An occupational therapist evaluates and facilitates the acquisition of
developmental milestones, especially in the areas of gross motor, fine
motor, visual, and adaptive skills. However, just as important is the
quality of skills; i.e. the “how” the child completes the
task vs. just “what” the task is. For example, if a child
is standing on one foot but the arms are waving, the body is swaying,
and the face is grimaced, then the task is too effortful for the child
even though the child is standing on one foot.
Gross Motor Goal: to promote age-level physical balance, coordination,
strength, stamina, and enjoyment
Fine Motor Goal: to promote age-level hand and finger coordination, strength,
endurance, and efficient use of tools; e.g. writing and eating utensils
Visual Development Goal: to promote comfortable and efficient visual perception,
visual memory, and visual-motor skills to be used in all areas, such as
social, pre-academic and academic work, motor skills.
By six months:
Gross Motor:
* sits briefly without support
* pulls self to sitting from lying on back
* bounces on feet when supported in standing
Fine Motor:
* holds bottle to mouth by self
* uses raking (clawing) to try to pick up small objects
* passes object from hand to hand
Visual:
* turns head past midline to watch a large ball roll by when supported
in sitting
* looks at objects a few feet away
* grabs own foot while lying on back
* reaches to pat reflection in mirror
By age one:
Gross Motor:
* crawls
* pulls self to standing position and stands unaided
* walks with aid
* rolls a ball in imitation of adult
* moves to music
Fine Motor:
* reaches, grasps, puts object in mouth
* picks things up with pincer grasp (thumb and one finger)
* tears paper
* turns thick pages of book
Visual:
* enjoys looking at pictures in a book
* plays peek-a-boo
* puts objects into others, such as nesting cups
* imitates scribbling with crayon
Between ages one and two:
Gross Motor:
* walks alone well with infrequent falls
* walks backwards
* picks up toys from floor without falling
* pulls toys, pushes toys
* seats self in child-size chair
* walks up and down stairs with hand held by another person
* rides alone on toys without pedals
Fine Motor:
* builds tower of 4-6 small blocks
* puts four rings on stick
* places five pegs in pegboard
* drinks from cup without a lid with little spilling
* grasps thick crayon with thumb and fingers
* turns small knobs
* paints with whole arm movement, shifts hands, makes strokes
Visual:
* completes a 1- to 3-piece puzzle or form board
* helps dress and undress
* turns picture right side up if given upside down
Between ages two and three:
Gross Motor:
* runs forward without falling
* jumps in place with two feet together
* stands on one foot 1-2 seconds without support
* walks on tiptoe
* kicks a ball forward
Fine Motor:
* strings four large beads
* turns single pages of book
* snips with scissors
* unbuttons large, easy buttons
* uses one hand consistenly in most activities
* imitates circular, vertical, horizontal strokes
* washes hands by self
* rolls, pounds, squeezes, and pulls clay
Visual:
* matches identical simple pictures
* points to 6 body parts in a picture when asked
* shows which is blue, yellow, or red when asked
* eats with fork
Between ages three and four:
Gross Motor:
* runs around obstacles
* walks on a line
* balances on one foot for five to ten seconds
* hops on one foot
* pushes, pulls, steers wheeled toys
* rides tricycle
* uses slide independently
* jumps over six inch high object and lands on both feet together
* throws ball overhead
* catches a bounced ball
Fine Motor:
* builds tower of nine small blocks
* uses fingers to show age
* buttons and unbuttons medium-sized buttons
* does finger plays to songs well
* copies circle
* imitates cross
* manipulates clay material (rolls balls, snakes, cookies)
Visual:
* completes five-piece puzzle or 10-piece form board
* guesses a full picture by looking at half of it
* kicks a ball while it is rolling
Between ages four and five:
Gross Motor:
* walks backward toe-heel
* jumps forward 10 times without falling
* walks up and down stair independently, alternating feet
* turns somersault
* hops 5 times on 1 foot
Fine Motor:
* cuts on line continuously
* copies cross
* copies square
* prints some capital letters
* demonstrates preference for right or left hand
* places key in lock and opens it
Visual:
* counts objects aloud to at least 6
* selects big, bigger, biggest; small, smaller, smallest
* sorts objects by color, size, shape
* draws some simple recognizable objects
Between ages five and six:
Gross Motor:
* runs through obstacles and avoids objects
* walks on balance beam
* can cover 2 meters hopping
* skips on alternate feet
* jumps rope
* skates
* balances on 1 foot for 12 seconds without swaying
* rides a bicycle
Fine Motor:
* cuts out simple shapes
* copies triangle
* traces diamond
* copies first name
* prints numerals 1 to 5
* colors within lines
* has adult grasp of pencil
* had handedness well established
* pastes and glues appropriately
Visual:
* names most upper case and some lower case letters
* recognizes own name when written in upper case and lower case letters
* plays simple card games such as Go Fish
* completes 12-piece interlocking puzzle
* dresses and undresses independently
* draws person with at least 6 different body parts
By age six, child should be able to print all numbers 0-9 and all letters without copying.
Occupational therapists use standardized evaluation and informal observations to determine developmental status of a child. They also rely heavily on parent, caregiver, day care provider, and teacher report of how child compares to peers and siblings. As child enters school, becomes involved in team sports, has play dates, etc. the therapist is interested in how the child functions in daily life.