Early Intervention Occupational Therapy Practice Guide for New Grads and New Practitioners

The following is an excerpt from a detailed guide that is based off of 10+ years of OT experience in early intervention, including the specialized area of feeding and dysphagia. OT Dude Club Members can gain full access to this resource to help them transition or start a new position in this very rewarding and fun population of occupational therapy.


…However, the approach that is being used more to support families is the Coaching Model, by Dathan D. Rush, Ed.D., CCC-SLP, M’Lisa L. Shelden, PT, Ph.D. based on the The Early Childhood Coaching Handbook, Second Edition. New practitioenrs to this population may want to consider reading this book, training in it, or becoming familiar with it. Why? It is believed that coaching best supports clients and their families because it is the caregivers who will be spending the most time with these clients and the time that you the OT spends with the client is relatively limited compared to their daily routines.

Coaching helps early childhood practitioners support other professionals and families as they enhance existing knowledge, develop new skills, and promote healthy development of young children, especially in their natural setting such as their home or community. Training in the coaching model (while not necessary, but highly recommended) will help OTPs to…

One unique quality of OTPs working in EI is the setting that they work in: the home and community. This means that OTPs get to work with clients and their families in their most naturalistic settings. Some EI can be clinic-based as well and parents may bring their child to the clinic. So this means that the OT may get to observe and provide interventions to clients during their regular daily rituals and routines, instead of a setting such as school-based OT. Note that some EI can be at the child’s daycare or school as well, as needed.

This means that the materials, equipment, and activities can vary differently between natural or clinic-based OT. In the natural setting, the OT often walks into a client’s home and uses whatever they have available. In clinic-based, the setting is more of a controlled environment and the toys and supplies that are available are typically provided by the facility.

A note on diagnosis: the diagnosis of ASD can be a tricky and emotional topic for families. Some may seek out a diagnosis in order to get services, some may be in denial and not want a diagnosis, or it can be systematic for how children are diagnosed. For example with systematic, in one funding source in California where I work, children may receive OT in this EI program even without an ASD diagnosis, but providers will not diagnose them until the child’s 3rd birthday – even if the kiddo shows significant signs of ASD.

Occupational therapists (OTs) play a crucial role in early intervention for children with autism spectrum disorder (ASD). Their goal is to support the child’s development and enhance their ability to engage in meaningful daily activities. Here is an overview of how occupational therapists work with young children who are autistic:

  1. Assessment:
    • Occupational therapists conduct comprehensive assessments to understand the child’s strengths, challenges, and developmental needs. This may include evaluating sensory processing, motor skills, fine and gross motor coordination, self-care skills, play skills, and social interactions.
    • The 2 most commonly used assessments for EI that I encounter are (1) Peabody Developmental Motor Scales -3 (PDMS-3) and (2) Sensory Profile 2. These two assessments are quick to administer, relatively quick to score, and easy to interpret as results which you can directly used, even word-for-word in your evaluation report.

OT Evaluation Report in EI Sample

Motor planning: Alex demonstrated difficulty with motor planning for novel movements, including the ability to ideate, plan, organize, or execute new motor movement patterns. This was evidenced by him being unable to imitate fine and visual motor based movements on the assessment tasks. This is an area in need of skilled therapeutic intervention.


Bilateral coordination: Alex demonstrated use of bilateral coordination with self-feeding for drinking milk and clapping. He demonstrated difficulty in activities that require both hands to work together seamlessly, such as holding and manipulating small objects, using utensils, or engaging in intricate play activities. The child may exhibit a preference for using one hand over the other, avoiding or struggling with tasks that necessitate the coordinated efforts of both hands.


Fine motor core subtests: 

J.K. scored impaired or delayed in the area of Hand Manipulation, with an age equivalent of 13 months and percentile rank of <1%. J.K. was able to transfer a cube to the other hand and pick it up with original hand. He was able to grasp Cheerio with an inferior pincer grasp. J.K. was unable to grasp a crayon with a power grasp or twist a cloth using both hands going in opposite directions.

J.K. scored impaired or delayed in the area of Eye-Hand Coordination, with an age equivalent of 9 months and percentile rank of <1%. J.K. was able to clap his hands at least 3 times and extend his arm to reach for a rattle with string. J.K. was unable to hold a cup with 1 hand and stir it with a spoon or insert 3 pegs into a board.

Both of these subtest scores combined equal a Fine Motor composite index score of 43. This score is in the impaired or delayed, with average scores ranging from 90-109. J.K. would benefit from opportunities to further develop his fine motor skills with occupational therapy. 


1. **J.K. will sustain engagement in fine motor activities for a continuous period of 5 minutes, demonstrating focus and participation in 4 out of 5 trials.**
– *Baseline:* J.K. currently struggles to sustain engagement in activities, often showing signs of restlessness or distraction within a few minutes of initiation.

2. **J.K. will develop proficiency in hand manipulation skills, as evidenced by making at least a 2-inch vertical line for 4/5 trials.**
– *Baseline:* J.K. is unable to make a vertical line 2 inches long given 5 trials.

3. **J.K. will insert at least 3 pegs into a pegboard within 5 minutes.**
– *Baseline:* Given 5 minutes or longer, J.K. is unable to insert 3 pegs into a pegboard.

4. **J.K. will demonstrate improved proficiency with self-feeding by using a utensil to eat food for 3/5 trials.**
– *Baseline:* J.K. is unable to use utensils given 5 trials for self-feeding.

5. **J.K. will demonstrate improved rest and sleep by sleeping through the night for 1 day out of the week.**
– *Baseline:* J.K. is unable to sleep through the night.

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