When to refer to an OT for help

Handwriting Concerns

• Writes with too much pencil pressure, too little pressure

• Irregular sequencing of strokes when forming letters

• Poor pencil grasp

• Problems with spacing, alignment and sizing of letters/words

• Slumped posture; holds head close to paper

• Lack of established hand dominance

Vision/Visual Perceptual Concerns

• Difficulty copying from board

• Reversal of letters or numbers after 7 years old

• Unusual eye movements; difficulty with eye tracking

• Difficulty discriminating, colors, shapes, doing puzzles

• Difficulty writing on lines, poor alignment

• Difficulty copying designs, numbers, letters

• Difficulty with eye hand eye foot coordination

Fine Motor/Self Care Concerns

• Difficulty with zipping, tying shoes,

• Difficulty managing utensils, food packages, feeding self

• Messy eater, difficulty swallowing, drinking from a straw

• Needs assistance with toileting

• Difficulty using both hands together

• Lack of well-established hand dominance 

• Difficulty cutting with scissors

• Difficulty coloring or drawing

Gross Motor Concerns

• Postural concerns

• Complaints of pain during physical activities

• Stiff and awkward movements

• Lacks age-appropriate strength and endurance

• Lacks age-appropriate coordination (hop, skip, jump, run, etc.)

• Clumsy—bumps into things, falls, unsafe mobility on playground, PE

Sensory Processing Concerns

1. Touch

• Reacts emotionally or aggressively to touch

• Finds some clothing distressing to wear

• Avoids messy activities: glue, clay, paint

• Scratches or picks at skin

2. Taste/Smell

• Avoids certain tastes or food smells

• Picky eater, especially regarding food textures

• Strong reactions to certain smells: perfume, cleaners, etc

3. Movement 

• Becomes distressed when feet leave the ground

• Avoids gross motor activities

• Dislikes when head is upside down (e.g. somersaults)

4. Hearing

• Difficulty functioning in noisy environment

• Holds hands over ears or appears startled by everyday noises

• Doesn’t respond when name is called, but hearing is OK

• Tunes out during class discussions

5. Vision

• Bothered by bright lights

• Covers eyes to protect from light

• Watches everyone as they move around the room

• Has difficulty finding objects in desk or drawer

6. Sensation seeking

• Enjoys making strange noises

• Can’t sit still, fidgets, rocks in chair

• Becomes overly excited during movement activity

• Touches people or objects

• Jumps from one activity to another