OCCUPATIONAL THERAPY REFFERAL GUIDE


Make an appointment with a therapist.

Please check all items which relate to your child:
SENSORY CONCERNS

  • Seems overly sensitive to touch (may withdraw or react negatively to hand holding or a pat on the shoulder).
  • Shows an unusual avoidance of grooming activities such as combing hair, brushing teeth.
  • Avoids gross motor play; does not enjoy playground activities. May be fearful of falling.
  • Overly sensitive to sound.

MOTOR CONCERNS
  • Lags in motor milestones
  • Appears clumsy, awkward in gross motor activities.
  • Has difficulty with balance activities.
  • Falls easily.
  • Fatigues quickly. Seems to have less endurance than other children this age.
  • Poor posture; leans or slumps in chair.
  • Poor fine motor control; difficulty manipulating small objects, difficulty holding pencil, poor scissors use.
  • Has difficulty forming letters; difficulty spacing letters and words.

BEHAVIORAL CONCERNS
  • Easily Distracted, short attention span.
  • Has difficulty sifting still; fidgety, restless.

SELF HELP CONCERNS
  • Slow to develop self-help skills (eg., self-feeding, toileting, dressing).
  • Has difficulty putting on clothes, manipulating fasteners, tying shoes.
  • Feeding difficulties ("picky" eater, problems in chewing, spills food, difficulty using cup or utensils)

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