Occupational Therapy for Children: Evaluation Visits

What is occupational therapy?

Occupational therapy (OT) is a type of rehabilitation that focuses on the tasks of living. Occupational therapy provides patients and families with the tools they need for success in daily life. The purpose of OT is independence and safety with everyday tasks such as getting dressed, bathing, brushing teeth, cooking, handwriting, and playing. 

What happens in an occupational therapy evaluation?

The purpose of an evaluation visit is to assess areas of function so that the occupational therapist can develop a treatment plan to meet the patient’s specific needs. The areas assessed during an OT evaluation depend on the patient’s age, diagnosis, and rehabilitation needs. Different methods and tools are used to evaluate the child’s abilities and develop a plan of care. These may include asking questions about the child’s activities, carefully observing the child during specific tasks, using therapy evaluation equipment, or completing an assessment that allows the therapist to compare the child’s performance in a task to other kids their age. An occupational therapy evaluation is usually performed at the first visit and may be done periodically during treatment.

Occupational therapy assessment for children ages 0-4 Years

Evaluation of infants and toddlers focuses on assessment of developmental skills as well as vision, strength, and neurologic function. Limitations in any of these areas can affect a child’s ability to do the jobs of childhood — to learn, grow, and play.

The occupational therapist will evaluate fine motor, visual motor and gross motor skills. A standardized assessment might also be completed which can involve the occupational therapist performing tasks with the child or having parents fill out a questionnaire.

Age appropriate self-care skills will also be evaluated. These include activities like feeding, dressing, brushing teeth, toileting or bathing. Occupational therapists can determine how a child is doing relative to other children the same age and provide recommendations to encourage development of these skills.

Occupational therapy assessment for children ages 5 and up

Evaluation of children and teens will focus on assessment of the skills needed for activities of everyday life. Part of the evaluation will include an interview with children and their parents to learn about the child’s ability to do daily tasks in home, school, and community settings. The occupational therapist will ask the patient and caregivers about how much assistance they need for daily tasks including dressing, bathing, toileting, grooming, and eating as well how the child is doing with school and play activities. The occupational therapist will also try to find out more about what the child likes to do and what motivates them.

After the interview, the occupational therapist will ask the child to perform a variety of tasks or assessments to identify any limitations or areas of concern.

Areas assessed in an occupational therapy visit

Different areas of function may be assessed during an occupational therapy evaluation. These include:

Fine motor skills: Ability to use the small muscles of the hands to manipulate objects such as toys, eating utensils, or a pencil for handwriting.

• Fine motor coordination may be assessed by watching the child complete a fine motor task like putting beads onto a string. Fine motor standardized assessments such as the 9 Hole-Peg Test or the Box and Blocks Test may also be used.
• Fine motor strength can be assessed using a dynamometer, a tool that gives a measurement of the number of pounds of grip strength when the patient squeezes it.
• The therapist may have the child give a handwriting sample or participate in a test of handwriting skills.
  

Gross motor coordination: Ability to perform large, coordinated movements

• An occupational therapist may evaluate coordination of both arms by throwing and catching a ball, using an arm bike, or reaching for objects in multiple directions.

Visual skills: How well children use their vision to perform daily tasks.

• Visual motor skills (hand eye coordination) may be assessed using a standardized assessment such as the Beery-Buktenica Developmental Test of Visual Motor-Integration or the Bell Cancellation Test.
• For children with vision loss, an occupational therapist will help assess how well they are able to navigate their environment and how vision loss impacts daily activities.

Activity tolerance: Having the energy needed to perform daily activities at home, school, and in the community.

• The occupational therapist will want to about the child’s energy level such as if being too tired limits daily activities or whether extra naps are needed. Parents might be asked to fill out a questionnaire about activity tolerance, or the occupational therapists may observe your child while they complete activities.

Musculoskeletal function: Function of muscles and joints.

• Assessment of musculoskeletal function includes measurement of upper body (arm) strength. 
• The occupational therapist may also assess muscle tone, or how much tension is in the muscle.

Sensation: Ability to detect pressure, touch, and temperature.

• Assessment of sensation will include finding out how well your child can sense things that come into contact with their skin. For example, the occupational therapist might ask your child to close their eyes and ask if they can feel a soft cloth gently brush against their hand.

Functional cognition: Ability to use thinking and processing skills to learn and complete tasks including self-care, school, and play.

• When assessing cognition, a therapist may ask how well the child follows directions, solves problems, or completes tasks without reminders. 
• The occupational therapist may observe functional cognitive skills during an activity such as making playdough from a recipe.

Questions and answers about the OT evaluation

How long does the occupational therapy evaluation take?

An OT evaluation can take anywhere from 30 minutes to an hour. Initial evaluations may require more time so that the occupational therapist can gather all the information needed to develop a plan for services that will best help your child.

Is the parent or family caregiver present the whole time?

This decision is usually up to the family. Typically, parents are asked to stay for the interview to provide therapists with more information about what the child is doing in the home setting.

Do you need a doctor’s referral for occupational therapy?

Yes, an order is required from a doctor, nurse practitioner, or physician assistant.

Is the OT evaluation covered by insurance?

Each insurance company offers different coverage for therapy. Please contact your insurance provider directly for more information.

What should my child wear to occupational therapy?

Your child should wear whatever is comfortable, preferably clothing that is easy to move in.

What do I need to bring to an OT evaluation visit?

For your initial occupational therapy visit, you will not need anything specific. However, your therapist may ask you to bring certain items to follow up visits such as splints or assistive devices. Your therapist will let you know what is needed.  

Are there any special occupational therapy considerations for teens or young adults?

The OT evaluation will use assessments and tools that are appropriate based on the patient’s age and individual needs. Evaluations for adolescents and young adults may include unique areas of assessment such as work, school, driving, cooking, and other activities of daily living.