Step by Step
301-846-GROW (4769)
[email protected]

9093 Ridgefield Drive | Suite 102
Frederick, Maryland 21701

Proudly providing services in Frederick, Maryland and surrounding areas such as; Montgomery County, Frederick County,
Howard County, Carroll County, Washington County and Charles Town, West Virginia. 

© 2013 way2grow. All Rights Reserved.

Every Journey Begins with Just One Step

Step by Step

Sensory Awareness Month-22 Tips for Helping you Child Deal with SPD

by Barbara Luborsky on 11/02/15

Sensory Awareness Month, Tip #1:

Have your child do wall push-ups to help her calm down. This is a way to get proprioceptive input. You can also tell her to "hold up the wall" as a way to get her to push against the wall for more proprioception.

This is the #1 tip because it is an easy way to get your child moving using her muscles against resistance. This will help your child get regulated, whether she is over-excited or lacking alertness. Things like climbing steps, carrying groceries, or playing with a weighted ball are all good ways to help your child get proprioceptive input. OT’s call it Heavy Work. Think “Wax on, wax off…” Give your child breaks in his day to stop and move - it only takes a few minutes to have an impact.

Sensory Awareness Month, Tip #2:

Make your own visual calming bottle with any empty, clear plastic bottle. Fill it with shampoo and add marbles, beads, buttons, glitter, etc. Make sure to super glue the lid!

It’s easy to forget the calming power of visual input for kids. With a calming bottle, you get the opportunity to spend time with your child while making it, which is a bonus.

As your child holds, turns and shakes the bottle to make the marbles and beads move, he is also getting the added benefit of the proprioceptive input (from moving his muscles against resistance) and is motivated to use his eyes and his hands together. He will be building strength in his eye muscles as well as he watches items move. This will also support development of attention. What a great thing to have on your shelf!

Sensory Awareness Month, Tip #3:

Add an olfactory component to Play Doh fun by incorporating your favorite essential oil. Lavender is known to be calming and may be a good one to try first.

Smells can be a powerful tool for calming or alerting and are often overlooked as a sensory strategy. Preferences are unique to each individual and you should be ready to spend the time that it takes to carefully try different smells with your child to see how she reacts.

Sensory Awareness Month, Tip#4

Flavor, texture, and temperature are all things to think about as way to provide oral input through food.

Oral input is very powerful and a well packed lunch can help to support your child through the latter part of the school day.

Chewy foods provide proprioceptive input to the jaw and tongue and are helpful for calming and alerting. Biting on a fresh bagel and pulling a piece off provides lots of proprioception to the jaw. Some children respond very well to crunchy foods (e.g. celery, apples) for this purpose as well. Other children can use highly flavored foods to regulate themselves. Examples of this would be spicy salsa or lemon wedges. For some children, sucking on an ice pop will really help increase level of alertness and eating warm or hot foods such as stew will help them calm and settle.

Sensory Awareness Month, Tip#5

Use double sided tape, glue or rubber cement to attach corduroy, velvet, or even sandpaper, to the underside of your child’s desk or work table so he can get some extra tactile input as he colors or plays.

Providing opportunities for your child to have easy access to additional tactile input can make a big difference in his ability to maintain his focus on desk work. Some children have success with tactile fidgets but these can also turn out to be a distraction in their own right, or they can get lost. This technique solves the problem by allowing the child to access tactile input easily, out of sight of classmates at school, and glued down so it can’t get lost!

Do some experimenting to see what your child likes best and give it a try. ?

Sensory Awareness Month, Tip#6

Doing somersaults or log rolling gives your child vestibular, proprioceptive, and deep tactile input. This will help your child integrate the right and left sides of the body and practice total body flexion (somersault) and extension (log rolling). Work on increasing spatial awareness by challenging your child to log roll straight across the room. As with all motor activities, make sure to go in both directions.

 Sensory Awareness Month, Tip #7

A fish tank provides wonderful calming visual input. If it has an aerator, there will also the calming sounds of air bubbles. Add vestibular by providing a rocking chair or use a bean bag chair to give deep tactile input.

At home or in a classroom, creating places where our children can sit quietly and regroup is a beneficial thing to do. This provides an opportunity to learn how to sit quietly and sends the message that taking time to do so is important.

 Sensory Awareness Month, Tip #8

Listening to music provides auditory input and can be very calming. Some children will do well with headphones while others may be bothered by the feeling of wearing headphones and will do better with ambient sound played over speakers. Use of music that is at a tempo of 60 beats per minutes has been shown to be calming. This does not necessarily mean it has to be quiet symphonic orchestral music. While intuitively it does not seem to make sense, some Reggae and rock music with a strong driving beat of 60 bpm will work well for some children. You can experiment to see what types of music your child responds to and which music best suits different times of the day for your child.

There are many engineered cd’s available such as the Sound Health series from ABT, and even cd’s specifically for children with sensory challenges from Strong Institute. An OT can help you figure out what auditory input will work best for your child. ?

Sensory Awareness Month, Tip #9

Gentle but firm pressure to the top of the head is often calming. You can teach your child to give this pressure to himself by lacing his fingers together and pressing down on the top of his head for a count of 5.

This is simple and easy, but is often overlooked as a calming sensory strategy.

Sensory Awareness Month, Tip #10

Try scented markers or colored pencils to offer your child some olfactory input.

Setting up an art area stocked with scented materials will allow your child to access the input whenever she wants to as well as giving her control over which scents she wants and for how long.

Sensory Awareness Month, Tip#11

It’s easy to make a bean and rice bin -- this is very calming and provides tactile input. You can use a shoe-box and fill it to a depth of 3” or use a large plastic bin and fill it to a depth of 8-12”, or anything in between.

Add a visual challenge by placing small items (buttons, beads, small toy animals, pom-poms, or marbles) in the box for your child to find. Higher contrast will be easier (EG all white rice and red and black checkers to find) while more visual complexity will provide your child with a higher level challenge (mix lentils and dried kidney beans in with the rice and have your child try to find pennies).

You can add a fine motor challenge by having your child find items with tongs or challenge your child to build strength by using a scooper to fill a large can and then dump it out.

CAUTION: this is not for children under age 3 or those with pica behaviors.

Sensory Awareness Month, Tip#12

Make sure your child has a rocking chair or rocking horse to access vestibular input at will.

Vertical vestibular input can be provided through a variety of options such as hippity-hops, bosu boards, Rody Riders and rocker boards. These provide a range of intensity levels of input and you will have to explore with your child which is the right thing for him. It is essential to have a safe place to use these items, especially those that travel through space, such as the hippity-hop.

Vestibular input means movement. Some children need regular vestibular input in order to remain calm. Providing these types of toys will allow your child to access the input as much as he needs it.

Sensory Awareness Month, Tip#13

Increase sensory input in the mouth by having your child use a straw to eat applesauce, yogurt, smoothies or milkshakes. If your child doesn't eat any of these foods, you can get similar input by using a bite and suck water bottle (e.g. Camelbak).

Aside from the proprioceptive input your child will get by working to pull thick liquids up through the straw, you can use oral input to help your child regulate herself by thinking about texture, flavor and temperature. In addition, there is an added benefit in terms of oral motor development from this kind of oral challenge. Working to pull things up the straw will encourage better lip closure and increased tone and development of muscles of the cheeks. This will aid in development of better oral control for speech sounds, bolus control (control of the food as it is chewed), and saliva management.

Sensory Awareness Month, Tip #14

Use auditory to help your child self-regulate by playing drums and other musical instruments together.

Playing drums and other musical instruments and moving along with different rhythmic tempos will help your child develop an understanding of concepts such as fast and slow. This assists in the child’s ability to understand and develop sequencing skills, organizational skills, and even better sound/symbol association skills.

Sensory Awareness Month, Tip #15:

Don’t forget that visual input can be calming and will help children focus. Bubbles, liquid motion timers, tether ball and balloons are all enticing to children and will draw their visual attention. Each of these will also challenge your child to visually track it as it moves through space, which helps him develop better coordination of the eyes working together.

For example, blow some bubbles for your child and try to get him to watch one bubble until it is close enough for him to pop. You may need to limit the number of bubbles you are blowing for him to one or two at a time. You can challenge him to pop the bubble by clapping, by poking it with one finger or by trying to catch it in his hand. This activity builds visual attention and ocular control. Having your child blow the bubbles will provide oral proprioceptive input as well as an opportunity to strengthen the muscles around the mouth.

Sensory Awareness Month, Tip #16

Here’s a fun way to get proprioception through the hands: cut the tip off of a nasal aspiration bulb and viola…a play doh shooter is born! By pressing the open end into a thick pancake of play doh, you plug the end. When you squeeze the bulb it pops out!

So fun and full of sensory, motor, language and cognitive development value! Try your hand at hitting a target, take turns, use different colors in a sequence…the possibilities are endless.

Sensory Awareness Month, Tip #17

Does your child love to crash into things? Here’s a way to help him do that. Find a place where he can safely climb to an age-appropriate height and then jump off and crash into soft pillows and mats.

Some children, especially those that are generally overwhelmed by vestibular input, will really love and benefit from engaging in this type of activity which offers them a short and intense burst of movement followed by the crash landing, which gives them a quick burst of proprioceptive input. This activity combines soothing input (proprioceptive) with overwhelming input (vestibular) making it easier for him to tolerate. Giving the child as much control as possible of the frequency, duration, and intensity of stimulation will also help him tolerate input that might be very distressing if imposed on him without warning.

Sensory Awareness Month, Tip #18

Your child can get lots of sensory input from participating in extracurricular activities.
• Swimming offers a great deal of proprioception along with
tactile, olfactory, and auditory especially in indoor settings
• horseback riding provides a high intensity mix of
proprioceptive and vestibular inputs along with olfactory and
• sports offer great opportunities to get your child running,
watching, throwing/kicking/catching
• kayaking provides high intensity proprioceptive with vestibular inputs and is great for challenging the child
to integrate use of the two sides of the body together
• dance, karate, and gymnastics all offer vestibular,
proprioceptive, tactile, visual, and auditory inputs in varying

Remember to take into account your child’s “sensory personality” when choosing activities. Some children will be very overwhelmed by the auditory demands of playing basketball in a large gym, while shooting hoops in the driveway may be the perfect activity them.

Sensory Awareness Month, Tip #19:

Make a sensory basket to keep your child happily engaged while you make dinner. During that “witching hour”, present a basket of intriguing sensory items. You might include items that provide input from several different sensory channels or stick to one sense. You can be creative and incorporate things that support learning of age appropriate concepts including items of a certain color or things that start with a certain letter.

Here are some examples:

• Sensory Basket- mixed inputs: kaleidoscope, silly putty,
scented markers and pad of paper, liquid timer, heavy turtle
lap pad, stepping stones …etc.
• Oral Sensory Basket: harmonica, kazoo, bubbles, chewy of
your choice, slide whistle, train whistle, recorder, straw and
cotton ball, Blo pens and pad of paper, chewing gum (if
appropriate for your child) …etc.
• Fine Motor Work Basket: silly putty, pop beads, pop tubes,
dominoes (to set up on edge in a row and knock down for
the “domino effect”), tongs and bowl of small items to grasp
and move from place to place using the tongs, clothes pins
with letters written in sharpie-clip to a set of cards with age
appropriate words to spell using the clips …etc.
• A “B” Basket: bubbles, ball, beads, bongos, blocks, book

Think of things your child likes and include some known favorite items and add some novel things as well. Also make sure your child will be able to manage items safely, e.g. Silly Putty can be a mess to get out of the carpet, so only include that if your child understands the rules for using it (stay in the kitchen where there is no carpet). Keep this basket for use only during that “witching hour” or perhaps for times when you need to be on the phone-that always seems to be the time they MUST have your attention-right? ?

Sensory Awareness Month, Tip #20:

Help your child decide which sensory activity to do by making a sensory “menu”. This can take many forms and can be structured to suit the age, developmental level, and personality of your child. The beauty of this approach is that it gives the child a sense of control as well as choices, even when the adult is actually in control by picking what activities to offer. This could take the form of a sign on the fridge, a stack of cards or photos, or something more elaborate, as described below.

One easy option is it use a file folder. Put your child’s name and a title on the outside. The name should reflect the purpose of the menu, e.g. “Susie’s Choices” (for the child who needs to have control), “Johnny’s Calm-Down Activities”, or “Bobby’s Sensory Menu.” On the inside of the folder put Velcro tabs on the right. On the left side you can tape an envelope to hold the activity cards. These can be made very simply by writing on index cards or for non-readers print out photos of items and glue them onto the cards. You can also use pecs if you have access and that is familiar to your child. Laminating can increase the lifespan of the cards. Place matching Velcro tabs on the back of each activity card.

Most children who have sensory challenges can benefit from engaging in sensory-based strategies every 1.5-2 hours. Helping your child keep that schedule by using a menu should help decrease the frequency/number of meltdowns as well as their level of intensity. For a child who is very upset, the menu can be used to guide him to a calming activity. Use one activity card and point to it to indicate that this is what he should do. When things are calm and your goal is to have your child engage in something calming put 2, 3, or 4 choices up, depending on your child’s age and ability to make choices.

After you make the menu, be sure to show it to your child and discuss how it will be used, explaining that one way it will be used will be to help him choose activities and another way it will be used is to help him when he gets upset to know what to do to calm down.

Sensory Awareness Month, Tip #21:

Many children find a hideout cave to be very calming. It is easy to make one in any number of ways. A large cardboard box on its side, clearing out a closet, a card table with a sheet over it, or pulling the sofa 24” away from the wall are all great ways to create a snug spot where your child can go to be in a sensory-dampened environment.

Once you create a space, you can work together with your child to determine what should go inside. Some ideas to start with would be bean bag chair, soft pillow(s), Lite Brite, flashlight, iPod/mp3 player, books, stuffed animals, chewys, fidgets… The thing to remember is that there is really no right or wrong to it, the important thing is to set it up so that it will help your child calm down and remain calm. For some kids less is better and making a spot where they can squeeze in snug between two pillows is all you need.

Sensory Awareness Month, Tip #22:

Proprioceptive input, or muscle work, along with deep tactile input are the best calming inputs. Here are some ideas about how to help your child get those inputs.

Weighted lap pads, blankets, backpacks, fanny packs, dolls, and animals are great. Another thing that helps many kids is to wear compression clothing. Bike shorts, unitards (full body leotard), compression shirts, and compression vests are all great ways to get this input. These are strategies you can try on your own and your child can wear these clothes or play with weighted items listed above for as long as they want.

Adding weight through use of a weighted vest or having your child wear cuff weights on her ankles or wrists is a bit different. It is important not to have your child wear weight for too long. If you try the suggestions in the first paragraph and they are not successful, I recommend that you consult with an OT before using weights that strap onto your child’s body or a weighted vest. These items have many variables to be considered such as the weight of your child, how much weight should be added and when and how long, your child should use them.

Making a Sensory Menu

by Barbara Luborsky on 10/28/15

Help your child decide which sensory activity to do by making a sensory “menu”. This can take many forms and can be structured to suit the age, developmental level, and personality of your child. The beauty of this approach is that it gives the child a sense of control as well as choices, even when the adult is actually in control by picking what activities to offer. This could take the form of a sign on the fridge, a stack of cards or photos, or something more elaborate, as described below.

One easy option is it use a file folder. Put your child’s name and a title on the outside. The name should reflect the purpose of the menu, e.g. “Susie’s Choices” (for the child who needs to have control), “Johnny’s Calm-Down Activities”, or “Bobby’s Sensory Menu.” On the inside of the folder put Velcro tabs on the right. On the left side you can tape an envelope to hold the activity cards. These can be made very simply by writing on index cards or for non-readers print out photos of items and glue them onto the cards. You can also use pecs if you have access and that is familiar to your child. Laminating can increase the lifespan of the cards. Place matching Velcro tabs on the back of each activity card.

Most children who have sensory challenges can benefit from engaging in sensory-based strategies every 1.5-2 hours. Helping your child keep that schedule by using a menu should help decrease the frequency/number of meltdowns as well as their level of intensity. For a child who is very upset, the menu can be used to guide him to a calming activity. Use one activity card and point to it to indicate that this is what he should do. When things are calm and your goal is to have your child engage in something calming put 2, 3, or 4 choices up, depending on your child’s age and ability to make choices.

After you make the menu, be sure to show it to your child and discuss how it will be used, explaining that one way it will be used will be to help him choose activities and another way it will be used is to help him to know what to do when he gets upset to help himself calm down.

Here's an Idea for Bathtime

by Barbara Luborsky on 05/28/15

Here's an idea for helping kids build skills while they play in the bath.  Use the pump from an empty liquid soap container and have your child put the bottom in the water and keep the pump above the water.  Place thumbs on the top and index fingers under the part that attaches to the bottle.  Press a few times and water will begin to spurt out!  I used it is a small pan of water to show you how it works.  Check it out.

I find that it's always a challenge to find ways to help children be more successful getting the pad of the thumb to the pad of the index finger for controlled and precise prehension.  Often the problem is that the child lacks the ability to rotate the thumb into position so the pads can meet.  In such cases, the child will often place the pad of the thumb against the side of the index finger, essentially closing down the web space partially or entirely.  Doing this prevents the hand from functioning as it is designed to function, with mobility within the palm.  If you try holding a pencil like this, you will feel that it makes your hand feel like a solid block, with no mobility at the fingers at all.

That is why it is essential to find ways to help children strengthen the muscles at the base of the thumb (thenar eminence), so they can have better control of the rotation and the ability to hold the thumb in opposition to the index finger.

Making a Find-It Toy-Fun and Learning Combined!

by Barbara Luborsky on 05/21/15

The simplest way to make a find-it toy is to use a clear plastic water bottle. However, you can use any clear plastic container, large or small, depending on your goals for the toy.  Choose the appropriate size depending on your child’s age and ability.  For a young child, you may want to use a small 8 ounce size, while an older child may enjoy the challenge of a larger bottle, which will weigh a lot more.  Make sure the bottle is completely dry and then, using a funnel, put enough rice in it so there is about 2 inches of space at the top.  This is a great thing to have your child help you do, especially if you are working on perfecting use of a spoon.  Work somewhere where it won’t matter if rice spills on the floor and give your child a spoon with some weight to it.  Have her spoon the rice into the funnel and remind her to watch the bottle as it gets full and decide when to stop.  Then put in any small objects that will fit in through the opening and that seem like they might interest your child.  Items such as pennies, buttons, beads, pegs, shells, or small toy animals would all be good choices.  Make a list of everything you put in so you can have your child try to find everything.  Next, glue the lid on with crazy glue.  Roll and shake the bottle around so that the objects are spread throughout the rice and are hidden.  That’s it!  You’re done.

Why make this toy?

This toy challenges the user to coordinate the eyes and the hands while manipulating the bottle to try to uncover the hidden objects.  It promotes wrist rotation, builds motor control at the wrist and forearm, and requires good attention, visual focus, visual tracking, and visual attention to be successful.  Playing with it will help promote all of these skills.

To make this toy, the child must use a series of steps.  Having children engage in tasks that require multiple steps is a good way to help them learn about and understand organization and sequencing-both of which are essential for doing things like writing a coherent paragraph, preparing a meal, or planning a long term project. 

When you are putting the project together, the child will 2 hands together to pour, use a spoon, and use a funnel.  These are all activities that require eye hand coordination, use of the hands as partners in “lead/assist” fashion, and precise hand skills.

It is easy to make this project more or less challenging, depending of the age of the child. You always want an activity to be just right for the child, meaning not too hard and not too easy.  Here are some ways to do that.

Make it easier by using only rice and putting in objects that are large and brightly colored.  This will make them stand out against the white rice and will make them easy for your child to find.  Putting a little less rice into the bottle will allow the rice to move more freely which will make it easier for your child to locate the hidden objects.

For an older child, using smaller objects, objects that are similar in color to the color of the background material or mixed colors for the background will all add to the level of complexity and challenge.  You can add lentils, split peas, kidney beans, or pasta to create a multicolored background which will increase the visual complexity of the task.

Here it is with rice only.


Here's what it looks like with some lentils, beans, and split peas mixed in to make the background more complex.

bottle many bugs

You can make themed bottles, such as an alphabet bottle for a child who is learning letters, a holiday bottle with items related to a particular holiday, etc. 


We would love to see a picture of your finished product.  Please send us a photo via facebook or twitter (@WaytoGrowOT). 



Public vs Private Models of Service Delivery-What is the Difference? Part 1

by Barbara Luborsky on 05/12/15

Ever since I finished writing the last post, I have been thinking about the topic of public vs private models of service delivery. For years I have been having the same conversation over and over with parents who are struggling to understand the differences between these two ways of providing services.  Many parents don’t understand why their child does not qualify for services at school. Others mistakenly believe that if their child is getting OT at school he is getting everything he needs in the way of treatment.  All parents want to provide the best opportunities and services for their children and making sense of this issue can be a real challenge. 

As I worked on this, it became clear that this topic should be broken into a 2-part post.  So, here is part 1, my take on the “public” side of it.

Public services (meaning provided free by the local jurisdiction) for children are mandated by the IDEA (Individuals with Disabilities Education Act), which is Federal legislation that requires assessment of all children suspected of having a disability.  IDEA mandates free and appropriate educational services to all children, regardless of disability, to be provided in the Natural Environment (for children under 3) or the Least Restrictive Environment (school aged children).  Occupational and physical therapy are among the services that are available to children with disabilities under Parts B and C of IDEA 2004. 

For school-aged children, the document that describes the individualized program for the child at school, is called an IEP (Individualized Education Plan).  For children under 3 years of age, the document is the IFSP (Individual Family Service Plan).  If the IEP/IFSP teams determine that the child has an educational disability and is in need of early intervention (under age 3) or special education (over age 3), those services are described in detail, on the child’s IEP or IFSP.  OT, PT and Speech are listed as “Related Services”.  In this context, OT services for the school aged child are meant to address issues that interfere with the child’s ability to participate in the school program and learn.  Thus, the focus of the intervention is facilitating access to educational programming, not on remediation of underlying deficits.  Children ages 0-3 are mandated to receive services through local Infants and Toddlers Programs. MSDE describes the related services of OT and PT in the following way:

The Early Intervention OTs and PTs work to overcome barriers, enabling children’s development and integration in family and community life such as participating in community play groups, library story time, and family mealtime.  The School-based OTs and PTs specifically work to overcome barriers, enabling children’s participation in school activities, involvement in learning, and ability to demonstrate what they have learned.


MSDE (Maryland State Department of Education) provides the following description of the distinction between school-based services and those provided in health-care settings.

Some children with disabilities obtain therapeutic services from OTs and PTs in health care settings. School-based OTs and PTs are not in any way meant to replace those professionals. In early intervention and school settings, OTs and PTs focus on those problem areas identified by the Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP) team that are directly affecting the child’s involvement and progress in participation and learning. Children benefit from collaboration among their early intervention or school-based providers and other healthcare providers.


In order to understand the IDEA and how it describes service delivery, it is crucial to understand two phrases:  these are “Free and Appropriate Education” (also referred to as FAPE) and “Least Restrictive Environment” (referred to as LRE). 

Looking at the FAPE, determining what educational program is appropriate for any given child is truly a complex endeavor.  Parents often disagree among themselves about what is the most appropriate setting for their child, so it is not surprising that between parents, educators and professionals there is rarely total agreement about what would be the most appropriate educational setting for any given child. The ability of the school system to provide that program for the child, even if there were agreement among all the parties as to what it would be, is certainly affected by budgetary concerns. Every student is different and the beliefs and opinions of parents about the needs of their children vary as well.  It is easy to see how this would be an area in which disagreement between the school system and parents is not uncommon.

A similar challenge exists in terms of identifying the least restrictive environment for a child.  In general, as the level of support increases, the setting is considered to be more restrictive.  Thus, to the greatest extent possible, students are supported in a “regular education”  classroom and services are provided whenever possible, on a “push-in” basis, meaning the therapist goes into the classroom in order to serve the child and provide a model for the teacher, who will integrate the recommendations of the therapist into the child’s educational program. 

Students needing more support may be assigned to special programs in separate classrooms.  These classrooms typically have a smaller teacher/student ratios, specialized curriculum materials and lessons, and highly trained and specialized staff.  This type of setting would be considered to be a more restrictive setting.  Providing services to students is very individualized,so that for each subject, the student should be provided educational services in the manner appropriate to the child’s needs for that subject.  So the student might be taught different subjects in different settings.  Throughout the day, a student might go to different sites in the school to attend groups with other students at a similar academic level, for each academic area.  In this way, each student’s program is individualized to meet his or her academic strengths and needs. The challenge is in identifying the least restrictive environment in which a student is able to function successfully.  As is the case when identifying what setting is “appropriate,” parents, educators and professionals will often find that they are not in complete agreement about what is the least restrictive environment for a student. 

Determining what challenges interfere with a child’s ability to access their educational program seems straightforward enough-evaluate the child and measure his or her skills.  However, things are often not so clear-cut and this can be another area of disagreement between parents, educators and professionals.  Does it interfere with a child’s ability to access his educational program if the child can’t pay attention?  What if she becomes overwhelmed when the classroom seems noisy or busy?  Is there an educational impact if the child can’t see well or speak clearly? Certainly, we could all agree that each one of these examples describes something that could interfere significantly with a child’s ability to function successfully in the school environment.  Yet, the challenge comes in determining what the school system is responsible to provide to each of these students as they deal with each of the issues noted.  Should the school system be required to provide assessment by a psychiatrist and then medications for children dealing with poor attention or extreme anxiety?  Perhaps teaching these students yoga or stress management techniques would be helpful.  Providing medication clearly would overreach the boundaries of parental responsibility.  On the other hand, the child with this type of attention challenge would definitely be more successful at accessing his educational program if he attended better. Should the school be required to provide eye glasses for a child who can’t see?  No, but preferential seating is certainly indicated, along with other accommodations such as large print books or use of appropriate technologies.

Before a child receives any services from the public school system, the child must be found to be eligible.  The procedure for establishing eligibility includes testing and analysis of the child’s strengths and needs and diagnosis, in order to determine if the child’s situation meets the definitions of a qualifying disability.  For provision of OT services, things are even more complex, because OT is not a “stand alone” service.  This means that the child can only receive OT if there is a qualifying disability requiring either educational services or speech-language services.  So no student would be eligible to get only OT. 


Section 504 of the Rehabilitation Act of 1973 addresses the needs of children who have disabilities, but do not require special education services under the IDEA. Under Section 504, these children can be provided with accommodations and services to help them access the general education curriculum. In some cases, these accommodations and services can include the services of the OT and/or the PT.


This post represents, in very brief form, the components of IDEA that determine placement and provision of services to students with disabilities from the public sector.  To learn more, you can go to the MDSE website, which has a great deal of information in accessible language.   Here is a link to look at:    

In the next post, I will discuss private sector service delivery.  As always, I welcome any comments and or questions.

What is Occupational Therapy Anyway?

by Barbara Luborsky on 12/05/14

Ok. So I am joining the 21st century and starting a blog.  Where to begin?  Maybe a good starting place would be to define occupational therapy (OT), which seems to be a field that is hard to understand. 

The term, “occupation” in this instance, refers to how one prefers to spend time.  Another aspect of this field has to do with occupational roles, which could be job related, such as teacher, or could be life related, such as parent, son, sister, or friend. 

So as “occupational therapists” we are tasked with assessing what is interfering with a patient's ability to carry out their various occupational roles.  We do this by determining what it is that the patient enjoys doing and then finding ways to use those activities to help the patient gain needed skills.  This might be helping someone gain strength in an arm that has been injured, building specific motor skills to support a necessary life task, or engaging in preferred occupational tasks to help improve attention, orientation, or self-regulation.   

For children, their main occupation is play.  Everything a child learns is first learned through concrete experiences in the body.  Motor activity and active play are the best foundation for later success with academic tasks.  

The roots of OT are entwined with the history of medical science and with our social history. Initially born out of a desire for more humane treatment of the mentally ill, it included adding the use of crafts and activity to treatment programs. In the late 1700’s, it was all but forgotten in the chaos that followed the Civil War.  Fortunately, it was revived in the early 1900’s, when the focus on “occupation”, meaning use of purposeful activities in the treatment of the mentally ill, was increasing.  On March 15, 1917, the National Society for the Promotion of Occupational Therapy (NSPOT) was founded.  This organization flourished and became more aligned with medical practice, until the Great Depression.  Following WW I, there was a surge in the development of the field as occupational therapists were called upon to help treat the many service members who had sustained head injuries in the war. 

WW II and the years directly following the war were another period of growth for the field.  There were not only soldiers with head injuries, but also many who survived amputation, due to the widespread availability of antibiotics and improvements in our capability to maintain sterile conditions in the operating theater.  Here was a large group of young men with many years of life ahead of them, facing the challenges of living without one or more limbs and in many cases, simultaneously dealing with the challenges of “shell shock” (as Post Traumatic Stress Disorder was  then called). Therapists were charged with helping these patients regain the ability to take care of their own daily living needs and also find ways to help them find meaning and purpose in their lives despite the challenges of their injuries.  Occupational therapists were uniquely qualified to help these patients because this is the essence of OT- addressing the physical and the psychosocial domains simultaneously.

OT’s help patients develop many kinds of skills.  These include:

Activities of Daily Living (ADL)- building independent skill for feeding, dressing, bathing, grooming

Fine motor skills- hand strength, manual dexterity,  motor tasks that require use of the two hands together such as buttoning buttons or using a zipper

Gross motor skills- controlling large motor movements such as walking, running, skipping, and hopping

Visual-motor integration- the ability to draw what we see, to copy letters and words

Ocular-motor- being able to use the muscles of the eyes to control and coordinate eye movements functionally

Sensory processing- being able to take in information from all of the senses, both external and internal, and processing/sorting/prioritizing them in order to respond and behave appropriately

Cognitive- including skills such as attending, processing information, thinking, remembering, inhibiting, etc.

Social and leisure skills development- including being able to make and keep friends, learning to live by the social conventions of one’s society, finding activities that enrich leisure time, and spiritual pursuits

Functional mobility and functional communication skills- being able to safely move about one’s home and community and having a means to successfully communicate with others

Practice settings include: Hospitals, Outpatient centers, Nursing and Rehabilitation Centers, Schools, Private Practice Clinics, Psychiatric Wards, Day Programs, and Community Health settings

Specialty areas: Hand therapy, burns, wound care, pediatrics, work hardening, geriatrics, and psychiatry

OT in the schools is Federally mandated through the IDEA to assist students with challenges that would prevent them from accessing their educational program.  OT is not considered a “stand-alone” service, which means it can only be part of an Individualized Education Plan for a student with a qualifying disability.

The school-based OT provides supports, accommodations and modifications, many of which are designed to be carried out by the teacher, that help the student access their educational program.  IDEA  does not require treatment of the underlying problems.

Private services focus on treating the patient's underlying problems as well as supporting and promoting optimal function across environments. 

The next post will be a more comprehensive exploration of the commonalities and distinctions between these two pediatric OT practice settings.