Referral Indicators

Occupational Therapy focuses on the following areas of a child’s development. If you notice any of the difficulties mentioned, a referral to Thrive OT is appropriate.

Gross motor skills (physical skills like running, jumping and co-ordination)

  • Clumsy – often trips over, bumps into things, awkward movements
  • Poor balance
  • Weaker than other children his/her age (floppy/lethargic)
  • Difficulty with hopping, jumping, skipping, running, throwing/catching a ball compared with other children his/her age
  • Avoids or shies away from playground equipment
  • Poor posture
  • Difficulty copying body position or performing new motor sequences

Fine Motor (table top skills, e.g. using pencils and scissors)

  • Hasn’t developed a dominant hand
  • Difficulty holding pencil, immature grasp
  • Difficulty using scissors
  • Alternates hands when crossing the midline
  • Draws on one half of the paper only
  • Difficulty with drawing, copying shapes or colouring-in
  • Difficulty with manipulating small objects/fine dexterity tasks
  • Can’t use both hands together with ease

Sensory Processing

  • Distressed by loud or sudden sounds
  • Avoids water/sand/messy play, dislikes getting hands dirty
  • Dislikes grooming tasks e.g. hair brushing/ washing, haircutting, toothbrushing, nail cutting
  • Overreacts to touch, can’t stand in line
  • Constantly touching or mouthing objects
  • Seeks excessive movement
  • Unable to sit still, restless or fidgety
  • Under-responsive or appears lethargic, lazy or unmotivated
  • Hesitates to play or climb on playground equipment
  • Seems unaware of own body or body position in space
  • Bumps into things, frequently knocks things over
  • Restricted diet, picky eater
  • Reacts strongly to smells
  • Unusually high or low pain threshold
  • Avoids eye contact
  • Mood variations, outbursts or tantrums

Visual Perception

  • Cannot complete puzzles/block designs appropriate to child’s age
  • Difficulty copying shapes, numbers, letter formations
  • Difficulty sorting objects according to shape, size and colour
  • Has a hard time finding things eg. objects in locker or desk
  • Letter/number reversals
  • Difficulty discriminating similarities and differences
  • Difficulty copying from the blackboard
  • Difficulty with position concepts (in front of, behind, under…)

Self-help skills (such as dressing, using cutlery)

  • Difficulty with dressing – sorting back from front, doing up fastenings
  • Difficulty with eating – messy eater, spills often, difficulty managing cutlery
  • Toileting – difficulty managing clothes, wiping self, opening/closing taps to wash hands


  • Poor concentration, easily distracted
  • Doesn’t shift attention easily
  • Can’t focus attention to complete a task
  • Difficulty settling or separating, often restless
  • Difficulties coping with change or unpredictability
  • Poor frustration tolerance
  • Impulsive
  • Overly sensitive
  • Emotionally immature
  • Temper tantrums
  • Overly affectionate
  • Fights frequently
  • Anxious