Activities of Daily Living (ADLs)

Poor participation in self-care tasks or ADLs may include:

• Feeding challenges

• Trouble using utensils

• Limited food repertoire

• Poor oral motor skills

• Difficulty manipulating fasteners

• Challenges sequencing steps (i.e. trying to put on shoes before socks)

• Unable to correctly orient clothing

• Challenges with toilet training

• Sleep difficulties

• Being distressed by or unable to complete bathing or showering

Fine Motor Skills

Motor skills, which refer to the movement and coordination of muscles to perform a task, can be divided into fine or gross motor skills.

Fine motor skills refer to the ability to effectively utilize the small complex muscles of the hand and fingers with appropriate coordination, strength, and dexterity. Fine motor skills are needed to grasp and manipulate objects and are critical for independence in tasks such as dressing, feeding, eating, play, and school activities (i.e.writing, cutting, coloring). Signs of poor fine motor skills include difficulties with:

• Managing clothing fasteners (i.e. buttoning, zipping)

• Tying shoes

• Picking up small objects (i.e. beads, raisins, puzzle pieces)

• Using utensils (i.e. spearing food with fork, cutting food with knife)

• Using both hands at the same time

• Writing, coloring, drawing, cutting

• Opening containers

Gross Motor Skills

Gross motor skills involve whole body movements requiring the large muscles of the body. Gross motor skills are needed for everyday functions such as standing, walking, running, jumping, and sitting upright. Children with gross motor challenges may have difficulty with the following:

• Standing on one leg when putting leg into pant leg

• Climbing (in and out of car/bed, up/down playground equipment, stairs)

• Navigating environment (i.e. walking around/between desks in classroom)

• Throwing/kicking ball

• Maintaining upright posture while seated at desk throughout school day

• Lifting/carrying items without becoming fatigued (i.e. lunch tray, backpack)

• Riding bike/tricycle

• Sitting up straight at their desk throughout the school day

Visual Perceptual and/or Visual Motor Skills

Visual perceptual skills involve the ability to organize and interpret the information that we see. Visual motor skills are the ability to plan and execute movement of our body based on what we see. Both visual perceptual and visual motor skills are necessary for everyday skills such as reading, writing, drawing, cutting, locating items, completing puzzles, and self care skills like getting dressed. If a child has difficulties with visual perceptual or visual motor skills they might have difficulty:

• Completing puzzles, mazes, hidden picture games, find the difference activities, or dot-to-dots

• With spatial concepts such as “in, on, under, next to, up, down, behind.”

• Differentiating between “b, d, p, q”

• Keeping their place on a page when reading or writing

• Finding items in busy backgrounds (locating a piece of clothing in a drawer)

• Copying from one place to another (e.g. from board to paper)

• Dressing (i.e. matching shoes or socks)

• Completing partially drawn pictures

• Attending a word on a printed page due to their inability to block out other words around it

• Sorting and organizing personal belongings

• Navigating familiar settings (may drop or knock over items)

• Staying within the lines when coloring

• Catching or kicking a ball

• Fastening buttons or tying shoelaces

Sensory Processing

Sensory processing refers to how we experience and respond to the information coming from our body and the environment. Watch this video to learn more about the 8 senses and sensory processing. Signs of sensory processing difficulty may include:

• Crashes into wall/people frequently

• Is irritated by clothing (certain textures, tags, seams)

• Has a very high or very low threshold for pain

• Has a limited food repertoire

• Becomes overstimulated by loud noise, bright lights, strong smells etc.

• Becomes distressed by hygiene tasks (i.e. haircuts, bathing, brushing teeth or hair)

• Is clumsy/has poor body awareness

• Dislikes messy play activities such as finger painting, playing in sandbox, slime, etc.

• Enjoys pressure/being squeezed (i.e. hugs, tight spaces, snug clothing)

Social Skills

Social skills are the skills, both verbal and nonverbal, that we use everyday to interact and communicate with other people. This includes speech, gesture, facial expression and body language. Social skills are critical in enabling people to interact positively with others and make and maintain friendships. Your child may need support in developing social skills if they have difficulties with the following:

• Understanding different tones of voice or reading facial cues

• Using appropriate body language and being aware of personal space

• Cooperation and turn taking

• Empathy and perspective taking (imagining what it is like to be somebody else or in their situation)

• Self-regulation and coping skills

• Starting, maintaining, and ending conversations appropriately

• Showing interest in what the conversation partner has to say, not interrupting them, and ask appropriate questions

• Advocating for themselves (i.e. asking for help, or asking for clarification when confused)

Emotional Regulation

Emotional regulation refers to the ability to identify and manage one's emotions. This includes the ability to calm oneself down, maintain attention, and control impulses, and is necessary for participating in self-care tasks, school, play, and social interaction. Signs your child may having challenges with emotional regulation include:

• Frequent crying, meltdowns, or outbursts

• Inability to be flexible

• Withdrawing or removing oneself from situations (i.e. running or fighting being the only strategy)

• Difficulty staying calm

• Frequently being grumpy or irritable

• Being anxious, nervous, worried, fearful, overwhelmed

• Sad, fatigued, tired, low energy

• Often being loud, aggressive, or fidgety, unable to concentrate and stay focused

• Being “on edge” and emotionally reactive

Achieving Developmental Milestones

Occupational therapy can benefit children who show signs of developmental delays. If your child is not meeting developmental milestones, you should contact your pediatrician. You can learn more about development milestones for kids ages birth to 5 at https://www.cdc.gov/ncbddd/actearly/milestones/index.html