2 Hour OT Workshop for Early Education Teachers. Includes: 1-Developmental Milestones and Red Flags 2-Fine motor skills development strategies 3-Sensory Strategies for the classroom 4-Teaching Handwriting

1. Innovative Classroom
Strategies
A proactive Approach to Early
Intervention in Today’s Classrooms

2. 1. Developmental Milestones Ages 6 months to 5
years
2. Red Flags to Refer for Intervention
3. How to recognize children that would benefit from
OT Services
4. Fine Motor Skills development; the building blocks
to an efficient pencil grasp
5. Using Handwriting Without Tears
6. Creating Sensory Smart Classrooms
7. Helping Children that can’t sit still
8. Favorite products that can be used in a classroom
setting
Innovative Classroom Strategies
Workshop Overview

3. Developmental Milestones and
Red Flags
(Ages 6 months to 5 years)

4. 6 months to 1 year

5. Developmental Milestones (6 months to 1 year)
Gross Motor Fine Motor
•Pushes up on extended arms (5 mos.)
•Pulls to sitting with no head lag (5 mos.)
•Sits with support of his hands (5-6 mos.)
•Sits unsupported for short periods (6-8
mos.)
•Supports whole weight on legs (6-7 mos.)
•Crawls forward on belly (8-9 mos.)
•Gets to sitting position without assistance
(8-10 mos.)
•Pulls self up to standing position at
furniture (8-10 mos.)
•Creeps on hands and knees (9 mos.)
•Gets from sitting to crawling or prone
(lying on stomach) position (9-10 mos.)
•Walks holding on to furniture (10-13 mos.)
•Stands momentarily without support (11-
13 mos.)
•May walk two or three steps without
support (11-13 mos.)
• Transfers objects from hand to hand (6-7
mos.)
•Uses raking grasp (not pincer) (6 mos.)
•Routinely rolls from stomach to back and
back to stomach (6 mos.)
•Uses pincer grasp (grasp using thumb and
index finger) (7-10 mos.)
•Bangs two one-inch cubes together (8-12
mos.)
• Pokes with index finger (9-12 mos.)
•Puts objects into container (10-12 mos.)
•Takes objects out of container (10-12 mos.
•Tries to imitate scribbling (10-12 mos.)

6. Red Flags (6 months to 1 year)
Red Flags 6 to 8 months Red Flags 8 to 12 months
• Seems very stiff, tight muscles
• Seems very floppy, like a rag doll
• Head still flops back when body is pulled to sitting
position (by 5months still exhibits head lag)
• Shows no affection for the person who cares for them
• Doesn’t seem to enjoy being around people
• One or both eyes consistently turn in or out
• Persistent tearing, eye drainage, or sensitivity to light
• Does not respond to sounds around them
• Has difficulty getting objects to mouth
• Does not turn head to locate sounds by 4 months
• Doesn’t roll over (stomach to back) by 6 months
• Cannot sit with help by 6 months (not by themselves)
• Does not laugh or make squealing sounds by 5 months
• Does not actively reach for objects by 6 months
• Does not follow objects with both eyes
• Does not bear some weight on legs by 5 months
• Has difficulty calming self, cries for long periods of time
• Does not crawl
• Drags one side of body while crawling (for over one
month)
• Cannot stand when supported
• Does not search for objects that are hidden (10-12
mos.)
• Says no single words (“mama” or “dada”)
• Does not learn to use gestures such as waving or
shaking head
• Does not sit steadily by 10 months
• Does not react to new environments and people
• Does not seek out caregiver when stressed
• Does not show interest in “peek-a-boo" or "patty cake”
by 8 mos.
• Does not babble by 8 mos. (“dada,” “baba,” “mama”)

7. 18 Months to 2 Years

8. Developmental Milestones (1 to 2 years)
Gross Motor Fine Motor
•Walks alone (12-16 mos.)
•Pulls toys behind him while walking (13-16
mos.)
•Carries large toy or several toys while
walking (12-15 mos.)
•Begins to run stiffly (16-18 mos.)
•Walks into ball (18-24 mos.)
•Climbs onto and down from furniture
unsupported (16-24 mos.)
•Walks up and down stairs holding on to
support (18-24 mos.)
•Scribbles spontaneously (14-16 mos.)
•Turns over container to pour out contents
(12-18 mos.)
•Builds tower of four blocks or more (20-24
mos.)
•Completes simple knobbed wooden
puzzles of 3 to 4 pieces (21-24 mos.)
Daily Living Skills
•Starts to feed self with spoon, with some
spilling (13-18 mos.)
•Likes to play with food when eating (18-24
mos.)
•Can put shoes on with help (20-24 mos.)
•Can open doors by turning knobs (18-24
mos.)
•Can drink from open cup, with some
spilling (18-24 mos.)

9. Red Flags 1 to 2 years
Red Flags 1 year to 2 years
• Cannot walk by 18 months
• Fails to develop a mature heel-toe walking pattern after several months of
walking, or walks exclusively on toes
• Does not speak at least 15 words by 18 months
• Does not use unique two-word phrases by age 2 (more milk, big dog, mommy
help)
• By 15 months does not seem to know the function of common household
objects (brush, telephone, cup, fork,
•spoon)
• Does not imitate actions or words by 24 mos.
• Does not follow simple one-step instructions by 24 mos.
• Cannot identify self
• Cannot form a two-word phrase
• Cannot hold and use a spoon or cup for eating and drinking
• Does not display a wide array of emotions (anger, fear, happy, excited,
frustrated)

10. Developmental Milestones 2 to 3 years
Gross Motor Fine Motor
•Climbs well (24-30 mos.)
•Walks down stairs alone, placing both feet on
each step (26-28 mos.)
•Walks up stairs alternating feet with support
(24-30 mos.)
•Swings leg to kick ball (24-30 mos.)
•Runs easily (24-26 mos.)
•Pedals tricycle (30-36 mos.)
•Bends over easily without falling (24-30 mos.)
•Makes vertical, horizontal, circular strokes
with pencil or crayon (30-36 mos.)
•Turns book pages one at a time (24-30 mos.)
•Builds a tower of more than 6 blocks (24-30
mos.)
•Holds a pencil in writing position (30-36 mos.)
•Screws and unscrews jar lids, nuts, and bolts
(24-30 mos.)
•Turns rotating handles (door knob) (24-30
mos.)
Daily Living Skills
•Can pull pants down with help (24-36 mos.)
•Helps put things away (24-36 mos.)
•Serves self at table with some spilling (30-36
mos.)

11. Red Flags 2 to 3 years
Red Flags 2 to 3 years
• Frequent falling and difficulty with stairs
• Persistent drooling or very unclear speech
• Inability to build a tower of more than 4 blocks
• Difficulty manipulating small objects
• Inability to copy a circle by 3 years old
• Inability to communicate in short phrases
• No involvement in pretend play
• Cannot feed self with spoon or drink from cup independently
• Failure to understand simple instructions
• Little interest in other children
• Extreme difficulty separating from primary caregiver

12. Developmental Milestones 3 to 4 years
Gross Motor Fine Motor
•Hops and stands on one foot up to 5
seconds Goes upstairs and downstairs
without support
•Kicks ball forward
Throws ball overhand
•Catches bounced ball most of the time
•Moves forward and backward
•Uses riding toys
•Copies square shapes
•Draws a person with 2-4 body parts
•Uses scissors
•Draws circles and squares
Begins to copy some capital letters
Daily Living Skills
•Can feed self with spoon without spilling
•Washes and dries hands and face
•Can do simple household tasks (help set
the table)
•Can put on simple clothing items, with help
for button, zipper, shoelace (jacket, pants,
shoes)
•Can run a brush or comb through own hair

13. Red Flags 3 to 4 years
Red Flags 3 to 4 years
• Cannot jump in place
• Cannot ride a trike
• Cannot grasp a crayon between thumb and fingers
• Has difficulty scribbling
• Cannot copy a circle
• Cannot stack 4 blocks
• Still clings or cries when parents leave him
• Shows no interest in interactive games
• Ignores other children
• Doesn't respond to people outside the family
• Doesn't engage in fantasy play
• Resists dressing, sleeping, using the toilet
• Lashes out without any self-control when angry or upset
• Doesn't use sentences of more than three words
• Doesn't use "me" or "you" appropriately

14. Developmental Milestones 4 to 5
years
Gross Motor Fine Motor
• Stands on one foot for 10 seconds or
longer
•Hops, somersaults
•Swings, climbs
•May be able to skip
•Copies triangle and other geometric
patterns
• Draws person with body
• Prints some letters
Daily Living Skills
•Uses fork, spoon independently
•Can chew with lips closed
•Goes to the bathroom independently,
with reminders
•Undresses independently, may be
able to unbutton and unzip

15. Red Flags 4 to 5 years
Red Flags 3 to 4 years
• Exhibits extremely aggressive, fearful or timid behavior
• Is unable to separate from parents
• Is easily distracted and unable to concentrate on any single activity for more than 5 minutes
• Shows little interest in playing with other children
• Refuses to respond to people in general
• Rarely uses fantasy or imitation in play
• Seems unhappy or sad much of the time
• Avoids or seems aloof with other children and adults
• Does not express a wide range of emotions
• Has trouble eating, sleeping or using the toilet
• Cannot differentiate between fantasy and reality
• Seems unusually passive
• Cannot understand prepositions ("put the cup on the table"; "get the ball under the couch")
• Cannot follow 2-part commands (“pick up the toy and put it on the shelf”)
• Cannot give his first and last name
• Does not use plurals or past tense
• Cannot build a tower of 6 to 8 blocks
• Holds crayon with fisted grasp
• Has trouble taking off clothing
• Unable to brush teeth or wash and dry hands

16. I. SELF HELP SKILLS: The student's ability to manage personal
needs within the educational environment.
II. POSTURE/FUNCTIONAL MOBILITY: The student's ability to
perform basic developmental motor skills, posture, and balance needed
to function in and move throughout the educational environment.
III. FINE MOTOR/PERCEPTUAL SKILLS: The student's ability to
manipulate and manage materials within the educational environment.
IV. SENSORY PROCESSING: The student's ability to process relevant
sensory information and screen out irrelevant sensory information for
effective participation within the educational environment.
How to Recognize Children that would
benefit from OT Services

17. Fine Motor Skills
Development
The building blocks to an
efficient pencil grasp

18. Importance of Good Sitting Posture
Start with Stability
• In therapy we talk about
the 90-90-90 rule. This
means that when seated
at a desk, we want to
ensure the following:
• Feet flat on the floor 90
degrees at ankles
• Knees bent at 90 degrees
• Hips at 90 degrees

19. • The top of the desk should be approximately
2 inches above the elbows when the arms
are bent at the student’s side. This will
ensure that the child’s neck, shoulders,
arms, hands and fingers are relaxed.
Adjustments you can make:
• Table legs can be adjusted
• Height of the chair
• Wedge

20. Preparing little hands for an
Efficient Pencil Grasp

21. Efficient pencil grasp

22. Fine Motor Skills Development
The building blocks to an efficient grasp
• Begin by strengthening the muscles that
are used to hold a pencil properly.
– Pincer control and strength
– Arches of the hand/webspace
– Radial and ulnar separation of the hand

23. Activities to Improve Pincer control
and strength
• Picking up small items
• Peeling Stickers
• Small beading
• Lacing
• Adaptive chopsticks
• Tweezers, tongs

24. Activities to Improve Arches of the
hand/web space
• Spray Bottles
• Wheelbarrow walking
• Cupping activities
• Making a ball with Playdoh
• Hole puncher, scissors

25. Activities to Improve Radial and Ulnar
separation of the hand
• Nesting and retrieving activities.
Ex: Placing and removing pegs in playdoh, Picking
up pompoms or small beads and placing them in
a container, picking up coins and placing them in
a piggy bank.

26. Writing Tools that Facilitate a
Good Grasp
EASELS:
• The angle allows for proper positioning of
the wrist
• You stick paper on the wall

27. Writing Tools that Facilitate a Good
Grasp
PENCILS/CRAYONS:
• Use SHORT and FAT crayons/pencils
• Build up with wikki stix
• Break crayons

28. Writing Tools that Facilitate a
Good Grasp
GRIPPERS:
• Use grippers on pencils to facilitate finger
placement
• Use winged grippers for children who cross
their thumb over the pencil
• Try different grippers

29. The Writing Surface
• Use dry erase boards to teach formation of
letters then practice on paper
• Use paper with clear defined lines
• Make boxes where you want children to write.
One letter per box to one word per box.

30. Teaching Letter Formation
• Go from TRACE to COPY to WRITE
• Trace a highlighted letter rather than dotted.
• Have children copy a word exactly UNDER
the sample.
• All letters are formed from TOP to BOTTOM
and LEFT to RIGHT. (Left handed children
can go from right to left)

31. Fundamentals to teaching Letter
Formation and Letter Concept
• Adopt an eclectic approach to teaching
handwriting. (HWT is a framework and
guideline…some children need more than that)
• Letters are a combination of a few basic strokes.
Teach the strokes first. Make them “feel” the
difference
• For very young children I start by teaching them
basic strokes and I like to add a sound to each
stroke (Based on ABC Boom)
• Make writing fun with a multisensory approach
sand, rice, shaving cream, paint, stickers, blocks,
yarn, wikki stix, textured surfaces etc…

32. Multisensory Approach to Learning
Letters
• To improve focus and prep the body for learning
begin with movement activities such as “dance
around time”, “shake the wiggles out of arms and
legs” game, “jump like popping popcorn” etc.
• Teach handwriting through a multisensory approach
using “VKAT”- Visual, Kinesthetic, Auditory and
Tactile approaches (from HWT).
• Use visual cues for starting points such as large,
colorful dots, stickers, arrows for direction,
highlighter letters for tracing, bright colorful borders
for lines.

33. Multisensory Approach to Learning
Letters (cont.)
• using kinesthetic or body movements to learn letters
are helpful before ever picking up a pencil. Use fingers
to trace in sand, sit on a scooter board and race to
trace the letters or use a Flashlight to trace a huge
letter(written in chalk on a chalkboard or on a piece of
bulletin board paper hung on the wall will work).
• Tactile approach includes using raised lined paper to
help with line borders, using finger painting for tracing,
tracing or copying letters in shaving cream, or forming
letters with playdoh.
• Remember if they can see it, hear it, and can touch--
handle--and experience it, they have a three way shot
at remembering.

34. From Handwriting without Tears
• From HWT I use the formation of the letters and the
order of the letters.
First teach letters with vertical and horizontals: L F E H
T I
Then teach circular letters: U C O Q G S J D P B R
Lastly teach letters with diagonals: K A M N V W X Y Z
• Teach formation of uppercase letters first then
graduate to lowercase letters.
• However I like to teach the CONCEPT of upper and
lower case letters from the very beginning.

35. Fundamentals to teaching Letter
Formation and Letter Concept
• I also like to teach the sounds of the letters right from the start.
Naming a letter and knowing the sound that letter makes are 2
different skills. I like to teach it in a song. Ex: “Every letter makes a
sound”. If children have a hard time naming the letter, I prefer to
teach the sound of the letter first.
• Some children may need you to create a storyline behind the
formation of certain letters. Ex: lowercase letter e, I tell children they
are in a car with the family driving vroom across (horizontal line) and
we forgot the dog so we stop and go back around around around
and stop (creates an e)
• Do not look at the final product, look at the process that the child
uses to make sure the approach is correct. It will help you determine
where the breakdown is.

36. Sample of OT Handwriting Session
• Gross motor activity to get the body ready.
• Begin by waking up little fingers ex: Putty, tweezers
• Use LETTER SCHOOL App to practice the letter.
• Teach formation of whiteboard with sounds/story
• Have the child copy the letter you just demonstrated
(draw a box where child needs to copy the letter)
• Practice the letter on paper (draw a highlighted box
where child needs to copy the letter)

37. Creating a Sensory Smart
Classroom

38. Creating Sensory Smart Classrooms
(Environmental Modifications)
• Goal is to create an environment that takes
into consideration the sensory needs of
all children. Try to find ideas that will benefit
all children.
• Sensory children have difficulty organizing
their bodies from the inside out. Our goal is to
try as much as possible to create a
classroom that helps them find balance
from the outside in.

39. Sensory Smart Classrooms
Classroom Organization:
1. Set up your classroom in stations and make sure you have a quiet area where kids can calm and regroup if needed
when class get too loud.
2. Make sure the quiet area has lots of book, heavy blankets, pillows. Bean bags, earphones.
3. Provide fidget toys such as tactile balls, “stress” balls.
4. Use visual schedules at the beginning of class that “maps” out the children’s day. This helps kids transition more easily
from one activity to the next and can keep them more organized.
Classroom Activities:
1. Use songs to help children transition such as “Clean up…clean up…” or flick lights
2. Make sure your schedule allows for movement breaks as well as table-top activities. Brain Breaks are great.
3. During circle time. Keep the children that have a harder time keeping still next to you or make sure you give them
something to hold like a puppet. Or give them a fidget toy to hold on to or even a weighted lap pad.
4. Try to plan activities that incorporate as many sensory components as possible. Ex: finger paint on textured surfaces.
5. You can begin all table-top activities with a little “chair exercise” program that allows all the children to get their state of
arousal at the same level. Ex: prior to commencing a handwriting task. Sing a song with the children that wakes up the
arms, legs, stretches etc…
6. Consider having a “treasure box” with a variety of sensory toys. You can send a child to pick a sensory toy that helps
them calm and become centered/organized. Ex: Put stress balls, fidget toys, body brush, lotion, etc…
7. Make a “bean bag snake” using a sock and dried beans. The over-aroused child can put it on his shoulders or lap to
help calm during circle time or at table-top.
8. Outdoor activities are an all around wonderful sensory experience.

40. Sensory Smart Classrooms
Sensory/Arousal:
1. For children who need to calm, use deep pressure such as pressure with
your hands to his/her shoulders
2. Another great way to calm is to give a child heavy resistive work to do ex:
carry heave books to the table, push/pull heavy cart.
3. For children who need increased arousal, have them do a few jumping
jacks, wall push ups etc… or use light touch from your finger tips or a feather
to awaken their senses.
4. For children who touch other peers during circle time, consider sitting them
against a wall or bookshelf for extra grounding and trunk support, give them
a fidget toy to hold
5. Touching others can be an indication that the child needs tactile input to his
hands. You can brush the child’s hands, have him play with playdoh/other
resistive mediums, play hand clapping games, crawling or wheelbarrow
walking,
6. For a child who has difficulty transitioning from one activity to the next, allow
him/her to hold on to an object that they like (aka. A transitioning object)
This helps them “keep it together” during the transition. You can also assign
a task to the child such as “helper” (ex: he holds the cards you will be using
and brings them to circle time)

41. Favorite products that can be used
in a classroom setting
• Weighted Items:

42. Favorite products that can be
used in a classroom setting
• Wedges and discs:

43. Favorite products that can be
used in a classroom setting
• Fidget toys:

44. Favorite products that can be
used in a classroom setting
• Visual Schedules:

45. Favorite products that can be
used in a classroom setting
• Brain Breaks:

46. Helping Children that can’t sit still
• Children with sensory processing disorders
have a tendency toward two major problems
regarding sitting:
1- Lack of focus
2- Inability to sit or stand for a long period
of time.
Their brain tends to "under register" movement,
and without that ability, they can't focus. Their
brains are telling their bodies to get up and
move to help them listen and attend
BETTER!

47. Successful strategies
• Provide as much support as possible while sitting
so the body feels secure. This includes: Feet flat
on the floor or footrest, Good back and hips and
knees at 90-degree angles.
• Allowing as much movement as possible without
disrupting others while sitting. This includes:
allowing small movement opportunities with the
hands, using fidgets, or with the mouth, using gum
or "chewys." Move and sit seat wedges or ball
chairs.

48. Movement is key
• Movement is what helps the brain develop
from infancy. Movement is stimulation
that the brain craves. Have plenty of
movement opportunities available for the
children.
• Remember, kids in motion, aren't
commotion! CHILDREN LEARN BEST
FROM MOVEMENT AND WE HAVE
FORGOTTEN THIS IN OUR
CLASSROOMS!

49. Nancy Amar OTR/L
cell: 786-384-0221
email:
MissMancy@gmail.com