OT Red Flags Checklist

When to seek an occupational therapy evaluation for fine motor or sensory concerns

How to Use This

How to Use This: Check only the items in your child's current age group. If you mark 3 or more items, that's a signal to request an evaluation. OT stands for Occupational Therapy — it helps children develop the motor and sensory skills needed for daily tasks like writing, dressing, and eating.

Early intervention makes a significant difference. If you check 3+ items in your child's age group, request an OT evaluation through your pediatrician or school.

Infant (0-12 months)

Does not bring hands to midline by 4 months

Not reaching for or grasping objects by 6 months

Strongly prefers one hand before 12 months

Avoids tummy time or has very low muscle tone

Does not transfer objects between hands by 7 months

Extreme aversion to certain textures (food, fabric)

Toddler (1-3 years)

Cannot stack 3+ blocks by 18 months

No scribbling by 18 months

Cannot turn pages of a book by 2 years

Excessive drooling or difficulty with spoon/fork

Avoids or is distressed by messy play (paint, sand, food)

Does not use both hands together for tasks

Seems clumsy or falls frequently

Preschool (3-5 years)

Cannot cut with scissors by age 4

Avoids coloring, drawing, or craft activities

Cannot copy a circle by age 3 or a cross by age 4

Difficulty with buttons, zippers, or snaps

Still uses full-fist grasp on crayon/pencil at age 4+

Overwhelmed by busy or noisy environments

Difficulty with transitions or unexpected changes in routine

School Age (5+ years)

Handwriting is illegible despite effort and practice

Extreme fatigue or hand pain from writing

Persistent letter/number reversals after age 7

Cannot tie shoes by age 7

Poor body awareness — bumps into things, misjudges space

Difficulty organizing materials, desk, backpack

Avoids or melts down over fine motor tasks

Trouble with attention and sitting still beyond what's age-typical

What OT Addresses

Fine motor skills, handwriting, sensory processing, visual-motor integration, self-care skills, executive function support, and adaptive equipment recommendations

Where to Get Evaluated

Pediatrician referral to outpatient OT, school-based OT evaluation (free through the school district), or private OT clinic

Important

This checklist is for screening purposes only and does not replace a professional evaluation. If you have concerns about your child's development, consult your pediatrician regardless of how many items you checked.

Early Intervention Access

You don't need a diagnosis to request a school-based OT evaluation. Under IDEA, you can submit a written request to your school district at any time, and they must respond within a set timeframe (varies by state, typically 60 days).

Next Steps

Next Steps: If you checked 3+ items, write a formal evaluation request letter to your pediatrician or school district this week. Use the 2e Advocacy Letter Template if your child also shows gifted traits alongside these challenges.

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