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Though this can vary, for many children the below is a brief summary of some of the signs of Dysgraphia. Often a mixture of cursive and print writing (especially at an age wen cursive has been introduced). Despite these mentioned challenges, a child that has signs of one of the above difficulties does not suggest that a child has Dysgraphia. Often a large focus for most OTs addressing handwriting difficulties, including Dysgraphia. Given our heavy focus on Sensory Integration at OTFC, we will also assess a child’s difficulties in touch perception and discrimination. In addition to these, the Handwriting Speed Test will provide insight into a child’s handwriting, compared to age norms of their peers. From such assessments it is important to establish what therapeutic approach is going to be most effective as well as appropriate.
Moreover, from assessments and information given from a number of people that spend time or work with a child, one can gain a picture of whether or not the child does present with Dysgraphia. Once the above areas are somewhat more consolidated, then we we would place further emphasis on mastering the skills through practice and repetition. For most children, if they have significant difficulties and clear signs of Dysgraphia, these difficulties will often continue and support will be required.
Pencil grips, slant boards, Dictaphones, use of computers, scribes, voice activated software and even oral assessment can be very effective in providing options for those that want to get their ideas across, but struggle to do so. So, now that we know a little bit more about Dysgraphia, we will next week look at some specific ideas to help those with handwriting difficulties, such as Dysgraphia, addressing remedial, functional and compensatory approaches for home and school. Rice, depending on the form with which it is used, can help children’s explore their sensory world in a great variety of ways. Of course, there are plenty of ways to use rice and I am sure many of you out there have more to share, so please feel free to comment on the post and share your other ideas. A system that is being employed in a number of schools, and we have had some success in Social Skills groups at our clinic, is Restorative Justice. Similar to this, some people often refer to emotions and emotional control as an ‘emotional balloon’ (i.e. Again, there are a number of other skills and strategies that can be employed, however the above list is a start and provides some useful differences to the ideas for younger children.
For many children, having to rely on Social Skills is a challenge at Kindy, School or even at home. As some children will soon be entering into their final stages of Kindy, the transition to school is a big change.
Providing support for group play (start with pairs) then build up to larger groups, especially for those children who are socially less confident. Start with simple physical games, so not as socially confronting, but focusing on taking turns, combining regulation and basic social skills. Parallel play (playing a game along side another child, without specifically interacting directly with that other child) is often a good starter. Sibling Play – how to support play and the inevitability of more heightened emotional situations with siblings at home and in the community.
First and foremost, remember that siblings are often together and there is always going to be more disagreement in social play due to this. Trying to avoid too many ‘pet interests’ or ‘obsessions’ to encourage new play ideas and variation with play ideas. These are just a few ideas and can provide some further guidance for teachers and families. Next time we will look at social skill support for junior primary school children and also for those entering middle and upper primary, where social awareness and social confidence are a factor. At OTFC we always trying to work with children and families in a holistic manner. While we strive to apply Sensory Integration and Play in our work, we are always keep Neurodevelopmental approaches involved.
Primitive reflexes are so named, as they should have a short lifespan and are evolutionary reflexes important in the early years of life.
ATNR: This reflexes emerges 18 weeks in utero, and is elicited when the baby moves its head to one side, causing reflexive extension (straightening) of the arm and leg on the side in which the head is turned, and flexion (bending) of the opposite limbs. Spinal Galant Reflex: The Spinal Galant Reflex happens when the skin along the side of an infant’s back is stroked.
TLR: The Tonic Labyrinthine Reflex (TLR) is essential for head management and movement helping prepare a child for rolling , crawling, standing and eventually walking. STNR: The Symmetrical Tonic Neck Reflex (STNR) is generally present between 6 to 11 months of age. If primitive reflexes are retained beyond 6-12 months of life, they suggest evidence of a structural weakness or immaturity of the central Nervous System (CNS).
Vestibular Input – If it is empty, it can be used as a simple swing, can prove to be a simple and effective form of vestibular input. Balance and Motor Planning – If a quilt cover is filled with foam cut offs, given the cut offs can be irregular shapes, a great challenge is to walk across this bumpy surface and balance.
Flying High (particularly for younger children, have a person stand on either side of the empty quilt, collecting each corner into two, and grabbing hold.
Hotdog (You can lay your child at the end of the empty quilt cover and slowly roll your child, wrapping them up in the quilt. Bumpy jungle (with a full quilt cover, encourage the child to walk across and stay balanced. Crossing the desert storm (place a blindfold on the child and get them to walk along the mats without the assistance of vision. Humpty Dumpty (Sitting on a gym ball, with a small child on your lap, bouncing up and down, then falling to the side onto the crash mat. Ok, so your child has maybe had a block of OT, or they are on a break from OT sessions, or they had some experience with OT’s and you saw some gains from this experience?
There are so many games, toys, apps and resources out there that can be purchased to support children beyond the work they do in the clinic. However, not everyone has suspension equipment, trampolines, foam equipment and an OT on hand each day!! Hand and finger strength – The strength required to pull back a peg is hard for many young children, so using a peg is an easy way to increase hand and finger strength.
Hand endurance – In addition to strength, the longer a child can hold a peg in their finger, the better the finger muscles get at enduring tasks, which is very important for academic and functional fine motor tasks. Pincer grasp – encourages the faster, accurate and automatic movements of the thumb and first finger. Early tripod grasp skills – as mentioned, the pincer grasp is required to be able to appropriately form a tripod grasp for early academic fine motors skills, such as crayon and pencil skills.
Developing muscle tone – although often debated, muscle tone has been shown to develop and increase, and working on activities using pegs can further increase the intrinsic and extrinsic hand muscles of the hand. Finger isolation – Given the size and shape of pegs, they are in a great position to work on isolating the movements of the thumb and index finger, strengthening those muscles to support academic and functional fine motor skills. We will continue to look at how basic house items can be used to help support areas of sensorimotor development, at home, to further the gains worked on during OT.
Once you get the hang of it, you want to just try and get the most fish you can during your turn. Until we get a complete version in our hands at OTFC (hopefully within the next few weeks) check out this link to see how the numbers game works! We revisit our favourite resources in this weeks blog, and will be looking at oral motor toys. These toys are used just about every day in the clinic, serving a variety of purposes. Dino flyers – These guys will fly off, if the user blows hard and long enough through the straw. Mixed oral motor toys (min trumpet, duck whistle, plane whistle, train whistle, bendy straws, bird whistles, space ship whistle).
The above toys are ones we often use in clinic, but a number of organisations such as Sensory tools Australia, Sensabilities and Windmill Toys have a variety of oral motor toys for all children. Breath control – Some children have some difficulty with efficient breathing, particularly adapting breathing patterns for different activities. Regulation – as mentioned in breath control, some children have difficulty with modulating their arousal levels and breath control, and oral motor activities can help support this.
Awareness of the mouth – For some children, body awareness is an issue that impacts a number of areas of everyday life.

Hand dominance, hand preference or handedness are all terms used to describe a child’s natural inclination for favouring one hand over the other for skilled activities. Hand dominance is an important skill in child’s development as it ensures proficiency and efficiency in tasks that involve more complex motor plans, motor accuracy and greater skill.
Hand swapping or using Right hand on the right side and Left on the left side are often attributed to a couple of areas of difficulty. The second common barrier to successful hand dominance is difficulties with crossing the midline. Language: Similar to crossing the midline, this is often an easy way to support describing and understanding hand dominance. Occupations can be defined as “activities that people engage in throughout their daily lives to fulfill their time and give life meaning” (AOTA, 2008). As a parent, do you feel like you are constantly making multiple meals at each sitting to accommodate that “picky eater” in your home? It may seem like there is a constant battle at meal time, but it is important to remember that shifting from a full liquid diet to pureed and table foods may be a difficult, overwhelming transition for your kiddo. If child prefers one type of consistency (sticky), introduce other foods with the same consistency – this will help them feel comfortable with the foods they are eating while trying new flavors. Make meal time a relaxed atmosphere, do not pressure your child to finish all of their food. If your child enjoys soft foods, mix foods in applesauce or yogurt to give food a softer consistency. It is important to note that if your child demonstrates avoidance behaviors as strong as gagging, vomiting, coughing, or extreme discomfort through mealtime, your pediatrician should be consulted. Our Supervising Occupational Therapist specializes in Pediatrics with an emphasis on Sensory Integration. Our clients receive a complete and thorough assessment, after which the therapist writes a report stating the findings and proposes a treatment plan.
ITS Information provides high quality therapy solutions to adults and children in Los Angeles.
Disclaimer: The information on this website is not purposed to replace professional medical diagnosis, treatment or even advice.
We have already touched on Dyspraxia, which has links to Dysgraphia, however Dysgraphia is a seperate entity and  a common difficulty experienced by children and observed by OTs. It requires motor, sensory, perceptual, praxis (motor planning) and cognitive functions and the integration of these functions. It is also important to understand that handwriting and drawing can often take time to develop and just because your child may have difficulty with this skill in kindergarten or Reception, it doesn’t necessarily mean they have Dysgraphia or significant writing difficulties. Rather, a combination of these challenges can signify difficulty in fine motor tasks, such as handwriting, or potential Dyspraxia. Avoidance of these tasks during preschool can further impact on the foundation skills of the hands required for handwriting. These can be observed in standardised OT Assessments such as the Miller Preschool Assessment, Beery VMI and SIPT. For many older primary children, changing pencil grips, spending hours on letter formation and correction may not produce the desired outcomes. Often after the assessment process, there is discussion around the best course of action to address writing difficulties. Similar to other skills (particularly fine motor skills of cutting, threading, twisting) handwriting can be improved through support addressing specific motor plans and sequences. Part 3 looks at a simple idea that can be used temporarily, or if you get a few, longer term.
It effect is more or less determined by the activity chosen, as such we will look at activities and then explain further what they are doing to help support a child better understand their sensory world. Importantly this can provide deep pressure directly to the hands, which is calming on the nervous system. Some children have difficulty sitting on their chair during dinner, so rather than getting a weighted lap pad, a try a bag of rice. Some children seek sensations, especially touch, and rice can be a very effective way to support this. Just find a length of PVC, some rice, drilling a few holes into the pipe and running sticks through, then covering both ends, will be enough to make your own rain maker. So next time you decide to get rice, think about getting a bigger bag and using it for a bit…then cooking the rest! Here, if a social skill or situation requires refinement, it is often a great idea to pick that up in the moment. Replaying a scene or reflecting on what has happened and then allowing a child to ‘redo’ that scene can help reinforce the appropriate social skill, with scaffolding from other peers and adults. We often find that older children are more able to appreciate the range of emotions, and can often correctly identify their emotions for each context. Managing conflict, dealing with the unpredictability of another child (or children) and requiring language to support play are often skills that require scaffolding and teaching. As such, we are going to look at a few stages of a child’s social skill development that we often see in clinic and also discuss with parents.
This can lead to increasing comfort levels and can provide a ‘guide’ for those more uncertain with social cues and social skills. It can give some children confidence in being and playing around others, before delving into more complex reciprocal play. Having specific and set time for individualised play 1:1 can lead to more positive experiences between a child and parent and also allows parents specialised time with each child. A child with a retained Moro reflex past 4 months, may become over sensitive and over reactive to sensory stimulus. During the birthing process, it is one of the reflexes responsible for helping babies to ‘unscrew’ themselves down the birth canal.
This reflex is designed to help the infant defy gravity in order to help them get up from lying on their tummy and into a crawling position. For example, retention can be caused by a baby not requiring that specific reflex at the appropriate time of development or function. There have been links identified between the inhibition of primary reflexes and the attainment of gross-motor milestones.
This presence of primitive reflexes is often found in combination with an absence or under-developed set of postural reflexes (above 3.5 years of age), as shown in the above graph.
In clinic, we often use techniques from the Move to Learn and Rhythmic Movement programs to support integration of primitive reflexes. Your OT has mentioned that your child has some difficulties with body awareness, and amongst other things, mentions doing some ‘crashing’ activities?
This simple item can be filled, suspended and wrapped up to create an excellent home OT resource. Again, creativity can always ensure children are engaged and challenged, so feel free to explore fun ways to use your quilt cover with your child!
At OTFC we are fortunate to have fantastic facilities to work on sensorimotor aspects of development, and with the experience of our OT’s, the clinic is a great place for children to explore and develop.
As such, our newest regular topic of discussion will be ‘Home OT on a shoestring’, to answer the question, how can you continue to make gains at home, through basic everyday things? These are by far one of my favourite simple home resources to use for early fine motor development, both academically (writing, drawing) and functionally (dressing, eating).
The beauty of OSMO is that the app combines tangible elements with the visuals from the iPad.
We have previously looked at oral regulation in our Chewing through the facts article, and for further explanation of how oral motor regulation can be effective, have a peruse through the article. Importantly, these are simple, low cost and can be used with bubbles, water, paint and other oral motor activities. In particular, children who have a low awareness of their mouth, muscles around their mouth and potentially low muscle tone in mouth muscles, can have difficulty with functional mouth skills (e.g.
If you think your child may benefit from some of the above reasons for the use of oral motor toys, check out these websites which have a comprehensive list of oral motor toys. An ability to Cross the Midline and Bilaterally Coordinate the hands are contributing foundation skills that ensure consistency in hand dominance (e.g. As discussed in one of our previous posts, if a child finds crossing their midline a challenge, then they may also experience challenges in using an emerging dominant hand, across their body (avoiding crossing the midline).
Some children naturally begin using their Left hand for a number of things early in their lives, but are guided to use their right by others (especially pencil based tasks).

For young children these occupations can include activities of daily living (dressing, eating), play, rest and sleep, and social interaction. Many parents and care takers report they have difficulty getting their child to try new foods and that their toddler may only have four or five types of food that they will eat on a daily basis. Listed below are some helpful tips to increase your child’s interest in trying new types and textures of food! For instance, if your child enjoys dolls, bring doll to table and have your child feed the doll.
The therapist will request a consultation time be set up with the parents to go over the report and answer any questions parents may have. You should always consult a qualified healthcare professional with questions about any medical condition.
When you identify all the individual components required in writing, it is not surprising that many children have great difficulty undertaking and being confident in the skill of writing.
This is largely due to the difficulties in the foundation skills in writing, by a later age. A bag of rice, a few small, coloured items (with an inventory), some material and plastic sheeting – and you can make a bag or items for searching and working on visual attention, figure ground and form constancy. Encouraging this form of problem solving can increase independence in social skills and decision making. Again, this is an example of how problem solving can support independence in problem solving. Given we are constantly striving for positive social interactions, when undertaking social skills groups, we are also keen to ensure conflict is managed in an equally positive manner.
Through the use of the scale, children can identify where they are feeling, or where others are, so they can modify behaviour to support interaction. From here we will address some ways to teach and support social skill development and success at school and home.
Primitive Reflexes are automatic, involuntary movements controlled from the brain stem and executed without cortical involvement. Inhibition, though involvement of higher cortical centres, will ensure more mature neural structures to develop.
Functionally this can appear as poor impulse control, emotional lability, sensory overload, anxiety and immaturity, motion sickness and difficulties with balance and coordination. This in an important reflex in the birthing process and should inhibited between by nine months. Prone – as shown in the photo on the left, when the head is tilted forward and the hands turn more fisted with elbow flexion. Children who retain the STNR may have not crawled or instead walked on hands and feet, bum shuffled or pulled themselves to stand then walk. As mentioned, retention of a reflex may impact the development of postural reflexes, which are required to support  child maturation and gross motor development to effectively engage with their surroundings.
You’re probably wondering how you can undertake the same level of engagement seen in sessions, at home? While not all children like this, those that do enjoy the pressure that can be provided from a large, foam filled crash mat placed on their back while they are lying down. At OTFC we often give children and families home activities to support the areas addressed as challenges for their children, outside of the clinic. However, in clinic there are a number of ways we use oral regulation and oral motor toys, and why they were important to mention in our top resources. Activities such as bubble volcano or bubble monsters (blowing through a straw into a container of bubbles) can be used to address controlled breathing and depth of breathing (i.e.
To successfully have a dominant hand, a child must have some proficient symmetrical bilateral hand skills (e.g. If something is preventing a child from participation in these occupations such as a diagnosis or developmental delay, occupational therapy can help.
Use of any information from the content of this site is solely at your own risk.All copyrights and trademarks remain property of their respective owners. It can manifest itself as difficulties with spelling, poor handwriting and trouble putting thoughts on paper as well as speed and quality of handwriting. Importantly, we have a number of advances in technology that can provide alternate options that can be cost effective and more likely adopted by the child.
As such, we will struggle to make progress in handwriting if there are difficulties in tactile perception, visual perceptual challenges or motor planning – hence the links with Dyspraxia. Given that many older children have a greater understanding of emotions, Restorative practices are often a good way to further develop feelings of empathy, and enhance problem solving and emotional understanding for children – hence its fit for social skills. Also providing scaffolding to guide’ what game will be played’, to initially provide ideas of what games to start and how to play.
These types of reflexes have survived evolutionary changes in humans, as they work on enhancing the chances of survival, growth or development and protect a child’s body from its external environment.
As mentioned above, if primitive reflexes are retained beyond 12 months of life, they suggest evidence of a structural weakness or immaturity of the central Nervous System (CNS). A retained ATNR can include difficulty crossing the midline from one side of the body to the other (including eye movements, such as tracking words across a page), poor bilateral coordination, affected balance when the head is turned, and lack of dominant sides (e.g.
Retention can impact postural control (particularly seated posture), coordination and sustained attention.
This reflex should gradually integrate, with other systems maturing and disappearing by about the age of 3-3.5 years. Crawling is an essential skill which helps train the child’s eyes to cross midline and learn eye-hand coordination. They play a vital role in survival for crucial periods but should then undergo inhibition or transformation. A number primitive reflexes are important for child birth, and in typical development, these reflexes naturally inhibit during the first year, and are replaced by postural reflexes. Oral motor toys can provide increased activity for the mouth, supporting sensory awareness and working on mouth muscle tone and endurance.
Occupational therapists are trained to modify the environment, develop skills, and promote meaningful engagement in all the areas of occupation for children.
Because writing requires a complex set of motor and information processing skills, just saying someone has ‘Dysgraphia’ is not always sufficient or even correct!
The best course of action is often dependant on the level of difficulty experienced with handwriting.
Here, we are often encouraging children to take more responsibility for their emotions and actions – though this does require explicit teaching and support from adults. Retention can lead to reduced muscle tone, balance difficulties, motion sickness and has been linked to a tendency to toe-walk. A retained STNR reflex can present as poor muscle tone, particularly a tendency to slump while sitting, impact concentration, reading and basic ball skills.
As such, the birth process is a key an important consideration in these reflexes, and a traumatic birth experience or birth by c-section could possibly contribute to retained reflexes. Postural reflexes are more mature patterns of response that control balance, coordination and sensory motor development. For most children, hand preference begins to emerge between the ages of 2 to 4, and usually by the age of about 6, most children will develop a preferred hand. A child cleverly compensates for this by swapping hands once the dominant hand is fatigued. This graph shows how developmentally, primitive reflexes decline as postural and definitive motor actions are gained. Challenges move up from addition to things such as multiplication, for more complex equations. The onset of hand dominance usually witnesses the non-dominant hand becoming consistently used as the supporting hand. Some children may take longer to establish hand dominance, particularly those who have had difficulty and avoided fine motor tasks earlier in their development. However, even in these instances, hand dominance can be continued to strengthened and worked on.

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