When To Refer

When To Refer

The problem checklist below may assist you in making referrals to an occupational therapist.

Motor Problems:

     delays in motor milestones
     difficulty or delays in prewriting or writing skills
     difficulty with manipulatives or learning skills such as buttoning and shoe tying
     lack of coordination (fine or gross motor)
     difficulty learning new motor tasks


Sensory Modulation Problems:

     overreacts to sensory input such as touch, sound, movement
     does not seem aware of sensory input
     lacks variety in foods he/she will eat
     craves excessive movement or physical contact


Executive Function Problems:

     attention problems
     poor organizational skills
     poor problem solving abilities


Behavioral or Relational Problems:

     poor self-regulation
     frequent, prolonged, or intense tantrums
     difficulty with transitions including transition to sleep
     difficulty making and keeping friends


Self Help Skills

     difficulty with dressing, grooming, toileting, etc.


If your patient is having problems in any of these areas, then an occupational therapy evaluation may be warranted. The child’s caregiver, or in the case of an adult, the patient, may contact us directly. They will need physician orders for their insurance company. Orders should simply state “OT evaluate and treat”. With the parent/patient’s consent we will be pleased to share evaluation results and progress reports with you.

Examples of children with whom an occupational therapist might work:

The following are examples of children referred to us. Each of these children demonstrated some problem(s) in the areas listed above which interfered with development.

Sam, 6 months old, was an irritable baby, but his “colic” did not seem to pass. He was in constant motion, preferring to be held in an upright position. He had a strong dislike for lying on his stomach and had difficulty sleeping. He startled easily and appeared disorganized in his movements.

Brian, age 2 years, had Down Syndrome. He was receiving early intervention services. Although he ate well as an infant, he was not willing or able to eat food that required chewing. He had never mouthed hands or toys and did not want to touch food or any sticky substances.

Bobbie, age 3 years, was delayed in speech. He was interested only in throwing or smashing toys and was aggressive in his play with other children. Motor skills seemed good, as he was in constant motion. A closer look revealed subtle balance problems, limited fine motor skills and difficulty with purposeful play.

Sophie, age 4 years, was a very cautious child. She watched other children, but did not interact. She had many fears, extreme separation anxiety, and difficulty in new situations. Brushing teeth, haircuts, certain clothes, or loud noises, all set off extreme reactions. Her language and fine motor skills were very good. Her parents struggled with how to manage her tantrums and “manipulative” behavior. Stress was already a major concern.

Lily, age 5-1/2 years, was diagnosed ADD. She saw a psychologist for temper outbursts, which could become totally out of control. Fine and gross motor skills are delayed, and she often becomes frustrated and angry when asked to do tasks. Lily was adopted from China at age 2.

Jason, age 7 years, was obviously bright and creative. By 2nd grade, he had not “outgrown” his distractibility and restlessness. He had difficulty with handwriting and reading, although math skills were good. His self-esteem was poor and he hated school.

Daniel, age 8 years, was diagnosed autistic. Sensory disturbances affected every aspect of life. Although gross and fine motor skills developed fairly normally, Dan did not use these abilities in a purposeful way. He was developing more repetitive behaviors in an attempt to organize his world.

Sarah, age 19 years, was diagnosed with Asperger Syndrome at age 9. She participated in regular education throughout elementary and high school. In college, she became anxious and unable to cope with the novel environment. Sensitive to many sounds and touch she began avoiding any social situations and eventually dropped out of school.