Swaps goal subject, functional context, dose cadence, and adds age-specific interventions. Skills and levels are unchanged.
Setting context: School-based OT
Use within scope. These templates are examples for licensed OTs and TVIs. Adapt goals to your student's baseline, IEP framework, and site policy. Refer out first when red flags are present.
Skill-by-skill graded protocols with FITT-P dosing (Frequency · Intensity · Time · Type · Progression), evidence tier per line, precautions/contraindications, and objective progression, regression, and discharge criteria — anchored to COPM performance/satisfaction change (≥ 2 points = clinically significant, Law et al.) and Goal Attainment Scaling T-scores (Kiresuk & Sherman).
Specialized population branches: post-concussion / mTBI, CVI (Roman-Lantzy-informed), low-vision, and complex learner (ADHD / DCD / ASD) each have their own triggers, intake add-ons, dosing rules, and discharge criteria.
Within 12 weeks, [Student] will complete 20 minutes of grade-level near-work tasks (reading, worksheets) with reported clarity and no working-distance compensation on 4 of 5 opportunities, to support classroom participation.
Short-term objectives
Within 4 weeks, [Student] will report no blur while reading grade-level print at 40 cm for 5 minutes on 3 of 4 trials.
Within 6 weeks, [Student] will maintain the Harmon working distance (elbow-to-page) for 90% of a 10-minute near task on 3 consecutive sessions.
Within 8 weeks, [Student] will independently apply accommodations (lighting, print size, position) prior to near-work tasks on 4 of 5 opportunities.
Progression criteria
Two consecutive sessions of stable Harmon distance and no reported blur → increase duration by 25%.
Independent application of accommodations across 3 sessions → fade cues.
Regression criteria
Return of squint / tilt / working-distance drift for 2 sessions → reduce duration and reintroduce environmental modifications.
New spontaneous complaints of blur or headache → pause, re-coordinate with optometry.
Discharge criteria
Meets LTG for 3 consecutive weeks with generalization across ≥ 2 school settings (classroom + one other).
Teacher / caregiver report of independent management for 4 weeks.
COPM performance & satisfaction scores ↑ ≥ 2 points on the identified near-work occupation.
Outcome measures
Canadian Occupational Performance Measure (COPM)
Goal Attainment Scaling (GAS) on the identified near-work occupation
School AMPS or teacher observation checklist for classroom participation
Precautions: Coordinate with developmental optometry — OT does not prescribe or modify refractive correction. Rule out uncorrected refractive error before addressing performance components.
Contraindications: Active photophobia or acute post-concussion visual symptoms — defer intensive near-work until cleared.
AOTA Practice Guidelines: Low Vision, 2020; Warren, 1993
Frequency
Daily (embedded in classroom routine)
Intensity
Passive — student maintains setup
Time
All near-work tasks
Type
Environmental / ergonomic
Progression
Fade cues as student independently sets up workstation across ≥ 3 settings.
Home program: Parent letter with 20/20/20 rule diagram, workstation photo, and 2-minute setup routine.
Client / caregiver / teacher education
Evidence II
Explicit teaching of near-work signs of fatigue, blur, and posture drift; when to prompt breaks; and how to advocate for accommodations.
AOTA OTPF-4; Feder & Majnemer, 2007
Frequency
1× / week during consult
Intensity
Low — didactic
Time
10–15 min
Type
Consultation / caregiver training
Progression
Fade to as-needed check-ins once teacher/caregiver independently identifies and responds to symptoms.
Visual Access — Contrast Sensitivity
Protocol · contrast
2 lines
Long-term goal (12 wk)
Within 12 weeks, [Student] will independently access grade-level low-contrast materials (photocopies, whiteboards, projected slides) using strategies and accommodations, to participate in classroom instruction 90% of the school day.
Short-term objectives
Within 4 weeks, [Student] will identify 2 personal contrast triggers (faded copies, dry-erase glare) and request a modified format on 3 of 4 opportunities.
Within 6 weeks, [Student] will apply a personal contrast toolkit (dark pencil, highlighter, contrast overlay, glare block) on 4 of 5 opportunities.
Progression criteria
Independent toolkit use in 3 consecutive sessions → fade prompts.
Regression criteria
Emergence of avoidance or refusal of low-contrast tasks → return to environmental modifications first.
Discharge criteria
Teacher confirms independent management across school day for 4 weeks.
GAS ≥ +1 on the identified contrast-loaded occupation.
Outcome measures
COPM
GAS
Teacher observation of participation in whiteboard / projected-slide tasks
Precautions: Coordinate with optometry — persistent contrast deficit warrants medical work-up.
Contraindications: Photophobia — introduce tints only after optometric clearance.
Intervention lines
Contrast enhancement toolkit
Evidence III
Bolder pencils / markers, highlighter tape for whiteboards, print-on-cream, tinted overlays (trial for individual preference), matte-finish laminate.
AOTA Low Vision Practice Guidelines, 2020
Frequency
Daily
Intensity
Passive
Time
All contrast-loaded tasks
Type
Environmental / adaptive equipment
Progression
Fade prompts as student self-initiates toolkit use.
Assistive-technology consultation
Evidence II
Screen-reader color inversion, digital contrast settings, tablet apps for capture-and-enlarge of whiteboard content.
AOTA AT position paper, 2016
Frequency
1× / week during consult phase
Intensity
Low
Time
20–30 min
Type
Consultation + training
Progression
Fade once student independently accesses AT for 3 consecutive weeks.
Within 12 weeks, [Student] will demonstrate improved binocular integration (reported single, stable print + safe navigation of stairs/playground) during near-work and mobility occupations, to support academic and safety participation.
Short-term objectives
Within 4 weeks, [Student] will complete a 5-minute sensory-fusion (anaglyph) activity without diplopia complaints on 3 of 4 trials — after optometric clearance.
Within 8 weeks, [Student] will safely navigate stairs and playground equipment without hesitation or excessive head tilt on 4 of 5 observations.
Progression criteria
Sustained diplopia-free anaglyph work at 5 min → advance to 10 min with cognitive load.
Regression criteria
Emergence of diplopia, headache, or suppression → stop, notify optometry, return to environmental / postural work.
COPM ↑ ≥ 2 points on the identified mobility or near-work occupation.
Outcome measures
COPM
GAS
CISS-15 rescore
Optometric stereo-acuity follow-up
Precautions: Sensory fusion / anaglyph work only after developmental optometry has cleared ocular alignment and ruled out contraindicated strabismus subtypes. Anaglyph tasks are not a substitute for prescribed optometric vision therapy.
Contraindications: Active manifest strabismus without optometric oversight. Photosensitive epilepsy — avoid strobing anaglyph stimuli.
Graded red/green anaglyph activities: gross localization → simple discrimination → sustained near-work with anaglyph text. Curriculum-neutral, OT-scope, after optometric clearance.
Cooper & Duckman, 1978; Scheiman & Wick, 2020
Frequency
3× / week
Intensity
Moderate — stop at first symptom
Time
5–15 min per session
Type
Sensory-fusion / anaglyph
Progression
Duration and complexity ↑ 25% every 2 symptom-free weeks.
Home program: 5-min daily anaglyph card + parent symptom log.
Environmental & postural support
Evidence II
Lighting, contrast, seating with lumbar support, stable working distance, and pre-mobility scanning routines for stairs / playground.
Warren, 1993
Frequency
Daily
Intensity
Passive
Time
All near-work + mobility
Type
Environmental
Progression
Fade cues as independence emerges.
Visual Efficiency — Convergence
Protocol · convergence
3 lines
Long-term goal (12 wk)
Within 12 weeks, [Student] will sustain 20 minutes of grade-level near-work with no more than one symptom of convergence stress (blur, diplopia, headache, print swim) on 4 of 5 school days, to support academic participation.
Short-term objectives
Within 4 weeks, [Student] will demonstrate NPC break ≤ 6 cm and recovery ≤ 10 cm on 3 of 3 trials (co-measured with optometry).
Within 6 weeks, CISS-15 score will decrease by ≥ 5 points from baseline.
Within 8 weeks, [Student] will independently apply the 20/20/20 rule during self-directed near-work on 4 of 5 opportunities.
Progression criteria
3 consecutive symptom-free sessions at current dose → advance duration by 25% OR add cognitive load.
NPC break improves by ≥ 2 cm on repeat testing → advance target size / complexity.
Regression criteria
NPC break recedes ≥ 3 cm from baseline → step down to previous level and coordinate with optometry.
CISS-15 rises ≥ 5 points → pause and reassess.
Discharge criteria
NPC ≤ 6/10 cm sustained across 3 sessions AND CISS-15 in sub-threshold range for 4 weeks.
GAS ≥ +1 on the identified near-work occupation.
Optometry concurs with discharge or transitions to maintenance.
Outcome measures
COPM
GAS
CISS-15 (pre / post / q6wk)
NPC serial measurement
Precautions: OT-scope convergence work supplements — does not replace — optometric office-based vision therapy where indicated. Stop any exercise that produces sustained diplopia, headache, or nausea.
Contraindications: Active post-concussion with worsening vergence symptoms — coordinate with medical team first.
Intervention lines
Office-based vergence therapy referral + OT co-treatment
Evidence I
CITT/RCT-level office-based vergence therapy administered by developmental optometry; OT co-treats via near-work endurance, posture, and generalization to occupation.
CITT Study Group, 2008 (Arch Ophthalmol); Scheiman et al., 2011
Frequency
OD-directed (typically 1×/wk office); OT co-treat 1–2×/wk
Intensity
Moderate
Time
45–60 min OD; 20–30 min OT
Type
Combined office-based VT + OT functional generalization
Progression
Per optometry; OT scales occupational demand as vergence measures improve.
Curriculum-neutral vergence supports embedded into functional near-work sessions. Not a substitute for optometric VT when indicated.
Scheiman & Wick, 2020; Rouse et al., 2009
Frequency
3–5× / week
Intensity
Low–moderate — stop at first sustained symptom
Time
5–10 min warm-up + 15–20 min functional task
Type
Neuromuscular + functional near-work
Progression
↑ duration or add reading load every 2 symptom-free weeks.
Home program: 5-min daily Brock string OR pencil push-ups + 20/20/20 rule reminder + symptom log.
Environmental / ergonomic + client education
Evidence II
Harmon distance, lighting, seating, and explicit teaching of symptom recognition and the 20/20/20 rule to student, caregiver, and teacher.
Feder & Majnemer, 2007; Warren, 1993
Frequency
Daily
Intensity
Passive
Time
All near-work
Type
Environmental / education
Progression
Fade cues as student self-manages.
Visual Efficiency — Accommodation
Protocol · accommodation
2 lines
Long-term goal (12 wk)
Within 12 weeks, [Student] will complete 20 minutes of sustained near-work with no more than one symptom of accommodative stress (blur, print swim, headache) on 4 of 5 opportunities, to support classroom endurance.
Short-term objectives
Within 6 weeks, binocular accommodative facility will improve to ≥ 8 cpm (or student-specific optometrist target).
Within 8 weeks, [Student] will independently initiate 20/20/20 breaks during self-directed near-work on 4 of 5 opportunities.
COPM ↑ ≥ 2 points on the identified near-work occupation.
Outcome measures
COPM
GAS
CISS-15
Optometrist accommodative-facility retest (cpm)
Precautions: Accommodative rehabilitation is optometry-led; OT contribution is functional generalization and habits. Discontinue any exercise that produces sustained blur, headache, or nausea.
Structured near ↔ intermediate ↔ far task rotation embedded in classroom-relevant occupations to prevent accommodative fatigue.
Scheiman & Wick, 2020
Frequency
Daily
Intensity
Low
Time
Every 20 min of near-work → 20 sec at ≥ 20 ft
Type
Habit / routine
Progression
Fade prompts as student self-initiates.
Visual Efficiency — Saccades
Protocol · saccades
1 line
Long-term goal (12 wk)
Within 12 weeks, [Student] will read a grade-level paragraph with ≤ 2 regressions per 100 words on 4 of 5 opportunities, to support classroom reading fluency.
Short-term objectives
Within 4 weeks, [Student] will complete a Hart Chart / column-scan task at target rate with < 2 regressions on 3 consecutive sessions.
Within 6 weeks, DEM or King-Devick-style scan time will improve by ≥ 15% (co-measured with optometry).
Progression criteria
Baseline error rate halved on 3 sessions → progress to next stimulus density.
Regression criteria
Regression rate ↑ 25% for 2 sessions → step down.
Discharge criteria
Meets LTG; teacher reports fluent oral reading; GAS ≥ +1.
Outcome measures
COPM
GAS
Timed oral reading fluency
DEM / King-Devick (OD-collected)
Precautions: Coordinate with optometry when saccadic deficit occurs with vergence or accommodative dysfunction.
Contraindications: Active post-concussion with worsening oculomotor symptoms.
Intervention lines
Saccadic training ladder — Hart Chart / column scan / dense text
Evidence II
Graded stimulus density (large columns → text density) with metronome pacing and reading generalization.
Scheiman & Wick, 2020; Ayton et al., 2009
Frequency
3× / week
Intensity
Moderate
Time
15–20 min
Type
Ocular-motor + reading generalization
Progression
↑ stimulus density every 2 sessions of criterion performance.
Home program: 3-min daily column-scan card.
Visual Efficiency — Pursuits
Protocol · pursuits
1 line
Long-term goal (12 wk)
Within 12 weeks, [Student] will demonstrate smooth pursuits in H/V/circular planes without head substitution on 3 consecutive NSUCO administrations, supporting playground safety and reading progression.
Short-term objectives
Within 4 weeks, [Student] will complete a 60-sec Marsden ball / laser pursuit with ≤ 1 loss of fixation on 3 consecutive sessions.
Return of head-dominant tracking → step down to gentler plane.
Discharge criteria
NSUCO pursuit rating ≥ 4 across planes for 4 weeks; GAS ≥ +1.
Outcome measures
COPM
GAS
NSUCO ratings (serial)
Precautions: Coordinate with optometry for suspected cranial-nerve or neuro-visual involvement.
Contraindications: Active post-concussion with symptom exacerbation.
Intervention lines
Pursuit training ladder — Marsden ball → figure-8 → metronome-paced
Evidence II
Graded pursuit training from evaluator-paced large targets to metronome-paced dual-task figure-8.
Maples, 1995 (NSUCO); Scheiman & Wick, 2020
Frequency
3× / week
Intensity
Moderate
Time
10–15 min
Type
Ocular-motor
Progression
↑ speed / dual-task load every 2 criterion sessions.
Visual Efficiency — Fixation Stability
Protocol · fixation
1 line
Long-term goal (12 wk)
Within 12 weeks, [Student] will sustain fixation for 30 sec under cognitive load without drift on 3 consecutive sessions, supporting reading and copying.
Short-term objectives
Within 4 weeks, sustain 20-sec fixation with dual-task (counting) with ≤ 1 refixation.
Contraindications: Nystagmus without optometric management plan.
Intervention lines
Graded fixation drills + postural challenge
Evidence II
Dot / Marsden ball fixation with progressive duration, cognitive load, and postural instability (balance disc).
Scheiman & Wick, 2020; Maples, 1995
Frequency
3× / week
Intensity
Low–moderate
Time
10 min
Type
Ocular-motor + postural
Progression
↑ time or add balance component every 2 criterion sessions.
Visual Processing — Discrimination
Protocol · discrimination
1 line
Long-term goal (12 wk)
Within 12 weeks, [Student] will discriminate confusable letters/numbers (b/d, p/q, 6/9) at ≥ 95% accuracy in classroom decoding and math tasks on 4 of 5 opportunities.
Short-term objectives
Within 4 weeks, ≥ 90% accuracy on 10-item confusable letter-pair worksheet across 3 sessions.
Progression criteria
Criterion accuracy 3 sessions → generalize into decoding tasks.
Regression criteria
Error rate rises ≥ 20% → step down to matched-pair sort.
Discharge criteria
Meets LTG in classroom context; GAS ≥ +1.
Outcome measures
COPM
GAS
Curriculum-based reading accuracy sample
Precautions: Rule out uncorrected refractive error before extended perceptual training.
Intervention lines
Graded discrimination ladder + tactile letter formation
Evidence II
Sorting/matching drills with progressive similarity, tactile letter formation (sand tray / rice bin / air-write) to strengthen visual-motor memory of letter forms.
Schneck, 2010; Feder & Majnemer, 2007
Frequency
3× / week
Intensity
Low–moderate
Time
15 min
Type
Perceptual + tactile
Progression
↑ distractor similarity every 2 criterion sessions.
Home program: 5-min daily confusable-pair worksheet + tactile letter tray.
Visual Processing — Figure–Ground
Protocol · figure ground
1 line
Long-term goal (12 wk)
Within 12 weeks, [Student] will locate target information on grade-level dense worksheets in ≤ 125% of peer time on 4 of 5 opportunities.
Short-term objectives
Within 6 weeks, complete a hidden-picture puzzle within age-expected time on 3 consecutive sessions.
Progression criteria
Age-expected time on 3 sessions → advance density.
Regression criteria
Frustration / task refusal → reduce density and reintroduce color cueing.
Discharge criteria
Meets LTG; teacher observation confirms.
Outcome measures
COPM
GAS
Timed worksheet completion vs. peer norm
Intervention lines
Graded figure–ground ladder — color cue → grayscale → text density
Evidence II
Hidden-picture / letter-search / word-search tasks with progressive density and reduced color cueing.
Schneck, 2010
Frequency
3× / week
Intensity
Low–moderate
Time
10–15 min
Type
Perceptual
Progression
↓ color cue every 2 criterion sessions.
Visual Processing — Closure
Protocol · visual closure
1 line
Long-term goal (12 wk)
Within 12 weeks, [Student] will recognize partially-obscured words and shapes at grade-level speed on 4 of 5 classroom tasks.
Short-term objectives
Within 6 weeks, ≥ 90% accuracy on partial-picture / partial-word closure tasks across 3 sessions.
Graded memory tasks with escalating span, delay, and interference; cross-modal auditory pairing to strengthen encoding.
Martin, 2017; Schneck, 2010
Frequency
3× / week
Intensity
Low–moderate
Time
10–15 min
Type
Perceptual + cognitive
Progression
↑ span, delay, or interference every 2 criterion sessions.
Home program: 5-min daily flashcard chain + look-cover-write.
Visual Processing — Form Constancy
Protocol · form constancy
1 line
Long-term goal (12 wk)
Within 12 weeks, [Student] will correctly identify letters and numbers across fonts, sizes, and orientations at ≥ 95% accuracy on 4 of 5 classroom tasks.
Short-term objectives
Within 6 weeks, ≥ 90% accuracy on multi-font identity-sort worksheet across 3 sessions.
Progression criteria
Criterion accuracy → ↑ font / rotation variability.
Regression criteria
Reversal errors persist → reintroduce tactile letter formation.
Discharge criteria
Meets LTG; b/d/p/q errors resolve in written output.
Outcome measures
COPM
GAS
Handwriting sample reversal count
Intervention lines
Multi-font sort + tactile letter formation
Evidence II
Sorting letters/shapes by IDENTITY across fonts, sizes, rotations; paired with tactile letter tray and multisensory formation.
Schneck, 2010; Feder & Majnemer, 2007
Frequency
3× / week
Intensity
Low–moderate
Time
10–15 min
Type
Perceptual + tactile
Progression
↑ variability every 2 criterion sessions.
Visual Processing — Spatial Relations
Protocol · spatial relations
1 line
Long-term goal (12 wk)
Within 12 weeks, [Student] will align math columns, follow directional worksheets, and interpret simple maps/diagrams at ≥ 90% accuracy on 4 of 5 classroom tasks.
Short-term objectives
Within 6 weeks, ≥ 90% accuracy on rotation-match and block-design copy tasks.
Progression criteria
Criterion accuracy → ↑ rotation angle and design complexity.
Regression criteria
Loss of orientation → return to explicit directional-language cueing.
Discharge criteria
Meets LTG; math and map tasks completed independently.
Outcome measures
COPM
GAS
Curriculum-based math alignment sample
Intervention lines
Directional-language + block-design ladder
Evidence II
Explicit directional-language work paired with graded block-design copies, rotation-match, and map/graph tasks.
Cornhill & Case-Smith, 1996; Schneck, 2010
Frequency
2–3× / week
Intensity
Low–moderate
Time
15 min
Type
Perceptual + language
Progression
↑ rotation / complexity every 2 criterion sessions.
Visual-Motor Integration & Handwriting Readiness
Protocol · visuomotor
2 lines
Long-term goal (12 wk)
Within 12 weeks, [Student] will produce legible written output for a 5-minute grade-level writing task with ≥ 90% legibility for size, spacing, and alignment on 4 of 5 opportunities, to support classroom written expression.
Short-term objectives
Within 4 weeks, Beery VMI standard score (curriculum-neutral parallel form or OD-collected) will improve by ≥ 5 points OR shape-copy accuracy will reach ≥ 90% at grade level.
Within 6 weeks, [Student] will independently apply spacing / sizing / alignment strategies during a 3-min copy task on 3 consecutive sessions.
Within 8 weeks, board-to-paper (far-to-near) copy speed will reach ≥ 80% of peer rate.
Precautions: Curriculum-neutral: OT does not deliver proprietary handwriting programs beyond scope and licensing. Coordinate with classroom writing instruction. Rule out grasp / postural / core-strength contributors before attributing legibility issues purely to VMI.
Intervention lines
Graded shape / symbol copy ladder
Evidence II
Preschool shapes → elementary shape set → oblique/complex forms → sentence copy → board-to-paper transfer. Vertical-surface warm-ups (chalkboard/whiteboard) before near-paper tasks.
Home program: 5-min daily shape / sentence copy + vertical warm-up on window / easel.
Postural + workstation foundation
Evidence II
Feet-flat seating, forearm support, paper angle, non-dominant stabilizer hand, Harmon working distance; pre-writing warm-up (proximal → distal).
Feder & Majnemer, 2007
Frequency
Daily
Intensity
Passive
Time
All writing tasks
Type
Environmental / ergonomic
Progression
Fade cues as student self-establishes.
Visual-Motor — Executive-Visuospatial Planning
Protocol · clock planning
1 line
Long-term goal (12 wk)
Within 12 weeks, [Student] will independently plan and execute multi-step graphic tasks (organizers, diagrams, extended written responses) with ≥ 80% completion on 4 of 5 opportunities.
Short-term objectives
Within 6 weeks, [Student] will use a plan-do-check strategy on a graphic-organizer task on 3 consecutive sessions.
Progression criteria
Independent strategy use 3 sessions → fade cues.
Regression criteria
Loss of structure → reintroduce checklist / graphic scaffold.
Discharge criteria
Meets LTG; classroom teacher confirms.
Outcome measures
COPM
GAS
Serial CDT (documented, not diagnostic)
Precautions: Failure ≥ 4 of 5 CDT criteria in older students → coordinate with neuropsychology / medical team.
Intervention lines
Plan-Do-Check strategy training with graphic organizers
Evidence II
Explicit metacognitive strategy training embedded in classroom-relevant graphic tasks (organizers, timelines, essay maps).
Within 12 weeks, [Student] will sustain a 20-minute grade-level near-work block (reading + generative writing) with no more than one symptom episode on 4 of 5 school days, to support academic participation.
Short-term objectives
Within 4 weeks, sustain 5-minute reading + 2-minute writing block symptom-free on 3 consecutive sessions.
Within 8 weeks, sustain 10-minute reading + 5-minute writing block with ≤ 1 symptom episode on 3 consecutive sessions.
Progression criteria
Criterion duration 3 sessions → ↑ 25% duration.
Regression criteria
≥ 2 symptom episodes in a session → step down 25%.
Discharge criteria
Meets LTG for 3 consecutive weeks.
COPM ↑ ≥ 2 pts on identified academic occupation.
Teacher confirms independent management for 4 weeks.
Outcome measures
COPM
GAS
CISS-15 / VSS-School (serial)
Sustained on-task time from classroom observation
Precautions: Address any Domain 1 / 2 underlying deficits concurrently — endurance work assumes stable access + efficiency.
Contraindications: Active post-concussion with symptom exacerbation — begin with sub-symptom-threshold pacing.
Intervention lines
Graded near-work endurance protocol
Evidence II
Time-based near-work ladders pairing sustained reading with age-matched functional writing; posture setup, prescribed micro-breaks (20/20/20), graded linguistic load.
Home program: Home reading log with symptom column; 5-min pre-reading warm-up.
Level 1
Visual Access
Foundational input — acuity and contrast. Without access, all downstream skills over-report deficits.
Near Acuity
VPA finding: Reduced near acuity or postural compensations at 40 cm.
Long-term goal (12 wk)
Within 12 weeks, student will complete grade-level near-point occupational tasks (reading, writing, worksheet) for 15 continuous minutes without postural or acuity compensations, 4/5 trials.
Short-term objectives
Tolerate near-point tasks with prescribed correction and Harmon working distance for 5 minutes, 3/4 trials.
Demonstrate correct posture (feet flat, elbow flexion, 16" working distance) with cue in ≤1 verbal prompt across a 10-minute writing task.
Intervention menu
Refer to developmental optometry (highest priority).
1× / week direct OT + daily 5-min classroom accommodation trials.
Progress monitoring
Re-screen L1 acuity ladder every 8 weeks; teacher log of near-task avoidance.
Referral
Yes — developmental optometry before intensive intervention.
Contrast Sensitivity
VPA finding: Fatigue or avoidance with faded print, whiteboards, low-contrast worksheets.
Long-term goal (12 wk)
Within 12 weeks, student will independently complete high- and standard-contrast classroom worksheets with equivalent accuracy (±10%) across 5 consecutive sessions.
Short-term objectives
Identify preferred contrast overlay and use independently in 4/5 sessions.
Tolerate whiteboard-to-paper copy task for 5 minutes with ≤2 loss-of-place errors.
Intervention menu
Refer to optometry / neuro-visual assessment.
Tinted overlay trial (yellow, blue, gray).
Matte paper, glare-control lighting, seating away from window glare.
High-contrast marker/pencil selection.
Dose
Environmental accommodations daily; OT consult 1× / 2 weeks.
Progress monitoring
Contrast preference log; teacher rating of fatigue on 5-point scale weekly.
Within 12 weeks, student will produce a grade-level 5-sentence writing sample with ≥ 90% legibility for sizing, spacing, and alignment.
Short-term objectives
Copy pre-writing shape sequence with correct proportions in 3/4 trials.
Board-to-paper copy of 3-line passage with ≤ 2 errors, 4/5 trials.
Maintain spacing (finger-space or spacing frame) across 3 sentences.
Intervention menu
Curriculum-neutral graded copying (shapes → letters → words → sentences).
Spacing / sizing frames, rulered-grid copying.
Vertical-to-horizontal transfer drills (chalkboard → paper).
5-minute visual-motor warm-up before writing tasks.
Postural setup + Harmon working distance.
Dose
2× / week direct OT + daily 5-min warm-up in classroom.
Progress monitoring
Handwriting legibility probe (sizing/spacing/alignment rubric) every 4 weeks.
Visual-Spatial Planning (Clock Drawing)
VPA finding: Clock-drawing errors suggesting visual-spatial planning or executive limits.
Long-term goal (12 wk)
Within 12 weeks, student will complete a plan-do-check drawing task with all planning components present, 4/5 trials.
Short-term objectives
Verbalize a 3-step drawing plan before starting, 3/4 trials.
Self-check completed drawing against model with ≥ 90% accuracy.
Intervention menu
Guided sequencing drawing tasks.
Drawing to verbal instruction.
Plan-do-check executive coaching.
Chunking complex figures into sub-plans.
Dose
1–2× / week × 10 min direct.
Progress monitoring
Clock-drawing or complex-figure probe every 6 weeks.
Referral
Consider neuropsych consult if severe or progressive.
Level 5
Functional Integration
Real-world endurance — the load test that reveals whether efficient sub-skills survive under classroom demand.
Reading Endurance & Fluency
VPA finding: Teacher reports 'shuts down after 10 minutes' — sub-skills collapse under load.
Long-term goal (12 wk)
Within 12 weeks, student will sustain grade-level near-reading task for 20 continuous minutes with prescribed micro-breaks and ≤ 15% fluency drop across the interval.
Short-term objectives
Sustain 5 minutes of grade-level reading with no postural break-down, 4/5 sessions.
Use taught 20/20/20 micro-break routine independently in 3/5 sessions.
Complete 10-minute reading task with fluency drop ≤ 20% from minute-1 baseline.
Reading endurance timed probe (words per minute across intervals) every 4 weeks; symptom checklist bi-weekly.
Author: Jeff Foster, MS, OTR/L, EdD(ABD). Templates are examples, not prescriptions. Clinician retains professional responsibility for goal selection, dose, and interpretation.
