OT Corner: Occupational Therapy in the Preschool Setting
By Amy Wagenfeld, Ph.D, OTR/L
Originally printed in April, 2005

The OT’s role in preschool services is to support a child’s ability to 
successfully perform the occupations (jobs!) related to that environment 
which, in most cases, is the preschool setting.  Occupational therapy also 
serves as a related service provider, which means we do not treat as a 
stand-alone entity.  In collaboration with other professionals who are 
providing services for the child and his/her family, occupational therapy 
in the schools is offered as part of the entire special education program 
to assist with educational outcomes.

The index below seems to be a fairly common list of self-help and classroom 
maintenance tasks (problems) that are observed most frequently by teachers 
or parents, and may lead to a preschool referral to OT.  This list includes
difficulties with:

1.	dressing,
2.	hanging up jacket,
3.	toilet training,
4.	hand washing,
5.	nose care,
6.	self-feeding, finger feeding, use of utensils,
7.	opening a lunch box,
8.	opening a milk carton,
9.	picking up toys,
10.	passing out crackers,
11.	pouring liquid into cups,
12.	passing out papers,
13.	updating calendar,
14.	watering plants,
15.	washing tables, feeding pets, and cleaning cages.

In addition to addressing these self-help skills, the OT will assess and 
work with the preschool population on such motor skills such as:

18.	fine motor skills,
19.	pencil and paper tasks such as forming prewriting forms,
20.	coloring,
21.	cutting,
22.	attention to tasks,
 23.	sitting in a group,
24.	following directions,
25.	asking for help,
26.	completing tasks,
27.	sensorimotor play, and
28.	constructional play,

which all form the foundation for academic readiness.  As you can see, 
like the earliest years, the preschool years are equally as important 
in terms of occupational therapy intervention, just different.  While 
EI may focus on the broader skill areas, once in preschool, working on 
pre-academics and self-help skills to prepare for ‘school’ are just as 
necessary as early intervention.

Preschool OT services evolved out of the civil rights movement, with formal 
legislation beginning in the 1970’s with the Education of the Handicapped 
Act (EHA), also known as PL94-142.  The EHA became an integral part of the 
Individuals with Disabilities Education Act (IDEA), yet the guiding 
principles have remained unchanged.  They are that:

A.	every child is entitled to a free and appropriate education that is 
        free to the families and is paid for by public funds (FAPE);
B.	children are to be educated in the most normal and least restrictive 
        environment possible (LRE);
C.	all children with disabilities must be provided an appropriate 
        evaluation to determine eligibility for services;
D.	the child receives an IEP, a document that needs yearly revision as 
        it lays out the child’s individualized education program;
E.	the parent and student be accorded participation in decision-making, 
        as this allows for an ongoing reciprocal dialogue between family and 
        school in terms of decision making; and that
F.	there are well defined procedural safeguards so that both procedures 
        for mediation and due process, as well as safeguards for the well 
        being of the child are available, should the need arise.

These six principles guide the provisions for federally mandated school 
services for the special needs child.  Now, I would like to talk about 
how occupational therapy fits into this picture.

Occupational therapy with the preschool-aged child is defined as a related 
service by IDEA and is directed towards improving, developing or restoring 
functions impaired or lost through illness, injury or deprivation, improving 
the ability to perform tasks for independent functioning when functions are 
impaired or lost, and preventing, through early intervention, initial or 
further impairment or loss of function.  In other words, we are there to 
service the child, as preschool-based therapy is child-centered rather than 
the family-centered EI.

I feel like this is a lot of information for one column, so I will pick up at 
this point and talk about what a preschool OT evaluation may look like, and if 
services are determined to be needed, how it might be carried out with your 
child(ren).  Until then, have a safe and happy month.