By: Loren Shlaes, OTR
Certified Teacher of the Alexander Technique

1. Encourage parents to make sure that the child is getting plenty of time to play outdoors. Studies show that there is a direct correlation between exercise, IQ, and school performance. Remember, movement is what activates the brain! I recommend to parents that they take their children to the playground for 20 minutes before dropping them off at school. If this is truly not possible, then have the child walk to school, or at least part of the way. One friend plays a game of hide and go seek with her five year old on the way to school every morning. Always precede tabletop tasks in the clinic with some form of gross motor activity.
2. Children who have a hard time attending often are shallow or inefficient breathers. Toys that encourage sustained exhalations are superb for improving respiratory function. I like bubbles, blow darts, whistles, Blo-Pens, kazoos, and inexpensive wind instruments, like ocarinas, harmonicas, and recorders.
3. Brain Gym exercises for improving handwriting, like lazy8’s or elephant 8’s, are fun and easy to do before starting homework. If a child has difficulty regulating his behavior at school, doing hook-ups can be helpful before class starts.
4. Craft activities are the perfect means for encouraging a child to develop his tolerance for frustration, attention span, eye hand coordination, and problem solving skill
5. Old fashioned board games not only require a good attention span, they develop sitting tolerance, and teach social skills like sportsmanship and turn taking. Other good choices: jigsaw puzzles, word games, and card games that take some skill, like cribbage.
6. A short attention span for tabletop or fine motor activities is frequently a sign that the child has undetected visual problems. Most likely there is a weakness in the child’s convergence, which is the ability to pull the eyes in for close work. Games that strengthen the neck and trunk, such as wheelbarrow walking, playing prone on scooterboards and on the net swing, and high intensity vestibular activities, such as spinning, {if the child enjoys them} will help. So will games that encourage scanning and visual pursuits, such as dot to dot, mazes, balloon tennis, I Spy, and chasing bubbles with a claw toy and popping them.
   If the child still resists tabletop activities after about a year of sensory integration therapy, it’s time to refer to a vision therapist for an evaluation.
7. Sometimes the simplest solution is the easiest. If the child is having a hard time focusing in the moment, does he need to go to the bathroom, have a drink of water, or is he hungry? Small children can’t always tell us these things, but more often than not, if a child becomes suddenly disorganized during clinic time, it’s because nature is calling.
8. If a child is persistently resistant to an activity you have chosen, is it because the child finds it too difficult or too overwhelming? Can the activity be graded or changed to make it more successful? Sometimes less structured activities, like Play-Doh, drawing in shaving cream, and hunting for small objects in a bin of beans or foam pellets are the best until the child develops some sitting tolerance. Conversely, does the child find the activity boring or too beneath him?
9. If the child has trouble sitting still while he’s working, give him a therapy ball or inflatable cushion to bounce on, and something to chew on like gum or a lollypop. Or move the activity to a swing or to the floor if possible. Another possibility would be to do writing at an easel or to tape homework to the wall so the child can stand. Not only is this easier for a child with low tone, it exercises the shoulders, which improves stability for fine motor control, and decreases visual distortion, making the work easier to see. Win/win!
10. Use activities that work on the skills you are trying to build that are not exactly the same as the skill itself. For instance, if you are trying to teach a child the correct way to hold a pencil while he is writing, give the child the pencil with the adaptive grip and play tic tac toe, draw pictures on the board using nubs of chalk, give him a coppertooling project, etc.

Featured Author: Loren Shlaes, OTR
Many thanks to Loren Shlaes for providing us with these great therapy ideas for our newsletter.
Loren Shlaes is a pediatric occupational therapist specializing in sensory integration and school related issues, particularly handwriting. She lives and practices in Manhattan. She blogs at http://www.pediatricOT.blogspot.com/.