Date implemented:
Clients Initials and Age: C.K. 4 years old
Diagnosis and any precautions: (1) Autism with receptive and expressive communication delay
Goal/s being addressed: (1) Motor planning [C.K. will follow a picture schedule to negotiate a 4-step obstacle course with no more than 2 prompts total,
3 out of 4 trials]; fine motor skills [Given a writing utensil and paper, C.K. will independently imitate a circle and plus sign, 3 out of 4 trials]; dressing skills [C.K.
will independently engage zipper and zip his coat, 3 out of 4 trials, by the end of the authorization period]
Specific Objectives for
Intervention Activities
this Activity (list 2-3)
(5)
(5)
C.K. will complete a four-step
obstacle course four times with
minimal assistance for
maintaining balance.
C.K. will engage zipper on zipper
vest with hand over hand
assistance followed by
independently pulling zipper all
the way up.
This activity was chosen to
Four-step sensory motor
address motor planning,
obstacle course: stepping
balance, and dressing skills. C.K.
stones, foam balance beam,
presents with impulsivity in his
bucket bridge, and zipper vest;
movements, frequently veering
to be completed four times in
to the side while walking,
the above order
creating a loss of balance. These
deficits interfere with his ability
10 minutes
to maintain adequate personal
space when interacting with
peers. The obstacles are
designed to challenge C.K.s
balance through different
surfaces/tactile input and
varying lengths of stride
required to go from one step to
the next. Additionally, C.K.s
decreased fine motor skills limit
his ability to participate in
dressing tasks, including those
Time allotted for session: 30 minutes
10/25/17
Results (link to activity
Activity Demands Modifications (provided
objectives; include
(setting, materials, and during the activity and
objective measures of
social requirements) planned for next
performance when
(5) session) (5)
possible) (5)
C.K. required a visual schedule Because C.K. was having trouble
and three verbal cues to follow engaging the zipper while
the sequence of a four-step wearing the vest, that portion of
sensory motor obstacle course. the activity was graded down so
The obstacle course included that the vest was flat on the
Setting: OT room
stepping stones, foam balance floor.
Materials: stepping stones,
beam, bucket bridge, and zipper
foam balance beam, bucket
vest. C.K. required minimal For a future session, it would be
bridge, and zipper vest set up in
assistance to maintain his beneficial to first practice with a
a square
balance with moderate verbal zipper on a flat surface
Social requirements: awareness
cues required to remind him to (attached to a board) before
of body in space and in relation
slow down and look where he attempting a zipper on a piece
to other people and objects;
was going. He completed the of clothing. Additionally, a visual
communication of need for help
obstacle course four times with or verbal description of the fine
when completing obstacles
moderate loss of balance. C.K. motor movements required to
and/or engaging zipper; self-
required maximal assistance to engage the zipper may be
regulation when completing a
engage zipper with hand-over- beneficial for C.K. as visual
nonpreferred activity
hand demonstration of where to schedules for both the therapy
place hands on vest. He session and the obstacle course
Grade down: Complete zipping
required moderate verbal cues were utilized by therapist.
step of obstacle course with vest
and additional time to pull up
flat on floor versus on body
zipper and additional verbal cue Because C.K. could maintain his
Grade up: Arrange stepping
to unzip vest versus pulling it balance relatively well, future
stones and bucket bridge to be
apart. C.K. completed zipping obstacle courses should increase
further apart, requiring larger
sequence four times total, two this challenge. Stepping stones
steps and increased
times while wearing vest and and bucket bridge should be
maintenance of balance
two times with vest flat on floor. spread further apart to increase
the distance required for each
C.K. met both objectives for this step. C.K. should continue to
activity though he required receive verbal cues to slow
more assistance than down and look where he is

Table work: imitation of shapes;
focus on correct and consistent
formation (counterclockwise) of
circles
10 minutes
utilized both at home and at anticipated with engaging the going in order to decrease
school, such as buttoning and zipper. He demonstrates instances of loss of balance.
zipping. By continuing to understanding of how the
practice these skills, his pieces fit together but lacks the
coordination and finger strength coordination and hand strength
will increase, leading to an to engage them. C.K. expressed
increase in independence in frustration with the zippering
dressing skills. step of the obstacle course and
required redirection of behavior
to complete the task. Though
this appears to be a
nonpreferred activity, he would
benefit from continued practice
in therapy sessions in addition
to other activities targeting
hand strength and bilateral
coordination for small tasks.
While completing table work,
C.K. will independently draw a No modifications were required
C.K. required minimal verbal
shape of his choice. during this activity. C.K. met
Setting: OT room cues for bilateral coordination
both objectives and
Materials: table and chairs; box and grasp. He completed all
C.K. will trace a circle with demonstrated good listening
to rest feet flat to facilitate 90- drawings with an emerging
correct formation 3/4 times. skills throughout the activity,
90-90 position while drawing; quadrupod grasp, wrist
only requiring redirection two
blank paper, crayons, extension, and forearm resting
This activity was chosen to times.
highlighter, markers on table. C.K. independently
address prewriting skills
Social requirements: awareness drew a rectangle with no
required for participation in C.K. traced two different circles
of body in space and in relation prompting. He successfully
classroom activities. C.K. one drawn with a different
to other people and objects; imitated a plus sign 4/4 times
demonstrates the ability to colored crayon and one drawn
communication of need for help with one verbal cue for direction
imitate a circle but with with a highlighter, a green dot
when tracing or imitating of lines. C.K. imitated a circle
inconsistent formation. As part to symbolize start, and a red
shapes; communication with 3/4 times with inconsistent
of Handwriting Without Tears, dot to symbolize stop. His line
therapist to facilitate formation and traced a circle
circles should be drawn in a was more precise and on target
conversation regarding shapes 3/4 times with correct
counterclockwise fashion to when tracing the highlighter
and colors formation and minimal verbal
build the foundation for letter circle. In future sessions, table
cues from therapist.
formation. C.K. consistently work to address circle formation
Grade down: Compete tracing
draws circles with a clockwise should utilize this technique
of circles with hand over hand C.K. met both objectives for this
movement which will again as it provides a visual cue
assistance. activity with independent
complicate future letter for correct formation. To
Grade up: Complete a simple drawing of a shape of choice
formation and writing. Table increase his challenge, the
drawing of a house, utilizing completed without direction or
work additionally allows for circles to trace can be drawn
basic shapes of circle, square, prompt from therapist. Due to
time to address and practice with just highlighter and no dots
and triangle increased attention to task, C.K.
appropriate writing posture, or drawn in a variety of sizes.
successfully imitated shapes
including wrist extension,
though he continues to require
 forearm flat on table, grasp, and
proper sitting (90-90-90).
C.K. will correctly identify the
shape of 4/10 puzzle pieces with
minimal verbal cues.
C.K. will correctly identify the
color of 4/10 puzzle pieces with
minimal verbal cues.
This activity was chosen to
Fine motor: remove and replace
address fine motor skills in
pieces of a train puzzle;
addition to identification of
identification of shapes and
shapes and colors. C.K. knows
colors to work on
the names of basic shapes and
communication skills required
colors but is unable to identify
for classroom activities
either when presented with an
object, such as a crayon or toy.
10 minutes
Continuing to address these
deficits in each therapy session
using various cues (verbal,
visual) will reinforce the name-
object connection and increase
C.K.s accuracy in identifying
shapes and colors, thereby
increasing his participation in
classroom activities.
S/OT name: Emma Sabransky
verbal cues for correct
formation. C.K. used an
appropriate grasp for the
duration of the activity except
for the last few minutes when
he regressed to a digital pronate
grasp, likely due to fatigue. He
would benefit from continued
practice with circle formation as
failure to correct this behavior
will impede future letter and
word development when
writing.
While completing a train puzzle
composed of ten pieces, C.K. C.K. demonstrated adequate
required maximal assistance and fine motor skills and
Setting: OT room
visual cues for identification of coordination for removing and
Materials: train puzzle set out
colors in addition to maximal replacing the puzzle pieces.
on floor/mat
assistance and therapist-offered Because he struggled so much in
Social requirements: awareness
options for shape identification. identifying shapes and colors,
of body in space and in relation
He independently identified neither objective for the activity
to other people and objects;
1/10 pieces correctly for color was met. In addition to verbal
communication with therapist
and shape. cues, C.K. was provided with
to facilitate conversation
PECS cards for each color in an
regarding shapes and colors
C.K. was unable to meet the attempt to help him match the
objectives for this activity as his puzzle piece to the correct color.
Grade down: Complete activity
current ability to correctly
with therapist identifying each
identify shapes and colors is Because C.K. benefits from
shape and color; C.K. must
severely decreased. Though he visual schedules and cues,
repeat each before removing
knows the names of basic future sessions that address
next puzzle piece
shapes and colors, he is unable color and shape identification
Grade up: Complete activity
to identify them on an object should incorporate PECS cards
while prone on linear swing to
and will list them off until he is to facilitate a matching activity.
facilitate extension and increase
correct, demonstrating that he C.K. should repeat each color or
core stability
is unable to consider the shape as he sorts/matches
objects properties and express them.
an accurate description. C.K. did
not demonstrate frustration
with this activity despite
needing maximal assistance.
Kushki, A., Chau, T., & Anagnostou, E. (2011). Handwriting difficulties in children with autism spectrum disorders: A scoping review. Journal Of Autism And
Developmental Disorders, 41(12), 1706-1716. doi:10.1007/s10803-011-1206-0

Abstract: Functional handwriting involves complex interactions among physical, cognitive and sensory systems. Impairments in many aspects of these systems
are associated with Autism spectrum disorders (ASD), suggesting a heightened risk of handwriting difficulties in children with ASD. This scoping review aimed to:
(1) survey the existing evidence about potential contributions to compromised handwriting function in children with ASD, and (2) map out the existing studies
documenting handwriting difficulties in children with ASD. The current evidence implicates impairments in fine motor control and visual-motor integration as
likely contributors to handwriting difficulties in children with ASD, though the role of the latter is not well-understood. Moreover, diminished overall legibility
and compromised letter formation are emerging points of convergence among existing studies of handwriting quality in children with ASD.

Each of my intervention activities incorporated some degree of fine motor skills and coordination as this is a current deficit for C.K. Decreased hand strength,
grip strength, and overall lack of motor planning for manipulating objects with fingertips affect C.K.s ability to complete fine motor tasks required for ADLs and
prewriting activities. As the article explains, there is an increased chance for handwriting difficulties in children with ASD. Additionally, fine motor control is
identified as one of the impairment areas that can contribute to this difficulty. When examining the effects of motor control or visual-integration deficits, it was
found from handwriting samples that children with ASD struggle with overall legibility, letter formation, alignment, spacing, and sizing, and speed. C.K. is not
currently writing, however, interventions have been focused on prewriting skills, specifically those utilized in Handwriting Without Tears. Because he
demonstrates fine motor deficits before beginning handwriting, it is important for therapy to address these issues now in order to prevent or lessen future
handwriting complications, such as those identified in the article. Future therapy sessions should continue to make fine motor skills and coordination a top
priority to increase hand and grip strength, grasp, in-hand manipulation, and manipulation with fingertips which will subsequently increase his independence in
prewriting skills and ADLs, such as dressing.

Find one peer-reviewed article that supports the intervention you planned/provided. At the bottom of your plan, paste the abstract and
citation and then in your own words describe how this supports your intervention plan. (5)

Total: 32 points