10 May 2019

Lava Paper: Dramatic Game Paper make learning handwriting more fun

Pediatric OTs or parents: If you’re working with a child who is highly intelligent but has poor handwriting and one of the reasons is that they are bored/don’t care about sizing rules….this “lava paper” (game paper) is for you.

Lava.paper modified 2019


10 Aug 2016

Easy Ways to Teach Your Child Problem-Solving Skills


Does your child get upset easily over small and easily fixable things, like a ball rolling under a table? It may be because he doesn’t realize he has any power to fix the problem. Luckily, you can teach him to feel more empowered. I introduce to you the PSST Method!

Download the PDF of this here: The PSST! Method: Teach Your Child How to Problem Solve

Or just read on.




The PSST! Method: Teach Your Child How to Problem Solve

Children who feel confident in their problem-solving abilities can better tolerate and handle unexpected events. All children of any age can benefit from learning problem-solving skills. Adjust your language or extent of experimentation based on your child’s age/ability/tolerance level. The steps stay the same. (Ideally, use them all in order. But using any is great.)

SAMPLE PROBLEM: Young John’s ball just rolled under the couch. John scrunches up his face, ready to cry. Daddy jumps up to go grab a broom handle and solve the problem.

WAIT! John needs to learn the steps BETWEEN the problem and a successful solution.

  1. Pause. Just briefly. See if the child will attempt to problem-solve. If not, proceed to step two. Eventually, your child may make the attempt.
  1. Frame the Problem. “Wow, the ball rolled under the couch, and we can’t reach it.” You can also provide “emotion” and “help” words. “Your face is turning red and you look really frustrated. You can say, “Please help me solve this problem.”
  1. Play “Dumb.” Whether you instantly have a solution or not, you can pretend you’re not quite sure what to do. Crinkle up your forehead and look thoughtful. “Hmmm….”
  1. Think Out Loud. Most adults problem-solve in their heads. If you can role-model the problem-solving process, you’re giving him valuable insight, and showing that it’s not magic. “The ball’s is under the couch. We have to get it out somehow…maybe we can try…” With an older child, you can ask them if they have any ideas.
  1. See What Happens. You may know that your hand won’t fit or his arm can’t reach, but he doesn’t. When it’s feasible to experiment (not a safety hazard or massive inconvenience), try it out. He learns a lot more that way. “Let’s see if your arm is long enough. Can you lie down and reach for it?”
  1. Repeat Steps # 4 (Think Out Loud) and #5 (See What Happens), until problem solved. “That didn’t work because the ball’s too far away, will my hand work? …No, too big. Hmm, maybe something small but long to help us get the ball.. see if this will work…no….hmm…let’s see if we can find something…oh, let’s try a broom handle!”
  1. Frame the solution. “The ball rolled under the couch and we were really frustrated and we didn’t know what to do. But we tried lots of ways to solve the problem and now we have our ball back. We are great problem-solvers!”

Repeat this process regularly. As he becomes more proficient, you can take more of a back seat to the problem-solving process.

Bonus: Consider sprinkling “What If’s?” into your conversations/play time. “We solved that problem! What if the ball landed in a tree? Or this hole? Or under the bed?” Talking is great, acting it out is even better. Play a game called “Problem-Solving Superheroes” where you deliberately practice these kinds of things.


Good luck – let me know how it goes!

PS: This method may seem obvious to you – but many caregivers would benefit from the reminder.

25 Mar 2015

Mental Health Energy Conservation

I struggle with depression and anxiety on a all-too-regular basis. I practice mental health energy conservation on a daily basis.
Throughout each day, I’m constantly doing an internal MRI-like scan of my body, figuring out how I am doing and what I can handle. I’m constantly self-talking to myself for reassurance (“okay Karen, you’ve checked the lint and you’re right here, you can start the dryer and chances are high it won’t explode into a ball of flames…” and previewing what’s coming next. I know myself pretty well and know what kind of issues are triggers for me, or where I need to have control to be okay. I know what drains me and what rejuvenates me. I’m lucky to have those skills, and I think my occupational therapy training certainly contributes to those abilities.
I have what I call an anxiety budget, similar to the fibromyalgia “spoons” theory of where you only have so many “spoons” in a day so you have to use them wisely. My goal is to get through the day without using all my anxiety coins.
For example, parallel parking downtown is a HUGE stressor for me, as is giving blood. I would try hard to NOT allow those two big stressors to be on the same day, because I know I will be at a deficit. I try to space out big stressors. I make sure if I have to see a lot of people (at a “fun” event), that I hopefully only have to do it once that day, and have time after to rejuvenate.
Somedays I assess myself when I wake up and I can tell it’s going to be a hard day, maybe I’m extra anxious. If I don’t HAVE to do my laundry that day, I won’t. I need to save all the coins I can. Or, maybe I have to for some reason, but I am aware that on a good day laundry may take me “5” coins, and for this day it may take up “15” because I’m going to be extra worried today that the dryer is going to start a fire. Another example: starting a blender always kind of scares me, even with headphones on the noise freaks me out and sometimes I get scared of electrical fires in the walls or something. So on a good day maybe I make a smoothie for 3 coins because I can tolerate the noise and won’t obsess over a fire, on a bad day I won’t touch the blender because it would cost me 15 coins and I can’t waste them on that.
It’s a constant balancing act, but my awareness is very helpful. It also allows me some compassion and grace, because I have accepted that certain things are much harder for me than others, and that it also varies by day or even hour or even minute. It also allows me to be extra aware of doing harder activities when I feel okay, and saving littler ones for challenging days. It helps me be more functional and not beat myself up so much. (Believe me, there are plenty of times I beat myself up or can’t function – it’s an art, not a science.)
Sometimes, brushing my hair or just starting self-care routines make me want to cry because they seem so hard. That’s a day I’m just going to prioritize the absolute REQUIREMENTS to be semi-functional, and maybe I don’t get a shower that day, but if I brushed my teeth and put on clothes, it’s a win.
From what I can tell (see below for more details), there isn’t much awareness -or at least it’s not called this – of the concept of mental health energy conservation. I’d love to hear from occupational therapists (e-mail, Facebook, here…) who work in mental health on their thoughts on this concept, as I know they address these challenges, maybe with a different name.
The keys are to remember that every person has unique challenges, especially as it pertains to anxiety – my parallel parking may cost me 30 coins and may only cost you 2 coins, whereas my public speaking is 5 coins in my mind and in yours its 50. I think awareness of this need for energy conservation allows for a big step in acceptance, compassion, and potentially a change in functional approaches to the day.
I’m eventually interested in working with someone to do research on this, but not anytime soon!
Okay, here’s what I just posted this on one of my OTD (occupational therapy doctorate) forums…I’m trying to be okay with B grades, I know this is not very well written, but hey….it’s a little assignment and I’m practicing mental health energy conservation by not obsessing over making it perfect. It was a qualitative query I came up with along with some discussion as to why (vague paraphrase of true directions)

How do adults (18-55) with mild depression describe their energy expenditure as it relates to participation in activities of daily life? 

 My review of the literature came up with no results that specifically focused on energy expenditure in relation to mental health and activities of daily life. The majority of articles focusing on energy conservation had to do with multiple sclerosis (Blikman, et. al, 2013), cancer (Mitchell, et. al, 2014), or other physical difficulties. Other articles focused on older adults and limitations in activities of daily life in the aging process, which occasionally addressed depression (Arbesman & Mosley, 2012). Others address activity limitations and depression with chronic conditions, but do not specifically focus on mental health. While I may have missed some articles in my non-exhaustive literature search, it’s clear that this is a very specific area that has had minimal attention.

Occupational therapists and many other health professionals have knowledge and experience in dealing with energy conservation, but it’s typically based on physical needs, not mental. Mental health occupational therapists clearly recognize that people with depression have limitations in ADLs, and that even an activity as benign and simple as pouring a bowl of cereal can seem exhausting. While they certainly address these issues, I don’t know if the therapists or clients are considering this or calling this a form of energy conservation. It would be interesting to see if adults with depression describe their energy expenditure for such tasks as physical or mental, or even perceive the limitation as an energy expenditure issue in the first place.

I think the occupational therapy field would benefit from a more evidence-based approach to managing energy conservation in younger adults with mental health challenges (I chose depression but I’d also be equally interested in anxiety). If there were an assessment that was linked to the COPM, it would allow the therapist and client to get the unique viewpoint of what activities take up the most energy expenditure for that particular client (emphasis on uniqueness), and give them goals for intervention. A support group and/or energy conservation program could also be appropriate for this population.

Occupational therapy is rarely seen in most major healthcare mental health settings these days, but mental energy conservation programs for ADLs could be a new way to promote OT in mental health, and a way to help more people handle their day to day ADL participation with more awareness, compassion, and knowledge, which may in turn reduce their limitations and allow increased participation.


Arbesman, M., & Mosley, L. J. (2012). Systematic review of occupation- and activity-based health management and maintenance interventions for community-dwelling older adults. American Journal of Occupational Therapy, 66, 277–283.

Blikman, L. J., Huisstede, B. M., Kooijmans, H., Stam, H. J., Bussmann, J. B., & van Meeteren, J. (2013). Effectiveness of Energy Conservation Treatment in Reducing Fatigue in Multiple Sclerosis: A Systematic Review and Meta-Analysis. Archives Of Physical Medicine & Rehabilitation, 94(7), 1360-1376. doi:10.1016/j.apmr.2013.01.025B

Mitchell, S. A., Hoffman, A. J., Clark, J. C., DeGennaro, R. M., Poirier, P., Robinson, C. B., & Weisbrod, B. L. (2014). Putting Evidence Into Practice: An Update of Evidence-Based Interventions for Cancer-Related Fatigue During and Following Treatment. Clinical Journal Of Oncology Nursing, 1838-58. doi:10.1188/14.CJON.S3.38-58


21 Nov 2014

Handmade creative clay pencil grips

To make a creative pencil grip, take the ink part out of a pen, roll it into a polymer oven-bake clay and bake it, following directions you can find online for safety [using appropriate clay, not burning your house down or experiencing toxic fumes by baking it too long, etc]. Here’s a tutorial. Here’s another. Those tutorials show a more covered pen, but I think the grip is better off being wound around the pen like in my pictures below. At least the tutorials give you the basics. I haven’t tried it myself. Use your own judgment as to whether it’s a safe and appropriate activity and method.

7 Jan 2014

OT Lego Strategies for Children

Dear OT,

My preschooler, John, loves playing with Legos. Unfortunately he gets frustrated because his hands are weak and his fine motor skills aren’t as good as his classmates. Any ideas? – Jane

Hi Jane,
Legos are great for working on many developmentally appropriate skills. Some strategies you can teach your child to make Lego play a little easier include:

LEGO STRATEGIES (Click link to download as PDF) Lego strategies
(Note: Consider practicing on larger Legos first!)


Place the legos closer to his body and make sure they are lower than his arms. He can stand up and push down on the Legos for more strength (thanks to the physics of levers – this is true for staplers and similar items as well).  That way his entire body is being used for the interlocking of the bricks, compensating for his hand weakness.


For the bigger pieces, if interlocking bricks are in correct position, just not fully pushed together, first move the item closer and lower as noted above, then use the flattened palm of hand to press them down firmly. The palm has more force/easier than the fingers. If a tower, it may need to be stabilized with the other hand to prevent tipping over.

If there is empty space beneath part of a Lego due to the design, it can get difficult/frustrating to add onto that Lego area. Temporarily remove that part of the design so that it’s fully on the flat/stable surface. Add on the necessary extra pieces. Then place the entire part back where it belongs.

Jane, I hope this helps. I imagine there are many sites on the Internet that can be explored to find even more ideas. Good luck with John! Therapeutically yours, OT 🙂

PS: There are plenty of OT skills that can be worked on using Legos! Fine motor, visual motor, problem-solving, social skills…let me know if you want more information!