Colleen Beck OTR/L

Colleen Beck, OTR/L is a pediatric occupational therapist and the owner and author of The OT Toolbox website. She manages all of The OT Toolbox social media accounts and runs the popular newsletter. Read about Colleen's experience and career as an occupational therapist, including how The OT Toolbox began on our About The OT Toolbox page: https://www.theottoolbox.com/about-us/ Colleen created The OT Toolbox in 2011 and since then has written thousands of blog posts designed to support therapy providers, educators, parents, counselors, admin, and caregivers in promoting the healthy development of kids. Check out Colleen's blog posts below:

Hand Strengthening Activities

by
hand strength with image of child's hand pinching play dough

Hand strengthening and finger strengthening are a part of occupational therapy interventions, in every day tasks. There is more to developing strong and efficient hands than just using a hand grip exerciser or therapy putty to strengthen fingers.

Here, you will find a collection of fine motor resources and hand strengthening activities that can be used to improve tone in the hands, increase stability in the thumb and fingers, develop and define arches of the hands, improve precision with in-hand manipulation, improve endurance in hand strengthening activities.

Below, you will find hand strengthening activities for kids, hand strength activities for adults, and therapy tools to develop hand strength. The activities to strengthen fine motor skills included in this post are perfect to improving grip strength, pinch strength, or as part of a finger exercises program for handwriting.

hand strength exercises with child's hand pinching play dough

One thing to keep in mind when it comes to hand strengthening and when creating a hand strength exercise program is that it is very possible (and a theme of a pediatric OT!) to develop fine motor skills and hand strength through play!

Hand Strengthening

Let’s take a closer look at hand strengthening…in fun and creative ways! 

Occupational therapists use functional tasks, or daily occupations, to improve hand strength so that the clients they work with can lead functional lives: so they can have strong and efficient hands to do those tasks that take up their day. 

Think about it this way: with weak hands, it is very difficult for a child to color a coloring page. But, through coloring and using crayons, they are improving their hand strength so they can color larger pictures or tackle more difficult fine motor tasks.

Adequate finger and hand strength is a crucial foundation skill necessary to successfully perform most activities of daily living such as opening snack wrappers, flushing the toilet, opening the tap, buttoning your shirt and so the list goes on.

Not only do we need adequate hand strength for our ADLs, it directly impacts on our ability to perform school related tasks such us cutting, writing and manipulating materials such as glue.

How do you know if a child has weak hands?

Hand strength is an important area of development. 

Kids who struggle with hand strength may have difficulty with grasping a pencil, coloring, holding and using scissors, managing clothing fasteners, attaching a seatbelt, squeezing a glue bottle, opening and managing food containers, tying shoes. There are many fine motor activities needed in school that will be a red flag for determining if a child has weak hands.

Luckily, there are many fun ways to improve a child’s hand strength. 

The best way to improve overall strength is through meaningful and motivating activities…especially everyday play! 

Here, you will find a collection of pinching, pulling, and pushing activities, weight bearing activities, squeezing activities, and overall grip and pinch activities. 

These ideas improve tone in the hands, increase stability in the thumb and fingers, develop and define arches of the hands, improve precision with in-hand manipulation, improve endurance in hand strength, and address hand separation into a fine motor side and a power side.

Fine Motor Strength is essential for so many reasons! From maintaining a grasp on a pencil to opening and closing scissors, to buttoning buttons, snapping snaps, tying shoes, coloring a picture without stopping, to most everything we do…hand strength matters! 

 
 
Use these hand strengthening activities to improve hand strength needed for pencil grasp, coloring, clothing fasteners, and using scissors or other fine motor tasks.

 

 
I wanted to cover fine motor strength and the skills kids need for pencil grasp, managing scissors, working clothing fasteners, and using those hands. 

So often, we see weak arches, instability, and low tone in the hands that transfers to awkward use of the hands, impractical grasps, and poor endurance in writing or coloring. Sneaking in a few strengthening activities each day can make a world of difference!
 


Hand Strengthening Activities


Today includes a collection of hand strengthening activities that can be used as hand strength activities for adults, and to develop hand strength. Scroll through the activities below to find creative hand strengthening ideas to improve grip strength, pinch strength, or as part of a finger exercises program for handwriting.

hand strength is made up of several areas. Picture of child's hands buckling their seatbelt.

One way I can tell if hand strength is an issue is if a child (or adult) is able to push the button on a seatbelt or car seat buckle to release the seatbelt. That button requires A LOT of strength in the hands, doesn’t it? You need various components of stability too: wrist stability, thumb stability, arch development, finger strength, separation of the sides of the hand, as well as range of motion of the upper body (shoulder, elbow, forearm, wrist, fingers) and crossing midline. This is a challenging functional task for those with hand weakness. 

For younger kids, it’s a safety issue to be able to push that button on the seatbelt. But at a certain age (different for each child depending on various issues), if they should be able to release their seatbelt, but they can not, this tells me that hand weakness is something to work on. 

There are, of course many other examples at various ages and stages with age-appropriate tasks that also show me that hand strength is lacking. This is just one example.

Let’s go into these factors effecting hand strength…

What Impacts Hand Strength?

Hand strength is impacted by various components. When it comes to hand strength, there is a lot to uncover. Many aspects of motor skills impact strength and endurance in the hands. Some of those areas include these concepts:

  • Intrinsic hand strength
  • Thumb strength and stability
  • Motor control
  • Separation of the sides of the hand
  • In-hand manipulation
  • Wrist stability 
  • Wrist extension
  • Finger strength
  • Range of motion of the arm: upper arm, forearm, wrist, fingers, and thumb
  • Hand muscle tone

A hand therapist will have various hand strength norms by using a dynamometer to measure grip strength, pinch strength of various pinches. Having an understanding of hand musculature and anatomy of the hand and upper extremity is important too.

First, check out our huge online library of fine motor activities. This is a collection of all of the fine motor activities on The OT Toolbox. There’s something for everyone.

One thing that makes a big difference in fine motor dexterity is addressing separation of the sides of the hand. This post explains more about motoric separation of the hand and here is another fun activity that really strengthens those muscles.

Intrinsic Hand Strength


One of my favorite ways to work on hand strength is by using tongs. These OT activities using tongs are great for developing and strengthening the arches of the hands for improved intrinsic strength.


occupational therapy activities with tongs

In fact, the intrinsic muscles are the muscles in the hand that define the arches of the hands, bend the knuckles, and oppose with the thumbs. Activities like this intrinsic muscle strengthening activity can easily be replicated at home or in the therapy room.

child's hands pushing a straw piece into a hole poked in an egg carton
Among these muscles are a group called the lumbricals. The lumbrical muscles have a job to bend (flex) the MCP joints and extend (straighten) the PIP and DIP joints. When the lumbricals are in action, the hand might look like it is holding a plate with the big knuckles bent and the fingers extended. Read more about strengthening the intrinsic muscles here.

Underlying skills needed for tripod grasp. Picture of a drawing of a hand holding a pencil and labelled areas needed for tripod grasp

When kids write or color with a thumb web space area squashed shut, it’s a sign of problems. Then might be compensating for thumb instability, underdeveloped hand arches, and/or poor strength. Each of these problem areas will lead to difficulties with handwriting, dexterity, manipulation of small items like beads, and pencil grasp. 

Another activity that is easy to set up is using play dough or more resistive thera-putty and pushing pegs (we used Lite Bright pegs) into the dough.

Writing with a closed web space is inefficient and will cause poor and slow handwriting, especially as kids grow and are expected to write at faster speeds. A closed web space while attempting to manage fasteners such as buttons and zippers will lead to fumbling and difficulty. So, what do you do if you’ve got a kiddo who is squashing that web space shut during functional tasks? I’ve got a few ideas on how to work on open thumb web spaces.

Thumb Strength and Stability

Next let’s talk about thumb stability and strength. This is needed to support dexterity of the thumb in pincer grasp movements and in opposition of the thumb to the fingertips.

Activities to promote an open thumb webspace

Here are even more ideas to promote thumb stability and tone with activities designed to open the thumb web space.


Strengthening the hand can occur through a variety of pinch and grip exercises. Here are ideas to strengthen the hands using clothespins.

In-hand manipulation Strength

In-hand manipulation is a skill requiring strength in the hands. Activities like this in-hand manipulation activity can boost these skills. 

There are several aspects to in-hand manipulation:
▪ Finger-to-Palm Translation: Movement of an object from the fingers to the palm i.e. picking up a coin and moving it to the palm.

▪ Palm-to-Finger Translation: Movement of an object from the palm to the fingertips. (i.e. moving a coin from the palm to the fingertips to insert into a vending machine.)

▪ Shift: Slight adjustment of an object on or by the finger pads. (i.e. adjusting a pencil up and down in your hand.)

▪ Simple Rotation: Turning or rolling an object 90 degrees or less with the fingers moving as a unit. (i.e. unscrewing a toothpaste lid)

▪ Complex Rotation: Turning an object more than 90 degrees using isolated finger and thumb movements. (i.e. Turning a paperclip)

Each of the above skills can occur with items “squirreled away in the palm using the pinky finger and ring finger. This is called “with stabilization”. If other items are not pocketed away in the palm while in-hand manipulation occurs, it is called “without stabilization”. 

One way I like to work on in hand manipulation is to use a foam puzzle and fill the spaces with beads. You can have the child hold the beads in the palm of their hand. Then, they can drop the beads into the puzzle spaces one at a time. Sort by colors or just drop a certain number of beads into the spaces. This works on coordination skills. 

Stabilization typically occurs around 2 years of age. Read more about in-hand manipulation here. Here are a couple of activity ideas that can be easily replicated at home.

Wrist Stability and Strength

Wrist stability is one of the essential areas that impact hand strength.

Due to the anatomical nature of the tendons in the forearm and hand, a stabile wrist impacts hand strength, specifically grip and pinch.

When the wrist is flexed (bent forward towards curved fingers in a grasp), there is little chance of fine motor dexterity.  A flexed wrist in functional tasks limits use of the fingers due to the tendons of the fingers being shortened as they work to stabilize the wrist.  The fingers just can’t move like they are supposed to.

There are many exercises and activities that can be done to build the stability of the wrist so that it maintains a slightly extended position during fine motor activities. 

    

One fine motor activity I like to use in OT sessions is to have the child use a small pencil sharpener to sharpen a pencil. A shorter pencil is better because you encourage the hands to move closer to the pencil sharpener. It makes the hands work hard to twist the pencil to sharpen it. This really works on wrist stability and hand strength.

Upper Body Strength Impacts Hand Strength

Upper body strength is made up of the muscles in the upper chest, muscles in the upper back and muscles attached to the shoulder joint. All of these muscles work together to create stability at the shoulder joint. This shoulder girdle stability is essential for establishing a solid anchor for the rest of the arm. Without this anchor it is difficult to develop good control in the lower arm, hands and fingers. In therapy-speak we talk about developing proximal stability before we can achieve distal control. 

The stronger body enables functional performance in purposeful activities, specifically strong and efficient hands.

Occupational therapists can use these hand strengthening activities to improve hand strength in kids or adults for improved fine motor skills.
 
 

hand strengthening activities: 

Hand strengthening activities can use the items you have in your home or therapy bag. Activities that involve play are best for developing hand and finger strength in kids. Some of these ideas can integrate play and stronger hands:

strips of paper and hole punch to make small red dots
  • Use a hole punch to create confetti for crafting
  • Everyday play activities using small toys or manipulatives
  • Weightbearing activities: play games on the floor
bubble wrap with numbres on the bubles written in permanent marker
  • Pop bubble wrap (write numbers or letters on the bubble wrap with a sharpie)
  • Attach paperclips onto the edge of a paper
  • Shoot a marble into a target with the thumb
  • Screw together nuts and bolts
hands tearing paper
Stack of plastic gold coins
stack of mini erasers
colorful pony beads and pipe cleaners
  • String small beads onto string or a pipe cleaner
  • Tie and untie knots
  • Pop beads

How will you use the hand strengthening activities and ideas listed above? Maybe in a home exercise program or in a therapy program that runs throughout the school year? Maybe you will use the ideas at home or in a clinic. The ideas are endless!

Think about it, how much do you use your hands throughout the day? Would you say it is from the moment you turn off your alarm clock in the morning to the minute you cover up in bed at night? How about the times you use them during the night, such as when you go to the bathroom or readjust the covers or the pillow?

One trick I like to use is using colored pencils to make little circles and then color them in with small pencil strokes. It really works on intrinsic hand strength and arch development.

If you’re like many of us, the list of necessary tasks you need to do using your hands each day could go on and on and on. No matter how often you use your hands, they need to be in good shape and strong enough to manage all the tasks you need and want to do daily. 

However, with children, they don’t necessarily think about the times they need to use their hands and the strength the hands need throughout the day, but we bet they often think of the times that their hands have failed them and they were too weak and they couldn’t accomplish the tasks and activities that were important to them. We do believe they think about those times.

On a personal note, I work with many kids in the clinic that struggle with cutting, coloring, handwriting, drawing, pencil grasp, gameplay, dressing, and other self-care skills and the one factor that often comes into play with my kiddos is their decreased hand and finger strength. 

Hand Exercises for strength

We put together a list of hand exercises for strength. You can find this below and it includes using tools like hand grippers, therapy putty, a squeeze ball, rubber bands, and other items. We wanted to include both items that you can find in the home and items that might be in a therapy bag or in therapy supplies.

For this blog post, we will be addressing hand strength exercises and activities that can be used in the clinic, classroom, and home setting with many of them simply using some inexpensive supplies that you may already have on hand.

Some are direct exercises for older kids while some will be fun game-like exercises or activities for younger kids because we all know children need to be motivated at their level of age and level of interest, that’s why we’ve given you a variety of ideas. Board games have a lot of small pieces that are great for manipulating and using in play. These are great fine motor items for older kids!

Also, one last note, please don’t forget that even gross motor activities can also help build hand strength too! Things like wall push ups, animal walks, crawling, heavy work exercises, pulling themselves while prone on a scooter board, weight-bearing over therapy balls, climbing, and playing on the playground equipment are all fun ways to add gross motor input but also support wrist strength and stability and strengthening of the arches of the hands.

hand strengthening exercises for kids

Below are hand strengthening exercises for kids that use a variety of different materials. You’ll find different activities and ideas under each section.

theraputty exercises

Therapy putty exercises are a great fine motor exercise for hand strength.

  • power grip is simply taking a ball of therapy putty and squeezing with a gross grasp until as flat as possible, repeat
  • flat pinch is taking the therapy putty and creating a fat therapy log for the fingers to pinch flat as they attempt to stay, repeat
  • full grip is taking the therapy putty and creating a fat therapy log placing it vertically within the hand and then squeezing to make the log grow out of the top within the webspace, repeat
  • thumb press is taking a log or ball of putty and squeezing or pressing the thumb into the ball or log, repeat
  • finger curl is taking the therapy putty and placing at the base of the fingers within the palm and then squeezing the fingers into the putty making and fist, repeat 

Squeeze ball exercises:

  • gross grasp is squeezing the ball repeatedly with the whole hand and holding for 3-5 seconds and repeating multiple times
  • gross grasp with a squeeze ball that has a face – simply squeeze with the whole hand to distort the face on the squeeze ball

Squeeze and feed the tennis ball (the size of the slit opening can make the ball easier or more difficult to squeeze open)

  • squeeze the ball open to feed the ball individual objects
  • squeeze the ball and scoop dry beans with a spoon to feed the ball
Rubber band exercises with Jenga blocks and rubber bands to create block structures

Rubber band exercises

  • wrap rubber bands around the fingers including the thumb and then stretch out the hands and fingers to spread the fingers outward as far as possible, repeat 

Hand pushes and pulls

  • simply place palms of hands together and push together, repeat
  • place a small squeeze ball between the palms of the hands and push together to flatten the ball, repeat
  • simply intertwine fingers together and attempt to gently pull them apart, repeat

Palm rotation with bounce balls or marbles

  • place 2-4 marbles or small bounce balls into the palm of the hand and attempt to rotate them in a circle while only using one hand

Fist to fan to fist fingers 

  • open the hand by fanning (spreading) out the fingers and hold 
  • close the hand by fisting the fingers together and hold

Make an O to fan to O position 

  • curl the fingers into an O shape and hold
  • open the fingers into a fan and hold 

Piano push 

  • slightly curl the fingers like playing the piano and then push against a stable surface such as a tabletop or wall, repeat

Crumbling paper balls 

Use any type of paper and work on this task as bilateral or unilateral exercises.

  • bilateral – use two hands with both working individually to crumple flat sheets of paper into paper balls (you can re-use each sheet by flattening the sheet again after crumpling or you can use a new sheet)
  • unilateral – use one hand at a time to crumple flat sheets of paper into paper balls (same as above you can re-use each sheet or you can use a new sheet)

Wringing water out of washcloths or sponges

  • bilateral – use both hands together to twist and wring out a wet washcloth or a small hand towel 
  • unilateral – use one hand at a time to squeeze a wet washcloth to wring out the water 
  • bilateral/unilateral – use two hands at the same time, but both working individually to squeeze water out of sponges

Create tongs out of a Pringle’s lid or other large flexible lids 

  • use these recycled lids as tongs and squeeze with the whole hand to pick up objects and sort them
  • You can also use cardboard to cut shapes or even small squares. Then use tongs to pick them up and sort them. Here is how we used cardboard hearts with tongs

Condiment bottles and a turkey baster

  • use condiment bottles or a turkey baster to blow cotton balls or pom-pom balls in a fun race against a partner (you can use one or two hands to squeeze)

Milk the latex glove 

  • this hand strengthening exercise is where you fill a latex glove with water and then knot the opening. Use a pin to poke a small hole into the tip of each finger then a child will work on squeezing the water out of each finger like milking a cow.
Paint snow with spray bottles

Spray bottle – Either use water or add food coloring or watercolors to the water. Then spray the water onto paper. We even painted snow with the spray bottles.

  • use a spray bottle to form letters on the sidewalk or side of the building 
  • use the spray bottle to clean a chalkboard  

Robot or Gripper claw apparatus

  • full hand reacher and/or gripper apparatuses are easy for kids to use to pick up objects at a distance to transport to a nearby laundry basket or box or simply from left side to right side or vice versa

Office supply tool use to promote hand strength when in use:

  • Stapler to staple along a strip of paper or even around shapes
  • Hole punch to punch holes along a strip of paper or even around shapes
  • Bottle glitter glue to trace letters or shapes
  • Rubber band wrap to wrap around a canned good or a fun pool noodle friend
  • Marker cap removal or matching to simply remove and put back on the marker or before use mix up the color caps on the markers and have the child fix your mix-up of marker caps 
  • Scissor cutting with play dough or putty to cut play dough or putty logs or snakes into pieces

House tool use to promote hand strength when in use:

  • New plunger removal from the floor (ugh, don’t use a used one) – simply use it on a hard floor surface to push down and pull up 
  • Pushing and pulling a weighted laundry basket – simply have a child push a weighted laundry basket across the floor or tie a rope onto the basket and have a child pull it hand-over-hand to themselves
  • Pulling a rope with any weighted object on the end such as a weighted scooter board, box, or even a chair – make sure they use hand-over-hand
  • Pull pieces of Velcro apart – you can use large strips 
  • Place whole hand chip clips onto the edge of a box, rope, etc., and remove 
  • Grasp and lift a canned good for hand strength in all planes – up, down, left, right, cross midline, bicep curl, etc.
  • Roll a water bottle or canned good in the open hand while supine on the tabletop – probably for an older kiddo
  • Palm down wrist flexion exercise – drape over the edge of a table and grasp a water bottle or dumbbell and flex up while lifting – probably for an older kiddo
  • Bean bag spatula flip (grasp activity) – use bean bags and a kitchen spatula to flip bean bags from one side to the other

Use commercially available tools and games to promote hand strength (Amazon affiliate links included below):

Amazon affiliate links are included in this blog post. As an Amazon Influencer, I earn from qualifying purchases.

  • Pop Toobs – pull apart for the fun sound and push together to do again or use more than one and link them together. Read about how to use pop tubes for fine motor skills.
  • Squigz – push onto a dry erase board, hard surface floor, or therapy ball and pull off in a color sequence 
squeeze a bath toy to work on hand strength
  • Lego brick building and destruction – use the bricks to build simple towers or even buildings or objects with the use of picture cards. You can also use them to build words.
  • Build and destruct Mr. Potato Head – use the fun game to work on hand strengthening. They can build the correct way or a distorted way for fun. 
  • Build and destruct Cootie Bugs using the fun game to work on hand strengthening. This one is a little tricky for younger kiddos as the legs must go in at a slight angle which may make them more appropriate for older kiddos. 

Would you like a fun game-like resource that addresses both hand and finger strengthening? Add these fun resources to your toolkit – Finger and Hand Exercise Game Boards and Year-Round Play Dough Game Boards.

These resources include 10-12 no-prep game boards that you can print and play to practice finger isolation, left and right-hand discrimination, overall fine motor coordination, finger dexterity and build hand and finger strength. If you want to jazz up any warm-up routine, these are what you need as they are engaging for kids and are a great tool to use before coloring, cutting, handwriting, or typing work. 

Want to read more about hand strengthening and further build your therapist toolkit? 

It’s my hope that these resources are a huge help for you! Here are a few more topics related to strength in the hands that you may need in your therapy toolbox: 

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

Check out the seasonal Fine Motor Kits that kids love:

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

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

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

Intrinsic vs. Extrinsic Hand Muscle Exercises

When working on hand strengthening, it’s helpful to understand the difference between intrinsic and extrinsic hand muscles. This is important for us occupational therapy providers who are explaining WHY we are doing the activities we are doing in therapy sessions, and how they relate to everyday tasks and the daily activities that require fine motor strength. 

Intrinsic hand muscles are the small muscles located within the hand itself, responsible for fine motor control, finger coordination, and refined movements like isolating the index finger, forming a tripod grasp, or manipulating small objects. 

Intrinsic hand exercises: Activities such as putty pinches, finger walks, or buttoning tasks are great examples of intrinsic hand exercises that target these small muscles. 

Extrinsic hand muscles originate in the forearm and are responsible for larger hand movements like gripping, squeezing, and lifting. These muscles work in tandem with the hand to support strength and endurance. 

(Basically, you want to target the small muscles within the hand)

  1. Therapy putty pinches – Pinch putty or clay using the thumb and each finger individually (especially the index finger).
  2. Buttoning practice – Use shirts or button boards to build fine motor coordination.
  3. Paper crumpling – Crumple a sheet of paper into a ball using one hand.
  4. Coin flipping – Practice flipping and stacking coins using the thumb and fingers.
  5. Finger opposition drills – Touch each fingertip to the thumb in sequence.
  6. Bead stringing – Use small beads, LEGO, or Duplo blocks to promote precision and control.
  7. Pegboard tasks – Place and remove small pegs using a pincer grasp.
  8. Clothespin clipping – Pinch and place clothespins on the edge of a container.
  9. Squeeze-and-release sponge – Encourage refined grip with a wet sponge. Bonus: Use chalk pieces on the wet surfaces.
  10. Lacing cards – Thread yarn or string through holes to improve finger dexterity.

Extrinsic hand exercises: Examples of extrinsic hand muscle strengthening activities include wrist curls using a small can, squeezing a stress ball, or using a hand gripper. Supporting both muscle groups builds the foundation for coordinated, strong, and functional hand use in daily tasks.

These activities want to target the larger muscles in the forearm that control hand movement)

  1. Wrist curls – Use a small can or light hand weight to curl the wrist up and down.
  2. Squeeze ball or therapy ball – Strengthen the flexor muscles through repeated gripping. Another good idea is to use squeeze bottles to spray water at a target. You can also use a squeeze glue bottle to get that squeeze action.
  3. Theraband wrist extensions – Anchor the band and pull the wrist up and back.
  4. Hammer rotations – Hold a small hammer or similar object and rotate the wrist side-to-side.
  5. Playdough squeezing and rolling – Roll thick dough into logs using palm pressure.
  6. Weighted object carry – Carry grocery bags or weighted items to build endurance.
  7. Towel wringing – Twist a wet towel to activate both grip and wrist muscles. Bonus: Use the towel for a tug-of-war game.
  8. Opening jars – Simulated or real jars help build functional forearm strength.
  9. Elastic band finger extensions – Place a band around fingers and stretch outward.
  10. Wall push-ups or tabletop push-offs – Engage upper forearm and wrist stabilizers. Kids also love animal walks or wheelbarrow races.

Does My Child Have Hand Weakness?

Wondering if your child might have hand weakness? There are a few common signs to watch for that can point to weak grip strength and reduced use of important muscle groups in the hands.

Kids with hand weakness may tire quickly when writing or coloring, avoid fine motor tasks like cutting or drawing, and struggle with daily activities such as opening jars or zipping jackets.

You might notice them using their whole arm to move rather than isolated finger or wrist motions, or frequently switching hands during a task. A loose or awkward pencil grasp, low endurance during schoolwork, or difficulty with utensils can also signal reduced hand grip strength or limited mobility in the small muscles of the hand.

As an occupational therapist, our job is to analyze function. That’s the everyday activities we do. You can check functional activities like towel wringing, using scissors, or managing clothing fasteners. This can offer insight into different types of grip strength, such as pinch grip and power grip.

If you notice these signs, it can help to introduce functional exercises that build strength through play, such as squeezing sponges, using therapy putty, or practicing with clothespins. A pediatric occupational therapist may use tools like a hand dynamometer to assess hand strength and create a plan that targets specific muscle groups for improved hand function.

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.

School Based OT and Getting Organized Tips

by
get organized as a school based OT

The school based-Occupational Therapist is getting ready to head back into the school year this Fall.  Getting organized can be one of the hardest parts of school-based OT.  These tips and tricks are some that I’ve used during my years as an Occupational Therapist working in the schools.  

Getting Organized for Back-to-School as a School-Based OT

A new school year brings new schedules, caseloads, and responsibilities. The workload can feel overwhelming before the first week ends. Building strong organization systems now is actually a form of self care that supports a smoother year and protects against burnout. A well-planned routine can help you stay focused on your students and the meaningful work you do.

Organization begins with the tools you use daily. Here are some ideas I like that are free or inexpensive and are easy to implement:

Paper Planner

A physical calendar or paper planner keeps schedules, meetings, and deadlines in one place. Writing things down creates a visual record that’s easy to reference during a busy day.

Weekly Brain Dumps

Weekly brain dumps clear mental clutter by moving every task, reminder, and idea onto paper. This keeps priorities visible and reduces the risk of forgetting important details. It’s important to put it on actual paper as opposed to a digital list on your phone. Then cross off those tasks or to-do’s when they are done@

Clean your space

A tidy workspace supports focus. Clearing surfaces at the end of the day means you start fresh each morning. Decluttering removes unnecessary items and creates space for the materials and tools you use most. Having a designated home base for keys, wallet, and phone prevents wasted time searching for essentials.

Morning routines

Morning routines set the tone for the day. Planning clothes, meals, and therapy materials the night before prevents rushing. This extra preparation gives you more time to connect with students and begin the day with energy. Recognizing your own wins, no matter how small, helps maintain motivation and reinforces the value of the work you do.

Strong organization habits allow you to manage the demands of school-based OT more effectively. Clear systems, purposeful routines, and intentional self-care can help you maintain balance through the school year.

Tips for helping the school-based occupational therapist get organized in the schools



One of the tell-tale signs of a school based OT is the suitcase on wheels that is pulled around from school to school.  Some school-based OTs pull a bin or carry a large bag, but whatever the means of dragging around that bag of OT tricks, it needs to be organized and it needs to be all in one place.  


The OT who works in schools might see kids from Kindergarten on up through high school age in the same day.  They could be travelling from school to school within a single school day and have a work day that includes visits to classrooms, scheduled IEP meetings, make parent phone calls, and complete annual reports.  


In order to avoid feelings of overwhelming disorganization, the school-based OT needs to be organized!


This post contains affiliate links. 

School-Based Occupational Therapy Organization Tips



These are some of the ways that I maintained order while working as an Occupational Therapist in the schools:

  • A great travel bag:  A bag on wheels is perfect for pulling fine motor tools, visual motor integration exercises, various types of scissors, and creative treatment activities. You’ll want a bag on wheels because sometimes an OT working in schools has to set up shop in storage areas, stairwell hallways, or backstage extra rooms.  Being a therapist who only visits a particular school one day a week, most Occupational Therapists don’t get a special work area. They might need to find a desk area where they can and that can mean a lot of walking inside the school.  You’ll also want to use a durable bag with a lot of pockets for holding treatment materials.  
  • Paper organization:  An accordion-style file folder is great for organizing different types of writing paper, several thicknesses of paper for teaching scissor skills, and therapist-parent communication forms or home recommendation sheets.
  • Binder: Keep all of your documentation sheets, schedules, calendars, note pages, and treatment planning templates in one place.  A portable three hole punch is perfect for filing away and organizing sheets of paper while on-the-go. 

More School-based Occupational Therapy organization ideas:

  • Take time to observe students in their natural environment.  Plan on “pushing in” to the classroom with treatment occurring right at the student’s work space.  Making adaptations and accommodations can happen with the tasks the student is working on at that moment. 
  • Make time to get to know the “helpers” and staff in your school.  The school principal, secretary, custodian, and teacher’s assistants can be a great help.
  • Keep extra pens, post-it notes, and highlighters in your bag.





I am hopeful that these tips will help with organizing a successful start to the school year.  An organization system can be so helpful in improving productivity, maximizing time management, and reducing feelings of overwhelming stress due to paperwork and disorganization.


One tip that I always use as a school-based OT is using a paper planner. I NEED to write things down on calendars, lists, and have it all in one place. Digital just doesn’t work for me!

That’s why I created my own therapy planner where I can pull out the types of pages that I need for my specific caseload. I print off pages and use them over and over again to make lists, brain dumps, and more.

The Build Your Own Therapy Planner is the ultimate back-to-school organization tool for school-based OTs. Designed with flexibility in mind, it lets you choose exactly the pages that work for your caseload so you can stay organized all year long.

The planner includes a one-page master planning sheet to map out your schedule with teacher lunch, recess, specials, and caseload information all in one place. This is perfect for taking the chaos out of scheduling. You’ll also find monthly calendars, to-do lists, IEP-at-a-glance pages, evaluation and re-evaluation trackers, and monthly consultation logs to keep your workload on track. For a personalized touch, choose from a variety of cover designs and patterned pages that you can print, laminate, and reuse to make your planner fun and functional.

It’s great for tracking meetings, planning therapy sessions, keeping tabs on your students’ progress. The Build Your Own Therapy Planner is designed to help you start the school year organized and confident.

Get it inside The OT Toolbox Membership.

school-based-ot-tips-for-organization

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.

Food Texture Issues

by
food texture issues

A child with food texture issues can have a lot going on beneath the surface. What looks like extremely picky eating can be texture aversions that impact nutritional intake and participation in meals. Let’s explore specifically food texture sensitivity and what to do about this aspect of “picky eating”.

Food texture issues and food texture aversions

This may be a complicated topic, because what one person deems “picky” may be another person’s dream diet. It’s all subjective, to say the least. But when does food preference become an issue and who can help? Sometimes young children can have sensory food aversions to specific textures. It’s here that we’re covering specific and common food texture sensitivity that we see in children. 

An occupational therapist can help, of course! 

Related: Not sure if you have a picky eater? Seeking out an occupational therapist to complete a feeding evaluation is key. Also be sure to check out the Food Inventory Questionnaire for more clarity.  

TYPES OF FOOD TEXTURE ISSUES

When food texture issues are the main culprit of a nutrition deficit, an occupational therapist can help you and your family identify the underlying factors and provide solutions to develop a broader food acceptance. Now, let’s dive into the various types of different textures of food  and try to get into the mindset of a “picky eater”.

Some things to consider are the various textures that a single type of food can have. When you break down each type of food, you can see how a child might have a fear of food textures. The foods they are eating might be different each time they try them!

Fruit Textures

In the fruit category, we have lots of different textures going on. You may come across a child who eats certain kinds of fruits, like grapes, but will not touch foods of a different texture, like strawberries. But why is sensory touch an issue? Let’s break down the various textures, both inside and outside of some common fruits:

  • Smooth fruits: grapes, apples, blueberries, coconut
  • Soft/slimy fruits: mangos, bananas, pears, peaches
  • Rough/bumpy texture fruits: strawberries, blackberries, raspberries, any fruit with edible seeds! 
  • Crunchy fruits: apples, pomegranate; underripe honeydew, cantaloupe, or nectarines 
  • Wet/Juicy fruits: pineapple, overripe berries, pears, oranges, kiwis, watermelon  

Meat Textures

Various meats are very common for children to avoid because of the meat textures. Oftentimes, the exception here is with processed meats like we would find in chicken nuggets.

The texture of tough meat can be really difficult to chew as an adult, much less a child. Because the texture is so different from what many babies start out eating (purees), the introduction to meat may be a bit of a shock for toddlers.  

  • Meat texture can range from crumbly (ex: ground beef) to stiff (ex: chicken breast) and from wet (ex: rarer steak) to dry (ex: plain baked turkey).
  • If a child is averse to meat, try offering it in many different forms before ruling it out! I find that cold cuts are often the most accepted of meats (besides chicken nuggets), usually offered on their own or alongside other sandwich foods. 

Cheese Textures

While there are harder cheeses, most toddlers are exposed to softer cheeses like mozzarella string cheese or sliced American or cheddar cheese. However, the temperature of these cheeses changes their textures.

We need to think about what reactions we get for something gooey like a grilled cheese sandwich versus something more firm, like a string cheese straight from the fridge. 

  • Most cheese is smooth and soft, meaning that the sensory input is fairly “low”. I have the word “low” in quotation marks because although it may seem like it is not very much input compared to something harder, crunchier, or bumpier, it may still be a texture that is non-preferred for some, leading it to feel like a much greater sensory experience for them. 

Pureed Foods

Pureed foods, and foods with a pureed consistency are often the most accepted foods on this list, as they are introduced very young and do not need to be touched by the hands to eat.

Using a spoon instead of the fingers reduces the amount of sensory nerve stimulation that is associated with the food texture, and is, therefore, lighter on the system. 

  • Pureed foods have a soft, silky, slimy, slippery texture. They do not require much activity from the mouth to eat – no chewing or moving the food about – all they have to do is swallow. This limits the amount of time to experience the food texture as well.  
  • If your toddler is stuck on purees, try first to introduce purees with chunks. Oatmeal is a good option in this category as well. 

Texture of Bread

Most toddlers love bread. The texture of bread is soft, smooth, not very complex in flavor, and easy to chew. It’s a calming food texture to eat!

Just like cheese though, the texture of bread can change, or be different depending on warmth of bread and especially the type of bread. In the case of bread, the texture changes when you toast it or add anything as a topping.

  • Texture changes between the middle of bread and the crusts may be why so many children prefer their sandwiches crustless! If your child does love bread but has limited nutritious foods in their repertoire, consider enriched breads with whole grains to try and fill that gap.  

Cracker Texture

Crackers share some of those characteristics: they are generally smooth and lightly flavored, but they are moderately crunchy. The addition of a “crunch”, or being a firmer item in general, may be the difference between your child being able to eat bread, but not crackers. 

  • Crackers can vary from brand to brand. Goldfish crackers from the commonly known brand can have a different taste and texture than a generic or store-bought brand. Similarly, a saltine can differ from brand to brand.

This list of foods and associated textures is certainly not exhaustive, but we hope you can use it as a resource to think about food textures moving forward. 

HOW TO BROADEN FOOD ACCEPTANCE

There are many ways to address food texture issues so that nutritional input is broadened to a healthy diet. Some of these considerations are occupational therapy interventions that may be addressed in therapy sessions. Below, we’re covering:

  • Oral sensory strategies for food texture sensitivity
  • Play-based strategies for addressing texture sensitivities
  • Explore food texture issues by playing with food
  • Texture exploration without food

Oral Sensory Techniques for food texture issues

They are various ways to improve texture acceptance, but not very many that we can discuss without knowing more specifics about which food textures are causing an issue. Broadly speaking, alerting techniques are recommended for kiddos that have limited food texture tolerance.

Alerting sensory techniques for feeding involve increasing stimulation to the nerves in the mouth in a way that the child enjoys. By increasing input in a positive way, the nerves become desensitized and primed for experiencing more textures.

If this were completed in a fashion that the child did not enjoy, the technique is no longer valid. In other words, forcing someone to do something they dislike is never a good way to increase that behavior in the future. 

Examples of alerting sensory input for feeding include:

  • Cold items like popsicles or frozen teethers/chewies
  • Vibrating items like an electric toothbrush or a (Amazon affiliate link) z-vibe 
  • Fun candies like pop-rocks (for that sizzle and bang!) or rock candy (for that super interesting mix of sharp, smooth, and crunchy texture). Candy is not the best mechanism for broadening a diet, but it can be a very well-accepted item that provides a new texture to the mouth. 

Alerting sensory inputs are not only beneficial for increasing food tolerance, but they are also great for attention, self-regulation, and more! Check out our posts about Sensory Popsicles and Sensory Water Bottles for more information on that.  

Play-Based Sensory Techniques for Issues with Food Texture

In conjunction with oral sensory techniques, I always offer families ideas to explore various textures in and out of the kitchen. 

Explore Food Texture Issues by Playing with Food

Important Disclaimer: Families that are not comfortable using food for non-nutritive purposes, like some of the activities below, should refrain from doing so. You know your family’s needs best! 

Exploring Texture sensitivity through Play without Food 

You can use pretend foods during playtime (they could be invisible or plastic/wood), or create a themed sensory bin using a variety of sensory bin bases for various textures. But really, ANY way to increase your child’s sensory input, especially to textures, will benefit their feeding experience. Remember that these items do not need to be mouthed to help. Just touching the skin increases texture tolerance. Here are some ideas:

  • Crawling or rolling on grass
  • Scooping and dumping sand
  • Making and playing with sensory doughs
  • Collecting rocks or seashells
  • Picking dandelions 
  • Water play (bathtub/ buckets/ bowls/ water table or pool)
  • Popping bubbles
  • Play dough activities galore 
  • Sequined items to manipulate
  • Exploring textures in the backyard

Other Mechanisms to Solve Food Textures Issues 

I will be the first to admit that sometimes, picky eaters are just picky eaters regardless of the sensory experience. If this is the case for your little one, I would check out Kids Eat in Color, a nutritionist who has tons of great resources for families with questions about picky eaters. 

Also, your OT may suggest other ways to increase functional independence during meal times with some adaptive equipment for eating. Although it may be stressful, try to keep mealtimes low-pressure and fun!  

The Sensory Lifestyle Handbook
The Sensory Lifestyle Handbook

The Sensory Lifestyle Handbook walks you through sensory processing information, each step of creating a meaningful and motivating sensory diet, that is guided by the individual’s personal interests and preferences.

The Sensory Lifestyle Handbook is not just about creating a sensory diet to meet sensory processing needs. This handbook is your key to creating an active and thriving lifestyle based on a deep understanding of sensory processing.

Sydney Thorson, OTR/L, is a new occupational therapist working in school-based therapy. Her
background is in Human Development and Family Studies, and she is passionate about
providing individualized and meaningful treatment for each child and their family. Sydney is also
a children’s author and illustrator and is always working on new and exciting projects.

Texture Progression

Introducing a texture progression or hierarchy can help children gradually tolerate a wider range of food textures.

Starting with smooth, predictable textures like purees and moving toward mixed, chewy, or crunchy textures gives the nervous system time to adapt without overwhelm.

Occupational therapists often use this approach to guide safe and structured food exploration, helping children build confidence and reduce anxiety at mealtimes.

Case Example:

OT Strategies for Food Aversion

Occupational therapy offers hands-on tools that support oral sensory needs and food exploration. Items like textured spoons, chew tubes, and vibrating tools (such as a Z‑Vibe) can help children tolerate new textures while building oral-motor strength.

These tools can be especially useful for children with sensory processing challenges, making feeding therapy more effective and personalized.

Multisensory Mealtime Approaches

Sensory challenges with food rarely begin and end at the table. Preparing the body through deep pressure activities, vestibular input (like swinging), or calming breathing exercises before meals can help reduce sensory defensiveness.

Integrating sensory diet strategies into mealtime routines creates a more supportive environment for children who are sensitive to food textures, smells, or presentation.

When to Seek Professional Help

Some feeding issues go beyond picky eating and require support from an occupational therapist or feeding specialist.

Signs such as frequent gagging, weight loss, refusal of entire food groups, or high distress around eating are red flags.

An OT trained in feeding therapy can assess oral-motor function, sensory sensitivities, and behavior patterns to create a targeted plan that supports safe and successful mealtimes.

Sensory Feeding Therapy Strategies for Texture Challenges

Sensory feeding therapy helps children who experience discomfort, vomiting, or refusal when trying new foods. These responses are often related to how their body processes sensory information, especially in children with sensory processing disorder or those on the autism.

Feeding therapists use evidence-based strategies like gradual exposure, play-based food exploration, and calming routines to reduce anxiety during meals. This type of therapy is especially helpful for kids who have developed strong food texture aversions and need structured, supportive guidance.

Food Texture Progression for Feeding Therapy

When working with kids who have food texture aversion, it’s important to move slowly and intentionally through food textures. Begin with very smooth, uniform foods and work toward more complex textures as tolerance improves. This sample texture progression supports swallowing, chewing, and comfort with small bites:

  1. Smooth textures: smoothie, cream, pureed vegetables
  2. Slightly thicker: soups, blended eggs, yogurt
  3. Soft solids: mashed pasta, soft cooked vegetables
  4. Mixed textures: oatmeal with fruit, cereal soaked in milk
  5. Crunchy or firm textures: dry cereal, crackers, raw veggies
  6. Multi-textured: layered meals like lasagna or sandwiches
  7. Unpredictable or resistant foods: salads, meats, mixed dishes

Progression can vary from child to child. Take cues from their preferred texture, use a fork to offer small bites, and always allow the child to lead. Click to see examples of food chaining activities that follow a texture progression.

Feeding OT Strategies for Food Texture Aversion

Children with food texture aversion may show symptoms like gagging, refusal, or strong reactions when offered unfamiliar or mixed textures. These reactions are a sign of sensory overload or a lack of integration between texture, taste, and smell.

Occupational therapists support these challenges using strategies like tactile food play, gradual exposure, and oral motor warm-ups.

Introducing new foods alongside preferred snacks in small amounts and without pressure can reduce fear and build tolerance.

Picky Eating Sensory Approach: What Parents Should Know

Picky eating isn’t always a behavior issue. It often stems from sensory discomfort. Children on the autism spectrum, or those with sensory processing disorder, may react to certain textures with avoidance, gagging, or even vomiting.

Foods like eggs, pasta, or cereal can feel too slippery, sticky, or crunchy depending on the child’s sensory profile.

A picky eating sensory approach focuses on building trust, offering food without pressure, and supporting regulation during meals. Simple steps like involving the child in food prep or offering foods on divided plates can make meals feel safer.

When to Seek Feeding Therapy Professionals

Sometimes, food refusal goes beyond picky eating and requires help from feeding therapists or OT professionals. Red flags include sudden refusal of smoothie, soups, or other familiar foods, extreme discomfort with food smells or textures, or refusal to swallow certain consistencies.

If your child regularly refuses vegetables, gags at new textures, or eats fewer than 10 different foods, it’s time to consult with a professional. Feeding therapy offers structured, individualized support and helps families develop realistic strategies for long-term success.

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.

Body Awareness Activities Using Proprioception

by
Body awareness activities

Let’s talk body awareness activities using proprioception, or heavy work to bring awareness to where the body is, how the body moves, and awareness of self. Proprioception is one of the senses that is involved with everything we do. This sensory system plays a major role in body awareness. Below you’ll find body awareness occupational therapy activities to support this motor concept.

Be sure to check out a related resource, our self awareness games blog post for activities to support overall awareness of self.

Take a quick moment to stop and consider the position you are in right now.  Are you lounging back on a couch?  Sitting at a desk?  Bouncing on a city bus as you glance at your mobile device?  Are you perched in an office chair with your legs folded under you? Are you hanging out at the playground and glancing at your phone while your kids run in circles?

body awareness and proprioception go hand in hand. Image is a picture of a body with arrows. Text reads: body awareness

Here’s one of my favorite OT tips for supporting proprioception and body awareness skills: If you need activities that provide proprioceptive input, and for quick grab-and-go options, our Heavy Work Activity Cards make movement breaks easy and visual.

What is Body Awareness?

The definition of body awareness is this…
Body awareness refers to being aware of the body’s position in space at rest and during movement. This concept can be broken down into having an awareness of body parts by name, movement, discrimination of sides of the body, and movement throughout space.

Related, are the concepts of dominance and mixed dominance vs. ambidexterity.

How does body awareness work?

Let’s break it down:

Being aware of our body position is something that happens automatically and naturally.  That body awareness occurs naturally.  The proprioceptive sense allows us to position our bodies just so in order to enable our hands, eyes, ears, and other parts to perform actions or jobs at any given moment. Proprioception activities help with body awareness.

The proprioceptive sense sends information about our body’s position to the brain so that we inherently know that our foot is tapping the ground as we wait on the bus or that our leg is curled under the other on the couch even while we do other actions or tasks.


This awareness allows us to walk around objects in our path, to move a spoon to our mouth without looking at it, and to stand far enough away from others while waiting in a line at the grocery store.  It enables a student to write without pressing too hard or too lightly on their pencil when writing, and it helps us to brush our hair with just the right amount of pressure.


Proprioception is essential for everything we do!


Sometimes, the proprioceptive system does not do it’s job.


When the proprioceptive system isn’t functioning properly, body awareness and motor planning can be a problem.

Kids need heavy work and propriocpetion to help with body awareness needed for skills like standing in line, motor control, and spatial awareness in school and in the community.

When a child needs to pay attention to where their body is in space at all times, they can not attend to other important information like what is happening in their world around them.  He or she can not automatically adjust to environmental changes.  The child then needs to visually compensate in order to adjust his or her body.  This can result in a child being clumsy, fearful, are even scared in certain situations.

Examples of Body awareness



Below are two situations that describe a child with proprioception challenges.  In both, imagine a child who struggles to know where their body is in space.


Body awareness navigating bleachers- Imagine you are sitting on a set of bleachers in a crowd of wiggly, moving, and LOUD students.  There is a lot going on around you, whether you are at a sporting event or in a gymnasium.  

But, you also notice the bleachers don’t have a bottom to the steps; that is, you can see directly down to the ground below you.  Kids are standing up, sitting down, jumping, roughhousing, and you are SCARED.  

Your body doesn’t know how to position itself in a safe manner. You don’t know what action will come next and you don’t know where to look. You don’t know where your feet are or if your hands are supporting you.

Climbing up and down the bleachers is downright terrifying! For the child with proprioceptive struggles, just sitting on a set of bleachers can be challenging and overwhelming.


Body awareness sitting at a classroom desk- Now think about the child who is sitting at their desk and is required to write a journal entry.  For the child with proprioceptive challenges, this can be a task with many “self-checks”.

They need to look at their feet to make sure they are under their desk so they don’t get in trouble for almost tripping someone between the desk aisles.  They need to make sure they are sitting upright in their chair and that their back is touching the chair’s backrest.  

They need to hold the paper and the pencil like they were taught.  They need to align the paper and the words and then think about how hard to press on the paper, how to make the lines for individual letters, and how to string together letters to make words.  

What a workout it is just to get settled in and started on a writing task!  By now they might have lost several minutes of the writing time and they still don’t know what they are even writing about!


Both of these situations happen on an every day basis.  

For the child with proprioception difficulties, the ability to be aware of their body in space and plan out motor actions is very much a struggle.  These kids might appear fidgety, unsure, overwhelmed, clumsy, awkward, uncoordinated, or lazy.



Body awareness is related to visual spatial relations.

How to use proprioception activities to help with body awareness

Body Awareness Goals in Occupational Therapy

When children or adults struggle with awareness of body positioning or movement patterns during activities, functional tasks can be a struggle. Every day tasks are difficult or impaired.

Occupational therapists work with individuals of all ages on functional tasks that occur in all aspects of daily living. Movement is part of the daily task completion, so it is likely that if body awareness is an issue, there are functional impairments at play.

Occupational therapy professionals will focus body awareness goals on the functional task that is impaired.

OT goals for body awareness can be specifically focused on improving body awareness during those functional tasks. Activities that address those goals can include heavy work, attention to task, motor planning, fine or gross motor skills, sensory input in the way of organizing proprioceptive input or vestibular input, visual cues and prompts. There are many ways this skill area can be addressed and these goals will be individualized for the child or adult.

Additionally, OT goals for body awareness may focus on motor planning. Proprioception is very closely aligned with body awareness and motor planning.

Need more information on proprioception and the other sensory systems and how they impact independence? Grab this free sensory processing disorder information booklet and free email series on sensory processing. 

CLICK HERE to get the free sensory processing information booklet.

Body Awareness Activities

In this blog post, we are specifically discussing how to use proprioception activities to help with body awareness.

The proprioceptive system is alerted through heavy work activities that involve heavy pressure, firm sensations, large, forceful motor movements, and pushing or pulling activities. These actions can be calming and organizing.

Try these proprioception activities to help with body awareness at home, in the classroom, or in play.

Proprioception activities at home

  • Carry full laundry baskets to the laundry area
  • Empty wet clothes into the dryer
  • Change sheets
  • Pull weeds
  • Pull garbage cans to and from the curve
  • Carry in grocery bags
  • Carry donations to the car
  • Wash windows
  • Scrub carpets
  • Shovel snow
  • Rake leaves
  • Mop floors
  • Vacuum
  • Rearrange furniture

Proprioception activities in the classroom

  • Carry piles of books
  • Rearrange furniture
  • Help gym teacher move mats
  • Carry bin of lunchboxes to/from the lunch room
  • Wall push-ups
  • Chair push-ups
  • Clap erasers
  • Stack books in the library
  • Place chairs on desks at the end of the day, pull them down again in the morning

Proprioception games and actions

Looking for more ways to add proprioception activities into play and therapy? Try the ideas below. Just click on the images to read more. 

proprioception sensory dough marshmallow   Snowball Shot Put Sensory Play for Kids
 
 
DIY Ice Wobble Balance Disk for Proprioceptive and Vestibular Sensory Play  After school brain breaks and activities for kids 
 
 
Travel Sensory Diet Proprioception and Handwriting 
 
Fine Motor Proprioception Play Dough Rocks Frozen Play Dough

In the Sensory Lifestyle Handbook, we cover motor planning and body awareness concepts as they are deeply related to sensory processing. Much like the body awareness activities listed in this blog post, the book discusses how to integrate functional tasks within the day that offer organizing and regulating input through functional activities.

Not only are these activities regulation tools, they are also activities that support development of body position in space and awareness of the body’s movements.

Click here to get your copy of the Sensory Lifestyle Handbook.

The Sensory Lifestyle Handbook
The Sensory Lifestyle Handbook

The Sensory Lifestyle Handbook walks you through sensory processing information, each step of creating a meaningful and motivating sensory diet, that is guided by the individual’s personal interests and preferences.

The Sensory Lifestyle Handbook is not just about creating a sensory diet to meet sensory processing needs. This handbook is your key to creating an active and thriving lifestyle based on a deep understanding of sensory processing.

Body Scheme and Body Awareness

Another way that you may have heard body awareness phrased is “body scheme”. This is just another way to explain the awareness one has of their body and the various parts of the body. Body scheme allows us to be aware of the spatial relationships of where the body is in space in a given activity.

Body scheme involves proprioceptive awareness so that we can move and interact in the world around us.

We can define body scheme as the awareness of body parts and the position of the body and it’s parts in relation to themselves and to the objects in the environment.

When there are deficits in body scheme, we may see certain difficulties:

  • challenges with apraxia, or difficulty with purposeful movement in relation to sensory input, movement, and coordination.
  • The individual might not recognize body parts or the relationship between them. This is especially observed in neuromuscular disturbances such as a CVA (stroke)
  • Movements may be considered unsafe. We might see difficulties with intentional movement and problems navigating busy hallways, stadium steps, bleachers, etc.

There are typically related deficits related to body scheme or body awareness difficulties. These may include:

  • Body awareness challenges like moving and utilizing the body without looking at or thinking about how the body needs to move. This awareness of the body in space results in functional and efficient movements with coordination.
  • Right/left disorientation or poor left/right discrimination in activities
  • Trouble identifying body parts. Try this body part identification activity to support this awareness.

Challenges with body scheme may be a cause of brain damage or brain injury such as a neuromuscular impairment. However, difficulties with body scheme may be a result of other deficits as well, including visual-spatial deficits, sensory processing challenges, verbal, or conceptual considerations.

Using Heavy Work Cards for Proprioceptive Input and Sensory Regulation

Proprioception is the body’s ability to sense its position in space, and when kids engage in heavy work activities, like pushing, pulling, lifting, or jumping. These types of activities activate the sensory processing system. This input supports better motor planning, coordination, and self-regulation. Our Heavy Work Activity Cards are a simple way to offer proprioceptive input through movement-rich activities that can be done in short bursts throughout the day.

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.

Calm Down Corner

by
Calm down corner ideas for calming sensory strategies.

For young (and old) children, a great calming classroom tool that supports learning, social participation, and school tasks is the calm down corner. A calming corner in the classroom can be a great sensory strategy to support emotional regulation needs in students. It’s a place to calm or re-organize in a personal bubble, meeting regulation needs so learning can happen. Let’s go over fun calm down corner ideas to support various regulation needs in the classroom.

Calm down corner ideas and tips

As a pediatric OT, I love easy activities that I can use over and over again. One of my favorites are my heavy work activity cards that I can print off and use different themes based on the time of the year. Stock your calm-down corner with visual supports like our Heavy Work Activity Cards, which offer quick movement options for sensory regulation.

They are a great addition to calm down corner ideas like the ones below!

Calm down corner ideas for calming sensory strategies.

Calm Down Corner

As an Amazon Influencer, I earn from qualifying purchases.

A classroom calming area can include a variety of movement and sensory based activities or tools. 

  • A place to sit: A visual space for a child to sit in their calming area, that is large enough for one child only. This could be a bean bag chair, a cushion or a pillow. These soft spots will help make the cozy corner comfortable so children feel they can stay as long as they would like. There are so many options when it comes to Flexible Seating tools – bean bag chair, movement seat, deflated beach ball seat, couch, soft chair, floor mats, large pillows
  • Soft surfaces – yoga mat, gymnastics mat, or soft rug
  • Headphones – with or without music, sound machine
  • Visual schedule of sensory strategies
  • Emotions Playdough mats can be a great tool for a calm down corner.
  • Things to look at – books, magazines, pictures, lava lamp (refrain from electronics that have a screen, as they are alerting)
  • Calming corner printables and other visual calming strategies – Check out these calming sensory stations for Spring
  • Timer – visual timers with countdown options are great
  • Preferred sensory items such as tactile toys, chewing items, plushies, fidgets, etc.
  • Books: Looking through picture books of all kinds, helps to give children something to do, while keeping their minds calm. Most of the time that children are interested in using a cozy corner, is when they are feeling overwhelmed. These Zones of Regulation books that talk about different feelings and support regulation and processing through feelings such as sad, scared, angry and more. These empathy and friendship books are another tool to consider. Place the books in a basket or a shelf for easy access. 
  • Emotional Supports: Visual and tactile supports help people of all ages, but it is essential to have a visual space in the classroom for preschoolers to retreat to when they need time to calm down. Soothing Sammy makes creating this area simple and makes it a positive experience for children. This adorable golden retriever has his calm down house which can be placed in the cozy corner, with items that help children calm down using their sensory system. As they calm down, they can use the visuals included in the kit to explain to other children and adults how they are feeling and what they need support with.
  • Stuffed Animals or Baby Dolls: When feeling lonely, sad, scared or overwhelmed, having access to baby dolls or adorable stuffed animals makes the space less lonely. Additions such as baby doll blankets, bottles and other caretaking tools, allow children to comfort others as they work on comforting themselves. 
  • Personal space: Adding a privacy cover or even simply a boundary to the cozy corner space helps children not to be distracted by other aspects of the environment. Placing fabric, cloth or other child-safe covers over the cozy space allows children to feel like they are in charge of their own space. Some child care centers place the cozy areas in small tents, (Amazon affiliate links) canopies (affiliate link) or wooden privacy cube like this one. (affiliate link)
  • A feelings check in could be a great addition to this space. The child could enter the calm down area and identify how they are feeling and then use strategies to support those needs.

This list is just the beginning! A calm down corner can include any item from the list above or classroom sensory diet strategies, based on the needs of the individual student.

This article on supporting self regulation in preschoolers offers valuable information on this topic.

Calm down corners can be quiet soothing areas to decompress for certain learners, while others need a more active calm down area in classrooms.

How to Add movement to a calm down corner

There are many different ways that children can calm down. Movement is one of the most beneficial and complicated ways to manage feelings and emotions.

There are two different types of movement patterns that support the sensory system.

Both of these types of movement activities increase awareness of where a body is in space, calms the central nervous system and regulates emotions in an amazing way. Movement is complicated as it can be alerting and calming. Picking the right activity for the desired outcome is tricky, but effective.

Help your learner understand what they need for self regulation, rather than bouncing all over the calm down corner.

How is movement calming?

Have you noticed that children seem to pay attention longer after moving around for a while? This isn’t just because they are tired after completing an active task. Children and adults are able to attend for longer periods of time when movement breaks are embedded into their daily schedules due to the sensory benefits it provides.

For adults that have desk jobs, it is widely known that every 20 minutes, they should stand up. This not only helps blood flow, but also awakens the body. When children are engaged in circle time, implementing movement based activities within circle (like freeze dancing, jumping and marching) is beneficial to improving attention.

Movement has many benefits, including helping calm down when feeling overwhelmed with emotions. 

When the sensory system becomes overstimulated due to internal feelings and frustrations, some people are quick to seek out movement activities to calm down. Adults may go for a walk or run, chew gum, lift weights or kick a ball. This strategy directly affects proprioceptive input.

There are many ways the body processes movement. This impacts the central nervous system in different ways.

  • Proprioceptive inputs is one of the ways the body processes movement. It tells the brain where the body is in space. Proprioception is guided by skin, muscle, and joint receptors in the body, to connect to the brain through the nervous system. In this way, a person knows where their body is in space, and what the body is doing, without needing to watch the body parts move. A great example of proprioception, is being able to walk down the stairs without looking at ones legs or feet
  • Heavy work, or tasks that involve heavy resistance, offers input to the muscles, joints, and connective tissue, and is essential to regulating the sensory system
  • In this article on neuroplasticity, evidence suggests the sensorimotor cortex that governs proprioception is not fixed, and can be changed through external manipulation.
  • Vestibular movement, like proprioception, also helps alert us where our body is in space. This system operates through the inner ear, passing information to the brainstem, affecting many areas of the body. If a person starts jumping, rocking to music, or dancing to calm the body, it activates the vestibular system. This article on vestibular activities does a great job explaining this system.

more about the vestibular system

Receptors in the inner ear, found in two structures (the otolith organs and the semicircular canals), respond to linear/angular/rotational movement, gravity, head tilt, and quick movement changes. 

The receptors in the ear, provide information to the central nervous system about the body’s position in space. Information is used to:

  • control posture, eye, and head movements
  • correct the eyes with head and body movements
  • muscle tone and postural adjustments
  • perceive motion and spatial orientation, and integrates somatosensory information

Through the vestibular and proprioceptive systems, the body processes information about where it is space, interprets movement patterns, and recognizes touch and joint pressure. These senses greatly impact the ability to calm down by triggering pressure points through movement (such as rocking or swinging). 

When a child (or adult) becomes upset or overwhelmed, it is helpful to utilize the vestibular and proprioceptive systems as intervention tools. This helps a person calm and self regulate, in order to process their feelings and problem solve. 

Because children often need sensory strategies to self regulate, having a designated calm down area set up in the home/classroom makes redirecting children to the appropriate calming activities much easier.

The Soothing Sammy program is a great way to encourage children to take part in creating their own calm down corner through a story about a dog, Sammy, a golden retriever. As children help build Sammy’s calm down area to use when overwhelmed, they are gently taught that it is okay to have a variety of feelings. As children look through the book, they learn how to use objects in their calm down corner when needed, including drinking water, wiping their face with a cloth, jumping on a small mat (proprioceptive and vestibular input) and much more. 

There are so many items that we can add to a calm down corner and every calm down corner will be different based on individual children’s needs. In the Soothing Sammy curriculum, there are recipes for lavender bubbles, slime, tactile fidgets, paint, and others.

Proprioception Calm Down Corner Ideas

Here are some great proprioceptive strategies to include in a calm down corner:

  • Calming Corner Printables- Print off the sensory stations listed below. These support heavy work needs (and vestibular input)
  • Jumping mat or small trampoline. When children jump, they put pressure on their joints 
  • Weighted blanket. Weighted blankets provide deep pressure over the entire body, making this activity one of the an effective whole-body proprioceptive strategies to help children calm down
  • Watering plants. Lifting a watering can, can impact joints all over the body. As children stoop down to pick up the watering can, moving it over plants of different heights, they are getting great input
  • Weighted ball. Lifting and rolling over a weighted ball increases proprioceptive input in the hands, arms, shoulders, and core. 
  • Play Dough. Squishing, squeezing and pulling apart playdough or clay, increases proprioceptive input in hands and small joints. 

Some of these activities can be alerting or calming, therefore some trial and error may be needed.

Vestibular Calm Down Corner Ideas

Movement with changes in positioning can be calming as well. Think slow, rocking movements. Here are some Vestibular strategies to include in a calm down area:

  • Farm Brain Breaks – These simple, yet fun activities, provide visual ways to complete vestibular activities
  • Calming Corner Printables- Movement like yoga poses or those offering brain breaks can be just the calming input needed.
  • Swinging – Help your child move and sway in different directions with an indoor or outdoor swing. A Sensory Swing for modulation is an amazing way to provide an option to swing in a home or preschool setting
  • Trampoline – Provide a small trampoline for your child to jump on. (Amazon affiliate link:) This toddler trampoline with handle is perfect for indoors spaces
  • Dancing – Any type of movement to music, including freeze dancing or shaking instruments (such as a tambourine, bells, maracas) or using scarves, are wonderful additions to a calm down corner
  • Yoga Poses – There are several themed yoga poses perfect for children. Add a yoga book or cards like these Unicorn Yoga Poses to any calm down area

calming corner printables

One tool to add to a calming corner or calming space is a printable that offers a visual designed to promote calming and organizing self-regulation. These calming corner printables are easy to print off and start using right away.

Over the years, we’ve created seasonal sensory paths, or sensory stations that support regulation needs. We’ve received wonderful words of thanks and feedback letting us know how loved these sensory stations have been.

Check out each of these seasonal calming corner printable packets. Pick and choose the ones that support your needs in the classroom, therapy clinic, or home:

  1. Summer Sensory Stations
  2. Fall Sensory Stations
  3. Winter Sensory Stations
  4. Christmas Sensory Stations
  5. Spring Sensory Stations

Additionally, other calming corner printables might include deep breathing posters. We have many free deep breathing exercises on the website, including:

Finally, a brain beak printable like our popular alphabet exercises makes a great wall poster for a calming corner of the classroom.

Keep in mInd about setting up a calming corner in classroom

Calm down areas should incorporate all the senses, as every mood, trigger, situation and response is different. Equally important is the co-regulation aspect, which relates to responding to the mood and behavior of those around us, or the peers that may be present in a classroom or home setting.

By utilizing a variety of calming tools in a calming corner, or calm down space within the classroom, children will be able to identify what they need, the moment they need it, while still engaging in active learning.

It can be daunting and complicated providing for the needs of all of your different learners, however, by incorporating vestibular and proprioceptive materials in a calm down corner, children are able to use these powerful movement strategies when they need them the most, all while taking a multisensory approach to academics.

Sensory Corner

We’ve covered ways to set up a calming area, but what if you really want to feature the cozy aspect of a sensory space in a classroom or home? A sensory corner is very much the same concept, with different terminology. The key to a calm down space is incorporating sensory components within these areas.

Research shows that having a designated space for children to have alone time in, during their school day, is a way to support emotional development and independence, while also teaching children that it is okay for their friends to take a break.

When combining visual, tactile and other sensory components into the design of a cozy area, children will independently seek it out when they need a break from their peers. 

in the classroom is a cozy or quiet space for one child to spend time independently when they feel like they need a break from the regular commotion of a preschool day. This area can be used to take a sensory break, to calm down when they are feeling upset or overwhelmed, or to just take a break. 

This area should be accessible for all children at any time of the school day. This area is best used when it is at the child’s level, is situated in an area of the classroom that is far away from the busier/louder areas of the classroom, and includes sensory supports to encourage calming and peaceful experiences. 

Whatever you call your safe space, and however you set it up, what matters most is your intention.

Sensory corners

Why Use a Sensory Corner?

A calming corner or a sensory corner may be used for many various reasons.

There are hundreds of reasons why children might need to take a break from other children in the classroom. They may feel sad, overstimulated or just need time to recharge.

This may include:

  • Feeling overstimulated in the classroom
  • Overwhelming feelings
  • Needing to recharge or refocus
  • Having a bad day
  • Changes in routines
  • Feeling “out of sorts”
  • Worried about a home situation
  • Worried about a friend situation or social situation
  • Worried about a test or project in the classroom
  • Sadness about home situations
  • Missing family or pets
  • Not sure what to expect or what is expected of them

Remember that the goal of the sensory corner is to offer a safe space, or to give children a place to calm down, feel safe, and regroup when they are overcome with big emotions at school.

One thing to consider is that a calm down area of the classroom can be effective at the start of the school year due to transitions in the classroom when a new classroom may mean a lot of unexpected sensory input. This is a great addition to back-to-school sensory activities that support students of all abilities.

Where to put a cozy area:

When looking at an indoor preschool classroom set up, there are many centers that are utilized by children throughout the day. The key is to avoid adding visual noise, or visual clutter when adding a cozy area to the classroom.

Some of the busiest areas include the circle time/gross motor area, the block area and the art areas. These areas tend to attract groups of children at once and aren’t the best spaces to put next to a calming area. 

The library, dramatic play and animal/science areas, tend to be more quiet spaces in the classroom. Each of these spaces will support a calmer environment to build a calm down area. When deciding what wall or area to place the calm down spot, keep in mind the following environmental components:

  • Is there a window nearby that will give off too much light?
  • Are there large gross motor/sensory spots that are noisy?
  • How many pictures are on the wall, and are they soothing?
  • What are the colors of the walls by the calming area, and are they overstimulating? 
  • Is the space adequate for one child, or will more children try to encroach on their alone time? 
  • Can this space be easily visible by a teacher doing active supervision?
  • Is this space near high traffic areas, like the entry door or bathroom?

Many spaces may feel like the perfect spot for a calm down space inside the classroom. You know your kids the best and where they spend most of their time. As the school year progresses, there may be times where you want to move your calm down area to a better spot, and that’s okay! 

Outdoor sensory corner ideas

Outdoor Sensory corner Ideas

Don’t forget about the outside as an option for a calm down space! We know the many benefits of outdoors as a calming area, so simply going outside is a great option for calming the mind and body while organizing (or regulating) the sensory motor systems. The outdoors is one way to add free sensory motor options to the classroom.

We’ve covered outdoor sensory diets before, and this is a great article to start with when considering an outdoor sensory space for home or classroom use. In fact, we love to select specifics for the home too, when it comes to sensory diets in the backyard. Even the playground or recess is a sensory calm down space for some kids.

Kids need quiet spaces while they are playing outdoors also. When setting up an outdoor learning environment, make sure to incorporate some independent areas in a shady area of the playground. These spaces could be near the garden, near a book reading area, under a nice shade tree or near a swing. You can even add an outdoor sensory swing as a calming option.

When setting up an outdoor area as a sensory corner for classroom breaks, consider what science says: Research on outdoor sensory play tells us that playing outdoors supports development, but there are emotional benefits as well as benefits to learning.

Some components to think about when setting up your outdoor calm down area include:

  • Is it sunny or shady?
  • Is it near an area where children will be running quickly?
  • Is it near a highly trafficked area, like a parking lot, walkway or door?

Quiet cozy areas should be available for children at all times. It isn’t a punishment corner, rather a space that children can “take a break” when they need it.

Here are 5 simple ways to incorporate cozy spaces outdoors so children have the opportunity to play on their own when needed. 

1.Place to Sit: The first step to creating a safe space is for children to have a space to be on their own. You can create this in a similar way with an area rug or cushion like the indoors, or you can create something with more of a visual “splash” like these calming spaces in children’s swimming pools. 

2. Gardens: Nature is a great accessory to a cozy nook area outside. Consider creating a cozy nook with a variety of plants. Adding trellis’s and arches where different vegetables and flowers and grow over a child’s safe space, incorporates natural colors and healthy foods into the safe space that children will spend their time. Sensory gardening is also a great option for a sensory break from the classroom that fosters learning!

3. Swings: Attaching a child safe swing to a tree provides a sensory rich safe space where children have the opportunity to have quiet time and self soothe. There are so many sensory swing options including a hammock swing and a platform swing. 

4. Individual Art Space: Child initiated process art in nature can be a calming and essential experience that supports children when they are overwhelmed or overstimulated. A simple way to create this individualized space is by attaching an easel to a fence and offering different mediums to use with the easel (markers, paint, chalk.) Some of these creative painting ideas are fun to try in a sensory calm down space.

5. Sensory Table: A small sensory table or a sensory bucket is a wonderful way to encourage individual calming time while outside. You can add a variety of different materials to the sensory tub, or offer options of 5 or six sensory buckets. This could include bubbles and wands, sand, goop or some more of these sensory bin ideas. Another idea is to set up a nature table. You could even use a picnic table with a sand writing tray on top where users draw in the sand on the table surface.

Best Practice for Calm Down Corners

No matter what you call them: calm down corners, cozy corners, or sensory corners…and no matter where they are located: indoors or outdoors, in the home, or in the classroom, these sensory spaces are a valuable tool for promoting self-regulation and emotional well-being.

They provide a dedicated space for students to practice calming techniques and engage in activities that help them manage their emotions. Calming corners may include tools such as breathing exercises, visual aids with coping strategies, mindfulness activities, and calming sensory items like stress balls or visual timers…or any item that offers a sense of peace.

The key is to create an environment that is quiet, comfortable, and free from distractions, allowing students to recharge and regain focus when needed!

If you are setting up a calm down corner for your classroom as you gear up for a new school year, be sure to check out our resource on back-to-school sensory activities as an addition to your classroom calming area.

Heavy Work Activities for Calm Down Corners and Self-Regulation

Including heavy work in a calm-down corner can help children reset their bodies and minds during times of dysregulation. The resistance and pressure involved in heavy work helps to activate the proprioceptive system, which is known to reduce anxiety and improve self-regulation. Use our Heavy Work Activity Cards in your calm-down space to give kids structured, calming options they can choose independently.

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.

Visual Impairment and OCcupational Therapy

by
visual impairment and occupational therapy

In this blog post we are covering all things vision impairment and occupational therapy. Visual Impairments such as convergence insufficiency, impaired visual saccades, or other visual problems like blurred vision can present as a problem in the classroom. Students with visual impairments will flourish with effective classroom accommodations for visual problems. Below, you will find strategies that school-based occupational therapists can use as accommodations for addressing visual needs while meeting educational goals.

Be sure to check out our resource on vision as a starting point.

Visual impairment and occupational therapy

Other resources that are helpful include:


Definition of Visual Impairment

Visual impairment can mean a lot of things. Basically, this is any vision disability where eyesight is impacted. Vision impairment is a term used to describe any reduction in a person’s ability to see that cannot be fully corrected with glasses, contact lenses, medication, or surgery. It can affect one or both eyes and may involve difficulty with visual acuity (clarity), visual fields (peripheral vision), or how the brain processes visual information.

Vision impairment includes a wide range of conditions, from mild vision loss to complete blindness. It can impact daily activities such as reading, writing, navigating environments, recognizing faces, or participating in school and work tasks. The World Health Organization defines vision impairment as a presenting visual acuity worse than 20/60 in the better eye, and blindness as worse than 20/400.

In occupational therapy, vision impairment is considered in the context of how it affects function, independence, and participation in meaningful activities.

Types of Visual Impairment

Occupational therapy works with an enormous variety of diagnoses and conditions. There can be many reasons for a visual difficulty. These can occur in childhood or at any age.

Here’s a list of diagnoses and eye conditions associated with visual impairment:

  1. Blindness (Legal blindness)
  2. Partial blindness/Partial sight
  3. Low vision
  4. Cortical visual impairment (CVI)
  5. Diabetic retinopathy
  6. Retinopathy of prematurity (ROP)
  7. Glaucoma
  8. Macular degeneration (age-related macular degeneration) 
  9. Retinitis pigmentosa
  10. Cataracts
  11. Amblyopia
  12. Strabismus
  13. Nystagmus
  14. Optic nerve hypoplasia
  15. Optic neuritis
  16. Albinism (ocular or oculocutaneous)
  17. Coloboma
  18. Leber congenital amaurosis
  19. Stargardt disease
  20. Usher syndrome
  21. Anophthalmia
  22. Microphthalmia
  23. Retinal detachment
  24. Cone-rod dystrophy
  25. Hemianopsia
  26. Ocular toxoplasmosis
  27. Uveitis
  28. Keratoconus
  29. Achromatopsia
  30. Batten disease
  31. Congenital cataracts
  32. Stroke(CVA)

Ways OT can help: 

There are so many ways an occupational therapy professionals can help with vision needs. We have a full list with more examples below.

  • Adapt tasks and environments (contrast, lighting, positioning).
  • Use tactile, auditory, and kinesthetic compensatory strategies.
  • Incorporate vision-related goals into play, self-care, school, and leisure tasks.
  • Collaborate with vision specialists (e.g., Teachers of the Visually Impaired, Orientation & Mobility instructors).
  • Promote safe mobility through environmental modifications and task adaptations.
  • Build strength, balance, and core stability through play or movement-based interventions.
  • Support motor development with hands-on guidance and tactile cues.
  • Collaborate with physical therapists and orientation & mobility specialists as needed.
  • Encourage self-advocacy and confidence in movement through supportive, success-based activities.
  • Offer large print options
  • Work alongside a behavioral optometrist or vision rehabilitation professional like vision therapy
  • Training in various devices and supports in various environments
  • Work with a mobility specialist

 

 
These classroom accommodations are strategies to accomodate for visual impairments that limit learning or interfere with classroom participation.
 

 

Visual Impairment Accommodations for the Classroom

The fact is, vision impacts learning. When visual problems exist, it can be be helpful to next address what to do about those problems to maximize learning. Often times when vision is discussed as a concern, a parent or caregiver may push back saying that the child has had their vision checked, and that they can see fine. Despite education, and handouts, the parent still resists getting a more in-depth vision evaluation for their child. Now what? Good news is that there are some accommodations that can be made in the classroom to assist the child. These strategies are also great for kiddo’s who already have glasses but are still struggling.

What are accommodations for visual problems?

Accommodations are strategies set forth that allow a student to change the method of how learning happens. Accommodations for visual problems can address visual needs through changes in seating, presentation of visual information, test information, or classroom activities without modifying what is tested, completed, or taught.

The visual accommodations listed below are means for addressing visual problems without changing classroom expectations for learning.

Preferential Seating

Preferential seating means a lot of different things to every professional. Typically, it mean that the kiddo is placed at the front of the room, closest to the teacher where they can receive an increased level of support from the teacher. However, this is not necessarily the best for a child with vision deficits. There are a few keys points to preferential seating for kiddos with vision deficits that should be considered.

● Proximity to the board
● Direction in which the child is facing in relation to the board or main work area
● Level of visual distractions around the room including posters, boards and other children
● Is the goal of seat work and need for use of board to achieve completion of work?

Proximity to the Board

Being closest to the board is not necessarily the best position for a child facing vision challenges particularly if they are not acuity based in nature.

For instance, a child that is struggling with saccades and tracking may not succeed in a front and center position. This would challenge their eyes constantly to look in all directions for information. A better position for them would be to the left or to the right in the first 2-3 rows. This would limit the amount of tracking to either side that would need to be completed.

This position would also benefit a child with who struggles with filtering visual information and needs information to be limited on one side.

When recommending a seat based on proximity to the board, it is important to think about what challenges the kiddo is facing visually and to recommend a seat that promotes success.

Face the Front

Is the Child Facing the Board?

There are a lot of classroom set-ups these days that have children not facing the board or at an awkward angle. This is okay if the child is not expected to copy work from the board or utilize information from the main learning space.

When it doesn’t work, is when the child needs to utilize this information. It is best to have the child facing the board straight on or with a slight angle if they are not seated in the center. Limit turning of the head over 45 degrees to prevent eye strain and an increased chance of the child losing their place when copying.

There are times that it is appropriate to have the child’s back to the board and main learning space. I will get to that in just a moment.

Reduced Visual Distractions

Limiting visual distractions and over stimulation is a large part in helping kids with visual deficits. If there is too much information in front of them or around them, they are more likely to get lost visually, leading to more time needed to complete tasks and increases in errors when copying or missing written steps.

This is one of the few times that it is okay to have a child’s back to the board or main work area. Especially, if the child does not need to see the main area. Typically, this is the case for lower levels of education such as kindergarten through second grade, or when the curriculum begins to focus on board directed teaching.

Other ways to limit visual distractions are to keep the main learning space clear of extraneous posters, charts or decorations, along with conscious choices for seating the child. Having the child’s back to busy walls and a large portion of their peers can be helpful.

Most people think that windows are distractions for kiddos, but for a child with vision deficits, sitting near or facing a window can give a much needed visual “break” from stimulation. So don’t rule out a window seat yet!

Use these visual impariment accommodations to help kids with vision problems flourish in the classroom.

Increased White Space

Worksheets can be very overwhelming for a child with a visual deficit. They may have a hard time reading a busy worksheet, completing a math worksheet or miss parts of multi-step directions.

One way to help avoid this is to provide increased white space. White space refers to the amount of blank or void areas on a piece of paper. The higher the amount of white space, they less likely a child with vision deficits is to struggle.

This means limiting the number of math problems on a page from 6 to 3 for example. Or utilizing the Handwriting Without Tears lined paper versus traditional triple lined paper.

Sometimes changing the handout or worksheet is not an option and other strategies need to be utilized. The use of an extra sheet of paper to block out extra information can be helpful in creating the white space that is needed.

Decreased Visual Distractions

I touched on this in preferential seating section in regards to the overall placement of the child in the room. However, visual distractions can also come from items in the child’s work space. Distractions may include name tags, behavior systems, letter lines, a peer across from them and even work to be completed. These visual distractions may cause the kiddo to feel visually unorganized leading to the appearance of sloppy work and poor time management, and even signs of anxiety.

One way to help eliminate visual distraction within the workspace is to limit what is on the child’s desk. Keep the kiddo’s work space limited to a name tag and one other item. If other items are needed on the desk or workspace, have them arranged so that they are not in the child’s direct line of sight while working.

For instance, crayon boxes and utensils may be shared at a table or grouping of students. Have the items place to the left or right of the child so that their direct line of sight is clear.

Also limit that amount of ‘work’ that is place in front of the kiddo. I say ‘work’ lightly as most ‘work’ for kids are worksheets and craft projects. By presenting one item at a time, it can help the child’s visual space remain clear and help them stay visually organized and on task.

Visual Structure for Reading and Writing

Sometimes limiting visual distractions is not enough support for visual organization. Sometimes, the child needs even more structure to support successful learning patterns and work completion.

One strategy is to provide the child with graph paper to write on. This is very structured and provides concrete boundaries for letter orientation, sizing, and spacing. It also provides visuals for completing math problems in straight lines.

Other forms of visual structure include colored lines to indicate top and bottom of the lines for writing, along with highlighted “spacer” lines for completion of longer work.

Color coding can also be a helpful tool in providing visual structure for older children. It be as general as a different colored folders/notebooks for each subject to allow the child to quickly scan and find what they need, to as complex as writing parts of a math equation in different colors. Or even going as far as to writing the parts of a paragraph in different colors.

Visual structure can be as simple, or as complex as it’s needed to be to meet the kiddo’s needs.

Use these classroom accommodations to help kids with visual problems succeed in the classroom.

 

Each child is different and finding the right visual supports is a trial and error process that takes time and patience to work through. Evaluating the child’s weaknesses will help to determine the best supports and path for success in the classroom despite their visual challenges.

More resources that can help with understanding and advocating for visual impairments:

What is Visual Processing and Visual Efficiency?


Visual Saccades and Learning


What is Visual Tracking?


What is Convergence Insufficiency?

What if you suspect vision problems?

Now what?  When vision problems are suspected after a screening by the OT, it is best practice to refer the family to a developmental optometrist.


A developmental optometrist will complete a full evaluation and determine the need for corrective lenses, vision therapy or a home program to address vision concerns.


As occupational therapists, it is imperative that we rule out vision problems before treating handwriting or delays in visual motor integration, to ensure the best possible trajectory of development and success for the child.

Occupational Therapy Vision Screening Tool

Occupational Therapists screen for visual problems in order to determine how they may impact functional tasks. Our newest Visual Screening Tool is a useful resource or identifying visual impairments. 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.
 
 
 
 
 
 
 
Visual accommodations like preferential seating, facing the board, and other visual accommodations can help a student with vision problems succeed in the classroom.

Visual Impairments and Occupational Therapy

One thing about a visual impairment that we don’t often think of at first is the body awareness and orientation aspect. These areas can really impact functional skills, which our primary goal in occupational therapy. 

There are other things we want to consider as well when we work with the child with a visual challenge. These items are listed below and they can be part of our evaluation as well as treatment interventions. We’ll want to add these factors to our documentation of therapy treatment sessions when we are offering our accommodations or rehabilitation services because each area listed might impact quality of life and life skills.

Because the school based OT helps with the child’s educational performance and participation, these are areas we should be aware of when creating treatment plans.

  • Peripheral vision
  • Vision loss or level of challenge
  • Visual acuity
  • Low vision and resulting needs
  • Visual fields
  • Visual tracking
  • Visual attention
  • Visual memory

Occupational therapy Evaluation for Visual Impairment

Occupational therapy plays a key role in supporting individuals with visual impairments by addressing how vision affects daily function and participation. When working with children or adults with visual impairments, OTs consider several key areas as part of an OT evaluation: 

Visual Acuity

  • Clarity or sharpness of vision.
  • Affects reading, writing, recognizing faces, and seeing details in the environment.

Visual Fields

  • The entire area a person can see without moving their eyes or head.
  • Peripheral field loss can affect safety, mobility, and spatial awareness.

Visual Tracking (Oculomotor Skills)

  • The ability to follow a moving object or maintain focus on an object while the head moves.
  • Impacts reading fluency, copying from the board, and ball skills.

Visual Scanning

  • The ability to scan a space or environment efficiently.
  • Important for locating objects, navigating spaces, and reading.

Visual Attention

  • Focusing on relevant visual information while ignoring distractions.
  • Affects classroom performance, self-care routines, and task completion.

Visual Discrimination

  • Telling the difference between similar-looking objects, letters, or shapes.
  • Impacts handwriting, reading, and puzzles.

Visual Memory

  • Recalling visual information after seeing it.
  • Essential for spelling, following directions, and remembering routines.

Visual Figure-Ground

  • Distinguishing an object from a background.
  • Important for finding items in a cluttered space or reading text on a busy page.

Depth Perception

  • Understanding spatial relationships between objects.
  • Crucial for mobility, stairs, catching a ball, and pouring liquids.

Eye-Hand Coordination

  • Using visual input to guide fine motor tasks.
  • Affects handwriting, dressing, cutting, and feeding.

Visual Motor Integration

  • Coordinating visual perceptual skills with motor output.
  • Impacts drawing, writing, and tool use.

Occupational therapy plays a key role in supporting individuals with visual impairments by addressing how vision affects daily function and participation. When working with children or adults with visual impairments, OTs consider several key areas:

1. Visual Acuity

  • Clarity or sharpness of vision.
  • Affects reading, writing, recognizing faces, and seeing details in the environment.

2. Visual Fields

  • The entire area a person can see without moving their eyes or head.
  • Peripheral field loss can affect safety, mobility, and spatial awareness.

3. Visual Tracking (Oculomotor Skills)

  • The ability to follow a moving object or maintain focus on an object while the head moves.
  • Impacts reading fluency, copying from the board, and ball skills.

4. Visual Scanning

  • The ability to scan a space or environment efficiently.
  • Important for locating objects, navigating spaces, and reading.

5. Visual Attention

  • Focusing on relevant visual information while ignoring distractions.
  • Affects classroom performance, self-care routines, and task completion.

6. Visual Discrimination

  • Telling the difference between similar-looking objects, letters, or shapes.
  • Impacts handwriting, reading, and puzzles.

7. Visual Memory

  • Recalling visual information after seeing it.
  • Essential for spelling, following directions, and remembering routines.

8. Visual Figure-Ground

  • Distinguishing an object from a background.
  • Important for finding items in a cluttered space or reading text on a busy page.

9. Depth Perception

  • Understanding spatial relationships between objects.
  • Crucial for mobility, stairs, catching a ball, and pouring liquids.

10. Eye-Hand Coordination

  • Using visual input to guide fine motor tasks.
  • Affects handwriting, dressing, cutting, and feeding.

11. Visual Motor Integration

  • Coordinating visual perceptual skills with motor output.
  • Impacts drawing, writing, and tool use.

OT Considerations

  • Adapt tasks and environments (contrast, lighting, positioning).
  • Use tactile, auditory, and kinesthetic compensatory strategies.
  • Incorporate vision-related goals into play, self-care, school, and leisure tasks.
  • Collaborate with vision specialists (e.g., Teachers of the Visually Impaired, Orientation & Mobility instructors).

In addition to sensory processing and perceptual aspects, visual impairments often come with physical challenges that occupational therapists must consider. These physical issues can impact mobility, posture, coordination, and overall independence. Here are key physical areas related to visual impairment that OTs address:

Postural Control and Stability

  • Children or adults with visual impairment may adopt compensatory postures (e.g., tilting the head, leaning forward) to optimize remaining vision.
  • Poor postural control can affect sitting balance, endurance, and core strength, limiting participation in seated tasks like handwriting or meals.

Gait and Mobility

  • Visual impairment may lead to cautious, unsteady walking, wider stance, or shuffling.
  • Individuals may avoid movement altogether due to fear of falling, leading to decreased physical activity and muscle weakness.

Balance and Vestibular Integration

  • The visual system plays a large role in maintaining balance.
  • Without reliable visual input, individuals rely more heavily on vestibular and proprioceptive systems, which can be underdeveloped or dysregulated.

Motor Planning (Praxis)

  • Difficulty visualizing actions before performing them can lead to trouble with sequencing, initiating, or completing motor tasks.
  • This affects dressing, navigating environments, and tool use (like scissors or utensils).

Spatial Orientation and Body Awareness

  • Visual cues help us understand where we are in space and how to move around obstacles.
  • Visual impairment can lead to reduced spatial judgment, making tasks like reaching, climbing, or navigating stairs more difficult.

Delays in Gross and Fine Motor Skills

  • Infants and young children with visual impairments may miss out on visually-motivated movement (e.g., reaching, crawling, walking), leading to motor delays.
  • Fine motor skill development can also be impacted due to limited visual feedback.

Fatigue and Overuse

  • Individuals with visual impairments may experience increased fatigue due to constant physical and cognitive effort to compensate.
  • Overuse injuries (especially in the neck, shoulders, and hands) can result from repetitive adaptive strategies (e.g., leaning, squinting, using mobility aids).

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

Sensory Processing Disorder Checklist

by
Picture of a checklist and magnifying glass. Text reads sensory processing evaluations

We’ve created a sensory processing disorder checklist as a tool for sensory processing needs. Having resources like this sensory processing and self-regulation checklist will support sensory needs in individuals of all ages.

Sensory processing disorder is a condition where the brain misinterprets sensory information so that the body responds in atypical ways. Sensory processing disorder can be broken down into different categories, but one thing is clear: interpretation of sensory input is “off”.

Printable Sensory Processing Disorder Checklist

Below, you will find a list of common sensory responses that might be seen with sensory processing disorder. Use this sensory processing disorder checklist to better understand responses to sensory input. It will be helpful to read this sensory processing disorder chart to get a bigger picture on this umbrella term.

Sensory checklists for each sensory system, great for identifying red flags for sensory processing disorder.

I see evidence of sensory processing challenges everywhere. Though not all of them should be classified as disorders. Sometimes it is ok to be a seeker or an avoider for our safety, wellbeing, career, or comfort. A person who is sensitive does not necessarily have a disorder until it affects their daily life. I do not like a lot of textures, however, I am functioning well in my day to day life. 

Here are a few other examples of sensory red flags that are not damaging:

  • Certain athletes feel a drive to exercise. They must do it for their well being. Perhaps their arousal level is off, and exercise provides the modulation they need.  
  • Football players love crashing and bumping.  Is it possible they are sensory seekers, driven to engage in this sport?
  • Goldilocks had a hard time finding the right porridge, bed, and chair.  Maybe she was sensitive to texture, taste and temperature. Eventually she found the right situation that suited her needs. She did not have a meltdown or shutdown in the process.
  • In The Old Hat, New Hat Book Papa Berenstain had a hard time finding the right hat. Too twisty, too twirly, too beady, too bumpy.  In the end he decided on his familiar hat.  This might be classified as a disorder if he “needed” a new hat and could not get one. We see this often with children having to get new shoes. Change is hard. 
  • What professions can you see might be tactile seekers?  Gardeners, artists, potters, masseuses, and chefs?
  • Who is likely to be avoiding stimuli when choosing their profession? People who choose to work at home, solitary workers, librarians, a spa manager, or an accountant?
  • Is it fair to say that people who choose high energy jobs are seekers or sensory integrated?  Nurses, teachers, taxi drivers, OT/PTs?  Maybe.  Perhaps like me, they are not seekers or well integrated, but driven to help.  I am exhausted mentally and physically at the end of the day.  My profession is probably toxic for me, but important enough that I keep going.

When looking at all the red flags in diagnosing others, it is important to judge the impact the difficulty is having on life. This level of difficulty will determine who needs sensory processing treatment, who needs accommodations, and who is doing just fine.

The picky eater who lives on two foods and is not getting adequate nutrition is worth taking a look at. A child who is so sensitive to textures that he can not find anything to wear to school, or gets naked everyday in public, is struggling. The child whose meltdowns are so significant, they interfere with their daily life, needs some intervention. 

In my career I have seen the whole spectrum of sensory processing difficulties. I have worked with children so impacted that it is a wonder they are surviving. On the other hand, I have evaluated children who are just quirky, not atypical. I remember trying to explain this to a parent. Her son was just quiet and introverted.  He liked chess and robotics.  He had a small social circle, but had friends and was doing well in school.  Not everyone needs treatment or “fixing”.  We all are not suited to be gardeners, football players, or electricians.  

When looking at sensory difficulties, we need to focus our attention on the impact.  This is why our goals are not often simply “improve sensory processing”.  In the examples above with the picky eater and the child who will not wear clothes, the goals would focus on increasing food intake, and decreasing tactile aversion so the student can wear something to school.

Sensory Processing Disorder and Early Intervention

I talk a lot about education and early intervention. Help stem the flow of a problem before it gets too big.  Educate large groups of people about a topic and treatment, so it can have a trickle down effect.  One of the key factors in working with people is understanding. In my book, Seeing your Home and Community with Sensory Eyes, I spend time in each chapter helping the caregiver or recipient of the information understand what is happening with sensory struggles. I describe why your child may be screaming, kicking, refusing, or melting down in each setting.  Then we look toward communication, treatment, and accommodation.  It is available here on the OT Toolbox, in digital format or on Amazon (affiliate link) in print if you prefer.

Sensory processing Disorder Test

Using a sensory processing disorder checklist is just one step in completing a SPD test or assessment. It’s important to start somewhere and getting information from parents, educators, and others who know and love the child or individual is a key step in moving in the right direction with a sensory processing disorder evaluation. We want to see what’s really happening and what’s impacting function so the checklist portion is really important.

A checklist for sensory issues can be part of a screening tool. This gathers so much information and can really drive the evaluation process.

Other sensory processing assessment tools include observation, questionaries, and then the standardized assessment performed by an occupational therapist. The evaluating OT will use one of several sensory processing assessments to create a clinical picture that is part of the skilled evaluation process for SPD.

Picture of a checklist and magnifying glass. Text reads sensory processing evaluations

Sensory Processing Evaluations

Here are some of the most common evaluations that can be used to assess sensory processing. These sensory processing disorder tests do can be used along with other sources of information to get a bigger picture of what’s going on.

Sensory Integration and Praxis Tests (SIPT)– This test is appropriate for children aged 4 months through 8 years, 11 months. It’s a very comprehensive assessment. The SIPT does require extensive training to administer.

Sensory Profile 2– This assessment is appropriate for birth-14 years, 11 months. It is a comprehensive evaluation and it has a school companion form for the child’s teacher to complete.

Sensory Processing Measure-2 (SPM-2)– This evaluation is appropriate for children aged 4 months-87 years. It is a quick assessment and it has a home and a school form that can be used for a comprehensive look at the child across environments.

Evaluation in Ayres Sensory Integration® (EASI)– This evaluation is appropriate for children aged 3 years through 12 years. It’s based on Ayres Sensory Integration® and it’s a very comprehensive eval. Examiners do need to be trained in order to do this evaluation.

Structured Observations of Sensory Integration (SOSI-M)– This assessment is appropriate for children aged 5 years to 14 years.

Here are a few other sensory processing assessments to be aware of:

Short Sensory Profile (SSP): 3–15 years

Sensory Experiences Questionnaire (SEQ 3.0): 5 months – 6 years

Sensory Rating Scale (SRS): 0–3 years

SensOR Inventory (SensOR): 3–55 years

Sensory Processing Measure (SPM): 3–10 years

Infant/Toddler Sensory Profile (ITSP): 0–36 months

Diagnostic Interview for Social and Communication Disorders (DISCO): All ages

Adolescent/Adult Sensory Profile (AASP): Adolescent and adult ages

Working in the sensory realm is difficult and confusing. There can be 1001 combinations of reasons a person is having difficulty, and just as many possible solutions.  Once you find a solution, it may only work a handful of times. Broaden your OT Toolbox with treatment ideas, checklists, and resources.

Speaking of OT Toolbox, our website is packed with valuable resources. Yes you can go onto AI and get a quick answer, but it will not be full of resources, hands on activities, and fun! 

With sensory processing disorder, input from each of the sensory systems can be interpreted by the brain in different ways. Kids can hyper-respond or overreact to sensory input. Or, they can hypo-respond, or under-react to sensory information.

Sensory processing disorder can be seen in children or on adults.

These sensory processing disorder checklists are broken down by sensory system

Sensory Processing Disorder Checklist

Putting it all together – Let’s look at all of the sensory systems in a list:

  • Visual System (Sight)
  • Auditory System (Sound)
  • Tactile System (Touch)
  • Gustatory System (Taste)
  • Olfactory System (Smell)
  • Proprioceptive System (Position in space)
  • Vestibular System (Movement)
  • Interoceptive System (Inner body)

Typically, sensory dysregulation within these three systems present in many different ways.  A child with sensory difficulties may be over- or under-responsive to sensory input.  They may operate on an unusually high or unusually low level of activity.  They may fatigue easily during activity or may constantly be in motion.  Children may fluctuate between responsiveness, activity levels, and energy levels.

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

Sensory processing disorder checklists for responses seen to sensory input.

Sensory Processing Disorder Symptoms

It can be overwhelming when you start looking into various symptoms in sensory processing disorder. But if you are wondering about specific signs of SPD in your child, it can be helpful to have a comprehensive checklist of various areas that impact learning, play and functioning. 

The comprehensive list of sensory signs and symptoms listed below are helpful to spot an issue in your child, but more so can help you pinpoint a starting point with helping your child so you can support their needs.

Sensory Processing Disorder checklists for each sensory system

red Flags for Tactile Dysregulation

Tactile defensiveness, or what is sometimes described as tactile differences, refers to differences in how an individual experiences and responds to touch-based sensory input. This can include avoiding certain textures or, for some, actively seeking out tactile sensory experiences.

When we use terms like disabilities, dysregulation, differences, or challenges, or our goal is not to label an individual as having a deficiency or to pathologize sensory differences. Sometimes you may even hear the term dysfunction. When these terms are used, the goal is to describe sensory preferences and needs that may be impacting participation in everyday activities.

It is important to recognize that sensory processing is a spectrum of diverse experiences. Some sensory responses may create barriers to functional skills, such as self-care, play, or learning, not because there is something “wrong” with the person, but because their sensory system may require additional support or accommodations. Using this lens allows us to be neuro-affirming: we are not trying to “fix” or “normalize” an individual’s sensory experiences, but to understand and support their sensory needs so they can engage meaningfully in their environment.

Tactile defensiveness refers to avoidance of certain textures or the seeking out of tactile sensory input. These indicators can mean a sensory issue with the tactile sensory system.

Consider the sensory checklist based on the tactile system:

Hyper-responsiveness of the tactile sense may present in a child as over-responsiveness or overreaction to tactile sensation. This looks like:

  • Overly sensitivity to temperature including air, food, water, or objects
  • Withdrawing when touched
  • Refusing certain foods because of food texture issues
  • Dislike of having face or hair washed
  • Dislikes of hair cuts
  • Dislikes of having fingernails cut
  • Excessively ticklish
  • Avoidance to messy play or getting one’s hands dirty
  • Avoidance of finger painting, dirt, sand, bare feet on grass, etc.
  • Clothing preferences and avoidances such as resisting shoes or socks
  • Annoyance to clothing seams or clothing textures
  • Resistance to hair brushing
  • Over-reactive to unexpected touch
  • Overreactions to accidental or surprising light touches from others
  • Avoids affectionate touch such as hugs
  • Avoids washing hands at the sink
  • Difficulty with clothing fasteners like buttons, zippers, and belts
  • Challenges in the shower or bathtub with soap, washcloths preferences, and soap textures
  • Refuses to use glue

Hypo-responsiveness of the tactile sense may present in a child as under-responsiveness or under-reaction to tactile sensation. This may look like:

  • Seeks out tactile sensory input
  • Bumps into others
  • High pain tolerance
  • Stuffs food in mouth
  • Licks items or own skin
  • Not aware of being touched
  • Seems unaware of light touch
  • Startles easily when touched
  • When getting dressed, doesn’t notice clothing that is twisted
  • Tendency for self-abusiveness: biting self, rubbing self with heavy pressure, head-banging, pinching self, etc.
  • Doesn’t notice a runny nose, messy face, or messy hands
  • Puts items in the mouth
  • Lack of personal space
  • Runs into other children without noticing
  • Has difficulty maintaining space in line; bumps into others without noticing
  • Falls out of chair
  • NEEDS to touch everything
  • Uses a tight pencil grip on the pencil
  • Writes with heavy pencil pressure
  • Tears paper when cutting with scissors
  • Unintentionally rough on siblings, other children, or pets
  • Always touching others or things
  • Seeks out messy play experiences
  • Prefers to rub or feel certain textures
  • Difficulty with fine motor tasks
  • Craves touch
  • Doesn’t seem to notice unexpected touch
  • Constantly playing in the soap or water at the sink

red Flags for Proprioception Dysfunciton

The Proprioception Sensory System is the recognition and response to the body’s position in space with an internal feedback system using the position in space of the joints, tendons, and muscles.  This sensory system allows the body to automatically react to changes in force and pressure given body movements and object manipulation.  The body receives more feedback from active muscles rather than passive muscle use.  Related to the proprioception system is praxis or motor planning.  Individuals are able to plan and execute motor tasks given feedback from the proprioceptive system. Praxis allows us to utilize sensory input from the senses and to coordinate hat information to move appropriately.

Hyper-responsiveness of the proprioception sense may present in a child as over-responsiveness or overreaction to proprioceptive sensation. This may include postural insecurity. This may look like:

  • Uses too little pressure when writing or coloring
  • Prefers soft or pureed foods
  • Appears lethargic
  • Bumps into people or objects
  • Poor posture, slumps in their seat
  • Poor handwriting
  • Inability to sit upright when writing or completing desk work; Rests with head down on arms while working
  • Poor awareness of position-in-space
  • Frequent falling
  • Clumsiness
  • Poor balance
  • Poor body awareness
  • Poor attention
  • Poor motor planning
  • Uses extreme force during tasks
  • Challenged by clothing fasteners ( how much force to use with fastening buttons, zippers, and belts, or snaps)

Hypo-responsiveness of the proprioceptive sense may present in a child as under-responsiveness or underreaction to proprioceptive sensation. This looks like:

  • Uses excessive pressure when writing or coloring
  • “Jumper and crasher”- seeks out sensory input
  • Can’t sleep without being hugged or held
  • Bumps into people or objects
  • Seems aggressive
  • Grinds teeth
  • Walks on toes
  • Chews on pencils, shirt, sleeve, toys, etc.
  • Prefers crunchy or chewy foods
  • Cracks knuckles
  • Breaks pencils or crayons when writing or coloring
  • Pinches, bites, kicks, or headbutts others
  • Difficulty with fine motor skills
  • Poor handwriting
  • Poor awareness of position-in-space
  • Stomps their feet on the ground when walking
  • Kicks their chair or their neighbors chair in the classroom
  • Frequent falling
  • Clumsiness
  • Poor balance
  • Constantly moving and fidgeting
  • Poor attention
  • Uses extreme force
  • Has unexpected bruises
  • Seeks out wrestling games

red Flags for Vestibular Differences

Vestibular dysregulation refers to differences in how an individual perceives and responds to movement, balance, and spatial orientation. This may look like avoidance of certain types of movement (such as swinging or climbing), or an increased need to seek out movement experiences (like constant spinning or jumping). When describing vestibular needs or sensitivities, it is important to approach this language with care. When we see red flags related to vestibular challenges, we can acknowledge that these sensory differences may affect a person’s comfort, safety, and ability to participate in daily activities.

Recognizing vestibular differences through this lens allows us to support each individual’s unique sensory profile without the goal of “correcting” or changing who they are. Instead, we aim to create environments, strategies, and opportunities that honor sensory needs and promote functional engagement. A neuro-affirming approach respects that sensory processing differences are part of human diversity, and that with the right supports, individuals can thrive in their own way.

The Vestibular Sensory System is the sense of movement and balance, and uses the receptors in the inner ear and allows the body to orient to position in space.  The vestibular system is closely related to eye movements and coordination.  Vestibular sensory input is a powerful tool in helping children with sensory needs.  Adding a few vestibular activities to the day allows for long-lasting effects.  Every individual requires vestibular sensory input in natural development.  In fact, as infants we are exposed to vestibular input that promotes a natural and healthy development and integration of all systems. 

Vestibular dysregulation and problems with the Vestibular Processing System can present as different ways:

  • Poor visual processing
  • Poor spatial awareness
  • Poor balance
  • Difficulty with bilateral integration
  • Sequencing deficits
  • Poor visual-motor skills
  • Poor constructional abilities
  • Poor discrimination of body position
  • Poor discrimination of movement
  • Poor equilibrium
  • Subtle difficulties discerning the orientation of head
  • Trouble negotiating action sequences

Hyper-responsiveness of the vestibular sense may present in a child as over-responsiveness or overreaction to vestibular sensation. This look may look like:

  • Experiences gravitational insecurity
  • Overly dizzy with motions
  • Resistant to moving activities such as swings, slides, elevators, or escalators
  • Fear of unstable surfaces
  • Unable to tolerate backward motions
  • Unable to tolerate side to side motions
  • Illness in moving vehicles
  • Avoids swings or slides
  • Gets motion sick easily
  • Appears “clingy”
  • Refuses to move from the ground (i.e. jumping or hopping activities)
  • Difficulty/fear of balance activities
  • Refusal to participate in gym class
  • Refusal to try playground equipment
  • Fearful on bleachers or on risers
  • Fear or dislike of riding in elevators or escalators
  • Fearful of movement
  • Dislike of spinning motions
  • Avoids chasing games
  • Overly fearful of heights
  • Nauseous when watching spinning objects
  • Poor posture
  • Easily fatigued
  • Poor coordination
  • Low muscle tone
  • Poor motor planning
  • Fearful when a teacher approaches or pushes in the child’s chair
  • Clumsiness
  • Poor attention
  • Difficulty or fearful on stairs
  • Fearful during situations of constant motion
  • Struggles or fearful on ladders
  • An extreme dislike of high places
  • Refuses to sit on or try a bike

Hypo-responsiveness of the vestibular sense may present in a child as under-responsiveness or underreaction to vestibular sensation. This may look like:

  • Constant movement including jumping, spinning, rocking, climbing
  • Craves movement at fast intervals
  • Craves spinning, rocking, or rotary motions
  • Poor balance on uneven surfaces
  • Constantly fidgeting
  • Increased visual attention to spinning objects or overhead fans
  • Bolts or runs away in community or group settings, or when outdoors or in large open areas such as shopping malls
  • Difficulty maintaining sustained attention
  • Impulsive movement
  • Constantly getting up and down from desk in the classroom
  • Walks around when not supposed to (in the classroom, during meals, etc.)
  • Loves to be upside down
  • Head banging
  • Hypermobile or all over playground equipment
  • Leans chair back when seated at a desk
  • Loves spinning
  • Rocks self-back and forth when seated
  • Poor posture
  • Poor coordination
  • Poor motor planning
  • A deep need to keep moving in order to function
  • Frequent falling
  • Clumsiness
  • Poor balance
  • Poor attention
  • Always in constant motion
  • Prefers being in high places

Red Flags for Visual SYSTEM Dysregulation

Visual dysregulation refers to differences in how an individual processes and responds to visual input, such as light, movement, patterns, or cluttered environments. Some individuals may be more sensitive to bright lights, busy visuals, or fast-moving scenes, while others may seek out visual stimulation through watching spinning objects or moving their eyes in specific ways. When we use the term dysregulation to describe these sensory experiences, it is not to imply a problem or deficit, but to acknowledge that visual processing differences may influence an individual’s comfort, attention, and participation in everyday tasks.

Taking a neuro-affirming perspective, we recognize that sensory differences, including those in the visual system, are a natural part of human variation. Our goal is not to “normalize” visual responses but to support individuals by adapting environments, offering accommodations, and providing strategies that help them engage meaningfully in their world. By understanding and respecting visual sensory needs, we can better empower individuals to navigate their surroundings in ways that feel safe and supportive.

Eighty percent of the information we receive from our environment is visual.  When perception of this information is not processed correctly, it can create an altered state that influences many areas:  eye-hand coordination, postural reflexes, and vestibular processing are all influenced and reliant upon the visual system. 

The visual system is the sensory system that most individuals rely upon most heavily for daily tasks.  Visual information is perceived by cells in the back of the eye.  These cells (rods and cones) relay and transfer light information into information that is transferred to the central nervous system.  These photoreceptors are able to perceive day time vision and night time vision, with adjustments to sensitivity of light intensity.  They are able to respond to different spectrum of color and differentiate color information.  The rod and cone cells, along with the retina, process a great deal of visual information in the neural structure of the eye before transmitting information to the central nervous system. 

The relay of information from the eyes to the central nervous system are made up of three pathways.  Pathways project to different areas of the brain and allow for:

  1. Processing and recognition of faces/shapes/motion (the “what” and “where” of objects)
  2. Integration of information in order to coordinate posture and eye movements
  3. Oculomotor adaptation.

Hyper-responsiveness of the visual sense may present in a child as over-responsiveness or overreaction to visual sensation. This may look like:

  • Complains of lights being too bright
  • Unable to tolerate certain lighting such as fluorescent overhead lights
  • Struggles with sudden changes in lighting
  • Challenged by bright or flashing lights
  • Colorful lights “hurt” the eyes
  • Complains of headaches in bright light
  • Complains of the “glow” of unnatural lighting
  • Distressed by light sources
  • Sensitive to light
  • Sensitive to certain colors
  • Distracted by cluttered spaces
  • Avoids eye contact
  • Trouble with puzzles
  • Frustration at the movies
  • Difficulty reading
  • Difficulty finding objects in a busy drawer

Hypo-responsiveness of the visual sense may present in a child as under-responsiveness or underreaction to visual sensation. This looks like:

  • Attracted to spinning objects
  • Difficulty with visual perception
  • Difficulty with eye-hand coordination
  • Difficulty with reading and writing
  • Holds or presses hands on eyelids in order to see flashing lights
  • Squints or presses eyelids shut
  • Flaps hands or objects in front of eyes
  • Holds eyes at the movies

red Flags for Auditory SYSTEM Dysregulation

Auditory dysregulation refers to differences in how an individual perceives and responds to sounds in their environment. This may include heightened sensitivity to certain noises, difficulty filtering out background sounds, or a strong preference for certain auditory experiences. Some individuals may cover their ears, avoid noisy environments, or become overwhelmed in spaces with unpredictable sounds, while others may seek out calming or repetitive auditory input. When we use the term dysregulation in this context, it is not to suggest that there is something wrong with the person, but rather to acknowledge that their auditory processing needs may impact comfort and participation in daily life.

A neuro-affirming approach recognizes auditory processing as a diverse experience, not a flaw to be corrected. Our role is to honor and support each individual’s auditory needs by offering accommodations, adapting environments, and providing tools that help them engage in ways that feel safe and manageable. By understanding these sensory differences, we can foster inclusion and respect for all sensory profiles.

Receptors for the auditory system are located in the inner ear and are responsible for receiving vibration from sound waves and changing them to fluid movement energy.  Information is projected to the central nervous system and transmits sound frequency as well as timing and intensity of sound input.  The auditory system is integrated with somatosensory input in order to play a role in controlling orientation of the eyes, head, and body to sound. 

Hyper-responsiveness of the auditory sense may present in a child as over-responsiveness or overreaction to auditory sensation. This may look like:

  • Startles easily to unexpected sounds
  • Dislikes noisy places
  • Overly sensitive to speakers on radios
  • Fearful of smoke detectors, overhead speakers
  • Shushes others or asks others to stop talking
  • Holds hands over ears
  • Sensitive to certain sounds such as lawnmowers or the hum of the refrigerator
  • Easily distracted by sounds and background noise
  • Hums to block out background noise

Hypo-responsiveness of the auditory sense may present in a child as under-responsiveness or underreaction to auditory sensation. This looks like:

  • Seems to be unaware of sounds
  • Holds radio speakers up against ears
  • Doesn’t respond to alarms
  • Makes silly sounds at inappropriate times or frequently
  • Mimics sounds of others
  • Talks to self
  • Difficulty locating sounds, especially when in a noisy environment
  • Hums in order to hear the sound of humming

red Flags for Gustatory System Dysregulation

Gustatory dysregulation refers to differences in how an individual experiences and responds to taste and oral sensory input. This can include strong preferences or aversions to certain flavors, temperatures, or textures of foods and drinks. Some individuals may seek out intense flavors like spicy or sour foods, while others may avoid specific textures or have a very limited range of preferred foods. When we use the term dysregulation in this context, it is not intended to pathologize sensory preferences, but to describe how these differences may influence eating habits, nutritional intake, and participation in mealtime routines.

Viewing gustatory processing through a neuro-affirming lens allows us to respect individual sensory needs and preferences without the goal of “fixing” them. Instead, the focus is on understanding how these sensory differences impact daily life and finding supportive strategies to promote positive mealtime experiences. This might include offering a variety of sensory-friendly food options, gradually expanding food exploration in a safe and supportive way, and working collaboratively with families to honor each child’s unique sensory profile.

The gustatory system perceives input through the tongue.  Taste cells in the mouth perceive five sensations: salty, sweet, bitter, sour, and savory.  The gustatory system is closely related to the sense of smell and proprioception.  How we perceive taste is deeply influenced by the sense of smell. 

While many children with sensory needs have a tendency to chew on their shirt collars or pencils as a sensory strategy in order to seek proprioception needs, the behavior may occur as a result or as a reaction to under-responding to oral input.  Other children may seek out intense taste sensations and in that case put non-edible items into their mouth to satisfy that sensory need.  Still other children may over-respond or under-respond to certain flavors or taste sensations.  For those children, it is common to experience food refusal related to texture or taste.

Hypersensitivity to oral sensory input may present in a child as over-responsiveness or overreaction to gustatory sensation. This looks like:

  • Dislike of mixed textures (cereal in milk or chunky soup)
  • Resistant to trying new foods
  • Avoids certain textures
  • Avoids straws
  • Avoidance of specific food or drink temperatures
  • Picky eating
  • Preference for bland foods
  • Avoids temperature extremes (unable to tolerate hot or cold foods)
  • Prefers foods that do not touch or mix on their plate
  • Use of only a specific spoon or fork or no utensil at all
  • Intolerance to teeth brushing.
  • Anxiety or gagging when presented with new foods
  • Drooling

Hypo-responsiveness of the gustatory sense may present in a child as under-responsiveness or underreaction to gustatory sensation. This may look like:

  • Licking objects
  • Bites others
  • Chews on clothing
  • Hums all the time
  • Prefers a vibrating toothbrush
  • Prefers spicy foods
  • Stuffs food into cheeks
  • Prefers food very hot or very cold temperature

red Flags for Olfactory System Dysregulation

Olfactory dysregulation refers to differences in how an individual perceives and responds to smells in their environment. Some individuals may be highly sensitive to certain scents and may become overwhelmed, nauseous, or distressed by everyday smells such as perfumes, cleaning products, or certain foods. Others may seek out strong or specific scents as a way to self-regulate. Using the term dysregulation here is not meant to label these sensory responses as a problem, but to acknowledge that olfactory processing differences can affect comfort, attention, and participation in daily routines.

A neuro-affirming perspective recognizes that variations in how we experience smells are part of natural sensory diversity. The goal is not to eliminate these differences, but to provide support that respects individual needs. This might include adapting environments to minimize triggering scents, offering preferred calming smells, and helping individuals develop strategies to navigate scent-rich settings more comfortably. By understanding and honoring olfactory sensory needs, we can foster more inclusive and supportive environments.

The olfactory system, or the system that enables the sense of smell, has receptors in the tissue of the nose that are connected by pathways to the brain.  Connections occur via two pathways, one being a direct route to neurons in the brains and the second being a path that passes near the roof of the mouth.  This channel is connected to the taste of foods.

There is some evidence indicating that the sense of smell is more associated with memory than the sense of vision or the other senses.  The connection of the olfactory sense to the emotional part of the brain and previous experiences, as well as hypersensitivity or hyposensitivity to smells can cause anxiety or sensory related breakdowns in children with sensory processing difficulties. 

Hyper-responsiveness of the olfactory sense may present in a child as over-responsiveness or overreaction to olfactory sensation. This may look like:

  • Overly sensitive to smells
  • Notices smells others don’t
  • Anxious around certain smells
  • Holds nose in response to certain scents
  • Challenged in the shower or bathtub, with overwhelming preferences and disliking certain scents

Hypo-responsiveness of the olfactory sense may present in a child as under-responsiveness or underreaction to olfactory sensation. This may look like:

  • Smells unusual items like paper or certain materials
  • Prefers strong scents

Red Flags for Interoceptive System Dysregulation

Interoceptive dysregulation refers to differences in how an individual perceives and interprets internal body signals, such as hunger, thirst, fatigue, pain, temperature, or the need to use the bathroom. Some individuals may have difficulty recognizing or responding to these signals, while others may experience them as overwhelming or confusing. When we describe interoceptive dysregulation, it is not to suggest a deficit or problem within the individual, but to acknowledge that these sensory differences can impact self-awareness, self-care, emotional regulation, and participation in everyday routines.

A neuro-affirming approach respects that interoceptive experiences vary widely among individuals and are a natural part of sensory diversity. Rather than aiming to “correct” these differences, the goal is to provide support and tools that help individuals better understand and respond to their internal cues in a way that feels right for them. This may include using visual supports, developing body awareness activities, or building self-advocacy skills. By honoring interoceptive needs, we can help foster greater comfort, autonomy, and engagement in daily life.

The interoceptive sensory system is an area that most people are not as familiar with.  This system is connected to amygdala, the emotional system, the limbic system, our emotional awareness, our feelings, and subconscious arousal.  Receptors for the interoceptive system are in our organs and skin.  The receptors relay information regarding feelings such as hunger, thirst, heart rate, and digestion to the brain.  This is the foundation to sensations such as mood, responding to the moods and emotions of others (co-regulation), emotions, aggression, excitement, and fear and in turn, promotes the physical response of our bodies. 

Physical responses include functions such as hunger, thirst, feelings, digestion, heart rate, and body temperature.

Hyper-responsiveness of the interoceptive sense may present in a child as over-responsiveness or overreaction to interoceptive sensation. This may look like:

  • High pain tolerance
  • Distracted and overwhelmed by feelings of stress
  • Distracted or overly sensitive to sensations of stomach digestion
  • Distracted or overly sensitive to sensation of heart beat
  • Always hungry or thirsty
  • Eat more and more often to avoid feelings of hunger
  • Unable to sense the feeling of being full; overeats or overdrinks
  • Overwhelmed by feelings of sadness, anger, happiness, etc. and unable to respond appropriately
  • High urine output
  • Use the bathroom more often than necessary to avoid feelings of a full bladder or bowel
  • Distracted by changes in body temperature
  • Distracted and overly sensitive to sweating
  • Overly sensitive to feeling ticklish or itchy
  • Overly sensitive to cold or heat
  • Overly sensitive to signs of illness
  • Fearful of vomiting

Hypo-responsiveness of the interoceptive sense may present in a child as under-responsiveness or underreaction to interoceptive sensation. This may look like:

  • Low pain tolerance
  • Poor or low response to interoceptive stimuli
  • Doesn’t know when to go to the bathroom
  • Never says they are hungry or thirsty
  • Does not drink or eat enough
  • Difficult to toilet train
  • Never complains of being cold or hot (always wears shorts in the winter or pants in the summer)
  • Never complains of sickness
  • Difficulty falling asleep
  • Unable to identify feelings of stress
  • Unable to identify specific feelings and appropriate responses

Sensory Checklists, explained

There is a lot to think about here, right? Taking a giant list of common sensory processing disorder lists and knowing what to do with that list is complicated. What if you had strategies to address each sensory system’s over-responsiveness or under-responsiveness so you could come up with a sensory diet that helps kids function?

In The Sensory Lifestyle Handbook, I do just that.

The Sensory Lifestyle Handbook

Sensory processing is broken down by sensory system so you can understand what you are seeing in the sensory responses listed above. Then, you can use the lists of sensory activities to help the child complete functional tasks while they get the sensory input they need to focus, organize themselves, and function.

The sensory activities are presented as meaningful and motivating tasks that are based on the child’s interests, making them motivating and meaningful.

You can get the Sensory Lifestyle Handbook and start building a sensory diet that becomes an integrated part of each day’s daily tasks, like getting dressed, completing household chores, school work, community interaction, and more.

Get your copy of The Sensory Lifestyle Handbook here.

Sensory checklists in early intervention

In young children, sensory issues can present leading to the early intervention process. Having a sensory processing disorder checklist on hand can help relieve some of the questions parents have about development and whether a behavior or action is typical or not.

Characteristics of sensory issues show up during these young years. You may see frustration or meltdowns due to unexpected touch.

You may identify tactile defensiveness even in the infant years when babies pull away from heavy input of a cuddle or wrapped blanket. You may notice sensory preferences in the way of seeking out a pacifier for comfort (long beyond the typical pacifier stage). You may even identify distress with certain aspects of sensory input as listed in the sensory processing checklists above.

A few helpful resources are listed below:

Meltdowns– This blog post covers temper tantrums verses sensory meltdowns.

This blog post on early intervention strategies for sensory differences covers important information for sensory needs during the infant to 5 years range.

Sensory integration at the playground – Exploring different sensory input areas at the playground can help identify sensory challenges in young children.

A Final Note on Examples of Sensory Processing Dysregulation

This extensive list of sensory red flags is meant to act as an educational tool for parents, educators of children.

As occupational therapists, we strive to support children and their “team” of parents, caregivers, family, and educators with resources and information that will serve the individual child so that they can function in everyday life tasks. 

The purpose of this sensory processing disorder checklist is to help parents and professionals who interact with children become educated about particular signs of sensory processing differences.

A checklist is not to be used as the absolute diagnostic criteria for labeling children with sensory processing disorder. It is simply a resource to be used as a starting point when identifying distress symptoms to explore further. 

If you have difficulty understanding your child’s sensory preferences, sensory avoidances, use this sensory processing disorder checklist as a starting point and reach out to a pediatrician and pediatric occupational therapist.

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.

150 Things to do This Summer

by
Print off this summer activity challenge for kids and keep the kids active and screen free this summer

Having a summer bucket list of Summer activities for kids that keeps kids from the inevitable summer boredom is good. And using an occupational therapy perspective on your Summer fun is better! We wanted to put together a Summer bucket list that actually helps kids develop skills and gain stronger bodies is powerful! This list of Summer things to do with kids and families this summer is a list of therapist-approved activities that help promote stronger core muscles, refined fine motor skills, and the very skills kids need to learn, play, and develop.

Read on for fine motor Summer fun and gross motor ideas for Summer that keep kids moving!

I also updated this blog post to add a big list of daily tasks that kids can do this Summer that are daily life skills tasks. These are important because these life skills are ones that happen during the day and are important to building functional skills in our kids. They also really facilitate executive functioning skills! I love to use a list like this along with a task tracker or a daily chore checklist type of printable because you can have your child do the tasks that contribute to the family household and they are learning at the same time. You could also use this list along with our screentime checklist where kids need to do a certain number of items from their list before they earn screentime for the Summer day.

Summer Bucket List

Need things to do this summer with the kids? Need therapist-approved activities for the whole family, that actually help kids develop motor skills, get off the screens, and build stronger kids? This printable list of summer activities for kids and families is just the thing to battle the boredom this summer!

I am a mom of four. I have heard, “I’m bored!” 4,000 times. Each summer. This summer might look a little different that most years, and because of that, I wanted to come up with summer activities for kids that are therapy-approved. These are summer things and active play ideas. You might call this an adventure challenge. You might call it a therapy home program. What this list of summer activities is for certain, is a way to get the kids active and off the screens. This list of 100 summer things (actually 104 summer things) costs little to no money, use the items found around the house, and meets the needs of kids. It’s part of our Wellness Challenge (More info on that coming next week!)

Print off this summer bucket list activity challenge for kids and keep the kids active and screen free this summer

100 Things to do this summer

There is just something fun about creating a summer bucket list with the kids. But, what if you could hand-pick the very summer activities that help kids gross stronger muscles, gain sensory input that helps with regulation, and motor activities that improve balance, coordination, strength, and endurance? What if your summer bucket list not only built a summer of family memories, but also stronger and more functional minds and bodies?

This printable summer bucket list does just that!

Well, here we are at the tail end of another school year. This is the time that most parents and teachers celebrate the end of school and the start of summer…maybe more than the kids. With the end of the school year, it’s a time to celebrate lazy, hazy days of summer. This year is a different. Parents are celebrating the end of distance learning. Teaching kids at home through distance learning, while working from home is simply not a sustainable task for most. The list below is 100 things to do this summer. These are activities to keep the kids (and the whole family) active, and enjoying time together in play. Play is healing. Play is a learning opportunity.

For pediatric occupational therapists, we know that play is the primary occupation of the child. Play is therapy and therapy is play. These summer activities for kids are designed to boost skills, while helping children emotionally, physically, and mentally.

Kids NEED active play. They NEED to move. Kids need to create, think outside of the box, and they need to be bored. With boredom comes creativity, interest-based thinking, and innovation. This list of 100 things to do this summer might be an idea starter.

The activities on this list fall into six categories: outdoor activities, indoor activities, water activities, games, creative “maker” activities, and imagination activities. Each summer activity challenges movement and is a summer activity that can be added to home programs.

When the kids say they are bored, send them to this summer bucket list checklist and ask them to pick something on the list. With 104 ideas, there is something for each day this summer.

Summer activities for occupational therapy home programs

Summer Bucket List for Occupational Therapy

The activities on this summer activity list inspire active play for kids. They build heavy work to add proprioceptive input. They add movement for vestibular input. They add tactile input. The activities are calming or alerting. They are sensory-based movement activities.

Use this list as a home program. The list can be sent home to parents to inspire active play each day. Or, post it on your fridge and when the kids say they need something to do, ask them to pick one activity. Your challenge is to complete as many of the activities as you can. When boredom strikes, add these activities.

Outdoor Active Play for a summer bucket list

  • Obstacle course
  • Nature walk
  • Climb a tree
  • Kick a ball
  • Driveway chalk
  • Go for a hike
  • Roll down a hill
  • Make a hideout
  • Draw the clouds
  • Run around the house
  • Pick flowers
  • Do jumping jacks
  • Fly a kite
  • Draw with chalk
  • Go swimming
  • Ride a bike
  • Watch the birds

Indoor Activities for a Summer BUCKET LIST

  • Animal walks
  • Couch cushion course
  • Balloon toss
  • Bowl plastic cups
  • Indoor balance beam
  • Freeze dance
  • Yoga
  • Build puzzles
  • Hand clapping games
  • Board games
  • Catch socks
  • Write in a journal
  • Wheelbarrow walks
  • Army crawls
  • Wall push-ups
  • Dance party
  • Play with stickers

SUMMER BUCKET LIST Water Activites

  • Water sensory bin
  • Spray bottle art
  • Squirt gun painting
  • Paint with water
  • Swim
  • Play in a sprinkler
  • Make a sensory bottle
  • Make sponge balls
  • Play in the hose water
  • Water flowers
  • Wash a car
  • play in the rain
  • Water table
  • Water balloons
  • Play in soapy water
  • Bubbles
  • Sink or float tests

Summer Bucket List Games

  • Red rover
  • Play tag
  • Hide and seek
  • Play Uno
  • Play cards
  • Soccer
  • Catch a football
  • Board games
  • Hopscotch
  • 4 Square
  • Basketball
  • Relay Race
  • Charades
  • 7 Up
  • Mr. Wolf
  • Tug of war
  • Lawn tic tac toe
  • Bean bag toss

Creative Activities for Summer

  • Torn paper art
  • Make play dough
  • Build with LEGO
  • Finger paint
  • Make a fort
  • Make a recipe
  • STM project
  • Make lemonade
  • Paint rocks
  • Leaf resist art
  • Coffee filter butterfly
  • Toilet paper roll craft
  • Paper bag puppets
  • Make bird treats
  • Create a song
  • Write a letter
  • Bake cookies
  • Draw

Imagination Play for summer

  • Think of a goal for you to accomplish
  • Dress up
  • Make up a play
  • Invent something
  • Make up a dance
  • Act out a story
  • Write a story
  • Imagine a cardboard box is something unique
  • Pretend to be something or someone else
  • Think of a new ending to a movie
  • Imagine all the things you are grateful for
  • Imagine you had $1,000. What would you do?
  • Think of a random act of kindness. And do it
  • Imagine you were…whatever you could do or be. How can you get to that point? Make a list of the steps.

Get this list in a printable format below! Print it off, hand it out as an occupational therapy home program, or hang it on the fridge and when the kids say they are bored, direct them to the list!

use this activity challenge for kids that are bored this summer or to use in ot home programs
summer activities for kids

Life Skills List for Summer

I also wanted to make a list of life skills tasks that kids can do this Summer. These are great to add to a Summer list, especially for daily tasks that kids do before doing something fun like playing outside with their friends or heading to the pool. Yes, it’s ok (and good!) to make kids do a short list of basic chores before they head out for the day.

Use this list along with our printable tools:

Life Skills Kids Can Do at Home This Summer

  1. Make their own breakfast or lunch
  2. Sort laundry by colors
  3. Fold and put away clean clothes
  4. Water plants on a schedule
  5. Make a grocery list with a parent
  6. Pack a bag for a day trip
  7. Sweep or vacuum a room
  8. Take out the trash and recycling
  9. Set a daily chore schedule
  10. Follow a morning routine independently
  11. Load and unload the dishwasher
  12. Clean up after a meal
  13. Plan and prepare a simple snack
  14. Brush and groom a pet
  15. Clean their room weekly
  16. Organize a bookshelf or toy shelf
  17. Write and mail a thank-you note
  18. Track their own screen time or reading minutes
  19. Make a to-do list for the day
  20. Check off completed tasks on a checklist
  21. Follow a visual schedule for the day
  22. Create a simple meal plan for a week
  23. Refill a water bottle throughout the day
  24. Practice telling time with a clock
  25. Make their own bed
  26. Dust furniture in one room
  27. Help with meal prep (cutting, stirring, measuring)
  28. Plan a picnic
  29. Follow a recipe
  30. Set the table for dinner
  31. Sort mail with a parent
  32. Budget and spend allowance money
  33. Create and stick to a summer reading plan
  34. Pack and unpack a travel bag
  35. Choose clothes for the next day
  36. Organize art supplies or craft materials
  37. Make a cleaning checklist
  38. Plan a family game night
  39. Clean out a closet or drawer
  40. Track the weather and dress appropriately
  41. Keep a daily journal
  42. Plan a backyard scavenger hunt
  43. Check and refill household supplies
  44. Make a summer calendar with events and activities
  45. Plan a DIY project or craft
  46. Keep a daily hydration log
  47. Create a quiet-time routine
  48. Use timers to stay on task
  49. Write a packing list for a sleepover
  50. Take inventory of school supplies

More things to do this summer

For more therapist-approved things to do this summer, use the Summer OT Bundle to work on all things handwriting, hand strength, fine motor skills, puzzles, scissor skills, and function in FUN and engaging ways.

If you are a therapist who just doesn’t have it in you to reinvent the wheel this summer, the Summer OT Bundle is for you.

If you are a parent who wants to work on the skills kids NEED to develop so they can write with a pencil and use scissors (but you’re tired of hearing the complaining about doing these activities), the Summer OT Bundle is for you.

If you need resources and tools to fill home programs, extended year programs, summer camps, or to have the babysitter do with the kids, the Summer OT Bundle is for you.

It’s 19 different products, resources, activities and guides to help kids gain the very motor skills they need to thrive. Read more about the Summer OT Bundle here and start having fun in effective ways this summer!

Summer Occupational therapy bundle

Click here to grab your copy of the Summer OT Bundle!

Free Summer Bucket List

Grab a copy of our Summer bucket list and send it home with therapy students for low-prep activities that support skill development. We wanted to select activities that are low budget and can be done over the Summer months. This is a great home program for carrying over skills…in a low effort way.

I love that these bucket list items are in a checklist format too…you can have your kids check off as many tasks as they do, without using a calendar that limits the students to a specific task each day.

This printable is found inside The OT Toolbox membership club (Level 1 free downloads) and Level 2.

Enter your email here to get your copy:

Get the printable Summer Activity Challenge

    We respect your privacy. Unsubscribe at anytime.
    Built with ConvertKit

    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 Activities for the End of the School Year

    by
    End of the school year OT activities

    School-based OTs are often-times looking for occupational therapy activities for the end of the school year. Here, you’ll find fun occupational therapy interventions for the end of the year! We all need a little boost at the end of the school year to get through to the summer, especially after a year like this one! Whether your kids were in person or online, they deserve a fun and engaging activity that will help them transition into summer break. Before we get into Summer bucket list making, it’s important to get through the end of the school year (and that IEP goes on hold for the summer break)!

    end of the school year OT activities

    end of school year ot activities

    End of the school year is a time to celebrate everything that was accomplished during the school year, and in the therapy room, that can be a huge progression! Simply by comparing beginning of the year OT samples to end of the year OT samples, and you can see the progression that was made over the year. This is a great time to look at the progress a child has made!

    We have some great end of the school year OT activities to make this time of year both fun, and skill-building. Sometimes therapy sessions can go right up to the last day of school, and making sessions extra fun is essential!

    An end of the school year OT must-do…Wherever you treat your clients, treat them to a super fun last day of therapy with a party! Rip up tissue paper to make confetti, blow up balloons, pick sprinkles out of putty, and make a quick fun-fetti cake in a mug. They can eat their dessert with the perfect grasp on their utensil of choice. Did you notice all the therapeutic benefits in that list? Because they won’t!

    Some extra-fun ideas to change up the therapy routine:

    • Make a craft- We have many occupational therapy crafts that support a variety of motor skills, sensory needs, fine motor skills, scissor skills, and more.
    • Sidewalk chalk- Grab some sidewalk chalk and head outside. Drawing on the sidewalks around the school is a great activity and one where you can target a variety of skills. Draw a sensory path, a hopscotch board, tic tac toe, or just draw for fun. There are so many benefits to sidewalk chalk.
    • Make a bead bracelet- Ask the student to select a word that represents their school year. Words like happy, proud, growing, or learning, or many others can be used. Then use letter beads to thread onto a pipe cleaner or string. Here is a list of student strengths to help come up with encouraging words.
    • Make a sensory bin- Sensory bins can be used to target a variety of skills and they are fun to play with! Kids love to walk into the therapy room and see a sensory bin ready for them. Materials like dry corn, beans, cotton balls, sand, shaving cream, pool noodles, or any materials! Here is a list of sensory bin bases ideas to get your creativity started.
    • Use paint brushes to paint water on a chalkboard on a vertical surface. 
    • Play dough and cookie cutters- There are many benefits of play dough and you can target so many skills. Pull out a few cookie cutters for an open-ended play activity that builds motor skills. Make the play dough activity extra fun by cooking up an extra large batch of homemade play dough. Then, hide small objects or coins in the dough for a fun surprise.
    • Make a Tie-Dye T-Shirt-How long has it been since you’ve tie-dyed? For me, it’s been over a decade, but I still remember the excitement of creating wearable, one-of-a-kind art. Depending on what the child’s needs are in therapy, you can use this tie-dye activity to address their needs.
      1. The first step for tie-dying is to get your material wet and ring out the access water. My OT brain jumped for joy at the opportunity to have my clients ring out a wet shirt! This action recruits the gross grip strength and bilateral coordination required to move the wrists in opposite directions. Not only that, but they have to hold the position and continue twisting as necessary for the water to be released – what a perfect activity for
        action-reaction!
      2. The second step is to form the shirt into a design. Fine motor coordination and finger isolation can be encouraged by using only the index finger and thumb to begin twisting the shirt. Eventually, the twist will become too thick to reach with one hand, and that’s where bilateral coordination comes into play once more. Maybe do this a few times until the twist is just right!
      3. Now my favorite part – breaking out the rubber bands. Rubber bands are often used in therapy for fine motor strengthening and bilateral coordination. This will be such a fun, new way to use them in your sessions! Use different resistance rubber bands based on their abilities, and use as many as you’d like. This task is also great for developing ADLs
        that require strong, coordinated fingers, like donning socks.
      4. Squeezing the bottles of dye can be a great workout for small hands! Use a fine-tipped bottle to increase the challenge and decrease the mess.
      5. Once the process is complete, they will have followed multiple steps and benefited from sustained attention and practice with proper sequencing. 
    • Nail Polish: Could your client benefit from visual motor integration and fine motor coordination? Have them paint your nails! Or, save your fingernails and offer them a small wooden car to paint – either way, it will be a blast.
    • Gardening: Working on self regulation, social skills, or sequencing? Planting is a perfect time to have conversations with your client, all while doing a refreshing, seasonally appropriate activity.
    • STEM: Have a little scientist on your hands? Use recycled materials to engineer catapults, cars, mazes, and more! Adjust the craft based on their therapeutic needs. You can learn all about recycled STEM ideas here.
    • Fresh Air: Is it a beautiful late spring day? Take therapy outside and let everyone soak up the good-feeling of vitamin D. Here are some great outdoor sensory ideas.
    Need occupational therapy activities for the end of the school year?

    Online Therapy Activities for the end of the school year

    Working in teletherapy at the end of the school year? Check out these teletherapy activities for occupational therapy for the end of the school year:

    • Show and Tell- If you haven’t done this already, a great way to encourage engagement during telehealth is to have the child give you a tour of their home. Most kids love to show off their things, and you can get a better sense of what items and space they have for planning their home programming. This time can be used to work on social interaction skills, descriptive skills, and you can address their deficits by having them interact with specific items they may find.
    • Scavenger Hunt– Another way to boost motivation in telehealth is to do a scavenger hunt! Ask them to find something blue, something yellow, something rough, something soft, something long and something short… you get the picture!
    • Make Play Dough– Making play dough with students is a great way to work on following a recipe and build skills. Then, each student can get their own set of play dough to send home at the end of the year for summer fine motor activities. These play dough recipes have you covered. Pair the play dough with some of these free play dough mats:
      1. Free Ice Cream Play Dough Mat
      2. Free Outer Space Play Dough Mat
      3. Bird Play Dough Mat
    1. Microwave Clean Mud for sensory play (not edible)
    2. Fruit Snack Train (to pair with a book)
    3. Outer Space Snack Mix (for an easy recipe idea)
    4. Tiny Sandwiches with peanut butter and jelly, bananas and honey, nutella and strawberries, hummus and cucumber – the possibilities are endless!

    Interactive Slide Decks for the end of the school year

    Bored with your current selection of Boom Cards? Check out these spring and summer themed slide decks! Staring at the screen just got way more therapeutic.

    Celebrate at the end of the school year

    Happy End-of-the-School-Year!

    Collaboration with Teachers and Parents at the end of the school year

    We all know that carryover of skills requires practicing OT strategies at home. The end of the school year is an opportunity for occupational therapists to collaborate more closely with teachers and parents.

    Sharing simple activity ideas that can be carried over into the classroom or home environment helps reinforce therapeutic goals and create consistency in expectations. For example, therapists might create a take-home activity kit or suggest classroom-based brain breaks that align with a student’s OT goals.

    Sending a brief end-of-year summary sheet or email with strategies has worked really well for me. It’s a good way to ask parents to do a Summer home program to work on therapy areas over the Summer.

    This way, we can help parents make sure progress made during the school year is acknowledged and carried forward into summer routines.

    Transition Planning

    Transitions happen after each school year. It might be the student will be going to a new grade, a new classroom, a different school, or new support services in the Fall. This upcoming change can be challenging for many students. Occupational therapists can play a key role in supporting smooth transitions by addressing both emotional and practical needs.

    Tools such as social stories, transition countdowns, or visual schedules can help students understand what to expect and reduce anxiety. Therapists can also facilitate meet-and-greets with incoming staff or provide sensory-friendly orientation materials.

    For students with higher levels of need, practicing routines they’ll encounter next year (like navigating the new school layout or organizing a locker) can build confidence. Thoughtful transition planning empowers students with tools to adapt and succeed in new environments.

    These are strategies that can be considered for a Summer program or for parents to think about over the Summer months.

    At the end of the school year, this might be a topic that the OT professional spends consultation time to educate parents on strategies.

    Printable Certificates or Awards

    Recognizing students for their hard work and progress is a meaningful way to end the school year on a positive note. Printable certificates or awards can be tailored to occupational therapy goals, such as “Super Scissors User,” “Handwriting Hero,” or “Flexible Thinker”. This is such a fun and affirming end of the school year activity!

    Therapists can personalize certificates to reflect each student’s achievements, giving them a tangible reminder of their growth. Sharing these with parents and teachers also helps highlight the impact of therapy throughout the year.

    • We have some printable certificates for occupational therapy inside the Level 2 Membership.

    Do any of these end of the school year activities sound fun for your occupational therapy sessions?

    Sydney Thorson, OTR/L, is a new occupational therapist working in school-based therapy. Her
    background is in Human Development and Family Studies, and she is passionate about
    providing individualized and meaningful treatment for each child and their family. Sydney is also
    a children’s author and illustrator and is always working on new and exciting projects.