Occupational therapy in middle school can bring about a lot of questions. When is OT appropriate for middle school students? What should OT focus on in middle school? And how can occupational therapy services support transition to middle school and further levels of education? This post will explore the tricky transition from elementary to middle school occupational therapy. We’ve previously covered occupational therapy for teens, but this article goes deeper into the middle school years.
Prior to the middle school years, occupational therapy in schools is pretty straight forward. In the younger grades, school based OT practitioners go into the school setting armed with playdough, scissors, pencils, crayons, glue, fidgets, and a few games/puzzles.
What about the middle school occupational therapy population? These teenagers are not motivated by crayons, Candyland, letter formation exercises, or cut and paste activities. Nor should they be.
Unless your middle school caseload is in a self contained classroom functioning at a preschool level, these games and activities are not appropriate or practical.
One thing that comes up a lot at the middle school age is that we might need to use our creative thinking cap as OT practitioners. There might be a little push back from the middle school student. They think they are too old for the therapy session, especially if they had OT in primary school. You can find some strategies and our experience in supporting middle schoolers and tips for how to engage a resistant child in therapy.
Middle School Occupational Therapy
Many therapists assist with transitions for children as their caseload moves from a direct to indirect, or consultative therapy model at this time, especially if they have been working with a particular student for several years.
Why? There are several valid reasons for doing so. According to APEX occupational therapy, the primary reasons for transitioning to a consultative model are:
- Teenagers are self conscious and do not care for a therapist coming into their general education classroom to sit by them, observe, or ask questions
- Middle school schedules are busy. Pulling a student for individual therapy weekly means they are missing valuable learning time
- Handwriting habits are set and unlikely to change at this age. Pencil grasp and letter formation skills are often formed by the age of eight, making adjustments in middle school difficult
- Visual perceptual skills are often developed by age 11
- Students do not want adaptations that make them stand out from their peers. They will resist noise cancellation headphones, a scribe for written notes, alternative seating, weighted items, or noticeable fidgets
- Executive function – many middle schools already incorporate these skills into their program through schedules, planners, online classrooms, and reminders
- Students at this age are most likely using technology to do much of their school work by this point, or accommodations have been made in their IEP already
- Students have often been receiving services since early elementary school. Changes are less likely to happen at this stage, if they have not already
Middle school occupational therapy is not a one size fits all model
There are several reasons to keep a student on a direct therapy service model during middle school:
- Self contained students work at a different pace than their mainstreamed counterparts. They may continue to need more intervention
- Lower level learners will need to be transitioning to a life skills or self help model, if they have not already. This means new objectives and goals to address
- Middle schoolers are a different breed of people. There are new social expectations, hormonal changes, levels of independence, and increased demands for self help skills
- It may take time to educate families and caregivers about this change in service model, and expectations. Automatically moving everyone to an indirect model, or discharging them, may be too abrupt for anxious parents or overwhelmed teachers
Barrier of Participation in therapy
One thing to consider in the role of occupational therapy in the middle school setting is the barrier of participation that occurs during the middle school years.
During school-based therapy in the younger school settings (early intervention, primary school years, elementary school years), students enjoy occupational therapy sessions. They are fun and exciting. Kids typically love to participate in therapy during these years.
In the middle school years, the school-based OT can start to see a barrier to participation that impact therapy sessions.
Barriers to participation in middle school occupational therapy can vary depending on individual circumstances and individual needs. These barriers can impact the middle school student’s goal achievement.
Specifically, middle schoolers may experience a social barrier to using the tools OT practitioners promote to support their needs.
The student might experience a social stigma and cultural barriers. surrounding their peers and the middle school culture. They may not want to participate in therapy sessions and this can impact the use of therapeutic supports.
Another barrier to participation in the middle school setting may be the issue of time constraints and scheduling conflicts. Middle school students participate in a full schedule, busy hallways, academic and activity commitments, and other responsibilities can make it challenging for students to participate in therapy sessions.
The Role of the middle school occupational therapist
Seruya and Ellen write about the Role of the Middle School Occupational Therapist. They highlight several important factors or strategies to intervention.
- Involve your learner in decision making about goals and objectives. These will be more meaningful and motivating to your students
- Transition away from typical handwriting goals to more functional goals
- Teach typing and word processing using a typing program
- Provide adaptations if your learner is not able to complete work in an effective manner. A scribe to write notes for them, word processing versus written documentation, lessen the workload if writing is too labor intensive, preferential seating to improve attention
- Address any lingering or new sensory concerns. Provide adaptation for these with preferential seating, alternative seating, gum or fidgets for self regulation, ear plugs to reduce incoming sounds, and organizational tools
- Address important life skills – learners need to know their emergency contact information, effectively groom themselves, take care of feminine hygiene issues, advocate for themselves, and follow a schedule
- Some interventions may require private therapy to be more appropriate such as meal preparation, laundry, ordering from a menu, shopping, budgeting, or filling out an application. These would be appropriate goals for students in a self contained classroom
- Incorporating brain breaks into a natural and functional movement needs. We talk about this more in our article on middle school brain breaks.
Some additional ways that occupational therapy can support students in grades 6, 7, and 8 include:
- Working on organization, particularly when it comes to using different books, folders, and materials for each class
- Managing a schedule with classroom changes, including hallway navigation and reading the schedule as well as sensory needs in a busy hallway
- Lunch considerations-making meal selections, using money to purchase various meal options, and other mealtime considerations
- Locker use including use of a combination lock, locker organization for obtaining needed materials for different times of day
- Self-care including clothing management for gym class or swimming
- Educate middle school teachers, parents, and other caregivers may not understand the role of the occupational therapist in middle school. It may be time for a little education on the services provided and the therapeutic model.
- Empathy – reducing therapy minutes may feel like the student is not going to improve, or they are being given up on. It is tough for parents to imagine their learner may never write a sentence, read independently, or live alone. This is the time to gently begin this conversation.
- Tool use including: rulers, protractors, calculators, graph paper, three ring binders, smaller desks, etc.
- Social awareness and behavioral challenges as a result of sensory, self-regulation, or emotional needs
- Changes in schedules, including bell ringing between classes, navigating between classrooms, short or lack of recess times, larger cafeteria, assemblies, etc.
- Supporting sensory needs in the cafeteria due to the larger sized room and more students in the area
- Collaborate with middle school teachers- work with educators and families to determine what are appropriate ADLs or functional goals and needs in the classroom, and how they can be addressed
- Communicate with family of middle school students on appropriate occupational therapy goals and interventions.
- Motivate middle school students- There may be a need for direct therapy intervention. Keep your students motivated with relevant and important treatment activities.
- Life skills in middle school occupational therapy- This may be the time to address life skills, depending on the needs of the student. The OT Toolbox has a series of life skills posts including cooking, laundry, filling out forms, and social stories.
- Keep goals and objectives focused on relevant and functional skills.
- Educate staff and caregivers about the role of the OT in schools.
- Provide resources, and make adaptations to the educational environment to help students better access their curriculum.
Still working on handwriting in middle school occupational therapy?
There are times when therapists are called to continue to address handwriting in their middle school population. Intervention needs to be functional, beyond basic letter formation. One tool is to use these middle school journal prompts to target handwriting skills, executive functioning skills, social emotional skills, and more.
Miss Jamie, a school based OT, has written a post about Addressing Handwriting in Middle Schoolers. She has gone so far as to write a second post here. One goal may be; this student will be able to independently write identifying information (name, address, phone number) without a model with 80% legibility.
Or; the student will be able to write or access information to fill out a form independently. In The Member’s Club, we have several form practicing pages to work on the life skill of filling out forms.
Middle School Occupational Therapy Activities that Build Skills & Confidence
Middle school brings a whirlwind of changes: more complex academics, shifting social groups, growing independence, and rising expectations. Occupational therapy in middle school plays an essential role in helping students successfully navigate these challenges. OT supports students through both direct services and consultation with teachers, staff, and families. These middle school occupational therapy activities are designed to help students with disabilities, including autism, ADHD, and other learning differences stay engaged in daily activities and grow their independence.
As part of special education, OT is considered a related service, meaning it supports the educational goals identified by the IEP team.
The role of OT at this level also often includes collaboration with other professionals, including occupational therapy assistants, teachers, and school counselors. Whether supporting mental health, developing organizational skills, or promoting social participation, the school OT helps students succeed in both academics and life skills. These strategies and recommendations are tailored to each student’s unique needs, goals, and disability profile.
Middle School OT Goals
These middle school OT goals target key areas often addressed in school-based services and can be adjusted depending on the student’s level of support. They’re designed to align with IEP objectives, classroom expectations, and real-world success.
Executive Functioning & Organizational Skills for Middle School OT
- Student will use a planner to record assignments with 90% accuracy across 3 consecutive weeks.
- Student will organize materials for each subject using a color-coded system or binder labels with visual prompts.
- Student will initiate class routines (like unpacking, turning in homework) with fewer than 2 verbal cues per day.
These skills are especially important for students with ADHD or executive function challenges, and are often addressed through both direct and consultation-based OT services.
Self-Regulation & Mental Health for Middle School OT
- Student will use a self-selected coping tool during transitions to remain calm in 4 out of 5 observed opportunities.
- Student will identify emotional triggers and demonstrate appropriate regulation strategies in the classroom.
- Student will participate in a sensory strategy routine to support emotional regulation and reduce stress during work tasks.
Many students with autism, sensory differences, or mental health challenges benefit from personalized routines that support their self-awareness and self-control in the school setting.
Fine Motor Skills, Writing & Daily Activities for Middle School OT
- Student will demonstrate correct pencil grasp and maintain legibility during a 10-minute writing task.
- Student will complete scissor-based assignments (cutting, folding) with accuracy in 3 out of 4 trials.
- Student will complete locker organization or classroom prep tasks using checklists or visual cues.
Fine motor skill development directly supports academics, note-taking, and participation in school-based routines.
Visual Motor & Sensory Processing
- Student will accurately complete copying tasks from the board or screen using appropriate spacing and alignment.
- Student will participate in visual perceptual games or strategies to improve attention to detail in worksheets and tests.
- Student will recognize sensory overload and use pre-taught calming strategies to re-engage in classwork.
These modifications often support visual processing, spatial awareness, and focus, especially important for students with sensory processing differences or visual stress.
Social Participation & Life Skills for Middle School OT
- Student will participate in 1:1 or group-based activities to build peer interaction and conversation skills.
- Student will follow social problem-solving steps with visual prompts during role-play or real scenarios.
- Student will demonstrate responsibility for personal belongings (e.g., backpack, lunchbox, planner) with 80% independence.
These school OT goals promote confidence, peer connection, and independence—all crucial for the middle school years and beyond.
Frequently Asked Questions about Occupational Therapy in Middle School
Next, let’s cover some of the FAQ about occupational therapy in middle school.
What is the role of occupational therapy in middle school?
In middle school, occupational therapy (OT) supports students as they navigate increased academic demands, growing independence, and complex social expectations.
The role of OT includes helping students participate in daily routines, improve organizational skills, develop executive functioning, and support emotional regulation. OT can address challenges related to handwriting, sensory needs, transitions between classes, or even managing materials like lockers and binders. Services may be delivered through direct OT sessions, consultation, or a collaborative approach with teachers and other school professionals.
Why would a child need occupational therapy in school?
A student may need occupational therapy in school if difficulties in areas like fine motor skills, attention, self-regulation, or sensory processing interfere with their ability to access the curriculum or participate in school routines.
Students with autism, ADHD, or other disabilities may benefit from OT support. The IEP team, which includes special education staff and related service providers, determines eligibility and appropriate OT services based on the student’s educational needs—not just their diagnosis.
How do I move from 1:1 OT to a consultation model for middle school students?
Transitioning from 1:1 OT to a consultation model is common in middle school. This shift reflects the student’s growing independence and the increased need for support in natural classroom settings. To make this change:
- Start by reviewing IEP goals and assessing progress.
- Collaborate with the IEP team to determine readiness for consultation.
- Set up a plan to fade direct services while increasing teacher support and classroom strategies.
- Provide visual supports, checklists, and recommendations the student can use across their day.
This model emphasizes real-time problem-solving, supports carryover of strategies, and encourages student self-advocacy.
What does an OT consult on with middle school teachers?
An OT consultation with middle school teachers might include:
- Strategies for improving executive functioning (e.g., managing binders, using planners)
- Classroom modifications for students with sensory processing needs
- Tools to support handwriting and note-taking
- Promoting self-regulation with movement breaks, sensory strategies, or calming routines
- Helping students navigate transitions, such as changing classes or participating in group projects
- Addressing mental health concerns with structured supports that build confidence
Consultation ensures that strategies are integrated across classes and aligned with student goals.
How can OT help with self-regulation in middle school students?
Middle schoolers experience an explosion of emotional, cognitive, and physical changes, which can challenge self-regulation.
Occupational therapy can support students by teaching sensory strategies, creating regulation toolkits, building awareness of emotions, and integrating movement or sensory activities into the day.
OTs may also provide visual supports or check-in systems that help students recognize and respond to their internal states. This is especially helpful for students with ADHD, autism, or mental health diagnoses.
How does OT help with transition services in middle school settings?
OT plays an important role in transition planning, especially in the middle school years, when students begin preparing for high school and future independence. OT support may focus on:
- Building daily living skills (e.g., organizing materials, self-advocacy)
- Teaching self-determination and participation in IEP meetings
- Supporting the development of routines at school and home
- Collaborating with transition coordinators, special education teams, and related service providers
By addressing barriers early, OT helps students build the foundational skills they’ll need for success in high school and beyond.
transition from elementary to middle school
Students that attend occupational therapy services in the elementary grades may move on through their school career with a continued need for occupational therapy support.
What can you do to help this transition to middle school occupational therapy? This article on AOTA covers transitions to middle school and includes ideas for groups in the middle school transition period.
Ideas include:
- Consulting with various teachers throughout the day
- Consult with parents
- Meeting with students in a small group setting to cover transition issues that are similar for several students
- Working with students in a group in life skills or support rooms for group therapy interventions.
- Consulting with student aides (if the individual has this level of support)
- Creating small groups as extracurricular activities to address areas such as social skills, emotional needs, worries, or intermural types of heavy work activity
Depending on the needs of the individual, therapy interventions for the above areas may move to a consult basis.
Working with middle schoolers can be challenging. They are suddenly big and somewhat awkward as they navigate the changes of adolescence. There is a lot more going on than just navigating a bigger school!
One last tip as an occupational therapy provider in the middle school setting: Try not to be in the hallways when they are transitioning between classes…it can be like walking through a stampede!
Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.
