Tier 1 interventions
Tier 2 interventions
Tier 3 interventions
fluoxetine for anxiety and hyperactivity
A. Making posters with colored markers on poster paper
B. Leather tooling a wallet with premade designs
C. Knitting a blanket following an assigned pattern
D. Freestyle painting a design on the wall in a public area
People with oppositional defiant disorder respond best to moderate, but not too much, structure. The choice of activities should be client centered and should capture the interests of the individual. Making posters allows the client to capture the style of art found in graffiti and tattoos while providing clear boundaries in the form of the poster paper and safe tools.
A. Ideational praxis
B. Motor organizational praxis
C. Symbolic play
D. Exploratory play
Ideational praxis is the ability to conceptualize and identify a motor goal and ways to achieve this goal. Problems in this area may lead to difficulties in generating independent play.
A. Infants and toddlers with established risk because of a diagnosis automatically qualify for Part C services.
B. Infants with marked developmental delays but without a specific diagnosis automatically qualify for Part C services.
C. An OTR® is automatically a member of an evaluation team in early intervention programs.
D. Early intervention is always provided by a multidisciplinary team.
As part of IDEA Part C, all children with established risk are eligible for services.
A. “I see that you’re becoming upset by your teammate. Let’s calm down and breathe for 10 seconds.”
B. “You seem to be getting upset by your teammate. Verbally threatening is not a good behavior to show others.”
C. “I need you to stop, pause for a while, and calm down.”
D. “You seem really upset right now. Would you want to take a minute to calm down or just go back to your room for now?”
When a potentially dangerous situation commences, such as a threat of assault, the OTR® should offer the adolescent choices for effective coping strategies to deal with emotional outbursts.
C. Model of Human Occupation
D. Dynamic Interactional Model
A. The activity should involve some degree of challenge.
B. The activity should be completed easily.
C. The activity should require multiple sessions to finish.
D. The activity should require primarily observational learning.
Activities for clients with major depression should be able to be completed easily to provide a sense of success and competence.
C. Reading a book
D. Playing a video game
Interoception is the ability to perceive information from inside the body. Children with autism spectrum disorders typically have difficulties with toileting because of insufficient ability to perceive the need to urinate and eliminate.
A. Redirect the behavior to a more appropriate one
B. Insist that the child put the cell phone away during the evaluation
C. Find out more about the child’s insistence on checking the weather
D. Introduce the child to a new weather app for the smart phone
An evaluation includes identification of factors that affect participation in occupation, and this ritual is one such factor. It is good client-centered practice to obtain the client’s perspective on what the weather at 1:05 means to this person and to gather enough information about it to determine whether this factor is a strength or a weakness.
A. Set academic, functional, and measurable goals achievable within a 6-month time frame
B. To the maximum extent possible, the student must be educated with nondisabled peers
C. Transition planning must begin with an emphasis on future vocational goals and independent life skills
D. To be succinct, the IEP reports only the needs and challenges of the student
A general education environment is considered first because the IEP process includes placement in the least restrictive environment possible.
A. The group must be heterogeneous.
B. Participants should be encouraged to practice their new language skills in settings outside of the group context.
C. The OTR® should lead this group as an occupational therapy group rather than engage in the group as a co-leader.
D. Parallel group activities or tasks should be included to maximize social interaction.
People with autism spectrum disorder typically do not generalize skills well. A challenge in practice is to facilitate carryover of rehearsed skills from therapy sessions to other settings to ensure that participants can apply the skills in cross-contextual situations.
A. “I think that participating in occupational therapy will make you feel a lot better.”
B. “I noticed you’ve been feeling like this for 3 days straight now, and it might be helpful for you to participate in occupational therapy.”
C. “I can see that you aren’t feeling well. Let’s try doing something you like that will not take too long and see what happens.”
D. “I can see that you aren’t feeling well, and I’m sorry for this. Can we try again tomorrow?”
When working with a client who is depressed, it is essential to relate with understanding and empathy. Encouraging participation in any way can be helpful.
A. Person-Environment-Occupation Model
B. Occupational Adaptation Model
C. Model of Human Occupation
D. Ecology of Human Performance Model
The Model of Human Occupation articulates the three dimensions of doing.
A. Place the student’s desk at the back of the classroom
B. Reduce the number of math problems to one per page
C. Increase the number and variety of spontaneous activities in the school day
D. Increase the number of other students at the student’s lunch table
Presenting math problems one to a page reduces sensory overload by removing clutter on the page, allowing the student to attend to one math problem at a time and supporting the student in an inclusive setting by altering the task.
A. Develop a social skills program for children with behavioral concerns
B. Provide direct services to children in special education
C. Provide a presentation to teachers on multisensory handwriting strategies
D. Integrate technology for children with autism
Tier 1 includes general education schoolwide services geared toward prevention of educational difficulties.
A. Identify which standardized assessments to use to provide a holistic picture of the child’s abilities
B. Gather information to create the student’s occupational profile
C. Send home a Sensory Profile questionnaire for the parent to fill out
D. Observe the child in the classroom to determine whether an occupational therapy assessment is warranted
The occupational profile is the first step in determining needs, skills, and abilities and identifying whether further assessments are needed.
A. Document the progress the OTR® has made with students with oppositional defiant disorder to justify continuing work with these students
B. Increase the frequency of visits to the students on the OTR®’s caseload with this diagnosis because the task force will scrutinize intervention with these students
C. Research intervention strategies to make sure that the intervention the OTR® has been providing to these students is considered best practice
D. Contact the superintendent and request to be appointed to a seat on the task force to study violence and the incidence of oppositional defiant disorder
AOTA’s societal statement on youth violence has clearly articulated the role occupational therapy should play in this area. Prevention is within the scope of occupational therapy practice, and practitioners should welcome any opportunity to participate.
A. An art program with well-established boundaries in which students are encouraged to pursue their own interests
B. A chess club in the library in which students participate in tournaments and, when not playing, participate as observers
C. A school basketball team that has the rule that students cannot play in a game if they miss a practice or are tardy or absent from school
D. A science club in which students work together in small groups to prepare science projects for the state science fair
A. Give a reward every time the child flushes the toilet after using it
B. Suggest a sensor-activated toilet to ensure it is flushed after each use
C. Use a visual schedule depicting the correct flow of actions during toileting
D. Facilitate memory by prompting the child to flush the toilet after each use
A visual schedule tends to work better than auditory and operant conditioning for children with autism when teaching them the correct steps in using the toilet.
A. Offer the client a choice to discontinue the session and ask the nurse about medication changes and effects
B. Immediately report the situation to the nurse and ask the client to rest for the day
C. Ignore the client’s response because it might be an effort to avoid work
D. Speak to the client privately and inquire whether the client is telling the truth
OTR®s should be cognizant of the possible functional performance effects of medication. Offering a choice is an effective way of handling an adolescent.
A. Referral to an alternative school located nearby
B. Assignment of in-school suspension during gym class
C. Implementation of a behavioral plan
D. Replacement of gym class with another class
A. The child must be between 4 and 7 years old.
B. The vest is worn for 45 minutes to 1 hour at a time.
C. The vest’s weight should be no more than 10% of the child’s body weight.
D. Weight should be distributed over the trunk and upper extremities.
The evidence-based recommendation is that the vest weigh no more than 10% of the child’s body weight.
A. Social Skills Rating Scale
B. Occupational Therapy Psychosocial Assessment of Learning
C. Canadian Occupational Performance Measure
D. Test of Playfulness
The Canadian Occupational Performance Measure is a structured interview used to develop a client’s occupational profile.
A. Make the child hold a vibrating toy and put it close to the face
B. Provide deep pressure on distal parts of the body and slow linear rocking
C. Ask the child to touch the lips with a piece of cracker
D. Provide only preferred foods during feeding sessions
Tools can be used to provide oral stimulation to desensitize oral hypersensitivity.
B. Conduct disorder
C. Attention deficit hyperactivity disorder
A. Demonstrate the steps involved in completion of the craft activity.
B. Explain the purpose of the group and verbalize expectations.
C. Orient members on the safe use of equipment needed to complete the project.
D. Provide samples of the craft project at various stages of completion.
Once introductions are made in a group setting, the purpose of the group should be clearly explained so clients know what the expectations of the group include.
A. Sensory Integration and Praxis Test
B. DeGangi-Berk Test of Sensory Integration
C. Sensory Profile
D. Sensory Processing Measure
A. Provide sensory activities to help the child become calmer and more organized
B. Change the therapy time so the medication is still in effect during occupational therapy sessions
C. Ask the parents about possible side effects of the medication affecting behaviors and performance
D. Recommend taking a break from medication and observe whether behaviors improve
OTR®s need to monitor and report possible effects of medications on performance and behaviors.
A. Allow the child to adjust to the classroom setup for a few weeks and observe whether there are difficulties
B. Further develop the child’s attention and sitting span to prepare for the structure of kindergarten
C. Ask the teacher to position the child closest to the front of the class for immediate monitoring
D. Defer kindergarten until the child is able to sit for at least 30 minutes at a time
The PEO Model focuses on the transaction between the child (person), the classroom (environment), and school-related tasks (occupation). By allowing time to adjust, the parent will be able to assess the fit between kindergarten and the child’s strengths.
A. Activities that establish normal daily routines
B. Activities that engage the client socially
C. Activities that do not require too many choices
D. Activities that allow for self-expression
For clients who have self-concept symptoms, activities that allow for self-expression and self-exploration help combat feelings of worthlessness and guilt.
A. Ask the child to cheer up because many activities have been planned for the day
B. Ask whether the child wants to discontinue the session
C. Discontinue the session and report the signs of depression to the parent
D. Offer the child a change in activities from planned handwriting to artwork
When a client is depressed and shows signs of self-concept issues, engaging in occupations that involve self-expression can help the client deal with his or her emotions.
A. Following simple designs using plastic interlocking blocks
B. Fishing for letter puzzles while on a swing
C. Playing Simon Says with a peer
D. Making a sandwich using play dough
A. Occupational therapy is one of 16 primary services provided for children in need of early intervention services.
B. Occupational therapy is a related service provided only as a support to special education services.
C. Occupational therapy is provided as a fee-for-service intervention for children in need of early intervention services.
D. Occupational therapy is primarily a school-based service provided for children in need of early intervention.
As part of IDEA Part C, occupational therapy is listed as a primary service, as are speech and physical therapy and special instruction.
A. Assess individual members’ likes and dislikes
B. Set ground rules with clear expectations
C. Do an ice breaker using a large parachute
D. Identify the time-out chair for participants who misbehave
Clients with oppositional defiant disorder need clear rules about what behaviors are acceptable and not acceptable. Expectations for participation in the group need to be made explicit.
A. Interview the student
B. Interview the teacher or caregiver
C. Read the student’s school file
D. Observe the child at home
People with oppositional defiant disorder are not always truthful and generally do not have insight into their oppositional behavior. They are unlikely to be able to articulate an accurate picture of their behavior.
A. Train the parent to use a sensory diet to help the child remain calm throughout the day.
B. Use the ALERT Program to train the child to self-regulate.
C. Train the child to use breathing and relaxation techniques when feeling hyperactive.
D. Provide a therapy ball for seating in the classroom.
The ALERT Program teaches children self-regulation skills to self-monitor their arousal and energy levels.
A. All interventions must be provided in the school context.
B. All interventions must be provided in the home context.
C. All interventions must be provided in all natural contexts of performance.
D. All interventions must be provided in the private clinic.
As part of IDEA Part C, all interventions must be provided in all of the client’s natural environments
A. The sensory environment is completely structured to allow for optimum integration of sensory information.
B. Sensory experiences are limited to one sensory factor at a time to ensure mastery.
C. Passive participation on the part of the child is encouraged.
D. Appropriate activities are done individually and not in a small group.
The Ayres Sensory Integration Intervention program is applied individually rather than in groups.
A. Activities of daily living
B. Rest and sleep
D. Social participation
Social participation is an area of occupation that pertains to behavior in the context of a social system, in this case a family. This youth’s interaction with others and fulfillment of roles in the family system are impaired by defiant behavior.
A. Moodiness and agitation
C. Blurred vision
D. Mydriasis and hyperthermia
Of the options, only A is a possible side effect of central nervous system stimulants.
A. The way the child modulates various stimuli in the classroom environment
B. The teacher’s teaching styles and whether they match the student’s learning styles
C. The demand that the classroom rules place on the child’s ability to follow them
D. The child’s ability to navigate the physical classroom
The occupational environment includes classroom rules, which create a demand for mastery. The interaction between the child’s ability to follow the rules (desire for mastery) and the occupational environment creates a press for mastery.
A. Feeding dolls
B. Stacking colored rings
C. Dipping hands in rice grains
D. Pretending to be a fairy tale character.
Functional play uses real objects to re-create real-life situations.
A. Knox Preschool Play Scale
B. Bruininks-Oseretsky Test of Motor Proficiency
C. School Function Assessment
D. Beery-Buktenica Development Test of Visual-Motor Integration
A. Observation during occupational performance
B. A life events inventory of the client
C. Interviews with caregivers
D. Interviews with roommates in the facility
A life events history can provide an accurate history of the client.
A. Provide client education on the effects of prescription medication
B. Review the contract for safety procedures the client will follow when thoughts of suicide commence
C. Contact the client’s school system to see if a suicide prevention program is in place
D. Reinforce the need for follow-up occupational therapy treatments to monitor progress
A contract for safety is the client’s written agreement that he or she will tell an appropriate person if he or she is having thoughts of suicide. Preventive measures are the MOST urgent and important part of the discharge plan for clients with suicidal tendencies.
A. Use movement-based activities to help the child improve focus and attention during structured tasks
B. Use highlighted ruled paper to enable the child to stay within boundaries when writing
C. Facilitate the child’s development of strategies to develop mastery of handwriting tasks
D. Strengthen the child’s hand muscles to improve pencil grasp
Modifying or adapting task tools is an intervention strategy of the Ecology of Human Performance Model.
A. Self-administered occupational performance checklists
B. Self-perception questionnaire related to occupational performance
C. Social interactions and social adjustment inventory
D. Functional capacities and work readiness evaluation
Social skills such as getting along with others and functioning socially in a group situation have been found to be significant predictors of employment for individuals with mental illness. This would be the most beneficial information to gather in this assessment.
A. Immediately ask the child to stop and sit in a corner to relax
B. Ask the child to slow down the swinging by pulling a trapeze bar for proprioceptive input
C. Ask the child to slow down while doing slow, deep breathing
D. Let the child continue because the vestibular stimulation ceases with autonomic activation
Research indicates that proprioceptive input inhibits vestibular stimulation.
A. Steps to support the child’s transition to preschool
B. Projected dates of each individual service to be provided
C. A detailed report and documentation of all sources of income for the family
D. A statement of all expenses to be incurred from occupational therapy services
A. Use of the most appropriate standardized assessments
B. Observation of the children’s function in various contexts
C. Observation of the children without their parents to see their natural behaviors
D. Use of an unfamiliar examiner to provide more objective results
Integrated developmental assessment incorporates multicontextual sources of information.
A. Easily gets dizzy with linear swinging
B. Shows increased hyperactivity and movement
C. Dislikes being touched and hugged
D. Shows guarded and cautious movement
According to Dunn’s model, low registration of stimuli is demonstrated by sensory seeking.
A. Memory limitations
B. Poor speech intelligibility
C. Low intellectual ability
D. Habitual behaviors
Autism spectrum disorder is characterized primarily by social interaction problems and habitual behaviors.
A. Tolerate holding a French fry for 5 minutes while seated at a restaurant
B. Tolerate sitting at a restaurant for 5 minutes while eating preferred home food
C. Tolerate sitting at a restaurant for 1 minute while eating a French fry
D. Tolerate putting a French fry near the mouth for 5 minutes while seated at a restaurant
Increasing food intake is difficult if the child is unable to tolerate sitting for a long time. Increasing the amount of time seated at a restaurant with preferred food must be the priority.
A. An isolated room free from any kind of distraction
B. A small classroom with two other children and soothing music
C. A small corner of a sensory gym where two other children are swinging
D. A quiet corner in the child’s classroom with a chalkboard divider
Sensory integration techniques emphasize the use of naturalistic environments for intervention. Using a small classroom where two other children are doing handwriting tasks is the most naturalistic environment similar to an actual classroom without unnecessary sensory stimulation.
A. Holding a cup while pouring water from a large pitcher
B. Donning a dress and buttoning the five 2-inch buttons on the dress
C. Writing the child’s own name while stabilizing the paper
D. Holding the handle of a small bucket while filling it with water from a faucet
Of the options, holding the handle of a small bucket while filling it with water from a faucet is the most appropriate play-based activity for the child’s age.
A. Install space enclosures or cubicle walls
B. Widen doorways throughout the office
C. Enlarge signs and elevator controls
D. Prohibit other workers from speaking loudly
A. Ensuring that all of the children’s skill deficits are addressed
B. Helping develop a weekend plan of activities with the families
C. Educating families about their child’s deficits and needs indicated in the evaluation
D. Modifying families’ lifestyle to ensure carryover of intervention at home
Of the options, only involving families in selecting activities reflects a family-centered approach to intervention.
A. Use a water gun to squirt water inside the toilet bowl to teach the concept of in and out
B. Ask the child to sit, keep deflecting the urine stream inside the bowl, and slowly stand
C. Place a piece of cereal inside the bowl to serve as a target
D. Use a piece of cardboard to elevate the rim of the bowl for a visual cue