An evaluation is the start of a therapeutic relationship.  It is an opportunity to gather data, observe, and use critical thinking skills.  Standardized assessments provide data for qualifying children for services.  They can also establish a baseline for creating goals and designing a remediation plan.  Selecting an appropriate motor assessment for your client will ensure that the child can engage and that you collect the information you need.  Considerations when choosing an evaluation should include the child’s age, referral reason, test length, types of activities included as testing tasks, and what the test is measuring.  A description of four motor assessments commonly used by both OTs and PTs are described below.

 

Bruininks-Oseretsy Test of Motor Proficiency (2nd Edition)

 

Also known as the BOT-2, this tool is widely used by occupational and physical therapists.  Fine motor categories include fine motor precision, fine motor integration, manual dexterity, and upper-limb coordination.  Bilateral coordination, balance, running speed/agility, and strength subtests make up the gross motor portion of the test.  Tasks vary from dribbling a tennis ball to coloring in shapes, performing jumping jacks, and cutting out a circle.  An abbreviated short form provides a brief overview of motor functioning.  BOT-II is appropriate for children ages 4-21 years.

 

Peabody Developmental Motor Scales (2nd Edition)

 

The PDMS-2 is standardized for children from birth to age six.  This evaluation is a basal and ceiling evaluation, so you only need to test skills that are appropriate for the child’s age level.  When the child is unable to complete three consecutive tasks successfully, that category is discontinued.  For the youngest population, tasks will include aligning their head, pulling to sit, propping on forearms, and tracking a rattle.  Older children will stack blocks, lace beads, kick a ball, balance on one foot, and more.  Subtests include reflexes, sustained control, locomotion, object manipulation, grasping, and visual-motor integration.

 

Miller Function and Participation Scales (M-FUN)

 

This assessment is standardized for children ages two to eight.  The test has visual motor, fine motor, and gross motor domains.  Fine and visual motor activities are child-friendly games such as “Find the Puppies” and “Go Fishing.”  Gross motor activities are embedded into a “Statue Game,” soccer practice, and more.  The M-FUN kit includes a home and classroom observation checklist that examines social skills, sensory needs, and ability to regulate.  While this assessment takes longer than the others to administer, it provides comprehensive data which can aid in writing goals and intervention planning.

 

Toddler and Infant Motor Evaluation

 

Created for children ages birth to age three years and six months, the Toddler and Infant Motor Evaluation (TIME) assesses movement quality.  Five subtests that assess mobility, stability, motor organization, social/emotional abilities, and functional performance.  Optional subtests are available for advanced practitioners and include component analysis, quality rating, and atypical movements.  Activities include sequencing movement into different positions and free-play with a caregiver.  Open-ended parent questions along with a Likert questionnaire provide both contextual information and data on current performance.

Affirmations are a quick, easy (and free!) intervention for children who are working on building their self-esteem.  These positive messages can foster a growth-mindset.  Affirmations can be especially impactful for children who have excellent self-awareness skills.  Especially when there is a gap between their potential and what they can actually do.  When a child recognizes a challenge (whether it is listening to the teacher or sharing with a friend), they can withdraw from the activity.  This limits their practice and ultimately growing skills in that area.  Affirmations can help kids reframe the situation and recognize their strengths.

 

Of course, honor what is unique about the child when creating your own affirmations.  Does the child have a deeply creative imagination?  Share that!  Are they loving to animals?  Let them know that you recognize that and teach them to recognize that in themselves.  Older children can be guided to contribute their own ideas for affirmations.  Here are some ideas to get started:

 

Affirmations for Relationships:

 

Reciprocal play and communication can be challenging for many children with developmental delays.  The back and forth nature of conversation and the inability to control the other individual can make for a difficult scenario.  These affirmations will help children see their ability to interact with others in a positive light.

 

 

Affirmations for Regulation:

 

These will look different depending on what tools the child uses to regulate and what language they respond best to.  The point of these affirmations is to help the child understand that they have control over their body and how they feel, and can make positive changes to make their body feel good.

 

 

Affirmations for Executive Functioning:

 

If we want our children to be as independent as possible, we need to be sure to give them a mindset to empower them to try when things are tricky or present a challenge.  These affirmations are great for children of all ages and abilities:

 

 

Affirmations for Any Day:

 

Starting each day with a positive affirmation can create a growth mindset and build resilience for when any challenges inevitably arise.  When children are empowered, feel in control, and their self-esteem is nurtured, they are better able to access the higher level skills that help keep them at their best.

 

 

Do you use positive affirmations with your child or students?  Share any favorites in the comment section below!

Children with autism spectrum disorder, attention deficit disorder,andother developmental delays often have professionals of all different backgrounds providing strategies for their success.  While occupational, physical, and speech therapy, special education, and applied behavior analysts have different focuses, these professionals often use the same foundations to help kids learn and grow.  Read on for the most common behavior strategies that the whole team uses:

 

Use Positive Reinforcement

 

Teachers and parents use positive reinforcement with both neurotypical children and kids with disabilities for a valid reason.  Their developing brains make stronger connections with positive reinforcement than negative.  Try to catch them at their best, whether by saying hello to a friend, listening to your message, or trying something new without getting frustrated.  Recognize and praise their behavior.  Therapists and educators are as specific as possible with praise and positive attention based on what the child can comprehend.

 

Define Expectations

 

It is helpful to remember that little ones lack the time and experience to understand what you expect of them.  This goes for daily routines but is even more evident when children are in a novel situation.  Communicate expectations to them by sharing what you want them to do (“let’s sit by a friend during snack for five minutes”) rather than the behavior you want to avoid (“we don’t take our friend’s snack.”)

 

Use Controlled Choices

 

This strategy is enormously helpful because it can be used before, during, or after a behavioral incident.  As an adult, you know what is best for the child at a given moment.  Based on that, offer the child two choices that would be appropriate for the situation.  It can be as simple as “would you like the blue chair or the green chair?”  The ability to make a (supported) decision empowers children, even amid a meltdown.

 

Consider the Environment

 

We wouldn’t expect most adults to be able to engage in a complex task when they are in a busy and loud office and haven’t had a break in several hours.  However, we too often expect the equivalent out of children and adolescents.  All children have sensory preferences that can enhance or discourage their learning behavior at a given time.  Whether it is a speech-language pathologist helping a child learn to communicate their needs, or a BCBA assisting a child in attending at circle time, the environment plays a significant role in children’s behavior.  If you feel dysregulated in the space as an adult, the child likely feels the same.  Educators and therapists modify the environment by adding quiet areas, access to noise-canceling headphones, adding movement breaks, having the child sit near the teacher, dividing the class in half for certain activities, etc.

 

Model Expected Behavior

 

 Modeling the correct behavior can be challenging in the heat of the moment.  However, you may notice that the most experienced therapists and educators remain calm and collected during a behavioral episode.  They realize that the child will become even more dysregulated if they become elevated.  Try using a quiet voice, breathing deeply, and being present without outwardly judging the behavior.  Sometimes, this strategy alone can help a child refocus.

The expectation for kids to start writing is getting earlier and earlier all of the time. However, the youngest children don’t have the physical development needed to use the small muscles in their fingers and hands to hold and control a pencil. Writing is a foundational learning skill that helps requires visual-motor integration, bilateral coordination, midline crossing, etc. It is correct that it is an important skill to master. But how do you get young children started before jumping in with a pencil and paper? Read on for several ideas to help kiddos get ready to write without actually writing.

 

Strengthen Big Muscles First

 

For a person to write successfully, they need to be able to stabilize their upper arm. If the movement comes from their shoulder joint when they write, they will get tired out quickly. Use play to strengthen the upper body. Wheelbarrow walking, crawling, and animal walks all work well for this. For an extra fun activity, tape a big piece of paper to the bottom of a child-sized table. The child can lie underneath it and straighten their arm to paint.

 

Get vertical!

 

Tape a piece of paper to a wall or find an easel with a chalkboard or blackboard. Let the child color to their heart’s content. Kids enjoy the novelty of this activity, and it allows for practice with grasp and getting the wrist into the correct position for writing. If this feels tricky, tape a sheet of paper to the wall and let them place stickers on it for a similar effect.

 

Draw!

 

Creating simple drawings is a great way to work on visual-motor integrations skills. Sometimes referred to as hand-eye coordination, visual-motor integration involves using coordinated movements to make marks with intention. Start with easy drawings and work your way up. An excellent progression could be drawing a smiley face, then a person, then a teddy bear. First, demonstrate how to make it so that your child can copy you. For ideas and inspiration, check YouTube or your local library for drawing guides.

 

Letter Recognition

 

Letter recognition is a part of learning to write. Point out letters in books, on signs, blocks, and in their name. Focus on capital letters, to begin with since those are the first letters they will most likely learn to write. Alphabet magnets are a popular exploration item. With adult support, kids can start learning the names of the letters and recognize them.

 

Write… But Not On Paper

 

Practice creating letters in new and different ways! Try rolling out play-doh letters, making letters with sticks, lines and curves cut out of paper, Legos, and anything else you have handy. You can make a sensory tray with a box lid and fill it with rice or salt to trace letters. As a bonus, many children are kinesthetic learners, and this activity can help reinforce the other work you do.

 

Kid-Size Tools

 

When the concepts and skills are coming together, and your child is ready to start writing letters, use child-sized writing utensils. This promotes the development of a mature grasp. Start with bits of chalk and broken crayons. For older kids, try golf pencils.

Most children benefit from proprioceptive sensory work built into their day. The proprioceptive system receptors are located in our joints and muscles and tell us about where our body is in space. The benefits of stimulating this system vary for different children but can help children feel regulated, calm, and ready to focus. Unlike the vestibular system , the proprioceptive system cannot be overloaded. The benefits of heavy work last for up to two hours after engaging. Try to build planned activities into your day to support your student or child’s participation all day long.

 

1. Play:

 

Play is a creative and natural method of learning and exploring the world. Encourage running and jumping as part of play, draw a hopscotch game in chalk or offer a jump rope. Indoor and outdoor trampolines provide lots of sensory input to the lower body. If you have monkey bars nearby, try to test how long you can hang on. Create an obstacle course including several of these activities to make a memorable play experience.

 

2. Animal walks:

 

Common in occupational and physical therapy and physical education classes, animal walks are fun and motivating and great for sensory input and motor planning. Try crab walks, bear walks, snake crawls, dinosaur marches and wheelbarrow walks. Get creative and make up a new animal walk!

 

3. Clean up a space:

 

This is a functional life skill that children can practice at any age. Some cleaning activities like vacuuming or sweeping provide proprioceptive input. Younger and older kids can use a towel and wide sweeping motion to wipe down tables or spills. For even heavier input, delegate the task of pushing in chairs or pushing light furniture into place to kiddos.

 

4. Carry:

 

Carrying heavy items can be a purposeful activity where children get a chance to help out. Try letting them bring in groceries, carry books to another room, move their chair by themselves or wear a slightly weighted backpack.

 

5. Get outside:

 

For children of all ages, the outdoors provides lots of opportunities for proprioceptive input. Go on a nature walk. The more challenging the climb, the more proprioceptive input they will get. Using a small shovel to move snow or dig dirt is another way children can help out.

 

6. Snack time:

 

Do you know anyone that chews on a pen or pencil? The jaw has several proprioceptors, and by chewing on something hard, people get lots of regulating input. A more functional strategy would be to eat something crunchy or chewy. Carrots, celery, nuts, and granola work well and can easily work into your usual snack time. Older kids (and adults) can get the same benefit by eating crunchy foods or chewing on gum.

 

7. Use a weighted ball:

 

Try a soft weighted ball for a quick and easy way to get input. Starting at two pounds and increasing to higher weights, weighted balls are versatile and easy to have nearby. Try throwing and catching the ball, rolling it back and forth to each other, or slamming it onto the ground.

The vestibular system, located in the inner ear, gives us information about how our head is oriented in space and is essential for balance. The vestibular system is closely linked to the visual system and postural control. Some children experience challenges related to the development of this system, and it may reflect in their poor balance, frequent movement-seeking behaviors, or reluctance to participate in activities that involve positional changes. Input to the vestibular system is often organizing, and effects of stimulation can last for up to eight hours!

 

Occupational therapists provide interventions that develop the vestibular system to help children fully participate in movement activities, whether they:

 

Seek vestibular input- These children love to spin, swing, and be on the move.

 

Have postural control challenges- Postural challenges are indicated by frequent leaning, falling out of a chair, or a child resting their body on a table surface.
Are over-responsive to vestibular input- Children in this category may be fearful of swinging, get carsick, and dislike climbing stairs.

 

Have perceptual challenges- Children who often appear uncoordinated or have trouble timing the movement of their body to music (such as during circle-time songs) may fall into this category.

 

Since there are a variety of dysfunctions possible within the vestibular system, it is best to get an occupational therapy evaluation when there are concerns. This system can be easily overloaded for over-responsive children, resulting in nausea for a prolonged period. Occupational therapists provide services and ideas for carryover in various settings so that children can be exposed to activities both in and outside of the school or clinic setting.

 

The Playground

 

Playgrounds have built-in structures that are perfect for getting vestibular input. Slides provide an opportunity for children to both climb and descend in a smooth movement. Many play areas have various swing choices, giving children a chance to sit or lay down (as in a tire swing). Both spinning for a short amount of time and pushing back and forth can provide organizing input. Monkey bars work well for both climbing and hanging upside-down- an impactful way to change the position of the head.

 

At Home

 

Are you thinking it may be challenging to carry over vestibular work at home? Try this! Allow your child to sit on the couch and then hang their upper body upside-down off of it. It gives the same impact as hanging off of monkey bars and may even be more accessible to little ones who are not fond of heights. If you have an office chair on wheels, let your child explore spinning on it. Be sure to allow them to turn themselves so that they remain in control.

 

Outside

 

Children naturally work on developing their vestibular system in outdoor spaces. Climbing up rocks or hills, log-rolling down a grassy hill, or practicing somersaults or cartwheels can all be done without special equipment. Jump-roping, riding a bicycle, and rocking on a porch swing, are also organizing activities children can do outside.

 

The Gym or OT Clinic

 

OT clinics have special tools that can target a child’s specific vestibular system needs and build skills in other identified areas of need at the same time. In these spaces, you’ll often find climbing equipment, scooter boards, balance beams, a variety of different swings, spinning boards, and more.

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