What is the recommended approach for occupational therapy in a preschooler?

Occupational Therapy for Preschoolers

For preschool-aged children with developmental delays or disabilities, occupational therapy should consist of 9-12 individual sessions (minimum 30 minutes each, ideally twice weekly) focused on sensory-motor skill development, visual-motor integration, and participation in daily activities, with concurrent parent training to facilitate carryover into home routines. 1, 2

Core Intervention Framework

Occupational therapy for preschoolers is fundamentally based on using purposeful, developmentally appropriate activities—feeding, movement, play, and social interaction—to build adaptive skills and address developmental dysfunction. 3 The intervention should target multiple domains simultaneously:

• Sensory-motor abilities: Balance, fine motor precision, and visual-motor integration show significant improvement after short-term intervention 1
• Participation in daily occupations: Diversity of activities, independence levels, and parental satisfaction all improve with targeted therapy 1
• Developmental skills: Goal-directed (mastery) play and engagement behaviors increase, while nonengaged behaviors decrease 4

Treatment Intensity and Structure

Deliver therapy at minimum twice weekly (one individual 30-minute session plus one group 30-minute session per week) for optimal results. 2 Research demonstrates that preschoolers with developmental delays receiving this intensity develop visual-motor skills at a rate faster than expected compared to typically developing peers. 2

For children under 3 years with autism spectrum disorder, occupational therapy should be integrated into a comprehensive early intervention program providing 20-30 hours per week of structured therapy, with occupational therapy as one component alongside speech therapy and behavioral interventions. 5

Essential Intervention Components

Focus on activity-based functional goals rather than isolated skill training. 6 The intervention must include:

• Sensory integration techniques: One-on-one sessions using sensory integration approaches effectively decrease nonengaged behavior and increase mastery play in preschoolers with autism 4
• Visual-motor skill development: Direct intervention targeting visual perception, motor coordination, and visual-motor integration produces statistically significant improvements 2
• Parent education and training: 5 hours per week of parent education facilitates carryover of strategies into daily routines and enhances long-term outcomes 5, 1
• Environmental modifications: Structure and routine establishment through written daily plans prevents cognitive overload 6

Service Delivery Models

Occupational therapy for preschoolers can be delivered across multiple settings:

• Home-based: Parent-managed interventions with therapist guidance 5
• Center-based: Clinic or preschool settings for individual and group sessions 2
• Community-based: Daycare and community organization partnerships using a tiered model (awareness workshops, consultations, individual follow-ups) 7

A tiered organization model is particularly effective for community settings: Tier 1 provides awareness workshops for parents and caregivers, Tier 2 offers consultations to community agencies, and Tier 3 delivers individual follow-ups for children requiring more intensive support. 7

Expected Outcomes and Timeline

After 9-12 sessions of occupational therapy intervention, expect:

• Significant improvement in balance, visual integration, and fine motor precision 1
• Increased diversity of participation in daily activities 1
• Enhanced independence in self-care and play activities 1
• Improved parental satisfaction with child's functional performance 1
• Decreased nonengaged behaviors and increased goal-directed play (particularly for children with autism) 4

Critical Implementation Principles

Avoid compensatory aids and adaptive equipment during active skill-building phases. 6 The focus should be on retraining normal movement patterns and developing intrinsic abilities rather than compensating for deficits. 6

Integrate therapy techniques into actual daily functions rather than practicing isolated skills. 6 For example, work on fine motor skills during dressing activities or mealtime rather than through decontextualized exercises.

Involve parents and caregivers as active participants, not passive observers. 3 Occupational therapy facilitates parents' occupational performance in coping effectively with caregiving challenges and family life demands. 3

Common Pitfalls to Avoid

• Do not focus solely on impairment-based goals when functional participation goals are more appropriate 6
• Avoid using devices that immobilize function or prevent normal movement patterns 6
• Do not implement therapy in isolation—coordinate with speech therapy, behavioral interventions, and educational services for children with complex needs 5
• Do not delay intervention—early occupational therapy prevents disability progression and decreases dysfunction 3