When should a child be evaluated by an occupational therapist? (Part 1)


It is important to keep in mind that each child develops at his/her own pace.

The moment a child’s performance is impaired/influenced/limited in a life sphere (school, play, social skills, self-care, communication) the child should be referred for an occupational therapy assessment. If a child shows impairment in one of the following areas and/or struggles to cope with his/her current grade this child can be referred for an occupational therapy assessment

1. Fine eye-hand coordination?

This is the ability to use eyes and hands together to perform a task.  We all use this skill every day in different kinds of situation:  tying shoe-laces, writing, cutting, dressing, the list is endless. It can only be the child’s hand function that is causing the impairment but vision (acuity and eye-muscle functioning) also play a big part. Children that struggle with in-hand manipulation/hand strength and/or individual fingers movements will find this skill difficult. Children that don’t have a dynamic tripod grip may also find writing/colouring/drawing difficult.

Dynamic Tripod grip

How will I know if a child has a problem?

  • The quality of the child’s writing/colouring/drawing is insufficient for his age
  • Your child will struggle with activities that kids the same age finds easy
  • e.g. buttoning small buttons when dressing, picking up small objects,
  • threading beads, etc.
  • Your child will rather get involved in gross motor activities than table-top tasks                                                                                                                 

2. Muscle tone and/or postural control

Muscle tone refers to the natural stress in the muscle when at rest. It is not the same as muscle strength.

Postural control is influences by the proprioceptive (internal GPS of the body) system and the vestibular (movement and balance) system. A child that that had impairment with postural control or low muscle tone will use more effort to assume and maintain different postures/positions. Impairment here may influence gross motor skills, fine motor skills and weight bearing tasks. As these kids find it difficult to sit still their concentration will also be negatively influenced.


How will I know if a child has a problem?

  • Tires more easily than other children
  • Struggles to sit upright in a chair (slouches)
  • Appear clumsy / uncoordinated
  • Wants to sit when the have to stand and lie down when the have to sit
  • Rides on her chair                                                                                         (w-sitting)
  • Find it difficult to maintain one position for a long time
  • Slouch in chair
  • May use a broad base of support when sitting – e.g. w-sitting
  • May drool
  • Finds it difficult to sit still – fidgety
  • Usually doesn’t part-take in endurance sport

3. Visual perceptual skills?

These skills are necessary to interpret seen information in the brain. These skills are the building blocks for reading, writing and maths.

How will I know if a child has a problem?

  • Kids who struggle with foreground-background will ‘steal’ words/
  • letters from other sentences/words and add it to the word/sentence they are busy reading. Also struggled to find one items amongst others
  • Kids with a limitation in position in space and/or spatial-relationships
  • will confuse p/b/d, reverses letters/numbers e.g. 7/L, 2/s, ei/ie, 31/13
  • Kids with a limitation in form-constancy will struggle to read different
  • Fonts, to copy the teacher’s hand writing, struggles to know that a capital and lower case A is the same letter and struggles to find e.g. a triangle that is hidden begin other shapes
  • Kids with impairment in closure struggles to take parts and make it a whole e.g. building puzzles, struggles to see the picture when only the outline is visible, struggles to place letters (visually) together to form a word
  • Kids with impairment in discrimination will for example struggle to find a certain word/number on a page and to find the differences between 2 pictures
  • Kids with a limitation in memory will for example struggle to copy work from the black board and to follow visual instructions
  • Kids that struggle with consecutive memory will for example find it problematic to copy words/sentences/numbers correctly from the black board

4. Visio-motor integration

This is the ability use visual perceptual skills and finger-hand movement together to copy what you have seen. It is important to test a child’s visual acuity and eye-muscle functioning when you suspect a problem here.

How will I know if a child has a problem?

  • The child struggles to copy work from the black board/a book

5. Bilateral integration?

That is the ability of both sides of the body to work together to perform a task in a coordinated way. We use this skill daily e.g. skipping, riding a bicycle, eating, swimming, running and much more.

Gross impairment here will influence laterality and midline-crossing negatively.

How will I know if a child has a problem?

  • Appears to be uncoordinated when doing tasks e.g. eating
  • Difficulty in performing gross motor tasks e.g. skipping, galloping, jumping-jacks, etc.
  • Struggles more to perform a task using both hand together but performs adequately when doing the same task using only one hand

6. Midline-crossing and laterality

Dominance will start to develop between age 2 – 4 years and should be intact by 5 years 6 months of age. Only 5% of the population is truly ambidextrous – the rest of the kids that that swaps their hands/feet exhibits cross-dominance. Cross-dominance influences processing speed negatively and will this influence work speed as well as his fine-motor skills negatively. The ability cross the imaginary midline of the body is midline-crossing Kids that show impairment here may also struggle with fine-motor skills, bilateral integration and processing speed.

Charming little girl is smiling while doing yoga in fitness hall

How will I know if a child has a problem?

  • Choses a dominant hand later than expected or not at all
  • Swaps/changes hands while performing a task
  • Uses her left hand on the left side of her body and the right hand
  • on the right side of her body
  • Don’t want to cross the midline of her body
  • Moves the book to the left/right when drawing/writing
  • Turns/leans her body to the left/right when drawing/writing
  • Turns the paper while drawing/colouring
  • Poor sense of direction
  • Confuses left/right after 7 years of age

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