School Occupational Therapy Scope of Practice

school occupational therapy scope of practice- school desks in front of a chalkboard

If you are new to school based occupational therapy treatment, you may be confused about how this differs from the private medical model.  Once you have a few IEP/504s under your belt, you will become a master in defending what therapist in the school do (and do not do). Knowing the points of a school occupational therapy scope of practice is essential. This is a harsh reality, and takes a while to get used to this treatment model compared to outpatient OT. In this article, we will explore how school-based therapy differs from private therapy, and determine What School Based OT’s Should Address.

school occupational therapy scope of practice with school desks in front of a chalkboard

Another resource you’ll want to check out is how to request a school evaluation.


Ideally in the helping profession, occupational therapists should “fix what is broken.”  This is the model I followed for 25 years before moving to the school district. School based therapy is a different ball game all together.  We are “related services,” meaning we provide a service to help students meet their educational goals.

This is where is gets tricky.  While it may be true that Johnny can not tie his shoes, will not eat cafeteria food, or wear button-down shirts, he is getting his education without the need to do these things.  Here is why: Johnny can wear Crocs or Velcro shoes, he can pack a lunch or survive on water during the school day, and can wear other clothes instead of a button-down shirt.

I had a high school student I inherited who had a buttoning goal. He only wore button-down shirts to church on Sundays, never to school. Number one, this was not affecting his education, and number two, if he had not learned buttoning by age 19 with years of training, my few minutes a month was not going to make much of a difference. For the record, I tried. I added the caveat that he had to wear button shirts to school to make it educationally relevant (this was a stretch), and made sure he was working on this every day.  After months of what I knew was going to be wasted time, we settled on Velcro shirts that have buttons attached to looked like a real button-down dress shirt. 


There are differences in documentation in the medical model of occupational therapy and the school occupational therapy model. This is because of differences in intervention based on medical needs vs. educational needs. Here is what the American Association of Occupational Therapists has to say on school-based therapy versus a medical model. This is a great brochure to have on hand for parents and staff at your schools.

Does School Occupational therapy address self help skills?

What kind of self-help skills do you think OTs should look for in developing a treatment plan? Cooking, dressing, grooming, laundry, money management, chores?

What self help skills should a school occupational therapy practitioner address?

This depends on the educational setting. As a general rule, school-based therapist should not be expected to teach cooking, grooming, and laundry unless it is educationally relevant. One of our schools has a program that makes and sells cookies as part of their life skills class.  One student was having fine motor difficulty measuring, rolling, and cutting the cookies.  For him, this specific cooking and life skills goal was relevant to his education.

The student who just wanted to make pancakes, but this task served no educational purpose, was not in need of skilled therapy for this task.  If making pancakes were part of his educational program, then yes it might be relevant to address from a fine motor, or executive function skills angle.

self-help skill that may be addressed in School OT

Sometimes a school occupational therapy referral will target self help skills. And sometimes this is appropriate when it impacts education. Here are some things to consider:

  • Using utensils – maybe. While it is true that your student can get by using their hands to eat, is it safe?  Beyond safety there is social appropriateness, and improving fine motor skills to consider. Check out our resource on using a spoon and fork to assist with this area.
  • Grooming – maybe. If there is a reason your student must brush their hair or teeth at school as part of their educational program, then you may have a case to address this. Deodorant? Maybe not. This might come into play with the middle school student or high school student who is using the pool in the school physical education class.
  • Toileting – the physical aspects of toileting such as clothing management, hand washing, motor coordination, and adaptations, yes.  Maybe even as far as advising on a time schedule or visual supports. Sitting with a kid for 20 minutes waiting for them to go; maybe not. The Toilet Training Book is a good resource for supporting a variety of levels and needs.
  • Laundry – if this is part of their educational program. Some programs have life skills built in like laundry tasks.  If this is the case, this might be an educationally relevant goal.  If so, goals like these are often addressed at a problem-solving indirect level.
  • Chores – again educationally relevant ones.  These are all great life skills but what educational impact do they have to get specific therapeutic services?  Emptying trash cans, recycling, cleaning dishes, washing tables, etc. may be part of a classroom management routine, or may be just a life skill being taught at school.  Consider the relevance before committing to long term direct intervention on waste management.


Handwriting is a big one…it seems like every school based occupational therapy student has a handwriting goal. Check out my post on “How Long Should OT Address Handwriting Skills?” (Coming soon) in order to gain an understanding of when and how much intervention to provide in handwriting. Handwriting services at some point need to be dismissed if the student is not motivated, progressing, over a certain age, or producing functional work. 

Instead look for underlying causes of handwriting difficulties such as weakness, coordination disorder, sensory processing difficulties, or visual perception deficits. Address the underlying causes to improve overall fine motor skills and handwriting.

Some things to ask yourself are:

  • Does cursive handwriting need to be addressed or could this be done at home through a home program (likely much more effective with daily practice)
  • Should near point copying skills be addressed to support the ability to copy homework from a chalkboard?
  • What about pencil pressure? When the pencil markings tear paper and result in illegible written work, should this be addressed?
  • When should we target writing speed? When the written work is illegible because it’s too fast or when it’s so slow that the student can’t keep up with written material. What is the fine line between these areas.

The list could go on and on!

WHAT Sensory Processing Needs SHould SCHOOL BASED OT ADDRESS?

We all have sensory issues. Everyone has idiosyncrasies that make us unique. I am sensitive to smells, textures, and auditory input.  However, I function just fine in my work setting.  I wear clothes that I like, use gloves if I need them, and have ear plugs if something is too loud.  My sensitivities are bothersome at times, but not impacting my work to the point that I can not do it. 

Sensory processing difficulties can have some educational impact.  There are many students who are so sensitive to smells, sounds, or textures, that it impacts their learning, or the learning of those around them. Attention and behavioral challenges interfere with learning and acquiring new information.

Sensory based strategies can help set the foundation for improved learning. These techniques and adaptations are put in place with the sole purpose of helping students reach their academic milestones and participate in their education.

Social skills and social function in the school system

What school-based OTs should address in terms of social skill functioning depends on the expectations in the classroom.  There is a place for therapists to address social skills in class either in a direct or consultative model.  These might include:

How to Decide if a need is in the scope of practice for school occupational therapy

Because we are a helper profession, it is going to take some practice and reinforcement to truly understand the role of therapists in the school system. This advice is not just for occupational therapists.  Physical therapists and speech language pathologists go by the same standards.

When deciding what to address in therapy, ask yourself some questions:

  • Is this skill relevant to their education?
  • Can a teacher provide the same information/practice?  If so, you can provide recommendations and advice rather than direct treatment
  • Can this student perform all functions of their school day without this skill?  This is especially relevant when being asked to address shoe tying, eating, hair brushing, or buttoning.  *You can work on buttons and tying shoes as an activity to improve your fine motor coordination goal
  • Is this something that matters to the teacher and/or parent? If not, you will not get the carryover you need for success
  • Does the child have the necessary skills to function in their environment? Their handwriting might not be perfect, but at some point, it is functional, and works for their educational setting
  • Will adding OT have a positive or negative impact? Some students do not need to miss any instructional time being pulled out for therapy or having a therapist push into a classroom.  A consultative model or recommendations may suffice
  • Is it time for dismissal?  At some point the teachers know what to do to follow your OT plan of care, or your therapy interventions are not having any impact on the student’s education. Therapy can become a crutch for parents/teachers/students.  It is nice to feel wanted and needed, but opening your schedule to help new students is even nicer.

Thoughts from An experienced OT on the scope of school based occupational therapy

This is the end of my third year as a school-based OT. I am finally getting my head wrapped around my role in the school system.  After 25 years in outpatient private practice, it has taken me this long to reprogram myself. There are still times when I want to address something because the child needs it as a life skill.  I must go back to my list of questions above and ask myself if this is truly an educational need.

As my caseload grows, unfortunately some of these decisions are becoming easier based on time constraints.  I find myself prioritizing the students who truly need skilled therapy to survive the day at school, or have some sort of educational impact. Students who in theory should have more therapy due to their function level, get less because their needs are stable, they are not progressing, and their teachers are doing a great job helping them access their education.

Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.

Outdoor Sensory Path Ideas

Now that the weather has started to get warmer, you might be looking for some outside activities. I know a lot of people have 101 reasons not to go outside (too hot, too cold, pollen, etc.) but being outdoors provides such great sensory input. Without adding any activities, the outdoors provides natural input; there is sunshine, wind, birds, flowers, dirt, water, and more. For those looking for more than environmental sensory input, in this post you will find some great sensory path ideas.

This is a Summer occupational therapy activity you can use for many goal areas.

outdoor sensory path ideas

There are so many ways to gain the benefits of sensory motor skill work using an outdoor sensory pathway!

What is a Sensory Path?

Before diving right into outdoor sensory path ideas, we need to take a step back to define a sensory pathA sensory path is a defined path, or walkway that directs users to complete a variety of sensory-motor tasks. The activities that make up a sensory path are typically gross motor tasks that incorporate proprioceptive inputvestibular input, and visual input, in order to meet sensory needs. These sensory systems are powerful regulating tools to organize and this is why motor movements in a sensory path engage these systems. It’s a great tool for supporting gross motor coordination.

Using an outdoor sensory path is a motor skills task. Read more about kinesthetic learning as a tool for skill development.

A sensory path is typically a literal pathway on the ground; it may be painted onto a sidewalk or schoolyard. It may be stickers or images stuck to a floor or hallway in a school. Or, it might even be a chalk path on a sidewalk or driveway.

Many of you are familiar with the  the (Amazon affiliate link) sensory pathways displayed on walls and floors of the school building. These are available commercially, or sensory paths can be made with paint and stickers.  The fun does not have to end there!  This Sensory Obstacle Path book is a great resource for getting started.

Other ideas include using our printable version of sensory stations. These PDFs, when hung on a hallway or as part of an obstacle course, become an interactive sensory pathway. The ones you’ll find on The OT Toolbox include:

Outdoor Sensory Path Ideas

Many children (and their caregivers) do not know where to begin when playing outside.  Unfortunately, people have become so accustomed to technology, they have forgotten how to play.  Creating a sensory path gives defined boundaries to an activity.  Children really do thrive on structure and repetition. 

With these outdoor sensory path ideas, you can create great occupational therapy obstacle courses with defined limits.  Set up the path, then determine how many times it needs to be completed in succession.  I love the idea of having students use counters or objects to define how many rotations they have done. I use puzzle pieces, coins, clothespins, or any other small item that can be slipped into a pocket.

A lot of the following games use sidewalk chalk, but feel free to use rope/tape/paint/string or cones and buckets to define your space. We have other ideas in our indoor obstacle course post.


This is a classic game. I hope it continues to be passed along from generation to generation. All you need is a piece of chalk, a couple of counters, and a little space. It’s easy to set up as a sensory path:

  1. Draw out your grid. 
  2. Learners can hop on one foot, jump with feet together, jump left and right or feet apart, squat to retrieve objects and turn around.

Hopping and jumping are great proprioceptive activities that help to organize the sensory system.  Feel free to make your hop scotch permanent with paint, although changing the obstacle courses frequently adds to their appeal.

Outdoor sensory path ideas – The Sensory road

How about using that same chalk and creating a road to travel? Dust off the Big wheels or scooter boards, draw a path/road with chalk, and add some obstacles. If you use a scooter board, you can incorporate some prone extension activities.

Have kids pick up objects along the way and deposit them in another container. Put cones or buckets in the road to navigate. Attach a wagon filled with weights to increase the workout.  You can use chalk, tape, rope, chain, or whatever you have handy. 

You can even create a temporary space or paint the road on your space for long lasting fun. When my kids were young, we used a roll of masking tape to create a road in our unfinished basement. They would move their ride on toys around the basement along the masking tape road.

Activity obstacle course

  • Another outdoor sensory path idea is an obstacle course. Think; relay races from field day or P.E class.  Use a large spoon to carry rocks or pinecones from one end to another.  This can be the entirety of the game, or spice it up with more obstacles.  Carry the pinecone, jump over the sticks, go around the bushes, crawl under another obstacle. Add calisthenics such as sit ups, pushups, jumping jacks, or side hops to the sensory path.
  • Amazon (affiliate link) has a nice Obstacle Course in a Box if you are looking for a prepackaged idea.  Here is a kit of simple staple supplies such as rings, bean bags, and cones.
  • Animal Walk Sensory Path- Another idea I love is using an animal walk theme, where the child can move through a sensory path with different animal walks. It prompts you to think about adding items for jumping, hopping, throwing, kicking, crab walks, crawling and more.
  • What do you have around the house you could turn into an obstacle course?  Once, we made a string maze with rope/string for learners to climb their way through. This is a great activity for supporting motor planning skills.
  • Use these pool noodle ideas to create a course of rings and hoops. They show ideas for the pool, snow, and more.

Outdoor sensory walk

  • Check out these garden sensory paths that tie nature and sensory input into a delightful garden feature. These sensory paths feature the tactile sense. Take those shoes off and get your feet in the earth.  Create a path with different textures: grass, pebbles, stepping stones, concrete, pea gravel, sand, mud, wood planks, shells, sticks and more. There are some nature sensory paths that people have built into their landscape, as well as temporary ones build into carboard boxes or trays.
  • Temporary outdoor sensory walk – You can create an outdoor sensory path that can be removed when the play is done. Get different plastic tubs, fill them with different textures, and create a fun tactile path.  Ideas might include: rocks, water, pebbles, grass clippings, sand, birdseed, leaves, sticks, and more.
  • Benefits of Nature Play – This post highlights outdoor sensory path ideas using nature play.  Use what is already available to enlighten the senses and create some great outdoor play.
DIY ninja warrior course ideas- wooden pallets, slack line, climbing structures, playground equipment, stepping stones

Another idea for a sensory walk is a ninja warrior course.

Ninja Warrior courses

With the rise in popularity of American Ninja Warrior, kids and adults are really getting into fitness through obstacle course training. Have you ever thought about making your own DIY ninja warrior course?

Build your own course or purchase ready-made pieces you might have around the house. Some ideas include:

  • wooden pallets
  • Wooden boards like a 2×4 in different lengths
  • Slanted wood balanced on rocks or bricks
  • Climbing walls

You can also purchase Ninja Warrior materials and create a backyard ninja course:

Chalk walk ideas

I love using a chalk walk as a sensory path because it requires just chalk and an outdoor space. You can target so many skills with a single chalk walk!

Chalk Walk

We mentioned a few ideas to create a chalk walk (hopscotch, making a road, or an outdoor chalk line path), but what are some specific ways to incorporate different movements using just chalk? Here our our ideas to support proprioceptive, vestibular, and visual input?

Where to make a Chalk Walk?

Another nice thing about a chalk walk as a therapy tool is that all you need is a box of sidewalk chalk. We’ve made chalk walks at different places:

  • Sidewalk
  • Driveway (Read about our driveway sensory diet for more inspiration!)
  • Park or playground
  • Empty parking lot
  • Cul-da-sac in a neighborhood
  • Playground basketball court

You can incorporate different sensory motor tasks that are inspired by sensory integration therapy, using just the chalk and a large writing space. Some ideas include:

Hopscotch: Create a hopscotch grid with different shapes or numbers to promote balance and coordination.

Balance Beam: Draw a straight or wavy line for kids to walk on, encouraging balance and body awareness. Here are more balance beam ideas to add to your list.

Obstacle Course: Design a chalk obstacle course with different challenges like hopping, spinning, and tiptoeing.

Alphabet Path: Write the alphabet in a path for children to follow, promoting letter recognition and movement.
Number Line Jump: Draw a number line and have kids jump to specific numbers, integrating math skills with physical activity.

Shape Jumping: Draw various shapes and have kids jump from shape to shape, enhancing spatial awareness and motor planning.

Simon Says Path: Create a path with different actions written in each section, like “spin,” “hop,” or “crawl.”

Color Hunt: Draw different colored circles or shapes and ask children to run to specific colors, integrating color recognition and Animal Walks: Draw animal footprints and have kids imitate the movements of different animals as they follow the path.

Emotional Faces: Draw faces with different emotions and ask children to move to the face that represents how they feel, integrating Sensory Tracing: Draw large letters or shapes for children to trace with their fingers, enhancing tactile feedback and fine motor skills.

Breathing Circle: Draw a large circle and practice deep breathing exercises while walking around the circle.

Dynamic Paths: Create paths with different textures by adding elements like sand or water to the chalk, stimulating tactile senses.

Chalk Mazes: Draw mazes for children to navigate, enhancing problem-solving skills and spatial awareness.

Jumping Dots: Place dots in varying distances for kids to jump between, promoting proprioception and muscle strength.

Shadow Tracing: Use chalk to trace shadows at different times of the day, combining sensory input with outdoor exploration.

Body Part Path: Draw a path with labels for different body parts (e.g., “touch with left hand,” “step with right foot”), promoting body awareness.

Spiral Walk: Draw a large spiral for kids to walk or run around, providing vestibular input and promoting balance.

Toss at a Target: Draw circles with letters inside. Throw a pebble into a circle and then write that letter with chalk. Here is a letter writing activity with chalk.

Inclusive Chalk Walk

The nice thing about creating a chalk walk for kids is that you can individualize it to meet the needs of the kids you are working with. So, for some kiddos that require more inclusive ideas, you can definitely create a chalk walk that supports their needs. You could also incorporate self regulation strategies like deep breathing breaks in the task, or make it smaller or bigger. It really depends on the kids you are supporting!

Grade the Chalk Walk Down– Grading down a chalk walk to make it more inclusive for lower-level kids involves simplifying tasks. This is something we do naturally as occupational therapy providers, right? We can offer the support level needed AND ensure that the activities are achievable and engaging, because that’s what helps the child achieve their goals! This is what we call the “just right challenge“.

Here are some strategies that support occupational therapy goals of gross motor coordination, fine motor skills, sensory motor skills, and executive functioning skills:

  • Wider paths: Draw wider lines or paths to make it easier for children to walk on without losing balance.
  • Simpler shapes: Use basic shapes like circles and squares instead of more complex patterns.
  • Shorter distances: Reduce the length of the path or the distance between tasks to avoid overwhelming the child.
  • Fewer steps: Limit the number of steps in a sequence to keep tasks manageable and less confusing.
  • Visual aids: Add visual cues or markers, such as arrows or footprints, to guide children along the path.
  • Lower jumps: Create lower hopscotch squares or stepping pads to reduce the height children need to jump.
  • Verbal prompts: Use clear, simple verbal instructions to guide children through each activity.
  • Physical support: Provide hand-holding or use a handrail for balance and support as children navigate the path.
  • Use of props: Incorporate props like balance beams or stepping stones with tactile feedback to aid movement.
  • Repetitive patterns: Use repetitive patterns that children can easily recognize and follow.
  • Reduced speed: Encourage children to move at their own pace, focusing on slow and deliberate movements.
  • Inclusive themes: Integrate themes or characters that the children are familiar with to make the activities more engaging.
  • Stationary tasks: Include more stationary tasks like tracing shapes or drawing within a specified area.
  • Sensory breaks: Incorporate sensory breaks with simple tasks like sitting and deep breathing or stretching.
  • Pairing up: Pair children with a buddy for guidance and encouragement.
  • Positive reinforcement: Provide immediate positive feedback and encouragement to build confidence.
  • Adapted challenges: Offer different levels of challenges for each task so children can choose according to their abilities.
  • Consistent routines: Use a consistent order for tasks to help children anticipate and feel more comfortable with the activities.
  • Use of color: Utilize bright, contrasting colors to make the paths and shapes more visually distinct and easier to follow.
  • Minimize distractions: Ensure the environment is calm and free of excessive distractions to help children focus on the activities.

Then, to grade the activity up, or add more challenging tasks to the chalk walk, use one or more of the items above and make it more challenging for the chalk walk user. This is how we can support individual needs and work on developing those goals!

Sensory Chalk Walk

In addition to the motor skills that a chalk walk supports, you can also add in sensory integration strategies that offer specific tasks for vestibular input, proprioceptive input, visual input, and even tactile input. For more information on this, check out our resource on Ayres Sensory Integration Therapy.

For example, we used a wet chalk activity to add a messy sensory play experience. This was a fun way to work on visual motor skills while addressing sensory defensiveness. You could also make liquid driveway chalk paint to add sensory writing tasks to the fun.

  • Spirals for spinning around a central point
  • Maze for finding the way out
  • Wavy lines for tiptoeing
  • Hopping pads for both feet
  • Single line for walking or crawling on either side of the line
  • Zigzag paths for jumping side to side
  • Alphabet stepping stones
  • Numbered hopscotch squares
  • Dotted lines for skipping
  • Animal footprints to follow
  • Balance beam lines
  • Twisty lines for galloping
  • Shapes to jump into (circles, squares, triangles)
  • Arrows for direction changes
  • Line with stopping points (large circles) to take deep breathing breaks or a prompt to do a motor task like hopping 5 times)
  • Concentric circles for jumping in and out
  • Ladder rungs for stepping up and down
  • Patterns for matching (left foot, right foot)
  • Start and finish lines for timing races
  • Swirly lines for crawling
  • Parallel lines for jumping over
  • Star shapes for jumping to different points

More outdoor sensory path ideas:

The weather does not have to be perfect to use your outdoor sensory path ideas. Kids do not mind rain, wind, mud, temperature changes, or snow. “Back in my day” we used to get sent out no matter what the weather had in store for us.  It was great for our sensory system, along with building valuable skills. 

Sidewalk chalk obstacle course

Free printable set of resources!

Free Chalk Walk Sensory Kit

We created a free printable resource just for sensory motor skill development…a Chalk Walk Kit! This activity guide has chalk drawing figures designed to support proprioceptive, vestibular, and visual input for calming and organizing sensory input.

Pick and choose the chalk walk options to create an individualized sensory path to meet specific needs.

Work on motor planning, coordination, balance, midline crossing, and much more…all with just a piece of sidewalk chalk.

To get this resource, enter your email address below. Member Club Members will find this resource inside The OT Toolbox Membership Club!

Free Sidewalk Chalk Sensory Path

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    Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.

    Summer OT Programs

    Summer therapy program

    Is it summer break yet?  This is what all the school based occupational therapy providers and teachers are asking. Whether you are working in a school system or with children who go to school, you are going to want some great summer programs to offer.  Summer activities can range from seated table worksheets, chores, arts and crafts, self-help skills to outings, camps, and classes. 

    All the above are great to work on retaining and learning new skills.  The only bad activity is no activity.  I know teenagers want to sleep all summer, but this is not going to help build critical skills, especially for those students who need a leg up.  In this post we will explore some great summer program and activity ideas. We also have occupational therapy at home ideas that you could do this Summer.


    David Quinn and Morgan Polikoff researched Summer regression and concluded on average, students’ achievement scores declined over summer vacation by one month’s worth of school-year learning, (2) declines were sharper for math than for reading, and (3) the extent of loss was larger at higher grade levels.

    According to Scholastic, students lose about a month’s worth of learning on average over the summer. Some studies show that children lose up to 40% of their learning over summer break. For example, children in grades 3 to 5 lose about 20% of their school year gains in reading and 27% of their gains in math. In the summer between 5th and 6th grades, 84% of students experience summer slide in math. 

    This is especially important for students who are struggling to keep up with their peers in school.  When I am doing end of year meetings, I make sure to stress carryover of goals with parents.  I want their students to have an advantage of practicing OT interventions all summer, not sliding backward. While everyone can benefit from a summer program, students with special needs are on the top of my priority list.

    Summer therapy program

    Summer Program Schedules and Routines

    One of the key components of summer vacation that differs from the school year, is schedules (or lack of them). Kids thrive on predictability, consistency, and expectations. Parents mistakenly feel that students have been on a strict schedule all year and need a summer free for all. 

    Just like adults, children feel more confident and secure when their daily activities are predictable and familiar. A consistent daily schedule and step-by-step routines give children a predictable day.

    Schedules and routines in the group care setting and at home help children: feel in control, feel safe and secure, know what is happening next, and engage in learning. Engaging, predictable environments and ongoing positive adult-child interactions are necessary for promoting children’s social and emotional development and preventing challenging behaviors. You can help by following clear and simple schedules and routines. (Hemmeter, Ostrosky, and Fox 2006).

    Using a visual schedule at home is a great idea to keep this routine!


    There are several key factors in establishing a summer program (or any other time) schedule and routine:

    • Keep it simple. A routine does not have to include outings, pricey trips, or a packed schedule.
    • Help family members break down one of their scheduled tasks into steps to create the routine. For example, the morning routine might be: go to the toilet, get dressed, eat breakfast, brush your teeth.
    • Encourage families to let their children be as independent as possible. You might have to break a task down into chunks to have children help.
    • Let parents know that reviewing the schedule every morning and throughout the day with their child helps them know what is going to happen next.  They can use visual schedules, pictures, lists, timers, or whatever works for them.
    • Remind families to keep the routine and schedule as similar as possible each day but offer some choices when possible (do you want the red or blue shirt?)
    • Let parents know they should also be flexible. You can say something like, “Plans change, things happen, but give your child a warning ahead of time if things are going to be different. Let them know what is going to happen.”
    • Refer to the schedule before and after activities throughout the day. 

    Here is a fun June Summer Activity Calendar to get your summer program started!


    Some learners need a sensory diet or program built into their summer to keep their systems regulated.  This article on Sensory Diets is informative in building and using this tool. 

    You can of course incorporate your sensory diet into your daily schedule.  For example, after the morning routine, add animal walks.


    Personally, I love a good workbook or paper activity. Arts and crafts are my jam. The possibilities for workbooks are endless and often overwhelming. My standard advice is to pick a couple of websites and resources you trust, and go from there.  For example, the OT Toolbox (and The OT Toolbox Membership gets you everything done for you!) has multiple programs and printables to choose from that follow the same type of theme or pattern to add to your summer program.

    • Summer Activity Bundle Included in this bundle of printable resources are tools to address fine motor skills, visual perception, visual motor skills, sensory processing, self-regulation, pencil control, handwriting, and more. 
    • Occupational Therapy Activities – great OT activities to get you moving this summer.
    • Summer Fine Motor Kit Printable no-prep Summer fine motor activities and fine motor worksheets designed to build strong hands.
    • Handwriting Practice for Summer
    • Summer Bridge Workbooks – These workbooks are my go-to suggestion for parents. I used these with my own girls 20 years ago and they are still very popular.  Must be a good sign. I like that there are specific pages for each day on different subject matter to touch all the academic areas without being overwhelming  Prevent summer learning loss! Summer Bridge Activities is an AWARD-WINNING summer learning series that is an easy and proven way to help children retain their classroom skills. Research shows that on average, children can lose 2.8 months of grade-level equivalency skills over their summer vacation. By using Summer Bridge Activities books students enter their new grades prepared and confident.  These are available at other retailers, but I like all the information presented on their website.  Check out the contents of each book before deciding on a level. Some learners are going to be too advanced for their grade group. Whereas struggling students may need to drop down a level or two.
    • Teachers Pay Teachers is another one of my favorite websites for resources.  This search for Summer Packets brought up multiple different suggestions.
    • Check out this June Morning Work activity packet aimed at kindergarten level students. Carry over the important daily routine with a daily work page.


    A good mix of summer occupational therapy activities including indoor AND outdoor activities is great to add to your schedule. These activities use things you have around the house or can easily find at the Dollar Store.


    An increasingly popular option for home and summer programs is the Choice Board. A choice board is a visual tool that teachers can use in their classrooms to allow students to… make choices! Choice boards consist of two or more options of activities for students to complete.

    The teacher specifies what choices are available, and the student selects what activity (or activities) they’ll do. Choice boards give students a chance to make decisions about what they are going to do.  Eventually they will get all the activities done, so it does not really matter which order they get them done.

    Some choice boards are made to give students choices without having to do all the activities.  For instance, pick 3 from the board for homework.

    Summer Outings that build skills

    Summer programs would not be the same without outings!  Not everything has to cost a ton of money.  There are lots of summer programs for kids out there. Here are a few ideas that are free or low cost:

    • Summer bowling program
    • Movie series – older movies during the summer that only cost a few dollars
    • Library – the library usually has a book challenge or other activities like Lego club, book club, arts and crafts, and more
    • Recreation Center – check out your local recreation center for activities.  They usually offer lower cost summer camps as well as great activities.
    • Staycation – have you seen all there is to do in your home town?  How about being a tourist for a few days and check out the local sights.
    • Membership – a summer membership can help create a summer schedule. If you go enough times, the cost is minimal. We loved the aquarium, zoo, water park, amusement park, children’s museum, and more
    • Classes – several places offer fun classes during the summer. The craft painting and pottery places offer classes. Usually the dance studios have something going on, as well as the gymnastic centers.
    • Bible Camp – if this is your preference, Bible camps are usually free and you can check out more than one church.


    This is only the third year in my 30 years as an OT to have summers off. You can bet I am super excited!  We have travel plans galore.  I am thinking of adding the Summer bucket challenge for adults to my summer plans.

    Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.

    Visual Noise and Learning

    Visual noise in the classroom

    In this post you will be discovering how to create a calm classroom, specifically tips to avoid the visual noise that distracts learning in the school environment. Classroom décor and organization can directly effect the engagement level of children in any classroom or learning space. When the environment is too visually stimulating, a student’s ability to focus becomes difficult. Keeping children’s attention can become frustrating. When a classroom environment that is soothing and organized is created, children are better able to stay engaged. In this blog, you will learn about the three different ways to make your classroom visually calm. 

    Visual noise in the classroom

    What is Visual Noise?

    When working with children, teachers think about all of the colors of the rainbow, and want to make classrooms bright and cheery. So many classroom theme sets have fun colors, bright designs, and patterns, contrasting bulletin board boarders, etc. Many believe that having a colorful classroom will keep children interested and engaged. 

    Visual Noise is just that: a visually distracting, or “noisy” visual scene in the classroom. A lot of teachers set up bulletin boards throughout the room with cut-outs in various themes: animal/monster/any theme , alphabet stickers, and painted murals on the walls. Maybe your classroom has a circle time rug that includes the ten different color squares. Perhaps you want to make sure all the children have something they like to do, so you have 20 fine motor choices in the manipulative area. 

    There is just one problem with using these types of visuals in the classroom, they are distracting! 

    • The bulletin boards all around the room are adorable, and fun to look at. So during circle time, you might find a child gazing at the wall, figuring out what new item is there. 
    • When there are rugs filled with colors, you may notice children looking down at the rug, maybe at the bright colors, while singing the color song in their head.
    • If teachers provide too many choices in one area of the classroom, children work with one toy for three minutes, then they are onto the next, without honing in, or practicing the skills that were intended.
    • For young children, and lots of adults, less is more! 

    visual processing

    Humans use vision from birth, to engage with the world around them. The way your brain process what you see, impacts how you interpret your interactions with the environment, and the people around you. To learn more about vision, this amazing PDF discusses visual hypersensitivity and under-sensitivity (or sensory seeking). 

    There are some visual processing red flags that may indicate difficulties with visual processing or ocular motor control:

    • Increased sensitivity to light
    • Easily distracted by visual stimuli, or difficulty sustaining visual attention to an activity
    • Frequently squints, rubs eyes, or gets a headache after visually demanding tasks such as reading, using a phone/tablet/computer, or watching television
    • Loses place in reading or writing
    • Trouble finding things they are looking for, even when they seem to be “right in front of them”
    • Distractions with reading
    • Difficulty tracking visual information
    • Difficulty initiating or holding eye contact
    • Difficulty focusing on one piece of visual information
    • Increased fear of, or desire for, being in the dark
    • Difficulty discriminating between similar shapes, letters, or pictures
    • Letter reversals or number reversals
    • Difficulties with handwriting such as letter reversals, sizing, spacing, or alignment of letters
    • Frequently loses their place while reading or copying
    • Often bumps into things
    • May be slow or hesitant with stairs
    • Difficulty with visually stimulating activities, i.e., puzzles, locating objects in pictures, completing mazes, word searches or dot-to-dots
    • Trouble knowing left from right or writing with both hands

    How to reduce visual noise when planning your classroom

    When planning out your classroom, visual stimulation is important, however there are many ways to make sure there is reduced visual noise, so the environment is not overwhelming.

    Think about how you feel when you go to the spa. Those deep earthy wall colors calm your bodies and nerves instantly! The Montessori and Reggio Emilia educational philosophies advise visual components as a way to keep their classroom calm and focused.

    The Reggio Emilia philosophy recognizes the environment as the child’s third teacher. What is in a child’s environment, how it’s organized, and what it looks like, directly impacts what a child will learn that day. 

    two ways to make sure your environment is visually calming 

    Colors – When picking out colors for your classroom, whether it be for the furniture, rugs, or wall decor, the best way to support a calm visual classroom, is to choose more natural colors. These include blues, greens and browns.

    • Choose toy baskets, or white bins, as opposed to brightly colored ones.
    • Consider turning toy shelves around or covering with neutral fabric to further reduce visual noise.
    • Choose predictable carpet rugs (Amazon affiliate link) like this one, instead of random colorful squares. Carpet samples of neutral colors are an excellent idea to create boundaries while limiting visual distraction.
    • When decorating your walls, allow for empty blank space, and use more of children’s artwork. Consider the use of cloth and fabric.

    Classroom Organization – When choosing how many activities and materials to place in each are of your classroom, keep in mind that less is more! When children have too many options to choose from, this can create a short attention span, and overwhelm from choice overload.

    Organization in the classroom can mean stacks of papers, tons of sticky notes, messy desks, and disorganized files, too.

    In a typical preschool classroom, there are 8 areas of learning: art, fine motor, science, reading, dramatic play, block, large motor and snack! When you use furniture to visually create specific spaces for each center, the classroom is organized, and children know what is expected of them in each area.

    Older classrooms may not have the toys, block areas, and motor components, but there are designated areas: group areas, centers, desks, cubbies, or lockers, teacher areas, information centers, etc. All of these areas can be considered when it comes to visual input.

    This blog from Lovely Connection, on preschool classroom set up, includes important aspects to think about as you plan your classroom layout. She includes information about including noise, popularity, supervision, boundaries, space, and the race track (when kids run around the room in a circular pattern!)

    What happens when children are still overwhelmed, even when the environments are visually calming?

    When a child feels overwhelmed for any reason, having a calm down corner, that is easily accessible and they can stay in as long as they need, is a must have.  My Soothing Sammy Emotions Program.” is an effective calm down area because students are excited to spend time with the adorable golden retriever Sammy. Not only does “The Sammy Program” teach children how to calm down, it guides them through communication and problem solving situations in a visual way that isn’t overwhelming.

    Check out this great blog about visual processing and visual efficiency from the OT Toolbox archives. When a child has visual processing difficulties, they have a harder time taking in visual information, and processing it in order to make sense of it.

    This visual processing bundle, also available in the Toolbox, can support children who are demonstrating visual processing challenges. 

    The Sensory Lifestyle Handbook (also available on Amazon) written by Colleen Beck of the OT Toolbox, is a great resource to start understanding sensory processing disorders.

    A final note about visual noise

    Visual noise doesn’t only occur indoors, it can happen outdoors, especially if there is a lot of activity and sunlight. Being mindful of the visual stimuli outdoors, is just as important as setting up an indoor classroom.

    If you have a child who is having a hard time visually processing their environment outside, these visual sensory activities can be completed outdoors to support their sensory system.

    While considering visual sensory overload in the classroom, also be sure to check out our resource on auditory sensitivities in the classroom. Both are very useful in setting up an inclusive classroom environment for success.

    Classroom themes are adorable and cute! When planning your classroom, keep in mind how “busy” and overstimulating different colors and amount of objects can be. This will help keep your students calm and engaged. Although everyone processes their environment differently, anyone can all benefit from a more calming environment, especially when learning new skills! 

    Jeana Kinne is a veteran preschool teacher and director. She has over 20 years of experience in the Early Childhood Education field. Her Bachelors Degree is in Child Development and her Masters Degree is in Early Childhood Education. She has spent over 10 years as a coach, working with Parents and Preschool Teachers, and another 10 years working with infants and toddlers with special needs. She is also the author of the “Sammy the Golden Dog” series, teaching children important skills through play.

    How to Support Sensory Needs in the Cafeteria

    how to support sensory needs in the school lunchroom

    The cafeteria is a terrible place for people with sensory sensitivities.  If you have ever joined your child for lunch at school, you will agree.  Two hundred or more children, 1000 different smells, and the chaotic noise level do not create a great eating environment for anyone. In this post we will explore how to support sensory needs in the cafeteria. For the school based OT, the cafeteria can be an alternate environment for addressing daily functional needs. Because this setting is so commonly targeted in school occupational therapy, we wanted to create a blog post centered around the sensory considerations in the school cafeteria.

    How to support sensory needs in the school lunchroom

    There are three great steps I use to try and untangle the web of sensory processing difficulties. I try and understand, communicate, and accommodate.  When the behavior is noticed first, we tend to focus on that, without taking the time to understand and learn what is really going on. If a behavior is based on a sensory reaction, often it will diminish once the sensory needs are addressed.

    Much like the sensory stimulation of a fire drill, the sights, sounds, scents, and overwhelming amount of people in the cafeteria can result in sensory overload. We might see sensory dysregulation pop up and if this happens on a regular basis, we might even see overstimulation anxiety because the student knows this highly stimulating experience is coming up at a specific time each school day. It’s very stressful!

    This post is just one of several, highlighting strategies and tips to understand, communicate, and accommodate sensory needs. “How to support sensory needs in the cafeteria” is an excerpt from my book, Seeing your Home and Community with Sensory Eyes.  I wrote this book to provide a road map to assist caregivers in navigating environments and settings that trigger sensory outbursts daily.  It is a great resource for therapists, educators, and caregivers.

    How to support sensory needs in the cafeteria

    The first of many strategies on how to support sensory needs in the cafeteria includes understanding what senses may be triggered in this environment.  This sensory input may be great for seekers, or too much for avoiders:


    Almost all your senses can be considered in the cafeteria lunch room:

    • Visual:  200 children, 100 different food items, sitting close to peers, people eating with their fingers, people chewing with their mouths open, messy eating, lunch boxes, trays, drinks, food, and containers all create a visual distraction.  This makes it difficult to focus on eating when there is this much visual stimuli present. Sometimes it takes a combination of input to send a person into overload, while for others one event such as watching someone lick their fingers can be a trigger.
    • Olfactory:  200 children and 100 different food items combine to form thousands of combinations of smells.  One food might smell fine, but when added to twenty others, it is an unbearable combination. The brain and olfactory system have difficulty making sense of the number of the smells coming in at once.  For me, smelling food at a time or place it “does not belong” is a big trigger.  I cannot tolerate the smell of lunch foods cooking early in the morning, or someone bringing their smelly lunch into our office.
    • Auditory:  200 children all whispering at the same time creates a loud noise, especially when combined with eating noises, chewing, burping, gulping, licking fingers, and smacking lips.  Misophonia is a newer term used to describe the hatred people feel toward certain sounds, especially the sound of chewing food. Plus, then you have trays dropping, teachers yelling announcements, kids that get louder and louder it seems…the sudden sounds, students moving quickly through the lunch lines…all of this combines to impact the sensory sensitive person, especially when it comes to auditory sensitivities.
    • Gustatory:  students buy cooked lunch food, or bring food from home.  Unexpected or disliked food options can present an issue for a picky eater.  While the cafeteria is an opportunity to try new foods by sharing with peers, this is not advised, as allergens and germs can be spread this way. 
    • Tactile:  many children sitting in proximity, sitting on benches, touching feet underneath the table, touching food, and struggling to open different containers can quickly feel overwhelming.  The sensory avoider has difficulty processing this much tactile input, while the sensory seeker becomes energized and craves more.
    • Proprioception:  sitting close to other people can set off alarm bells to someone who is sensitive.   A person without body boundaries struggles to stay seated and keep an appropriate distance from their peers.
    • Vestibular:  while attempting to sit still for a length of time the students will be in and out of their chairs, leaning on the table, standing at the table, or moving around the room.  Some students have such difficulty sitting still, they are unable to do anything else.
    • Emotional/behavioral:  anxiety, lack of control of the situation, lack of self-control, frustration, anger, interrogation, inability to express oneself, and excitement all contribute to acting out behaviors.  Often the behavior is noticed first when there is a sensory trigger.

    When the senses overload, we might see a fight or fright reaction, impacting the limbic system. Overwhelming sensory input can trigger an automatic safety response called a ‘fight, flight or freeze’ response. We might see all kinds of sensory responses as a result.

    There is visual noise where there is overwhelming background noise constantly. There are a lot of moving pieces happening all at once. Sometimes a simple conversation can ease the anxiety and set the stage for new or difficult situations.

    Lunchroom Sensory story

    The second strategy for how to support sensory needs in the cafeteriais learning to communicate about sensory preferences; how things look and feel, and what can be done to make life easier to navigate. 

    This is a sample conversation about the cafeteria:

    “The cafeteria is where you eat lunch.  There are many other students eating at the same time.  This can be a fun break for some, while overwhelming to others.  It is important to eat good food while you are at school to help you learn, focus, stay healthy, and grow.  We can decide together if we are going to pack you a lunch from home or have you buy food at school.  We can decide each day by looking at the menu.  There are rules to follow in the cafeteria to keep everyone safe, and I need you to make good choices while you are eating.”

    You’ll want to make the lunch room sensory story very specific to the individual. This means that you want to include specifics about the time the student goes to lunch, where they sit, and the routine that they need to follow for getting their lunch and putting their tray back, or where they get their packed lunch from and where they throw away trash. These specifics mean that it’s difficult to use a social story found online or on websites as a download, because the overwhelming nature of the school lunch room is different for each individual because of the specifics of the setting, which is completely unique for each school.

    But, you can use the cafeteria sensory story in different ways, which can be very beneficial:

    • Laminate the lunchroom sensory story and use it each day as a handout on the lunch table. The student can use a dry erase marker to check off tasks as they happen.
    • Put a small version of the cafeteria sensory story into the student’s lunchbox. This can be laminated as well.
    • Read through a lunchroom sensory story before going into the cafeteria. This can be incorporated as part of the student’s routine.

    Sensory Questionnaire for the Cafeteria

    One thing that is helpful is to do a sensory questionnaire with the student to really identify where the sensory challenges are popping up. A sensory processing checklist is helpful for this.

    These are some questions to ask someone about their perception of the cafeteria:

    • Do you like the cafeteria?  Do you like sitting with your class all together?
    • What can you smell in the cafeteria?  What smells great or terrible?
    • Do you like the food in front of you?  What is your favorite?  Do you eat all your food each day?  If not, what makes it hard to eat in the cafeteria?
    • Is it loud in the cafeteria?  Do you even notice the noise?  What can you hear?  Does it make it harder to concentrate on your food, or are you able to tune out the chaos?  Can you hear people eating, talking, chewing, and moving around?
    • Are you having trouble staying in your seat for a long time?  Do you like sitting this close to people or do you feel like people are in your space?
    • Is it hard to have conversation while trying to filter out all the noises and eat at the same time?  Would you rather sit quietly; maybe with a book, or at the end of the table?
    • Are you able to open all the containers, cut/scoop your food, use a napkin, and drink from your cup?
    • Do you like touching the food, or would you rather have a fork?  Do you need more napkins or wipes so you do not feel so messy? Are you spilling food on your face, hands, or table?

    Accommodate by learning how to support sensory needs in the cafeteria

    Step three involves making accommodations to assist a person with sensory processing disorder navigate the environment easier, and with less distress. 

    For example, autism and the loud noises or sudden noises can impact the rest of the day. Keeping this in mind, caregivers can help the transition go smoothly before, during, and after lunch time. Some things that specifically might help include visual schedules, a visual timer (Amazon affiliate link), noise cancelling headphones (Amazon affiliate link), quiet sitting spaces, and transition strategies for entering and leaving the cafeteria.

    Some people frown on making accommodations as they feel it is giving people a crutch or making excuses.  Always keep your end goal in perspective. Is the goal of the cafeteria to sit quietly and enjoy the meal like everyone else, or to refuel and get nourishment for the rest of the day? 

    • Provide accommodations such as ear plugs, headphones, compression vest, weighted vest, or lap pad.
    • Consider possible flexible seating options.
    • Provide preferential seating at the end of the row to minimize distractions.
    • Create a sensory friendly table away from the crowd for the children who are overwhelmed.  This can be called the sensory table or the overflow table.  Children can choose to sit at one of these smaller tables if they are feeling over-stimulated.  This separate table is to foster improved self-regulation, not to make the student feel punished or isolated.
    • Create smaller areas for dining such as an empty classroom.  Smaller areas help children focus on their food.
    • Essential oils help mask noxious odors.  A child can wear an essential oil necklace or have a drop of oil under his nose which may be more pleasing than the combination of smells in the cafeteria.
    • Talk to the child about what foods are preferential, as well as the ones that are going to be difficult to eat.  Cafeteria staff and the teacher can work with families to decide if hot lunch is preferential, versus a packed lunch from home. 
    • Allow the child to stand at the table and eat if sitting is proving to be too much to handle. As long as the child stays in his designated spot while eating, this can be an acceptable choice.  It is not acceptable for children to walk around the room with bites of food in their mouth.
    • Provide conversation starters to aid in social skills.
    • Be specific about the cafeteria rules.  These might include: no throwing food, stay seated, do not share food, use a napkin, use utensils, chew with your mouth closed, and clean up after yourself.
    • Be sure the child can open all their containers.  Provide safety scissors for opening baggies if the child does not have the strength or coordination to pull them open.
    • Allow middle school or older students to read quietly instead of talking; if socializing is too overwhelming.  While social skills are important, lunch can be a nice break time during the day.  Students can use this time as a sensory break, by engaging in a book.  Ask your students why they might prefer to read instead of talking to friends.  Is it because they need help socializing, are being teased, or they would prefer a break during the day.

    Real Life Examples of situations observed in the cafeteria

    We often see or hear about situations in daily life that do not make sense. By being able to understand and untangle these situations, it is easier to provide support.

    The child or person:

    • sits in the cafeteria for the 20-minute allotted time but does not eat.  The cafeteria is overwhelming to the child with sensory sensitivity.  Children with sensory processing disorder often have difficulty maintaining focus; they are unable to do much more than remain in their chair.  Providing accommodations or preferential seating can help the child maintain his arousal level and focus enough to eat.
    • is disruptive.  The cafeteria is overwhelming and less structured than the regular classroom.  Adding accommodations or preferential seating can help the child focus and make better choices.
    • is awkward with peers.  Social skills are difficult to learn and use correctly.  Socializing is even more difficult when trying to eat while filtering out all the distractions in the cafeteria.  Provide opportunities for good socialization, such as conversation starters or topics.
    • gets out of his seat to move around the room.  The cafeteria is overwhelming and unstructured time, therefore self-control tends to deteriorate in this space.  Adding accommodations such as a wiggle cushion, ankle weights, head phones, ear plugs, preferential seating, or standing on one spot instead of sitting can help the student maintain self-control.
    • gags or covers their face.  There are many different smells and sights in the cafeteria, including cooked lunches and food brought from home.  A sensitive child may have difficulty filtering these different odors and visual input.  The combination of smells may prove to be too much.  Preferential seating at the end of the table away from the center of the smells, sitting further away from the kitchen, or adding essential oils to mask the odors can help.

    Fun activities about how to support sensory needs in the cafeteria

    Sometimes children are not able to sit quietly when they are waiting or finished with what they are supposed to be doing.  Adding a few quiet ideas to pass the time can be great.  Of course some of the items are not going to be appropriate for the cafeteria, but can be used in other settings:

    • Waiting Games for Kids – these games are great for times when waiting is necessary. In an effort to get away from screen time, these are great suggestions.
    • Practice walking in line activities to work on spatial awareness.
    • Use a toolbox of coping strategies.
    • Focus on body awareness.
    • Focus on turn taking in getting food from the cafeteria line, waiting for dismissal, etc.
    • Would you rather questions Ask each other questions which begin “would you rather”? The Measured Mom has 100 questions you can print out if you prefer to keep a supply in your bag.
    • 20 Questions – this is a classic game that never gets old. Use this for students who are finished eating, waiting, or having difficulty getting their body organized
    • Riddles and brain puzzles are a great way to quietly get kids thinking about something other than the cafeteria
    • Social stories are another great idea for how to support sensory needs in the cafeteria.  This set of fun and engaging social skills activities are a great starting point to help students navigate acceptable cafeteria behavior and tackle social and emotion problem-solving situations.
    • Cafeteria Expectations activity- Often, students forget proper cafeteria behavior. You can easily review and help your students be ready with this movement game and craft.
    • The OT Toolbox is full of great resources.  Seeing your Home and Community with Sensory Eyes –  This guide can assist caregivers, individuals, families, therapists, and teachers untangle the web of senses to give correct guidance and assistance.  The Sensory Lifestyle Handbook – The Sensory Lifestyle Handbook is your strategy guide for turning sensory diets and sensory activities into a sensory lifestyle. The Sensory Processing Disorder Handbook – This 26 page guide explains SPD in easy-to-understand terms.
    • Social stories for the lunch room.
    • Take some time after eating lunch in the lunchroom and calm down or regulate in the calm down corner or a school sensory room.

    Sensory Lunchroom Considerations

    Because of my sensory “issues,” I avoid the cafeteria like the plague. Luckily for me, not much OT treatment has to be done in the cafeteria. I can work on feeding, opening containers, and social skills in the classroom. 

    However, when the cafeteria is the best option, I take a deep breath and forge ahead. Teachers and other staff can easily be triggered by environments as well as children. Structure sensory breaks after overwhelming situations for both staff and students, and encourage accommodations as needed.

    Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.

    What is Overstimulation Anxiety?

    overstimulation anxiety

    Do everyday environments like the grocery store, the mall, or your office leave you feeling anxious and stressed? Does the thought of going to these places that are highly overstimulating with sights, sounds, smell…and people… fill you with dread or a sense of anxiety? If you answered yes to both these questions, you might be suffering from overstimulation anxiety, or some aspect of social emotional skills worries. Our kiddos that we work with with sensory processing needs probably have some aspect of stress associated with overstimulation, and maybe even a sense of doom that they feel when thinking about or heading into stimulating environments.

    overstimulation anxiety

    In this post we will explore what is overstimulation anxiety, what causes it, and therapeutic interventions to help minimize symptoms. Overstimulation anxiety can play a huge role in sensory dysregulation, especially when it comes to self regulation and the ability to use coping tools to support the worries!

    Our resource on sensory processing red flags can be a helpful tool as well because it highlights how sensory processing issues, like overstimulation worries, might show up as our OT kids being overwhelmed and overstimulated.

    What is overstimulation anxiety?

    Sensory overload (another term for overstimulation) is when your five senses — sight, hearing, smell, touch, and taste — take in more information than your brain can process. When your brain is overwhelmed and overstimulated by this input, it enters fight, flight, or freeze mode in response to what feels like a crisis, making you feel unsafe or even panicky. Read more about this in our blog post on the limbic system.

    All of this recognizes the ability to check in with emotions and feelings. This is can be a real challenge point for some of our kids! It requires:

    When suffering from overstimulation anxiety, also known as sensory overload anxiety, you may experience sensory overload in unfamiliar environments, when you are surrounded by new people, or when expectations are unknown to you. Your senses become heightened and perhaps you are over-responsive to sensory information that would not affect a person without anxiety.

    To learn more about situations that can trigger overstimulation anxiety, check out my book, Seeing your Home and Community with Sensory Eyes. It is a comprehensive guide to helping yourself or others navigate different environments. It is broken down into chapters for ease of scanning to find the relevant information.  Ultimately, the book answers the question, “why do they do that?”

    If you are a child or adult with sensory processing dysfunction, it is probable that being in certain situations will cause you anxiety. The fear of not knowing what sensory experiences may arise is enough to cause you to have a heightened arousal level and be anxious about the “what-if’s” or “maybe’s,” with new experiences. It can even lead to a sensory meltdown.

    What is sensory overload

    What is Sensory Overload?

    So what is sensory overload? According to WebMd, sensory overload and anxiety are mental health conditions that are deeply related to one another. In some studies, up to 80% of people with sensory processing difficulties experience anxiety. When a person feels anxious or already overwhelmed, they may be more prone to experiencing sensory overload in certain situations. Likewise, experiencing sensory overload can make you feel a sense of anxiety. 

    Sensory overload and anxiety are mental health conditions! It’s when overwhelming sensory input interferes with our ability to filter out unnecessary and conflicting sensory input. This impacts participation in daily tasks.

    So, whether your anxiety causes sensory processing difficulties or your sensory issues cause your anxiety, it is important to address both manifestations.

    The way I like to explain it is by describing a busy mall at Christmas time. The lights, crowds, sounds, hustle and bustle are VERY overwhelming. We even wrote a blog post about Christmas mindfulness that goes into this a little more. It’s very overwhelming and that sensory overload is just too much for many of us!

    Another way to explain it is by describing therapy burnout that most of us are familiar with. The feeling of overwhelming stress because of productivity, caseloads, extra tasks, emails, phone calls, and everything else that puts us on the verge of burning out. Adding extra sensory input like a jackhammer outside your window will likely cause an overload and you might want to just toss your desk…but you likely won’t. Our kids with sensory needs, however, just might toss that desk.

    What causes sensory overload?

    According to the folks over at Psych Central, there are many causes of sensory overload, and some underlying conditions that can make you more sensitive to sensory overload. 

    • Sensory processing sensitivity (SPS)– People with higher levels of SPS, or heightened awareness and reactions to their environment, are also known as highly sensitive people. Being highly sensitive is a personality trait, with about 1 in 5 people fitting into this category. Take the sensitive person quiz to find out if you are an HSP.
    • Sensory processing disorder (SPD)– SPD is usually diagnosed in childhood, although adults can also get a diagnosis. It involves either much higher or much lower responses to sensory input than most people experience.
    • Autism spectrum disorder. Autistic people are more likely to experience both SPD and anxiety.
    • Attention deficit hyperactivity disorder (ADHD)– People with all types of ADHD may also experience higher rates of sensory overload than people without neurodevelopmental conditions.
    • Post-traumatic stress disorder (PTSD)– Experiences of trauma that cause PTSD can create more hypervigilance, or awareness of your surroundings. People with PTSD may experience more sensory overload and anxiety in response to sensations that remind them of past trauma.
    • Anxiety disorders– Many anxiety disorders, but particularly generalized anxiety disorder, have been linked to sensory processing issues.

    What are the symptoms of overstimulation anxiety?

    Overstimulation can be triggered by too much input in the environment. You might feel overwhelmed and sensitive to

    • bright lights, chaotic movement, or a cluttered environment
    • rough, tight, or itchy clothes
    • loud noises, voices, or music
    • scents including chemicals and perfumes
    • foods with strong flavors
    • hot or cold temperatures
    • too many people in one place (body awareness and proprioceptive sense when there are people in your space)

    As a reaction to overstimulation, you might feel:

    • overwhelm that makes you want to either shut down or have a meltdown
    • irritation or rage
    • tension in your face, neck, shoulders, or back
    • having either too many thoughts in your mind, or none at all
    • exhaustion
    • dissociation, or being separated from yourself and your surroundings

    Because children have limited problem solving, language, and emotional regulation, their responses are often more exaggerated. They exhibit tantrums, meltdowns, shutdown, or other maladaptive behavioral reactions. We notice the behavior first, however, meltdowns caused by overstimulation usually can be traced back to a trigger.

    What can you do to help combat sensory overload anxiety?

    Speak to your doctor. Your doctor can help you navigate mental health resources by suggesting specific therapy sessions or medications that could be helpful. Depending on your age, particular triggers, and any associated conditions that you may have, your doctor may recommend some kind of anti-anxiety medication or antidepressant. 

    Self Care. Keeping yourself well-rested, well-fed, and hydrated are easy ways to empower yourself should you encounter an unexpectedly difficult or overwhelming situation. You can also explore techniques like meditation, mindfulness, and breathing exercises to help yourself de-escalate if you find your sense of anxiety on the rise. 

    Different types of therapy. Many people find that therapy can be very helpful in navigating anxiety and developing tactics for managing difficult situations.

    Identify and avoid triggers. Once you are aware of the particular sensations, situations, or stimuli that make you feel overwhelmed, you can make efforts to stay clear of them. Being upfront with your friends and family can allow them to help you avoid these triggers, too. For example, instead of enjoying a birthday celebration in a busy restaurant, opt for someone’s quiet backyard. Instead of visiting a crowded, loud theater, host a video viewing party at home.

    Create a support network – Reaching out to friends and family and sharing with them the struggles you are facing can allow them to offer support. Helping them to understand what you are going through can also make you feel less alone. 

    Some situations that cannot be avoided can be helped with therapy, medication, and a supportive social network.

    Tips for dealing with overstimulation anxiety

    There are certain steps you can take on your own to help address your struggle with overstimulation. These are not replacements for therapy but can help you cope with sensory overload in the moment. Here are some tips to address overstimulation:

    • Control your environment – Making sure to avoid environments that are full of triggers is a way to help alleviate the frequency of your symptoms. You may find you need to avoid loud concerts, or big parties, or make accommodations to better tolerate them.
    • Create a safe space – The world is full of unknowns, and creating a space where you can feel at ease is one way to help give you peace of mind. We call this a personal bubble when helping kids with this safe space. We can also help them to understand personal space. Try to create a space that you can go to feel safe. Somewhere that is free of any triggers that may cause you to feel overstimulated. This is what sparked the Man Cave and She Shed!
    • Develop a plan – There are only so many ways to control our environment. Preparing for situations in which you may be exposed to a trigger can help you feel more at ease when going out into the world. Practicing deep breathing exercises, engaging in positive self-talk, keeping noise-canceling headphones (affiliate link) nearby, and developing an exit strategy for situations that might trigger you can make you feel more prepared. I travel with earplugs (affiliate link) and a sweater wherever I go.  As a side note, I have tried all types of earplugs and find Mighty Plugs to be superior.
    • Stay healthy – Getting regular and high-quality sleep, exercising, and eating a healthy diet are all ways to stay one step ahead of overwhelming situations. If you do these things, the likelihood of feeling prepared for whatever challenges you might face is much higher. You may find you are extra sensitive when you are tired or hungry. A little beach therapy goes a long way!
    • Communicate your needs – Whether it is at work or school, communicating your needs is an important part of living with sensory overload episodes. It is possible that accommodations can be made to help you feel more comfortable in the spaces that you need to attend.  Open and honest communication can make you feel vulnerable. It is worth the trade off for some peace of mind.

    Additional resources

    Taking a look at the input from the environment with “sensory eyes” means that we look at how the sensory information can be a form of overwhelm!

    overwhelmed and overstimulated

    If you or someone you care for struggles with overstimulation anxiety to the point that the overwhelm becomes too much for functioning in day to day tasks, you/they are not alone. This is not a behavioral disorder, or a personality trait. It is caused by something in the wiring of the brain. Try and think of it that way, as if it was a vision or hearing loss. Keep returning back to the feelings and advice you would give to someone who needed glasses.

    Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.

    Sensory Needs and Navigating the School Fire Drill

    fire drills and autism

    Who remembers a childhood fire drill?  Did you know that memories are driven by emotions?  People remember times or events that trigger emotional responses because of the overwhelming input leads to sensory dysregulation.  Luckily having a few strategies in place can help the child with sensory needs navigate a fire drill.

    sensory needs and fire drills

    Sensory Processing and Fire Drills

    A fire alarm is one of them. If you work in a school system (school based OT or otherwise), you are probably faced with regularly scheduled fire drills. In the southern United States, there are also tornado and earthquake drills. Due to the increasing number of school shootings, a lock down drill has also been implemented. 

    The sudden sound, moving quickly out of the building, excitement/fear during the event, and an unexpected change in routine during the day, can create a lasting memory for a sensitive person, especially when it comes to auditory sensitivities.

    The fire drill does not have to be a traumatic event. In this post we will learn about Navigating the School Fire Drill; including understanding, communicating, and accommodating for sensory processing difficulties.

    Navigating the School Fire Drill

    Fire alarms are not isolated to school buildings. While teaching a seminar last year in a large hotel, the fire alarm went off.  This brought up old feelings and memories as people rushed out of the building to gather near the tree outside of the building.  There was no protocol to gather by the tree, however, old habits die hard!  The adults were able to fairly quickly resume class after the fire alarm was resolved, however, some people were shaken.  A person with sensory processing disorder can be out of sync for several minutes, or the rest of the day. For example, autism and loud noises can impact the rest of the day. Keeping this in mind, caregivers can help the transition go smoothly during and after the alarm.

    While this post focuses on navigating the school fire drill or alarm, the information can easily transfer to anywhere there might be an alarm.

    Today’s post comes from an excerpt from my book, Seeing your Home and Community with Sensory Eyes. It is a comprehensive guide to helping yourself or others navigate different environments.  I broke it down into chapters for ease of scanning to find the relevant information.  Ultimately, the book answers the question, “why do they do that?”

    There are three steps you can implement when working on helping someone with sensory difficulties (or typical people who need to learn to prepare for something new).  Understanding, communicating, and accommodating are great strategies.

    Fire Drills and Sensory Processing

    The first step to repair and remediate the sensory reaction and response is to understand what is going on when trying to navigate the school fire drill.

    Almost all your senses can be triggered during a fire alarm:

    • Visual:  flashing lights, disorganized movements, lots of people rushing down the hall or stairs, many children and adults moving at the same time, fire truck, and fire fighters.  It is especially difficult to process all of this concurrent visual information, as there is an expectation to move quickly.
    • Auditory:  alarm buzzing or beeping, children and adults talking, children crying, fire trucks, opening and closing doors, shuffling feet, and moving furniture.  Sudden unexpected sounds and disorganized sounds happening at the same time creates auditory chaos.
    • Tactile:  several people close together, who might bump into each other, the difference in air temperature from indoors to outside, quickly donning coat or hat, or bumping into parts of the building. In a tornado drill students sit in the hallway with their head tucked down, or under a mat or desk.  Sitting under a desk can be especially confining to a sensitive person.
    • Proprioception:  sudden disorganization can cause a decrease in body awareness.  A person may trip over his feet, fall on the stairs, bump into people, get too close, push people out of the way, or stumble.  In a tornado drill students sit close together, under a desk or mat, tucked into a ball, or against the wall.  This feels overwhelming to a sensory avoider.  The amount of activity can be stimulating and exciting to a seeker.
    • Vestibular:  child may become disoriented by the sudden movement, walking down the stairs, and quickly navigating the building. Sounds and other incoming information can increase vestibular disorganization.
    • Olfactory:  the close proximity of many people, or fire/smoke odors if there is an actual fire.  Not being able to get away from smells can feel overwhelming to a person who is sensitive.
    • Emotions:  Maladaptive behavioral reactions can be caused by: fear, anxiety, excitement, clumsiness, impulsivity, lack of control, difficulty following directions, difficulty processing what is being said, shut down, or defiance can cause maladaptive behavioral reactions.  The emotions are often the first outward signal of distress.

    All of the sensory input happening during this time is especially a challenge because for the child with sensory processing needs, or regulation needs, this is very sudden input. Sometimes teachers know that the drill is going to happen and other times they don’t. We need to keep our kiddos safe during this time but the onslaught of input can be very distressing for some of our students.

    We see a hit to the limbic system, the sensory system receives sensory messages, like the shrill fire drill sound, and directs them to the part of the brain that needs to process it to keep us safe. The sudden sensory input can trigger an automatic safety response called a ‘fight, flight or freeze’ response. We might see all kinds of sensory responses as a result.


    The second step to seeing the community through “sensory eyes” and navigating the school fire drills, is learning to communicate about sensory preferences, how things look and feel, and what can be done to make life easier to navigate.  When you think about all of the visual input happening during a fire drill, it can be a lot for those with sensory needs.

    There is visual noise in the way of students and classrooms rushing to their designated safe space. There are a lot of moving pieces happening all at once. Sometimes a simple conversation can ease the anxiety and set the stage for new or difficult situations.

    conversations about the fire alarm

    The loud fire alarm sound can be very distressing. Having a conversation about the fire alarm can help.

    This is what a conversation about the fire alarm might sound like

    “There are times when the fire alarm will go off.  Sometimes it will be a drill.  Let me explain what this is.  In the event of a real emergency, we need to know what to do, so we will practice first.  The fire alarm is very loud. It lets us know there is an emergency, and we will need to move quickly.  When you hear the alarm, get out of your seat, and make a line at the door.  We will go down the hallway, down the stairs, out the back door, and stand by the tree at the far end of the parking lot.  I will count and make sure we are all here.

    we can go back inside after the drill or emergency is finished. There will be a fire truck and fire fighters.  They are here to help us.  If it is a drill, there is no emergency, just a practice.  The fire fighters will talk to the principal and we can go back inside.  If it is an emergency, they will do their job to make sure the building is safe before we go back in.

    It is important to follow directions and stay together.  Let everyone do their job and remember each person has a different job to do.  Focus on your own job.  What is your job during a fire alarm?

    If everyone follows directions, it will go quickly and smoothly.”

    Ask Students Questions about Fire Drills

    These are some questions you can ask to understand the fire drill better:

    (You can modify or eliminate some questions depending on the audience)

    • How do you feel about the upcoming fire drill after hearing about it?
    • Do you remember other fire drills, or is this the first?
    • How did you feel after going to the fire drill?
    • Were you scared the noise the alarm made?
    • Were you able to follow directions and listen?
    • Was it exciting doing something new and different?
    • Do you have questions about why there is a fire drill?
    • How did you know it was a drill and not an emergency?
    • What do you do differently in a real emergency?   Answer: nothing. Treat a drill the same as a real emergency.
    • Did anyone cry during the drill?  What can you do to be a good friend?
    • If the sound of the alarm bothers you, what can you do?

    How to Accommodate for Fire Drills

    The third step in navigating the school fire drill involves making accommodations to assist people with or without sensory processing disorder participate in the event easier, and with less distress.  As with most sensory adaptations, it is a lot of trial and error to determine what the right combination is for each of your students.

    • Provide ear protectors for sensitive children.  This will lessen the sound, allowing them to focus on the instructions.  In the middle of a fire alarm (rather than a planned drill), this may not be the best option due to timing.  In this case, allow child to hold hands over his ears.
    • Use the buddy system; children who are not bothered by the fire alarm can assist the more sensitive children. Children like being in charge, and a struggling student can have a good example to model.
    • Stand near children, or hold their hand, to insure they are not stumbling or falling.
    • Place sensitive children near the back of the line so they do not feel overwhelmed by being so close to other children.
    • Use a guide rope to help guide small children.  Each child holds onto a portion of the rope.  This keeps them in a line and gives a specific place to be.
    • Have strollers or a wagon ready for children who cannot safely navigate out of the building. Sometimes slow moving children are even slower when faced with a stressor.
    • Reassure children throughout the alarm, while continuing to provide information about what is happening.  Sometimes not knowing what is happening is worse than knowing.
    • Provide a calm and quiet environment after the event is over.  Dimmed lighting, quiet reading, small group, or independent play can help restore equilibrium after an event such as a fire drill.
    • Use a toolbox of coping strategies.
    • Use noise cancelling headphones for sensory intolerance
    • Use earplugs for sensory overload

    Real Life Examples on Fire Drills and Autism

    Sometimes you can see the behavior but not untangle why they are behaving a certain way. Here are some examples you might see when navigating the school fire drill

    The child or person:

    • shuts down and will not move.  The sudden noise has set up a flight, flight, or freeze reaction.  The child is unable to make decisions, follow instructions, or move.  Solution: physically help the child move out of the building.
    • is out of control.  The alarm has triggered a fight or flight response.  Solution: help the child physically to move through the building while reassuring him.
    • is loud or making strange noises.  The child is trying to drown out the sound of the alarm with his own sounds.  This is a normal reaction for a person with auditory sensitivity.  Solution: allow humming during this loud experience or provide alternatives such as ear plugs, covering the ears, or headphones.
    • covers his ears.  The sound is loud and feels deafening to a sensitive person.  While it makes sense for a child to use their hands to steady themselves or grab a teacher, covering the ears is a natural reaction and should be allowed, unless an alternative is provided.
    • stumbles and falls.  The child has diminished body awareness because they are focused on the sound of the alarm.  Solution: physically help guide the child down the hall and out the door to avoid an accident. Focus on body awareness.
    • bumps and pushes others.  Fight or flight reaction triggers the child to need to get people out of the way.  The child may have lost awareness of his body position in relation to others due to the sound and chaos.  Sometimes people do not realize they are pushing others. When someone may have accidentally brushed up against them, a sensitive person may respond as if they have been attacked. Solution: physically help guide the child out of the building. You can also focus on turn taking in hallways.
    • cries for a prolonged period after the alarm.  The after effects of an event such as a fire drill can last the rest of the day, or longer.  Solution: provide calming techniques after the alarm, structured time during the rest of the day, dimmed lighting, and a quiet classroom environment to allow the child’s sensory system to re-acclimate.

    What are some other strategies for navigating the school fire drill?

    • Social stories for a fire drill- A social story about a fire drill can help. Include information related to the student and the school.
    • Fire Safety activities are easy to use as traditional classroom lesson plans, centers, homework, independent work, or they’re great for fast finishers in first and second grades. 
    • Fire safety activities- Try activities on Firefighters, Fire Safety, and Classroom Fire Drill Procedures to help your students know the importance of practicing fire drills, what to do in case of a fire, and not be afraid of fire fighters!
    • Fire prevention weekthis website has a lot of resources for learning about fire safety
    • Seeing your Home and Community with Sensory Eyes – This manual is a valuable tool for understanding and effectively communicating with those affected by sensory processing disorder.  This guide can assist caregivers, individuals, families, therapists, and teachers untangle the web of senses to give correct guidance and assistance.  You can read this guide cover to cover for optimal learning, or by selecting chapters as needed.
    • The Sensory Lifestyle Handbook – The Sensory Lifestyle Handbook is your strategy guide for turning sensory diets and sensory activities into a sensory lifestyle.
    • The Sensory Processing Disorder Handbook – This 26 page guide explains SPD in easy-to-understand terms
    • A fire drill song might be helpful for some kids:
    • This video on fire drills is helpful:

    Fire Alarm and Sensory

    Adults can be triggered by sensory input the same as children.  Do not discount the feelings of others in the building, or making your own needs known. It is amazing the things we remember from our childhood.  Who remembers Stop Drop and Roll?  I remember practicing this and feeling terrified that I might actually catch on fire one day.  As a young parent, thinking about my own children being trapped in our house during a fire elicited some strong emotions. We prepared at home for any emergency and practiced as well.

    Do you think it is right to let teachers and staff know when the fire drill is planned? While this helps them prepare for the drill ahead of time and make accommodations, it ruins the element of surprise that would happen in the event of a real fire.  Planning and practicing are great ideas, however maybe there needs to be a couple of surprise drills thrown in the mix to simulate a real life emergency.  Something to think about.

    Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.

    How to Request an OT Evaluation at School

    One question that comes up over and over again is how to get started with OT as a related service in the school environment. Parents of young children might see issues that their child struggles in and feel that an OT evaluation might be in order. But how do you get started with this process? Many parents ask the question “how do I request an OT eval?!” This is a great question and one we want to cover here.

    School based occupational therapy can be tricky to navigate. There are a million and one steps to follow, and protocols to implement. Outpatient therapy is an entirely different ballgame. Once you have a doctor referral and insurance approval you are ready to start. But when it comes to OT in the schools, we fall under the educational guidelines. That means there are certain protocols directed by law.

    How to request an OT evaluation in schools

    In this post we will explore how to request an OT evaluation at school.  The occupational therapy evaluation process depends on where the eval request comes from and whether or not there is already an IEP in place.

    This request may come from a teacher, school psychologist, or parent. At times the occupational therapist may notice a student struggling, and get the ball rolling for an OT evaluation. We’ll cover each of these processes separately, because there can be differences. (See the challenge that we have with simply wanting your child to receive OT at school? It’s definitely not a one step process!)

    How to request an OT evaluation at school

    The first type of OT eval we’ll cover is the Teacher/parent driven referral. This means that the teacher or parent see a need for an occupational therapy evaluation.

    The referral may come from the classroom teacher, resource teacher, school speech-language pathologist (SLP), a member of the special education department, or a parent, to name a few. Essentially, anyone can refer or request an OT evaluation at school. Typically this type of request for an OT referral comes from an individual in the school system that works with the child, teaches the child, or sees the student struggling in some aspect.

    It is up to the IEP team to determine if occupational therapy support would be educationally relevant and required for the child to access their education.

    Protocols and procedures vary from state to state (and different countries), however, there should be some common steps for how to request and OT evaluation at school. The process is going to be much easier if the student already has an IEP (individualized education plan) and you want to add on OT services.

    When the student does have an IEP in place, the “next steps” for adding an OT evaluation would be:

    1. The teacher can speak with the school psychologist or directly to the school based therapist about their concerns. 
    2. Then they loop in the parents and request an evaluation planning meeting to get permission to perform an OT evaluation. Our resource, the OT Screening Request Letter is a great tool to have for this step of the process.
    3. If the parents grant permission, the evaluation process can begin. 
    4. The team will hold another meeting to review the results, and possibly a third meeting to add services to the IEP.
    5. All requests from parents need to be taken seriously and investigated. Once a parent makes a request, if the student already has an IEP, the steps would be the same as above.
    Occupational therapy referral process includes several steps

    The occupational therapy referral process includes several steps. First, is a screening.

    Pre-referral screening

    Before jumping right in to request an OT evaluation at school, it is important for the teacher/parent to know what they are looking for.  There are generally three steps in this phase (pre-referral screening, OT observation, and RTI/MTSS supports).

    1. A pre-referral screening is exactly as it sounds. It is a basic questionnaire that helps to screen the student before evaluation. This can cut down on unnecessary referrals or too many evaluations. This might look like a form on a piece of paper or a digital form that the teacher or other professional (speech, admin, etc.) can fill out with their concerns.  We do have a pre-referral checklist available as a resource for this step of the process. When filling out this checklist, the teacher needs to consider whether the form item involves a skill that is expected or performed in the student’s classroom or school environment, and whether the student is performing this skill at a level that is comparable to his/her peers. If the pre-referral screening is done digitally via a Google Form, it cuts down on time because it will allow you to easily send the form via email and receive responses electronically. The responses can also be printed.
    2. OT Observation- The therapy referral form might be followed by an observation by the school occupational therapist (after getting permission from the parents). Followed by suggestions for best next steps. These suggestions could include strategies for teachers to incorporate, or task/ environmental modifications. 
    3. Tiered Response- Some districts use an RTI (response to intervention), or MTSS (multi-tiered system of supports), or a similar tiered approach. The school therapist supports the student’s needs within the general education setting, by providing in-services/ trainings to the educators or small group support for teachers/students, before moving on to 1:1 support incorporated by the Student Success Team (SST). This approach provides services early to struggling learners and enables them to succeed in school. RTI requires collaboration between all school personnel and involves evidence-based instructional methods as well as decision-making based on data and monitoring of the student’s progress. The RTI model can increase student performance and decrease the number of referrals to special education.

    Communication is key throughout this process. After the screening process is completed, it’s helpful and appreciated to complete an OT screening results letter that describes the status of the occupational therapy screening.

    When the pre-referral strategies have been exhausted, it is time to put the formal evaluation process in motion.

    How to request an OT evaluation at school if the student does not have an IEP

    If the student does not already have an IEP, the process to request an OT evaluation at school becomes more complicated.

    Occupational Therapy is a related service. This means we support the educational goals and are not a stand-alone service. The Individuals with Disabilities Education Act (IDEA) of 2004 requires schools provide related services to a student with a disability who needs them to benefit from the special education being offered. If your child has a disability, as defined by IDEA, and needs special education and related services to meet unique learning needs, then he/she might be eligible for OT services. Your child must be eligible for special education before being considered for OT services in the schools under IDEA.

    Because OT is a related service, the student must qualify for an IEP under certain diagnostic criteria. Criteria states that to qualify for special education services, a child must have one of the 13 disabilities as defined by IDEA AND the impact of the disability must create a need for services. 

    Those disabilities identified by IDEA include:

    1. Specific Learning Disability
    2. Speech and Language
    3. Other Health Impairment
    4. Mental Retardation
    5. Emotional Disturbance
    6. Autism
    7. Multiple Disabilities
    8. Developmental Delay
    9. Hearing Impaired
    10. Orthopedic Impaired
    11. Visually Impaired
    12. Traumatic Brain Injury
    13. Deaf and Blindness

    In order to qualify for special education, the school psychologist will initiate a comprehensive evaluation. You can include related services in a comprehensive evaluation. If the evaluation reveals one of the 13 disabilities and there is an educational impact requiring special education, the team can proceed to offer an individualized education program outlining services.

    A student Qualifies for OT Evaluation but the Evaluation doesn’t indicate a Need

    Here is the tricky part. A student can qualify and be in need of occupational therapy services, but not receive them. Your OT evaluation might reveal below average fine motor skills, however if their IQ is in the average range, they will not qualify for special education. Similarly, a student might qualify based on the descriptions we listed above, and show a potential need for OT, but the OT evaluation shows that the fine motor or visual motor skill development is on age level for average range of development.

    This means you can not offer related services. It is a parent/teacher’s right to request an OT evaluation at school, but this does not guarantee they will get services.

    To have an IEP, the IEP team needs to agree that the child requires placement in special education classrooms and/or needs services that are only provided through special education.

    A second difficulty is that students who have borderline skills do not qualify for special education. If students are below average (but not too low), and are working to their IQ level, they are considered slow learners and do not receive services. This happens all the time.

    While we cannot suggest outside therapy, the hope is that you are able to make suggestions to the teacher that would benefit everyone in the class. If you have an MTSS model for OT (we do not in our district in South Carolina), you may be able to provide accommodations and strategies to the student directly. Each state will have different guidelines, so it’s important to look at the guidelines by state.

    Keep in mind about OT Evals in Schools

    The system has it’s flaws…

    No entity is perfect. The idea is to give students the education they need in their “least restrictive environment.” Special education, therapy services (whether push in or pull-out), resource, or special modifications are considered restrictions. If a teacher can educate the students without the expertise of specialized education, this is the recommendation.  Education is meant to be “appropriate”. The law of a free and public education does not require a school to Provide the best services possible for kids, or “maximize” their potential. Instead, the law requires that schools provide services that are “reasonably calculated” to help a child make progress. 

    For more information on specifics of OT evaluations, be sure to check out our resources on:

    Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.

    Sensory Room Rules, Protocols, and Guidelines 

    sensory room rules

    Today’s post on sensory rooms in schools is part of a series focusing on sensory rooms. We are going to explore the rules, protocols, and guidelines to using your sensory room. Other posts in the sensory room series highlight benefits, why have one, things to consider, cleaning materials, supervision, use by teachers and aides, building a sensory room on a budget, and sensory room equipment.

    sensory room rules and protocols

    Why do we need sensory room rules, protocols, and guidelines?

    Did you know that a sensory room is considered a controlled and intentionally created space that provides multi-sensory resources to support a student’s sensory needs? This space is used in the school environment to help students with regulation and sensory needs to help them engage in learning.

    Because of this, it’s important to have some sensory room rules and guidelines in place. The therapy providers reading this might be thinking, “Oh yes. We need to definitely regulate and maintain the integrity of the sensory room as a therapeutic tool”. It’s an option for supporting self-regulation.

    Unfortunately, chaotic and unpredictable environments are sometimes created when a room is poorly designed, or personnel are not trained how to properly use the room. It is essential that the support personnel like teachers, teacher aides, and other staff understand how to use the room itself, not just the equipment inside it. 

    In the sensory rooms that I’ve seen in place, some of the issues that come up include:

    • Something that we often see is that the paraprofessional takes their student to the sensory room for scheduled sensory breaks throughout the school day.
    • Items in the room might be used incorrectly, or the student wandering around and trying a few things.
    • Items are broken
    • Materials are not put back into place, leaving the space a mess
    • Students might be taken into the sensory room as a reward
    • Students are taken into the room after they are in a state of dysregulation.
    • Students use equipment like sensory swings very aggressively or unsafely
    • Students might be in the room unsupervised
    • There might be too many students in the room at once.
    • Staff haven’t been trained on the “why” behind the sensory input.

    This list is just the beginning of the iceberg! So many therapy providers have experienced different things when it comes to a calming space.

    People who do not understand sensory processing difficulties, may see the sensory room as a playground or free-for-all space. While it is designed for some freedom of movement, your sensory room is best used with some direction and instruction.

    The last thing you want to have happen in your sensory space, is for your student to feel/act worse than when they came in. Instructors who are given some rules, protocols, and guidelines, are better equipped to use the space to benefit each student’s unique needs.

    It is more important how you use the space not what you have in it. One of the most common mistakes is to go into a sensory room and turn on every piece of sensory equipment. This can be very over stimulating for some. If used incorrectly students can exhibit self-injurious or aggressive behavior.

    Remember the equipment is only as good as the person using it. 

    sensory room guidelines and rules

    What your sensory room should not be

    There are many positives of having and using a sensory room in a school setting.  It is important to use the space well, so it does not get a bad name. People might complain they sent their kids to the sensory room and they came back more out of control than before. You may have heard that Johnny acts out so he can get sent to the sensory room. Maybe teachers say their kids never “earn” their chance to use the sensory room. 

    These are common misconceptions and results of a poorly controlled space.

    What to avoid when Setting up Sensory Room Guidelines

    There are some things we’ve seen in the school settings that are actually counterproductive when it comes to setting up a sensory room. Some things that might be ineffective for students and staff include:

    • Don’t let the sensory room become a free for all space to send students to. The time needs to be planned and structured to work well.
    • Don’t make the sensory space a punishment for students. Getting the explosive student out of your classroom is important at times for the safety of the other students, going to the sensory room is not considered a punishment. It is a space to work on self-regulation and feel better so they can learn. Students who feel this is a punishment may avoid the sensory room when they can benefit from it, or may act out to get a change to go to the sensory room. 
    • Don’t let the space be used incorrectly. When not used correctly, some students are demanding a sensory break every 20 minutes because it is fun to get out of class.
    • Don’t make the sensory room a reward or something that must be earned. While the sensory room space is usually a positive experience and a reward, students who are out of control are not going to be able to earn this sensory break.  It needs to be recognized by the staff that your student needs a break, and explained that they need to work on their Zones of Regulation, or slow their engine down (Alert Program).
    • Don’t let the sensory room be a babysitter. We’ve all seen it; Teachers and staff need a break too. However, this space is not for students to be dropped off and left.  It is a supervised space with direct coaching.
    • Sensory rooms must not be used for the purpose of separating students from their peers, either during class or break times.
    • This space is not an alternative curriculum or alternative to formal education.
    • Sensory rooms are not alternative play spaces for students who prefer not to play outside.
    • A school sensory rooms must only be used for students who have been assessed by an occupational therapist as having sensory needs, and in accordance with the occupational therapist’s recommendations.

    Knowing what NOT to make from a sensory room can help to define the guidelines that allow us to use the space effectively…

    Sensory Room Rules

    Each space is going to be unique and have a different set of rules, however, there are some basic rules staff can follow:

    1. If your kid makes a mess, clean it up
    2. During cold and flu season it is best practice to wipe down equipment after using it, or use a sanitizing spray
    3. When you must leave a mess behind, due to time constraints, or some other circumstance, leave a note and your plans to return. Example: this swing is soiled, please do not use it. I will take it home and wash it.
    4. Keep fingers out of drawers, cabinets, closets, desks, or other “off limits” spaces. Restrict access to the sensory bin if your student is likely to throw birdseed all over the room.
    5. Keep all sensory room materials in the sensory room.
    6. Children should stay a safe distance from other kids on swings, being careful not to run or walk in front of or behind moving swings.
    7. Limit visits to 20 minutes. Be prepared to leave the room if an emergency student needs to come in.
    8. Limit the number of students in the sensory room to a certain number. This will depend on the size and space available in the room.
    9. Be considerate of the equipment and space. Some items are expensive and budgets are small. Schools with limited budgets do not replace equipment quickly.
    10. Supervision -Students using the room should be supervised at all times. Without one-on-one direct input, equipment can be damaged very easily. When you are on a tight budget, it is painful to see something broken.

    Guidelines for your sensory space

    If you are a therapy provider that was consulted to set up a sensory room in a school or if you are helping to create the sensory space, it’s a good idea to come up with some guidelines to help define how the room will be used.

    These are things to consider to help keep the space effective for the students that truly need it.

    • Decide if the room is going to be exclusively used by therapists and their students, or accessible by teachers (who may not have the skilled training, or supervision) to bring their class.
    • Decide how items will be labeled or classified. It can be really helpful to itemize the items
    • Who has priority over this space?  Is it an equal space for anyone, or does a treating therapist working with a student have the right to refuse more students coming in.
    • Scope out the room before bringing your class in there.  If a child is out of control, or having a meltdown, it is best to wait before bringing your ten students into the sensory room. Our teachers often call down to the sensory room (also inhabited by therapists) to see who is in there, and if the time is appropriate.
    • Adult supervision should be a given when working with children with special needs. They may have poor impulse control, muscle movement, and reaction times.
    • Use the room as proactively as possible by incorporating sensory escape/space time into their daily routine
    • Determine the desired outcome for the student. Is it to give them an escape from the busy sensory filled classroom or a sensory break? Would the student benefit from a calming or alerting activity? What equipment are you going to use to meet the student’s needs?
    • Guide the student towards either calming or alerting activities, depending on what he/she needs.  If the student needs alerting activities, ensure to do some calming, organizing activities afterwards before they return to class, so they are ready to focus and concentrate. Please see our movement break booklet and video here for more information
    • Explain how the prescribed item will be used, including the goals that the item will help to achieve, how long the item can be applied for and when it must be removed based on that assessment.
    • Consider the data. How will you keep track of who has used the space? How will you determine who needs what equipment? How will you know if something helped a student?
    • Equipment tracking- One guideline to consider is the status of the items in the sensory room. One thing we know for sure is that items that are used by kids tend to be used to their very end. So who will be responsible for making sure the sensory swings are working properly and that the ceiling attachment is still safe and secure? Who will monitor the items to make sure nothing has broken and to fix or replace them when they are?
    • How will you move kids through their time in the space? Will you use a visual schedule? A choice board? Timers?

    Sensory Room Guidelines: Understanding Who Benefits Most and Who Doesn’t

    It’s important to remember that the sensory room is not for everyone.

    Sensory rooms look like great play spaces. It’s the engaging items that look like toys. There are fun play things, lights, and items that might not be seen all that often. However, these are sensory tools. They are not for everyone to use, and for good reason.

    There are expensive pieces of therapy materials and equipment in there that can easily cause harm. It is also a dedicated space for sensory processing and regulation. 

    Just like everyone does not get to hang out in the Nurse’s office every day, they do not get to go to the sensory room either.

    One of the most important guidelines is to regulate who goes in there, so there is not a constant flow of students going in and out. Teachers will need to count on this space being free and available when they need it.

    Sensory Room Protocols

    These sensory room protocols are not steadfast laws or rules. They are good guidelines to follow to be compliant with least restrictive environment.

    • There needs to be a system in place to monitor and ensure regular cleaning and disinfection of equipment and surfaces to prevent the spread of infections.
    • Check your equipment. Make sure your hanging device is secure and rated for the weight and size of your participant. This is important on a regular basis.
    • Accidents will happen, even if you are standing right there, but these will be easier forgiven if you were supervising your student when this happened. Have paperwork in the room for documenting any incidents.
    • The sensory room should have a phone or overhead system in order to call either the main teacher, the front office, or for staff to call into the room.
    • Provide some sort of floor padding or crash pad. Concrete floors are not forgiving.
    • Supervision- This is both a rule and a protocol because it’s so important. There needs to be constant supervision of clients, particularly those at risk of falls or those using heavy or complex equipment.
    • Equipment must stay in the sensory room. This is a rule you can use, or decide to have a borrowing system for certain items. Loaning equipment is nice; however, it comes with risks, and takes away from the use of everyone.  If you have a large budget, you may be able to have multiples of certain items to loan.
    • Setting up a staff in-service is important. Providing proper training on the correct use of the equipment is a must for any school staff that will be in the room.

    Supervision in a Sensory Room

    One factor that we’ve mentioned over and over again in this blog post is the supervision aspect. It’s SO important for the safety of the students using the room that the time is supervised.

    But, for busy therapy providers and busy teachers, there’s just not a moment to spare in the school day.

    So, the question remains: Who is “in charge” of this space? And then, how do you keep the room from becoming a free-for-all where the items in the room are misused and broken or misplaced and kids are using equipment without supervision?

    We came up with a few ways to go about this. Some of these are strategies that we’ve seen in place in various schools. Others are things you can try. Not every school building will see success with these strategies. There are different student needs, different levels of support from administration and educators, and there is different levels of buy-in. The main thing to do is consider the options and think about what might work in the specific school ecosystem that you are servicing as a provider.

    How to structure a sensory room for success (supervision and usage)

    1. Hang rules for usage in the sensory room.
    2. Have a sign in sheet on the door.
    3. Make a rule that anyone using the room MUST clean up before they leave the room. When they check out, put a box to mark that they cleaned up the room.
    4. Limit the number of occupants at any one time. Depending on the size of the building and number of students that benefit from the room, that might be as little as 2 students to up to 6-7. Remember that co-regulation occurs even from a distance and that if a student is in a state of dysregulation, that can throw off others in the room. Consider having a station outside the room, like sensory paths or posters hanging on the wall that can be a transition space or an area where students can go if the room becomes inefficient because one individual is having a meltdown. This might lead to using the room with only one individual at a time. It all depends and should be a fluid status.
    5. Students might benefit from using the sensory room at a specific time in their day. A paraprofessional might be the one to take them to the room.
    6. Ensure staff is trained on the items in the sensory room.
    7. Color code the items in the room for type of sensory input. Students will have colors associated with their needs/regulation states and can select from one of those options.
    8. Use a check in/check out system where students can rate their levels of regulation (either with Zones of Regulation or Alert program for example). Then they can check out. Keep track of the data.
    9. Consider having students take off their shoes when entering the room.
    10. Consider limiting usage of the room to 10-15 minutes.
    11. Consider setting up a sensory diet for students who use the room often. They can have a checklist of items that meet their needs and use a rating system for marking off how they feel before using sensory room items and then after.
    12. Post a stop and breath sign at the door so that there is a period of deep breathing before entering the room and before leaving the room.
    13. Educate the staff that the sensory rooms should not be used with students who are in an agitated state. They should not be used as a punishment (i.e. in replacement of recess or as a time out.)
    14. Educate the staff that students should be used appropriately when the student asks for a sensory break or as part of a planned sensory diet. Here is information on how to create a sensory diet.

    A final thought on using a sensory room

    A sensory environment is a working/changing type of space. It will change depending on the needs of the current students, as well as staff. Rules and protocols may change over time, depending on the space, and who is using it. We have added several different protocols this year at our school based on experiences that have gone well, and not so great.

    Ideally, a school would have several different sensory rooms.  One that is quite safe with padded walls, floors, and soft everything, and another with more equipment for active regulation and heavy work.  Until then, make sure you are supervising your students in this space, and training those you work with to do the same.

    For additional information, check out this article for additional information on sensory needs.  Here is a great resource on sensory rooms.

    Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.