Middle School Occupational Therapy

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

Occupational therapy in middle school

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

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

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

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

Middle School Occupational Therapy 

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

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

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

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

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

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

Barrier of Participation in therapy

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

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

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

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

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

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

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

The Role of the middle school occupational therapist

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

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

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

  • Working on organization, particularly when it comes to using different books, folders, and materials for each class
  • Managing a schedule with classroom changes, including hallway navigation and reading the schedule as well as sensory needs in a busy hallway
  • Lunch considerations-making meal selections, using money to purchase various meal options, and other mealtime considerations
  • Locker use including use of a combination lock, locker organization for obtaining needed materials for different times of day
  • Self-care including clothing management for gym class or swimming
  • Educate middle school teachers, parents, and other caregivers may not understand the role of the occupational therapist in middle school.  It may be time for a little education on the services provided and the therapeutic model. 
  • Empathy – reducing therapy minutes may feel like the student is not going to improve, or they are being given up on.  It is tough for parents to imagine their learner may never write a sentence, read independently, or live alone.  This is the time to gently begin this conversation.
  • Tool use including: rulers, protractors, calculators, graph paper, three ring binders, smaller desks, etc.
  • Social awareness and behavioral challenges as a result of sensory, self-regulation, or emotional needs
  • Changes in schedules, including bell ringing between classes, navigating between classrooms, short or lack of recess times, larger cafeteria, assemblies, etc.
  • 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.

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.

middle school occupational therapy

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