All pathways

Direct skill-building

Targeted, practical work on an individual skill. Taught explicitly, practised deliberately, and supported with strategies or technology where that’s the most efficient route.

Practising the actual skill is still the best-researched route, so that’s where we spend most of our time. IJ

What I assess and work on

The practical skills needed to read, write and complete learning tasks more independently, plus the movement skills that help you join in. That can include reading, handwriting, organising ideas in writing, assistive technology and strategies that make difficult tasks more manageable.

Reading
Spelling
Writing and handwriting
Concentration and completing tasks
Catching and other ball skills
Running and movement skills
Speaking and communication participation
Compensatory strategies
Assistive technology

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How I develop and progress practical abilities

I first work out where the task is breaking down and establish a starting point. Then we practise the skill directly, with achievable steps, guided feedback and gradually increasing challenge.

The Foundation pathway may run alongside this to address postural control, balance, coordination, visual-motor skills, regulation or physical endurance. Progress is always measured in the ability that matters in everyday life.

Tap an ability for how I work on it, the research behind it and a note from me.

ReadingDecoding, fluency and understanding text.Strong evidence

Depending on the person’s needs, practice may include:

Explicitly learning the connections between letters and sounds
Blending sounds to read words and segmenting words into sounds
Breaking longer words into syllables and meaningful word parts
Repeated supported reading to develop accuracy and fluency
Learning strategies to identify key information and understand text
Using text-to-speech, audiobooks or accessible reading formats when appropriate

Measuring progress

Progress may be measured through reading accuracy, fluency, comprehension, independence and the amount of support required.

What the research shows

Across randomised controlled trials, phonics instruction — teaching letter–sound correspondence, blending and segmenting — is the only approach with demonstrated effects on reading and spelling in children with reading disability; auditory or visual training and coloured overlays did not show the same benefit. Read-aloud and text-to-speech tools show a moderate positive effect on comprehension where decoding remains effortful.

References

Galuschka, K., Ise, E., Krick, K., & Schulte-Körne, G. (2014). Effectiveness of treatment approaches for children and adolescents with reading disabilities: A meta-analysis of randomized controlled trials. PLoS ONE, 9(2), e89900. doi.org/10.1371/journal.pone.0089900

Wood, S. G., Moxley, J. H., Tighe, E. L., & Wagner, R. K. (2018). Does use of text-to-speech and related read-aloud tools improve reading comprehension for students with reading disabilities? A meta-analysis. Journal of Learning Disabilities, 51(1), 73–84. doi.org/10.1177/0022219416688170

SpellingSound–letter patterns applied in real writing.Strong evidence

Depending on the pattern of difficulty, practice may include:

Breaking spoken words into individual sounds
Matching sounds with letters and letter groups
Learning common spelling patterns
Exploring prefixes, suffixes, base words and word families
Practising the retrieval and use of words in meaningful writing
Using spellcheck, word prediction or speech-to-text where appropriate

Measuring progress

Progress may be measured through spelling accuracy, the types of errors made and whether learnt patterns are used in new words and everyday writing.

What the research shows

Explicit, systematic spelling instruction improves spelling and also transfers to reading and writing outcomes; the same phonics-based instruction that improves reading improves spelling accuracy in children with reading and spelling difficulties.

References

Graham, S., & Santangelo, T. (2014). Does spelling instruction make students better spellers, readers, and writers? A meta-analytic review. Reading and Writing, 27(9), 1703–1743. doi.org/10.1007/s11145-014-9517-0

Writing and handwritingLegibility, speed, endurance and getting ideas down.Strong evidence

Intervention may include:

Direct practice of letter formation, size, spacing and alignment
Developing writing speed, fluency and endurance
Adjusting seating, posture, paper position or writing equipment
Breaking written work into planning, drafting and checking stages
Using visual organisers to structure sentences and ideas
Learning keyboarding, word prediction or speech-to-text when these provide a more effective way to communicate

Measuring progress

Progress may be measured through legibility, speed, endurance, written output and independence with school or everyday writing tasks.

What the research shows

Handwriting interventions that did not include actual handwriting practice — and those with fewer than about twenty practice sessions — were ineffective, regardless of treatment type. Explicit handwriting instruction improves legibility, fluency and the amount written, and strategy instruction in planning, drafting and revising produces some of the largest gains in written output.

References

Hoy, M. M. P., Egan, M. Y., & Feder, K. P. (2011). A systematic review of interventions to improve handwriting. Canadian Journal of Occupational Therapy, 78(1), 13–25. doi.org/10.2182/cjot.2011.78.1.3

Santangelo, T., & Graham, S. (2016). A comprehensive meta-analysis of handwriting instruction. Educational Psychology Review, 28(2), 225–265. doi.org/10.1007/s10648-015-9335-1

Graham, S., & Perin, D. (2007). A meta-analysis of writing instruction for adolescent students. Journal of Educational Psychology, 99(3), 445–476. doi.org/10.1037/0022-0663.99.3.445

Concentration and completing tasksStarting, staying with and finishing real work.Strong evidence

We develop strategies that can be used during real learning and everyday activities, including:

Setting a clear goal before beginning
Using a stop, plan, do and review process
Breaking longer activities into manageable stages
Using visual instructions, checklists, timers and external reminders
Adjusting the workspace and reducing unnecessary distractions
Introducing planned movement or regulation breaks
Gradually increasing the time, complexity or independence required

Measuring progress

Progress may be measured through time on task, work completed, errors, prompts required and the ability to use strategies independently.

What the research shows

Cognitive-functional occupational therapy uses meaningful goals, planning strategies, environmental supports and practice in real activities to improve executive functioning and self-directed learning. The CO-OP approach uses guided discovery and a goal–plan–do–check strategy, and explicitly builds in transfer, so strategies learnt in therapy carry into everyday tasks.

References

Kim, J.-R. (2020). Effects of a cognitive-functional intervention method on improving executive function and self-directed learning in school-aged children with attention deficit hyperactivity disorder: A single-subject design study. Occupational Therapy International, 2020, Article 1250801. doi.org/10.1155/2020/1250801

Houldin, A., McEwen, S. E., Howell, M. W., & Polatajko, H. J. (2018). The Cognitive Orientation to daily Occupational Performance approach and transfer: A scoping review. OTJR: Occupation, Participation and Health, 38(1), 47–51. doi.org/10.1177/1539449217736059

Catching and other ball skillsTracking, timing and joining in with games.Strong evidence

Practice may include:

Learning the movement in manageable components
Beginning with larger, slower or softer balls
Gradually changing distance, direction, speed and predictability
Practising tracking, positioning, timing and hand preparation
Using demonstrations, external cues and specific feedback
Applying the skill in games, sport and playground activities

Measuring progress

Progress may be measured through successful catches, accuracy, consistency, confidence and participation in real activities.

What the research shows

Meta-analysis of motor interventions found that task-oriented approaches — practising the actual skill, with graded challenge and cognitive strategies — produce the strongest effects, while process-oriented approaches that train underlying components alone are not recommended for improving motor performance.

References

Smits-Engelsman, B. C. M., Blank, R., van der Kaay, A.-C., Mosterd-van der Meijs, R., Vlugt-van den Brand, E., Polatajko, H. J., & Wilson, P. H. (2013). Efficacy of interventions to improve motor performance in children with developmental coordination disorder: A combined systematic review and meta-analysis. Developmental Medicine & Child Neurology, 55(3), 229–237. pubmed.ncbi.nlm.nih.gov/23106530/

Smits-Engelsman, B., Vinçon, S., Blank, R., Quadrado, V. H., Polatajko, H., & Wilson, P. H. (2018). Evaluating the evidence for motor-based interventions in developmental coordination disorder: A systematic review and meta-analysis. Research in Developmental Disabilities, 74, 72–102. pubmed.ncbi.nlm.nih.gov/29413431/

Miyahara, M., Hillier, S. L., Pridham, L., & Nakagawa, S. (2017). Task-oriented interventions for children with developmental co-ordination disorder. Cochrane Database of Systematic Reviews, 2017(7), Article CD010914. doi.org/10.1002/14651858.CD010914.pub2

Running and movement skillsControl, coordination and confidence in motion.Strong evidence

Practice may include:

Developing the individual components of running
Working on balance, coordination, strength and movement control
Practising starting, stopping, changing direction and adjusting speed
Using visual targets, rhythm and external movement cues
Gradually increasing distance, speed and environmental complexity
Applying the skill during games, sport and community activities

Please note

Where pain, injury, significant gait concerns or complex physical impairment are present, we may recommend assessment by a physiotherapist, exercise physiologist or medical practitioner.

What the research shows

Contemporary motor-intervention research prioritises task-oriented and motor-skill practice, cognitive strategy use, and transfer into everyday participation, with structured practice producing measurable gains in gross motor performance and activity.

References

Speaking and communication participationThe everyday activities that surround communication.Scope of practice

Occupational therapy can support the everyday activities surrounding communication. This may include:

Preparing what to say ahead of a conversation or appointment
Practising conversations and developing turn-taking
Building self-advocacy skills
Managing regulation during social situations
Accessing and using communication technology

Please note

Assessment and treatment of speech sounds, voice, fluency or receptive and expressive language are specialised areas of speech pathology. Where these are the primary concern, we work alongside or recommend a speech pathologist.

What the research shows

Social participation, communication management, self-regulation, assistive technology and environmental modification all sit within the recognised occupational therapy domain; assessment and treatment of speech, language, voice and fluency sit within the scope of speech pathology.

References

American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. doi.org/10.5014/ajot.2020.74S2001

Speech Pathology Australia. (n.d.). Scope of practice in speech pathology. www.speechpathologyaustralia.org.au

The research behind this approach

Systematic phonics (letter–sound correspondence, blending and segmenting) has stronger evidence for reading and spelling difficulties than motor exercises, auditory training or coloured overlays.

Galuschka et al. (2014)

Handwriting research supports direct handwriting practice. Isolated sensory or component exercises without handwriting practice have not shown the same consistent benefit.

Hoy, Egan & Feder (2011)

Cognitive-functional OT approaches use meaningful goals, planning strategies, environmental supports and practice in real activities to improve task completion and executive functioning.

Kim (2020)

CO-OP uses guided discovery and cognitive strategies to help people learn and transfer practical skills.

Houldin et al. (2018)

Contemporary motor-intervention research prioritises task-oriented practice, motor-skill practice, cognitive strategies and transfer into everyday participation.

Smits-Engelsman et al. (2018)

Education, communication participation, motor skills, process skills, self-regulation, assistive technology and environmental modification all sit within the recognised OT domain.

Occupational Therapy Practice Framework (4th ed.)