
When to refer to an OT for help

Handwriting Concerns
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Writes with too much pencil pressure, too little pressure
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Irregular sequencing of strokes when forming letters
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Poor pencil grasp
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Problems with spacing, alignment and sizing of letters/words
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Slumped posture; holds head close to paper
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Lack of established hand dominance

Vision/Visual Perceptual Concerns
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Difficulty copying from board
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Reversal of letters or numbers after 7 years old
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Unusual eye movements; difficulty with eye tracking
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Difficulty discriminating, colors, shapes, doing puzzles
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Difficulty writing on lines, poor alignment
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Difficulty copying designs, numbers, letters
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Difficulty with eye hand eye foot coordination


Fine Motor/Self Care Concerns
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Difficulty with zipping, tying shoes,
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Difficulty managing utensils, food packages, feeding self
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Messy eater, difficulty swallowing, drinking from a straw
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Needs assistance with toileting
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Difficulty using both hands together
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Lack of well-established hand dominance
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Difficulty cutting with scissors
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Difficulty coloring or drawing

Gross Motor Concerns
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Postural concerns
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Complaints of pain during physical activities
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Stiff and awkward movements
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Lacks age-appropriate strength and endurance
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Lacks age-appropriate coordination (hop, skip, jump, run, etc.)
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Clumsy—bumps into things, falls, unsafe mobility on playground, PE


Sensory Processing Concerns
1. Touch
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Reacts emotionally or aggressively to touch
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Finds some clothing distressing to wear
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Avoids messy activities: glue, clay, paint
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Scratches or picks at skin
2. Taste/Smell
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Avoids certain tastes or food smells
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Picky eater, especially regarding food textures
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Strong reactions to certain smells: perfume, cleaners, etc
3. Movement
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Becomes distressed when feet leave the ground
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Avoids gross motor activities
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Dislikes when head is upside down (e.g. somersaults)
4. Hearing
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Difficulty functioning in noisy environment
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Holds hands over ears or appears startled by everyday noises
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Doesn’t respond when name is called, but hearing is OK
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Tunes out during class discussions
5. Vision
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Bothered by bright lights
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Covers eyes to protect from light
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Watches everyone as they move around the room
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Has difficulty finding objects in desk or drawer
6. Sensation seeking
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Enjoys making strange noises
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Can’t sit still, fidgets, rocks in chair
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Becomes overly excited during movement activity
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Touches people or objects
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Jumps from one activity to another