I recently started working with 22 month old, who presents with the following: when excited he will jump up and down and flap his arms and hands, is difficult to engage in purposeful play for more than a few minutes  (which requires a great deal of motivation to get him to engage for that period of time).  Enjoys play that is “movement” based or repetitive. I am looking for a way to get some structure in his session that is therapeutic, for I feel right now much of the session is spent trying to engage as well as redirecting.


A great way to get some structure into your therapy session would be to create a visual schedule using BrainWorks picture cards. Since he is little, I would keep it fairly short—maybe 5 pictures for a 45 minute session. Here’s how I would run the therapy session:

* Upon entering the therapy room, hold up two picture cards of whole-body movement activities. Good ones would be ball bath, platform swing, or jumping into a crash pad. He can then put the choice onto your visual schedule (this can be a strip of cardstock with five pieces of Velcro on it).
* While he is engaged in this activity, assist him to create the rest of the schedule for the session. Choices 2 and 3 should be “green arrow” activities to help him reach the threshold of input he appears to be seeking (I’m thinking he is a sensory seeker). Stick with these “green arrow” activities until you start seeing some adaptive responses (better communication, better eye contact, less hand flapping, etc.). Choice 4 should be a “yellow arrow” activity that requires pretty intense heavy work (prone on a scooter while being pulled by a rope maybe). This activity should help slow him down a little. Activity number 5 might be your choice—probably an objective you want to address (ADLs or a specific motor skill). Then you could reward him at the end by letting him choose any activity he wants (I would still have him select from 4 or 5 picture cards, so he begins to use this as an effective choice system).
* For activities 1–4, you are letting him make limited choices. For example, hold up two “green arrow” picture cards, he chooses one of them and puts it in the right spot on the schedule. At his age, I would offer no more than 2 choices. If he attempts to disengage or leave the area of the chosen activity, use the visual schedule to redirect him. After completing each activity, make a big deal about it, and let him take the picture card off to indicate that activity is “all done.” Let him see a reward card at the bottom of the schedule to be his motivation. While engaging in each activity, you can feel free to bring other motivational toys into the picture. For example, if he chooses jumping from the mini tramp into a crash pad, you could extend the interest in the game by having him “chase” a toy frog. You make the frog jump onto the “lily pad” then ask him to try to “catch it!” Make him repeat the activity several times before allowing the frog to be “caught.”

Best Wishes,