These skills are related to controlled dexterity, grasp efficiency, hand strength, handwriting, coloring in the lines, drawing, cutting, holding small items, turning pages of a book, self-feeding (use of utensils), self-dressing (tying, zippers, buttons, snaps), established hand-dominance, how well the hands work together, and other fine-motor tasks that require precision and coordination. Enjoyment of play activities such as puzzles, Legos and building blocks, and even popping bubbles can be compromised as a result of a fine-motor impairment.

These large movement skills are related to tasks that require balance (riding a bike, going up and down hills or stairs), integration of both sides of the body (skipping, jumping, dancing), posture and stability including fatigue (muscle tone, reduced core strength, floppy limbs). Gross motor skills also include gait and general movement (stopping and starting actions, changing directions), hand-eye coordination, and other aspects of strength and endurance.

Children with neuromuscular impairments and problems with oral praxis can exhibit challenges with feeding/swallowing and respiratory function. Adequate feeding skills can be dependent on proper postural alignment and control, swallow-breathe coordination, as well as on sensory factors that can influence a child’s feeding and swallowing. Evaluation of the mechanics of feeding include assessing oral motor functioning, feeding/swallowing, and respiratory coordination function. Determining effective treatment strategies to improve cheeks, lips, tongue, jaw and rib cage function is an important part of feeding therapy. Please note this is not a videofluoroscopic swallow study (VFSS). Please contact your pediatrician for a referral if your child requires a medically based swallow study.

Sensory processing and integration are the brain’s ability to receive and respond to incoming sensory input from the world around them. One or more of the five senses might be over or under sensitive to incoming stimuli. A child might be over-sensitive to noise or have difficulty distinguishing and separating speech from background noise (auditory-figure ground). A child may be over or under sensitive to temperature, pain, taste and even smell. It is not uncommon for children with sensory processing disorder to be over or under sensitive to touch. Behavioral outcomes might include the dislike of being touched/held or even seek deep pressure, or clothes feeling too tight, loose, itchy, scratchy, dislikes hands being dirty, and other tactile aversions and defensiveness. Protesting activities such as getting a haircut, hair combing, brushing teeth, and even poor toileting hygiene can be a consequence of a sensory processing problem. Playing too rough or having a high pain tolerance for example can be a result of an underdeveloped system.

These skills involve the ability to effectively and efficiently organize and interpret the information that is seen and give it meaning. Children who struggle to integrate or coordinate their visual systems and their motor systems may struggle with a variety of hand-eye coordinated tasks as well as school skills. Poor visual motor and perceptual skills may result in lack of awareness of body position in space and spatial relationships. Consequences may include bumping into and tripping over objects, dropping and spilling things, or remembering left and right. Difficulties with differentiating forms and transposing letters and numbers (b,d, p, q, 5, 2), losing place on the page, skipping lines when reading, and alignment of math computation problems are common school-based problems. Accurately reading charts, maps and diagrams, and finding what is being looked for are also areas that require adequate visual perceptual skills. Enjoying and playing with toys appropriately may be problematic due to the demands of coordinating visual information with motor output. Visual attention span, visual memory, visual-spatial relations, visual closure are other skill requirements related to this area.

Activities of daily living make up a large part of a child’s occupation. These self-care skills are related to dressing, feeding, grooming and personal hygiene. In particular, grooming and hygiene are crucial skills for social integration and acceptance. Individuals with ASD, ADHD, sensory processing disorder (SPD), and delays/disabilities with associated motor planning deficits can struggle with habituating these learned procedures into day-to-day living automatically. These skills can range from self-dressing, monitoring appearance not to look disheveled, oral hygiene, nasal hygiene, hair grooming, toileting, and sanitary practices (handwashing) and more. Fostering a greater independence in all environments and all areas of life is paramount for health and social integration.

Regulation of emotions is a significant function required for social competence and self-well-being. These skills involve the ability to be aware of and modulate one’s state of emotions and behavior in a given situation. Learning to cope with disappointment/failure, defusing anger and managing impulsivity can be very difficult for children with emotional regulation difficulties. It includes the process of monitoring, evaluating, inhibiting, and modifying emotional reactions in various settings and circumstances.

Specifically, this area explores and treats occupational performance issues associated with executive functioning issues. Executive Functioning refers to an individual’s coordinated ability to plan, initiate, organize, connect information, transition, shift mindsets, set goals, prioritize, remember, and self-monitor. Executive function deficit (EFD) is most prevalent in individuals that have been diagnosed with attention deficit hyperactivity disorder (ADHD), learning disabilities, TBI, anxiety disorders, autism spectrum disorders, and even apraxia/dyspraxia. Children with EFD are often forgetful, messy, disorganized, and easily overwhelmed. They can exhibit poor time management, poor emotional control, and often “don’t know where to start”.