Signs That Your Child May Need Occupational Therapy

Young Girl Writing in Her Exercise Book in the ClassroomAt school, you or your child’s teacher may be noticing difficulties in your child’s school performance. Although you may not be able to see your child work in the classroom, there are some things that you can look for outside of school that  suggest your child could benefit from occupational therapy services.

  1. Difficulty Focusing – If your child is having trouble focusing on her homework, it may be a sign that she’s also having trouble focusing in class. If she gets distracted by noises or people moving about at home, she might also have difficulty paying attention at school and may not be getting the most out of her education.
  2. Difficulty Starting Homework – Your child may have trouble with task initiation if she needs help from you to start her homework or if she   can’t start without having someone present.  Occupational therapists (OT), can help your child work on task initiation so she can be independent with her schoolwork.
  3. Math Problems Don’t Line Up – If your child is consistently getting the wrong answers with math problems, it may be because she has a hard time lining up the numbers correctly. This may be an issue with organization or spatial organization.
  4. Typing Difficulties – Does your child have trouble remembering where the letters are on the keyboard, moving her fingers, typing quickly (in comparison to her peers), or staying error-free when typing? These are all components of manual dexterity and visual memory, which occupational therapists can help improve.
  5. Handwriting Issues – If your child has a hard time writing quickly and neatly, reverses letters, doesn’t form letters correctly, adds too little or too much space between words, or confuses upper and lower case letters, she may need OT to improve her handwriting skills.
  6. Messy Backpack or Folders – This may be a sign that your child has decreased organizational skills, which can affect her ability to complete the correct homework each day.
  7. Forgotten Homework – Your child may benefit from using a planner or calendar system to help keep track of when her homework and projects are due, as well as dates of tests and quizzes. An occupational therapist can help assess her organization and planning deficits and find specific strategies to help her manage her homework.
  8. Lack of Time Management – Does your child have difficulty scheduling her time? Does she spend the majority of her time on leisure activities, while not leaving enough time for homework and getting to bed at a decent hour? If your child is in middle school or older, she should be able to manage her time with little help from her parents.
  9. Poor Fine Motor Skills and Coordination – If your child has difficulty holding a pencil correctly, erasing completely, cutting, folding, or coloring, this may be an indication that your child could benefit from OT. Read our blog addressing daily activities for fine motor strength

These are just a few of the things that may indicate your child could benefit from occupational therapy. Occupational therapists can work on fine motor skills and handwriting, time management, manual dexterity, organization, spatial relationships, memory, and more. By improving these skills, your child will have a greater chance of succeeding in school!

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Executive Functioning Tricks for High School Students

High school students are often faced with ever-increasing demands for organizational skills, planning longer-term school projects andhighschool boy managing busy daily schedules. When there are challenges in meeting these demands, the student’s performance and confidence may be negatively affected. Because this developmental stage is focused on increasing autonomy, the goal is to equip your teenager with strategies that they can carry out independently and internalize as they continue to mature. The best way to do this is to have them practice in their everyday life as well as receive consistent feedback from the adults around them. In addition, giving the teen opportunities to say what is working for them and what is not provides them with a sense of control and teaches essential self-monitoring skills. Below are strategies for some of the biggest challenges that your teen may be facing.

Tips for getting teens started on tasks:

  • Develop a schedule with start times
  • Use prompts that will remind the teen (e.g., written plan/schedule and/or use of timers, alarms)
  • Adults can reinforce the use of these strategies by offering positive feedback

Tips for planning and organizing:

  • Develop time lines for long-term projects
  • Explicitly teach the problem-solving process (i.e., identify goal, identify possible strategies, select the best one, develop sequential steps and gather what is needed, begin, monitor, and modify as necessary). Model this process a few times and have the teen carry out the process while verbalizing the steps
  • Create a specific and protected “study time” every day that focuses on planning and prioritizing assignments
  • Have the teen make use of a planner to track assignments, due dates and study time
  • Parents and teachers can monitor the effectiveness of these strategies and modify them as necessary

Tips for decreasing impulsiveness:

  • Teach the teen self-monitoring strategies to check work for careless mistakes
  • Have the teen develop internal self-talk that reminds them to stop and think prior to responding
  • Reinforce the teen when careful and conscientious behavior is observed

Tips for working memory:

  • Teach the teen how to preview new material for greater comprehension
  • Daily practice and review of information
  • Encourage active listening skills (e.g., asking questions) and playing with the material in meaningful ways


Making School Day Routines Easier with a Schedule

With school in session, it is important to solidify those morning, after school, and nighttime routines.  Using schedules provides predictability, encourages independence, and aids in transitions with your child.

Mother and daughter planning a schedule

Here are some quick tips to help make morning and nighttime routines easier with a schedule:

Types of Schedules:

A schedule can be created for any routine, such as bathroom, dressing, leaving for school, or after school routines.  For example, “Eat breakfast, brush teeth, and grab backpack” can be used for a morning routine, or “Eat snack, do homework, have 20 minutes of free time” could be used for an after school routine.

Location of the schedule:

Schedules should be placed where they are most accessible to your child.  If you are trying to promote independence while dressing, place a schedule on your child’s closet or dresser.  Bathroom schedules can be placed on a mirror, and morning/after school schedules can be placed on the refrigerator or door.

Using Pictures:

Pictures are great visuals for younger children or children who have difficulty understanding spoken language. Pictures can be drawn on a dry erase board or mirror, found on a computer (i.e., Google images), or cut out from a magazine.

Including your child:

Encouraging your child to help create his or her own schedule will increase comprehension and motivation for the responsibilities.  It is important to complete schedules before the routine begins.  For example, morning and after school schedules should be completed the night before.  Night schedules could be completed before dinner.  Your child should manipulate his or her schedule by moving pictures from the “to do” to the “all done” pile, or crossing off written tasks.


Having some flexibility with your child’s schedule is okay, as long as the schedule is set before the routine begins and the arranged schedule is followed.  Rearranging the sequence of tasks, giving your child choices, and introducing new activities allow for flexibility within schedules.

Setting routines and implementing schedules should help make life a little easier.  If you have any suggestions that make your morning, afternoon, and nighttime routines easier, please share them below.

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How To Improve Handwriting Skills, Part 2 | Pediatric Therapy Tv

In part 2 of How To Improve Handwriting Skills, Occupational Therapist works on specific  handwriting techniques with a student.  (Click here For Part 1)

In This Video You Will Learn:

  • What’s the best sitting position for good handwriting
  • What is a slant-board and how it can help
  • What is a helper hand

Video Transcription:

Announcer: From Chicago’s leading experts in pediatrics to a worldwide
audience, this is Pediatric Therapy TV, where we provide experience and
innovation to maximize your child’s potential. Now your host, here’s Robyn.

Robyn: Hello and welcome to Pediatric Therapy TV. I’m your host, Robyn
Ackerman. Today I am standing with occupational therapist
Deborah Michael. Deborah’s going to show us how to work with a
child on handwriting.

Deborah: You have to stay between the two red lines, right? All right,
are you ready? How’s your engine feeling now? A little slower,
right? Okay. Which pencil are you going to use?

Child: This one.

Deborah: Okay. Here goes the timer. Are you ready?

Child: What should I write?

Deborah: Well, let’s see your shirt. How about ‘Go Blackhawks’? Ready?
Okay, now you want to make sure your feet are on the floor, your
elbows are at the right height, and the chair is very important,
the chair you’re on. We already talked about that. The ball, the
chair, the blanket, go.

Make it a capital. Hit those two red lines. Let’s move this up a
little bit. Go ahead.

This is a slant board, which is easier to write on and also
easier when you’re copying from a blackboard. Here, let me get
that. I just wanted to show everybody. The slant board, when
you’re copying from the wall, it’s just easier than going all
the way down to the floor.

Child: Is ‘hawks’ capitalized?

Deborah: You have it right here. You can capitalize the whole thing.
There you go. Well, now you’re going really slowly. Let’s make
it a little bit faster because your time’s almost up. We
definitely slowed you down. Nice. Now let’s just copy this. You
can see how it’s a little bit easier with this slant board to
copy this. Just write ‘2010’ right there.

Beautiful. Just one more thing. Wait, this is your helper hand.
You need your helper hand on the paper. Go ahead. Good work. All
done. High-five. OK. Go take a break. Go run around.

Robyn: Thank you Deborah, and thank you to our viewers. And remember,
keep on blossoming!

Announcer: This has been Pediatric Therapy TV, where we bring peace of
mind to your family with the best in educational programming. To
subscribe to our broadcast, read our blogs, or learn more, visit
our website at That’s

Getting your Child to do Homework

With the start of a new school year, comes the responsibility of homework. From time to time, noncompliance, frustration, screaming and yelling can be combined with this task. To help avoid battles and headaches that can sometimes accompany homework, try these helpful tips.

Tips To Get Your Child To Do His/Her Homework:

• Determine a schedule. Make sure that your house has a routine for when it is time to do homework. Everyone should be aware and in agreement of when homework needs to be completed, and the designated time should remain the same everyday. For Girl Not Happy About Homeworkexample, homework could be started as soon as your child gets home from school or right after dinner. In regards to the weekends, homework could be done on Fridays when they get home from school or on Saturday mornings. It is a good idea for your child to complete the work as early as possible so they are able to enjoy their weekend and do not have the task hanging over their heads. Waiting until Sunday night may cause your child to rush on a particular assignment. In order for your child to have ownership, they should help with creating the homework schedule. Involving your child with the input and creation of the homework schedule can help them get on board and be more likely to follow through.

• “First, then” directives. Even with having a time schedule for when homework should be completed, you can still run into complications. Your child might want to do something more personally reinforcing than doing their homework. For example, they might want to watch television, play basketball or a video game, etc. When these situations arise, provide a simple “first, then” directive (i.e., “First you finish your homework, then you will have time to play basketball before dinner.”)

• Establish an area. Just like having a set time for your children to do their homework, there should also be a specific area in which homework is done. Once again, including your child in designating the location of the area can be very beneficial. With picking a homework station, you want to select an area that will have minimal distractions. For instance, completing homework at the kitchen table, computer room, or office studio might all be good places. Another option could be to go to the local library to complete homework. Make sure your designated space has all the proper supplies necessary: paper, pencils, art supplies, etc., in order to help limit time wasted locating and getting items to start the task.

• Let them pick. Let your child decide what subjects, he/she does first. As long as your child completes all of his/her homework it should not matter what assignment is completed first or last. If your child is having a hard time getting the amount of work done daily, or becomes especially frustrated with certain assignments, it may be helpful to discuss with his/her teacher some of the following suggestions: a strategy for what daily assignments should get priority, a time limit for a specific task, check lists for organizing what needs to be done, breaking assignments into chunks, outlining the steps of certain assignments.

• Keep quiet. While your child is working on homework it is wise for you to keep quiet and do your “homework” too. If you are being loud or engaging in more fun/exciting activities, your child might try to escape from their task and try to partake in what you are doing. While your child is working, this could be a good time for you to pay bills, read a book, or do some housework. You want to try to avoid doing things like watching television, playing on the computer, or doing Wii Fit.

• Guide; don’t do. You want to provide help and guidance while your child is doing homework. However, you do not want to do their assignments for them. Take a step back and only get involved when they ask for your help. Provide just enough help and prompts so they can continue to complete the assignment as independently as possible. If your child is able to do the task independently, look over their work when they claim to be finished. This will show you are interested in what they are completing and enable an opportunity for praising their work when done appropriately.

• Praise. The verbal praise given to your child when completing his/her homework and bringing home good grades should let them see how happy and proud of them you are. In addition, you can also use tangible reinforcers (i.e., going out for ice cream, giving them a special toy they wanted, having some extra television or video game time, or money). You may want to choose these types of rewards for a particularly challenging test, project, or assignment since you do not want to always rely on these tangible reinforcers. You do not want your child to always expect something for completing their homework or getting good grades; instead, you want to show them the personal satisfaction gained from working hard and trying their best when achieving a goal.

• Natural consequences. If your child flat out refuses to complete his/her homework, let them endure the natural consequences of not doing their homework. Write your child’s teacher a note or send an email informing him/her that your child had the time and opportunity to complete the homework assignment but chose not to do it. With the natural consequences of disappointing the teacher, points being deducted because of the assignment being late, or receiving a zero on the assignment, can make your child realize how important it is to do his/her homework.

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Helping Your Child Plan and Organize Their Daily Lives

The start of school brings many changes with children’s daily lives. Children must be able to transition between subjects, organizing their work, sitting at home, and independently taking the initiative to do their homework and monitor their own productivity. These above behaviors all fall under the label of “executive functioning.”

homework with mom and daughterMany children are able to complete these tasks and behaviors independently; however, a large portion of children also struggle with one or more of the behaviors and tasks. As a result, many children benefit from strategies to help develop their organization, planning, problem solving, time management, and monitoring of their work.

Parents vs. Children on Homework Assignments

As a psychologist, I often have parents inform me about constant battles that they have with their children to complete daily homework assignments. Specifically, parents often report to me that their children will do anything but start their homework (surfing the internet, texting friends from their cell phones, or watching television/playing video games).

Two major executive functioning tasks are involved with the child’s ability to complete daily homework: Initiation of action and time management. Children who demonstrate issues with their ability to complete daily homework benefit from strategies and interventions that target their ability to start and complete their work in a timely fashion.

Tips to help children complete daily homework:

  • Developing a daily “Need to” (homework, chores) and “Want to” (baseball practice, dance lessons, video game time) list of tasks
  • Prioritizing the list with estimated time requirements for each task
  • Verbally and physically prompting your child before starting each task by (e.g., “John, what is the next thing we should do?” while tapping him on the shoulder)
  • Positively reinforcing all self-initiating tasks by giving praise when your child starts a project on his/her own

Dealing With Your Child’s Forgetfulness About Assignments

Another major area of concern I hear from parents is that although their children are able to actually complete the work, they struggle with their organizational skills and will either forget about the assignments or lose the work between home and school. As a result of the difficulties with organization, all children benefit from strategies to improve this area of functioning.

Strategies that have proven to be effective with the development of a child’s organization include:

  • Structuring and scheduling designated ‘study time’ as part of your child’s daily routine.
  • Completing homework in a central location away from distracters including television, computer, telephone, and other people who might be disruptive.
  • Creating time-lines for long-term projects, breaking tasks down into basic elements with separate due dates for each task.
  • Discussing homework expectations with their teacher to determine the recommended amount of study time.

With the start of school, we want to help children be as organized as possible and ready to complete daily homework in a timely fashion. Following the above strategies and developing some of your own will ensure that your child will be more organized and less stressed!

5 Tips For Easing back into the school year

Another summer has flown by, and a new school year is right around the corner. Parents and children alike are wondering what the new school year will bring. Parents wonder: will my child have tons more homework this year? Will my child meet new friends? Will my child have time for extracurricular activities? Children Children walking to schoolwonder: Will I like my new teacher? Will I get a recess? Who will I eat lunch with? Will I get to ride the bus? Here are some tips on preparing for the school year ahead, so that everyone can have a smooth transition from summer into fall.

1. Map out the route to school

Whether your child is going to walk to school, take the bus, or carpool with friends, both of you will feel more confident in the transportation process if you know where your child is going (e.g. which streets), how they are going to get there (e.g. meet a friend on the corner; turn right at the red fire hydrant etc), and how long it will take. You and your child can take several practice runs at using this route before school actually begins so that you can work out any kinks that may arise.

2.Talk About Changes

Make sure to talk about any changes that may be occurring this year, such as a new teacher, a different classroom, a new school, or a longer school day. By being honest and open with your child, they will be more likely to voice their concerns, and you can then work through these fears right away. You can make a chart with your child, listing “things I am excited for” and “things I am nervous about” or “things that will be different”; focusing on the pros of this new change occurring, and reinforcing that you know change can be difficult and scary, but it will help them to grow and learn.

3. Prepare a homework space

Prepare a personalized study nook or a homework table where your child will be able to have his own space to concentrate and spread out their schoolwork. Help him to find a table and chair combination that promotes a 90 degree angle of the hips, knees, and elbows so that your child has a tall, supportive posture to elicit good postural control and attention to task. Make this area more exciting by allowing your child to hang a bulletin board nearby with a calendar or pictures on it; have a cup full of different pencils/pens/markers for a variety of assignment; or a plastic bin containing a pair of scissors, ruler, markers, glue, highlighters, etc.

4. Plan out lunches

Plan out “special” lunches that your child enjoys by creating a list that can hang on the refrigerator. This will help your child to be involved in her lunch-time meal plan, help to eliminate extra planning time for the “lunch packer” in the morning, and also help parents prepare before making a trip to the grocery store. This list can be broken into different categories, such as “fruits”, “veggies”, “sandwiches”, “snacks” and “desserts” so that your child can learn more about the food pyramid and will be able to help to pick out one item from each category when packing a lunch.

5. Ease into a sleep schedule

Start easing your child into a school schedule by having him go to bed and wake up at similar times he will have to do when school begins in a few weeks. Work together to find activities that help to calm him down and/or wake him up, to use at night to unwind before bed, or in the morning to get the body moving (e.g. a warm bubble bath; reading a book; watching 1 television show; jumping jacks; wheelbarrow walks).

Save Time: Incorporate Your Child’s Home Exercise Programs into your Daily Routine

Therapy Homework Doesn’t Have To Be Another Task On Your Long To-Do List

Girl Helping Un-pack GroceriesSometimes, it can be overwhelming to fit everything into your day when there is just so much to do! That feeling has often led me to wish that there were at least 28 hours to each day so that it could all be accomplished! Instead of feeling like your child’s occupational therapy homework is another thing to cross off your list, there are ways you can incorporate it into your usual daily routine. Below are some ideas to incorporate this homework into your routine to make it easy to get it done.

Ways To Incorporate Occupational Therapy Homework Into Your Daily Routine

1. Have your child transition from activity to activity as he gets ready to leave the house for the day by doing heavy work.

  • For example, he can wake up and do 10 jumping jacks before going to the bathroom to brush teeth, crab walk to the kitchen for breakfast, bear crawl to the bedroom to get dressed, and then frog jump from the front door to the car to leave for the day.

2.Have your child help you with household chores. For example they can:

  • push a laundry basket
  • help vacuum
  • wipe the table off after dinner
  • push in chairs
  • shovel snow
  • rake leaves
  • changing sheets on the bed
  • take out the garbage
  • help carry groceries from the car to the house and help put them away

3. Have your child use tweezers or clothespins to help make pizza for dinner (or another meal). Have him pick up pieces of cheese or pepperoni with the tweezers and put it on the pizza dough.

Please leave a comment if you have any additional tricks to fit your child’s therapy homework into your daily schedule!

An Introduction on Interventions for Executive Functioning

As discussed in my previous blog “What is Executive Functioning”, executive functions are the skills that help organize and guide a child through daily life.
There are many aspects of executive functioning:

  • Organization

  • Planning

  • Problem solving

  • Working memory

  • Initiation of tasks

  • Impulse control

  • The ability to monitor the effectiveness of one’s work

While these are different skill sets that require various accommodations and interventions, they all have several things in common.  The most common link between the various interventions is that they must involve a real-world, structured approach to teaching problem solving during everyday activities. The problem that we see all too often with clinical interventions, which don’t include practice in the child’s ‘real-world,’ is that the child may be a rock-star when completing tasks in a contrived clinical setting but still may struggle within the classroom. Read more

Strategies to Improve Homework Success

boy doing home workAfter a busy day, the last thing you want to do is fight with your child about finishing his homework. Turning in an assignment or performing successfully on a test should feel like a great accomplishment for you and your child, not a constant battle. Every child prefers different organizational and environmental strategies to help him focus and stay on task; and different strategies may work in different days depending on the child.

Homework Seating Tips:

• Exercise ball: By replacing a typical chair with an exercise ball, the child automatically receives more input to their body. He is now required to keep his feet flat on the floor, his shoulders down and relaxed, and his trunk erect with his muscles constantly firing as he keeps hjs body in an upright position. This extra input gives him increased attention and focus during fine motor and tabletop activities.

**Note: Exercise balls used as a chair are not appropriate for children who have poor postural control and weak core muscles, as this will cause them to focus on keeping their body stabilized on top of the ball, as well as on the task at hand. This may lead to rushed or sloppy work because their attention is on the exercise ball, noton their homework. Talk with an OT or PT if you have questions about the best seating for your child. Read more