Skill

Description

Neglect

Definition: Visual information presented on one side (e.g. right or left) is ignored.

Real Life Impact: Missing information presented when reading or on the board in the classroom,

Missing objects in a busy hallway/classroom, missing food on a plate, grooming, driving, hazard when cooking on a stove

Recommendations:

·         Referral to OT for visual perception neglect training (learning to carefully scan from left to right, eye patches, etc.)

·         Referral for vision test and/or neurologist to assess and correct neglect

Acuity

Real Life Impact: Driving, reading a novel or the board at school, using a computer

Recommendations:

·         Referral to optometrist for vision test and prescription for glasses/contacts

·         Change seating in classroom to sit closer to the board

·         Accommodations at school for bigger font on computer screen

·         Receive instructions (ex. from teacher) verbally instead of written/visually

·         Reduce clutter in environment

Colour Blindness

Real Life Impact: Interpreting traffic signs while driving, Enjoying leisure activities (ex. TV/movies

Recommendations:

·         Referral to optometrist for vision test

·         Strategies to reduce functional impact (ex. using colours they can see to mean danger)

Visual Perceptual

Definition: Being able to determine subtle differences in objects, pictures, letters/words; ability to recall visual traits of an object; being able to recognize a shape is the same even when rotated; being able to find a target object against a background.

Real Life Impact: Reading/writing objects and letters in class, bumping into objects in busy hallway, driving (depth perception)

Recommendations:

·         Referral to optometrist for visual testing

Referral to OT for assessment/intervention (ex. crossed lines test, visual training)

Hearing

Real Life Impact:  Hearing teachers in class, conversations with family/peers, safety as a pedestrian or driver in the community, safety when living independently (ex. hearing fire alarm)

Recommendations:

·         Referral for audiologist for hearing test

·         Asking others to repeat instructions

·         Receiving written instructions to complement verbal instructions

·         Ensure the person is facing you when talking

·         When receiving verbal instructions, do so in a quiet environment to reduce need to divide attention among several conversations

Fine Motor Coordination

Real Life Impact:  Handwriting, doing up clothing (ex. buttons/laces), typing, feeding, grooming

Recommendations:

·         Referral to OT for assessment of fine motor skills (ex. Beery) and handwriting (Handwriting without Tears)

·         Use of individualized pencil grips at school

·         Training of fine motor skills (ex. practicing doing up buttons)

·         Accommodations for extra time to write assignments/exams

Static Balance

Real Life Impact: Gross motor activities (ex. Sports), sitting/standing for long periods in class or at work, driving posture, walking on uneven surfaces (ex. hiking)

Recommendations:

·         Referral to OT/PT for balance and gross motor testing/training

·         Assistive aids (cane, walker, crutches)

Energy conservation strategies (ex. taking frequent breaks from standing)

Impulsivity

Real Life Impact: Money management, medication management, emotional regulation, conflict resolution, risky behaviours (i.e. drug use, sexual activity), rushing through tasks at work or tests

Recommendations:

·         Developing a routine through use of a planner

·         Read instructions fully and ensure that you understand the task before participating

·         Ask questions if you do not understand

·         Pros/cons list to assist in decision making

·         Teaching to consider all options and prioritize before making a decision

·         Reflecting on the consequences of your choices afterwards

Emotional Regulation

Real Life Impact: Social skills, communicating with others, relationships (working, friends/family, partners), emotional dysregulation of self (lack of insight into their own emotions)

Recommendations:

·         Asking the person what they are feeling instead of assuming

·         DBT skills training (de-stress tolerance, emotional regulation)

·         Roleplaying tough conversations with clinician

·         Assertive communication strategies (ex. I feel statements)

·         Completion of Tools for Life program (ex. body clues)

Memory – Immediate (Auditory)

Real Life Impact: Listening to a lecture, told instructions at home or in class, remembering someone’s name

Recommendations:

·         Writing things down during class/work or into agenda as soon as you receive the information

·         Asking the speaker to repeat the information

·         Use mnemonic devices (rhymes, phrases, diagrams, acronyms, repetition) for recall

·         Use an audio recorder (with permission) in class or ask for notes to be taken for you

Memory – Immediate (Visual)

Real Life Impact: instructions written on the board or in a Powerpoint, remembering traffic/construction signs while driving, following a recipe

Recommendations:

·         Use mnemonic devices (rhymes, phrases, diagrams, acronyms, repetition) for recall

·         Accommodations in class for note taker or recording the lecture

·         Asking for instructions/clarification verbally to complement visual information

Memory – Immediate (Auditory, Complex, Novel)

Definition:  Ability to remember more complex and new information, presented verbally, for a few seconds.

Real Life Impact: Class lecture with new/complex information, trying a new skill (ex. sport, hobby)

Recommendations:

·         Write information down as soon as you receive it

·         Use mnemonic devices (rhymes, phrases, diagrams, acronyms, repetition) for recall

·         Accommodations for note taker or receive notes beforehand so that they can direct their focus on lecture

·         Explanation through alternative formats (visual diagrams, Youtube videos, KhanAcademy)

·         Ask questions or to repeat information so that you understand

Temporal Awareness

Real Life Impact: Remembering appointments, scheduling their day (work/life/leisure balance)

Recommendations:

·         Set alarms for cueing (45 minutes of studying, alarm, 15 minutes off, alarm)

·         Use a scheduler/agenda to plan out your day and how long you’ll spend on each activity

·         Asking supportive individuals for reminders (ex. phone calls)

·         Use visual scheduler that children can help to make in the morning

Attention – Selective (Visual Distraction)

Real Life Impact: Focusing in class, studying at home, driving

Recommendations:

·         In class, sit at the front of the class to reduce visual stimuli (ex. other children)

·         Drive during non-peak hours and avoid construction areas to reduce people crossing, increased traffic

·         Request accommodations for extra time on assignments or testing done in separate class

·         Grounding/mindfulness (i.e. stay in present, deep breathing) when feeling overwhelmed

·         Setting limits when working on tasks and recognizing when you’re overwhelmed (ex. 30 min on, 15 off)

Attention – Selective (Audio Distraction)

Definition:  Ability to pay attention to one aspect of information presented despite other audio information competing for attention.

Real Life Impact: Focusing in class, studying at home, driving

Recommendations:

·         Wear noise-cancelling headphones when working in loud classroom/home environment

·         Study in quiet spaces (ex. library, bedroom) with no audio distractions (ex. TV, music)

·         Drive without others in the car and without radio/music distractions

·         Grounding/mindfulness (i.e. stay in present, deep breathing) when feeling overwhelmed

·         Setting limits when working on tasks (ex. 30 min on, 15 off)

Memory – Delayed (Written and Cued)

Real Life Impact: Test taking, remembering appointments/when to take meds, lectures/meetings

Recommendations:

·         Writing all appointments and information down immediately into calendar or notebook

·         Summarize/paraphrase information into your own words with key points

·         Use mnemonic devices (rhymes, phrases, diagrams, acronyms, repetition) for recall

Memory – Delayed (Auditory and Written)

Real Life Impact: Test taking, remembering appointments/when to take meds, lectures/meetings

Recommendations:

·         Writing all appointments and information down immediately into calendar or notebook

·         Use mnemonic devices (rhymes, phrases, diagrams, acronyms, repetition) for recall

·         Asking for clarification and reminders from family/friends

·         Practicing the information to familiarize and understand it (ex. math problems)

Memory – Working

Definition:  Ability to hold information temporarily and manipulate it in your head.

Real Life Impact: Keeping track of conversations, pop quiz, remembering appointments/when to take meds, lectures/meetings

Recommendations:

·         Writing information down immediately after

·         Use mnemonic devices (rhymes, phrases, diagrams, acronyms, repetition) for recall

·         Asking for clarification if you don't understand the information presented

·         Use active listening skills (eyes on speaker, calm mind)

Reduce distractions (visual/auditory) in your environment

Problem Solving (Numerical)

Real Life Impact: work (ex. cashier), assignments involving math at school, money management, medication management, managing time

Recommendations:

·         Use a calculator to help solve problems faster

·         Accommodations (extra time for assignments involving math)

·         Practicing basic math skills (division, multiplication, addition, subtraction) with worksheets or apps

·         Use excel spreadsheet for budgeting, or seek out support for finances (family, accountant)

·         Have medications put into blister packs

·         Reduce distractions (visual/auditory) in your environment to help focus on the task

Constructive Ability

Definition:  Understanding the way in which something is built or put together.

Real Life Impact: Ability to break down steps in a task (ex. cooking, building objects, completing school projects, morning/night routine), seeing big picture concepts from smaller things

Recommendations:

·         Creating a plan before completing tasks (i.e. know everything you need to do, how urgent each one is, how much time it typically takes)

·         Use an agenda/scheduler to help plan out when each task will be completed

·         Follow verbal/written instructions if provided

Route Finding

Real Life Impact: navigating your surroundings (ex. to school and between classes, appointments), managing time efficiently when going to destinations (ex. knowing how low it takes)

Recommendations:

·         Use a GPS/map app to help visually plan your route

·         Planning most efficient route before you leave and knowing distance/time it will take

·         Practicing the route to become familiar with the area and route

·         Support from bus drivers, peers/family

·         Identifying landmarks (ex. turn right at church)

·         Get address online/from person instead of just a building name

Sequencing

Real Life Impact: Cooking/baking, completing morning routines, school work

Recommendations:

·         Creating a plan before completing tasks (i.e. know everything you need to do, how urgent each one is, how much time it typically takes) and following it

·         Follow verbal/written instructions if provided and ask for clarification

·         Referral to OT for task analysis and recommendations

Attention - Divided

Definition:  Attending to multiple tasks completed at the same time.

Real Life Impact: Multi tasking (listening to lecture while taking notes, driving, conversation in busy environment), cooking

Recommendations:

·         Trying to focus and complete one task at a time if possible

·         Scheduling in advance so that you have enough time to complete all tasks

·         Accommodations (audio/video recording lectures, have a note-taker or receive notes before class)

·         Reducing audio/visual distractions (Noise cancelling headphones, sit near front)

Memory – Delayed (Faces and Names)

Definition:  Ability to recall information from some time ago (minutes, hours, days), presented visually and in written format, while auditory distraction is present.

Real Life Impact: Networking with people, social relationships, job interview, Scheduling appointments (ex. knowing who your OT is)

Recommendations:

·         Asking someone to repeat their name if you forget

·         Repeating their name back to them when meeting them

·         Writing their name down (ex. on appointment card)

·         Remembering distinguishing features (ex. wears glasses)

·         Reducing audio/visual distraction in environment when they introduce themselves

Memory – Prospective (Auditory – 2 Steps)

Definition:  Ability to remember to do something in the future that requires two steps to complete, starting with an auditory cue.

Real Life Impact: Remembering appointments/when to take meds, remembering tasks given at work or school, instructions from parents or teacher

Recommendations:

·         Write it down immediately after getting information into planner or notebook

·         Use mnemonic devices (rhymes, phrases, diagrams, acronyms, repetition) for recall

·         Asking for clarification on instructions and for reminders (ex. remember you have to clean visit your clinician after school tomorrow)

·         Use a calendar to plan out your daily routines

Mental Flexibility

Real Life Impact: Conversations/communication with others (seeing their point of view)

Problem solving around barriers (ex. driving and construction, re-adjusting schedule of everyday tasks due to bad weather)

Recommendations:

·         Keeping a schedule, and being able to prioritize and switch out tasks if a challenge arises (ex. raining and I cant bike, switch it out for another task)

·         Have a routine, and list alternatives if a challenge arises (ex. store closed, missed bus)

·         Roleplaying/assertive communication strategies

·         De-stress tolerance (learning to calm down and think of a rational solution and not being impulsive)

·         Asking for help from an adult if you are stuck

Abstract Reasoning

Real Life Impact: School lectures (picking up on key themes), transferring skills learned in school/from parents to daily life tasks (ex. math with money management)

Recommendations:

·         Guided discovery and cognitive mediation (i.e. therapist constantly questions and has individual answer what they should do next and how a skill links to an activity)

·         Breaking down an activity/scenario and identifying all the concrete skills (ex. body clues)

·         Working in groups or with peers on assignments to learn how they perform tasks and how they think and solve problems

·         Practicing concrete skills (ex. basic math skills for money management)

Judgement for Safety

Real Life Impact: Independent living skills (ex. cooking, laundry), driving, understanding emergency situations (ex. fire)

Recommendations:

·         Discussions through emergency situations and what to do, and having an emergency plan in place if living independently or trying new skills (ex. cooking)

·         Referral to OT for home safety assessment (ex. independent living skills scale, verbal reasoning scale of CCT to determine how they view emergency situations)

·         When in doubt, call for help

Foresight for Safety

Definition:  Ability to uncover the nature and significance of unsafe events before they occur.

Real Life Impact: High risk activities (unprotected sex, drugs, smoking), Independent living skills (ex. cooking, laundry), driving

Recommendations:

·         Discussions through emergency situations and what to do, and having an emergency plan in place if living independently or trying new skills (ex. cooking)

·         Referral to OT for home safety assessment (ex. independent living skills scale, verbal reasoning scale of CCT to determine how they view emergency situations)

·         Air on the side of caution. When it doesn't seem safe, don't perform activity

·         When in doubt, call for help

Comprehension and Humour Inferences with Distraction

Definition:  Ability to understand humour and implied information from conversations.

Real Life Impact: Conversations and social interactions, self-awareness, understanding leisure activities (movies, TV, reading novels)

Recommendations:

·        Roleplaying social situations with clinician

·         Teaching to pick up on non-verbal body language (i.e. smiling, laughing)

·         Asking others to clarify what they mean (ex. if they were literal or being sarcastic)

Executive Functioning and Combined Skills

Definition:  Ability to make decisions; ability to arrange things by importance; ability to list activities required to create a desired future action; ability to arrange elements according to one or more rules.

Real Life Impact: Completing independent living skills (ex. laundry, medication an money management, driving, prioritizing activities, keeping a scheduling), making major decisions

Recommendations:

·         Creating pros and cons list to assist in decision making

·         Breaking down an activity into steps and then prioritizing most urgent

·         Writing down incoming information immediately to organize for later

·         Ensuring all options explored (ex. before choosing a gym, weighing cost of membership, environment, goals)

·         Guided discovery and cognitive mediation (i.e. therapist constantly questions and has individual answer what they should do and consequences of actions)

·         Referral to OT for task analysis, goal setting and cognitive remediation interventions

Information Processing Speed

Definition:  Rate that data is manipulated in order to produce useful information.

Real Life Impact: Efficient completion of assignments/exams at school and at home, making quick decisions when driving or cooking

Recommendations:

·         Obtain accommodations for extra time at school

·         Having information presented verbally or written down to reduce demand on recalling from memory

·         Planning steps beforehand to follow (ex. recipe when cooking)

·         Potential supervision on tasks that may be more complex or if safety is a factor (ex. driving, cooking, tasks that require quick decisions)

·         Ensure good sleep hygiene to decrease fatigue and reduce audio/visual distractions

Mood and Behaviour

Real Life Impact: Maintaining relationships, self awareness of own emotions, motivation/confidence/self efficacy to complete tasks at school or at home

Recommendations:

·         Emotion regulation strategies (DBT, CBT, de-stress tolerance, motivational interviewing)

·         Behavioural activation strategies (ex. Action over Inertia workbook)

Endurance

Real Life Impact: Being able to complete a full work or school day, completing complex tasks (ex. online banking, cooking), potential for burnout or safety concerns (ex. rushing), additional carryover fatigue into other activities

Recommendations:

·         Energy conservation strategies (take frequent breaks, pacing, breaking tasks down into smaller steps)

·         Reducing divided attention (audio, visual stimuli)

·         Accommodations for extra time at work/school

·         Ensure good sleep hygiene

Comprehension and Communication

Real Life Impact: School and work, reading and writing, driving

Recommendations:

·         Following visual or verbal instructions and asking for clarification if required

·         Alternative communication (ex. pictures, videos, Dragon Dictation for speech-to-text)

·         Asking for simplified instructions

·         Energy conservation strategies (take frequent breaks, pacing, breaking tasks down into smaller steps)