety Occupational Therapy
Just like in kindergarten, sometimes we see clients that are worried or anxious about coming into the occupational therapy space. This might especially be the case for the new child experiencing OT for the first time. For parents to better know what to expect in OT sessions, read our getting started with occupational therapy blog post.
Using some of the same strategies listed above and under kindergarten separation anxiety can support these kiddos so they can participate in therapy. Separation anxiety may need work with a child psychologist, however occupational therapy can support families and the team using meaningful and motivating strategies as well as tools that enable the individual to participate in daily functional tasks.
Work to establish a secure relationship to the teacher/therapy provider/classroom support staff/peers with the aim of reducing dependence on parents or guardians in the school environment over time
Create a social story on being away from loved ones for short periods of time
Educate parents and educators on the limbic system and the possibility of the child being in a fight or flight state as well as tools to support the child in this manner
Educate and provide interventions on interoception and support the child with tools to slow a fast heart rate, etc.
Support the child and the family as a unit with education on co-regulation
Create a consistent goodbye routine. Try a wave at the window, a special hug pattern, or a simple phrase you repeat each day. This predictability helps ease transitions.
Use a comfort item like a small object from home, such as a blanket, scarf, or paper heart with kisses
Keep goodbyes short and positive
Talk about emotions. Name what your child might be feeling and normalize it: “It’s okay to feel sad or nervous when saying goodbye.”
Practice separation in small ways. Try short separations before school starts, such as staying with a trusted babysitter or family member for brief periods.
Prepare your child for what to expect. Talk about who they’ll see, what they’ll do, and when you’ll be back. Use visuals or picture schedules if needed.
Build self-regulation skills. Use calming strategies like deep breaths, squeezing a stuffed animal, or stretching to help regulate emotions during drop-off.
Encourage independence with routines. Allow your child to take part in getting ready, putting on their backpack, or walking to the classroom to build confidence.
Involve familiar family members. If multiple caregivers are part of the routine, make sure they follow the same goodbye pattern to provide a sense of security.
Watch for physical symptoms. Complaints of stomachaches or headaches can be signs of anxiety. Take these seriously and seek support if they persist.
Use books and pretend play. Reading books about school or playing “going to school” with dolls can help your child process and understand their feelings.
Limit big changes at the same time. If possible, avoid starting preschool during other major transitions such as a move, new sibling, or recent illness.
Stay calm and supportive. Your emotional state influences your child’s. Show confidence in their ability to manage the separation.
Communicate with the teacher. Let the classroom teacher know your child’s needs. Teachers can offer extra support during arrival time.
Seek help when needed. If anxiety is impacting your child’s daily function or not improving over time, talk with a pediatrician or occupational therapist.
Separation Anxiety and Occupational Therapy
Occupational therapy empowers individuals with meaningful and motivating tasks. When separation worries interfere with the things that matter most to the child, we see the intersection with occupational therapy.
As an occupational therapist supporting families in both early intervention and school-based settings, I often help parents navigate preschool separation anxiety with developmentally appropriate strategies rooted in emotional regulation. One of the first steps is understanding that separation anxiety is a type of anxiety that emerges when a child feels unsafe or unsure when leaving primary caregivers, especially in a new place with new people like a preschool classroom or a new babysitter.
It can look like temper tantrums, crying, clingy behavior, or even physical symptoms such as stomachaches or headaches. Some children experience nightmares or regressions in sleep routines. These are not behavioral “problems,” but symptoms of separation anxiety that reflect developmental needs. Pediatricians and child development professionals, including an MD, often agree that this is a normal stage that can benefit from structured support and consistency, not punishment or abrupt transitions.
One powerful tool I recommend is establishing a simple and predictable goodbye routine or goodbye ritual. This could be a wave at the window, a special hug sequence, or even a secret handshake. This can be something consistent that becomes part of your family’s life and supports the child’s ability to manage emotions.
Younger children may also benefit from a transitional object like a blanket or a paper heart with kisses on it tucked into their pocket or backpack. These comfort items act as sensory tools to reduce tension and help children self-soothe throughout the day. When families create and practice these routines together, it eases the stress of the exit and builds resilience over time.
It’s also important to involve family members in the routine if multiple primary caregivers are involved in drop-off. In some cases, when separation anxiety in preschoolers becomes disruptive or persists beyond the expected developmental window, it may be helpful to consult with a pediatrician to rule out other concerns such as illness or to discuss options if anxiety feels like a disaster at every drop-off. These small, meaningful strategies can transform what feels overwhelming into a smoother, more confident transition. It’s helpful for both the child and the parent!
Occupational therapy empowers individuals with meaningful and motivating tasks. When separation worries interfere with the things that matter most to the child, we see the intersection with occupational therapy.
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.
in white, another color (we used blue) and a background sheet (we used green)
(in red, yellow, and orange)
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