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Featuring articles from our principal Occupational Therapist, Dr Nicole Grant, members of the therapy team, and guest posts from members of our community.  

Posts tagged prep
Low Muscle Tone and Poor Attention - A Case Study

A young boy, 4 years of age, was brought to me for assessment about 9 years ago. He had not been diagnosed with any particular disorder, but was easily distracted and found it difficult to pay attention to the task at hand. He had been seeing a Speech Therapist for some time due to a slight delay in his speech development and he dribbled.

The boy's mum was mostly concerned that he would not be able to concentrate in class when he started prep next year. She wondered what she could do to help him at home, in readiness for school.

I gave the child some activities to complete and observed that he fidgeted in his chair, and was easily distracted, and yes - had difficulty paying attention. One of the first things I noticed was that when needing to apply force or pressure, e.g to mould playdough, he would move to position himself over the table to use all his strength, rather than relying on his hand strength alone. When I asked him to throw a ring or ball, he needed to use two hands to get any sort of distance. Throughout the assessment I asked the boy to complete desk-based tasks that assessed things like posture, attention, and fine-motor skills, and more active tasks that assessed his balance, coordination and proprioception.

During the assessment, the 4-year-old managed to respond to multi-step directions, and complete age appropriate puzzles and games. I found that when he began to lose focus and become distracted, his posture also changed and he would recruit compensatory muscle groups to move or exert force on an object. I asked this child if he ever got tired in the neck, back, arms or legs when sitting for a long time. He thought for a second then answered "Yes. Sometimes my elbows hurt." His mum hadn't heard this before and wasn't sure what he meant by this.

By the end of the assessment, it had become apparent that the attention difficulties experienced by this boy were more likely due to low tone, than because of any cognitive or intellectual dysfunction.

Low tone or hypotonia is explained well in Wikipedia:

"Hypotonia is a disorder that causes low muscle tone (the amount of tension or resistance to movement in a muscle), often involving reduced muscle strength. Hypotonia is not a specific medical disorder, but a potential manifestation of many different diseases and disorders that affect motor nerve control by the brain or muscle strength".

I recommended that the child engage in physical activities that promote muscle strength, balance and coordination, like climbing, running, and bike riding. He was already taking swimming lessons and going to structured gym classes, so he was already on his way.

With regards to desk-based work, I suggested that the boy be given a seat and chair that was appropriate for his size and that enabled him to sit with his feet flat on the floor and his back well supported. When performing desk-based tasks, it was probable that the child would become easily fatigued and possibly develop joint or muscle pain. He needed to be given the opportunity to stretch and change postures frequently.

With these strategies in place, and ongoing review of his progress and awareness of his needs, the 4-year-old boy should have no difficulty keeping up with his peers on commencing prep.

5 things your child should know before starting school (they might not be what you think!)

It’s that time of year again when many parents of pre-schoolers are preparing themselves and their little ones to start Prep.  It can be a time of trepidation, fear and excitement in equal measures for all involved. For first time Prep parents there is so much to think about. The move from childcare, kindy or preschool is enormous. All of a sudden, your child knows everyone, to suddenly knowing only a handful of kids, or worse – no one. Their routine (and yours) will change dramatically. They will be expected to follow school rules, comply, and adhere to the status quo. For our free-spirited little ones, this can all be a huge ask. Furthermore, many parents worry if their kids are truly ready. Are they ready to learn, and is academic success within their reach? In my occupational therapy clinical practice, I often see children whose parents are concerned that at the age of four, their son or daughter is still using a cylindrical grasp, or is writing the letter C backward. They worry that their kids are going to struggle once school begins. These are common fears, however you may be surprised to know that academic success depends upon far more than being able to recite and write the alphabet.

Before kids are ready to learn, there’s a few other skills they need to master first. You may be surprised to find that the skills I most value for school readiness, are not necessarily related obviously to academic performance. For a child to be ready to learn, they need to be confident and relaxed, mentally prepared, and comfortable. So how do we ensure our kids are in the right frame of mind, and able to independently achieve these things on a day to day basis?

Here’s 5 things that your child should know before starting school:

1.    Can they go to the toilet by themselves?

Your child may have been toilet trained for 3 years, but that’s not what I mean. Starting school often means having a uniform to wear. Some Preppies will have zips, buttons or other fasteners to contend with in order to independently adjust their clothing for toileting. If your little one is not confident with adjusting their clothing, they may hold on all day (which is very uncomfortable) or even have an accident. An anxious or uncomfortable child does not make for a happy learner.

2.     Can they open and close a lunchbox lid, and open food packets, yoghurt lids, open a popper straw etc.?

At pre-school, your child will probably have ready access to an attentive grown-up to help them get to their food. At school, the ratios are much higher, meaning that they may not get the help they need. They may also be afraid to ask! If your child struggles with their lunch, they may take longer to eat and miss out on lunch, or worse, avoid eating altogether. A hungry or upset child is not going to be in the right frame of mind for schoolwork.

3.    Can your child ask for help?

Yelling for Mum at home from down the hallway is very different to asking for help in class. Kids can be shy or unsure when it is ok to ask for help. Make sure your little one knows the rules, whether it be raising a hand or going to the teacher’s desk. A child who is afraid to ask for help, or is unsure of how to go about it, may miss an opportunity to clarify information or check if they are on the right track.

4.    Can your child wait?

At school, your child will be vying for the teacher’s attention along with 25 other kids. A child that has not learned to wait will quickly grow impatient and will be easily frustrated. They will need to wait in line, wait for lunch, wait to use the bathroom, wait their turn for the monkey bars, and the list goes on. Being impulsive or cutting in will not go down well with the teacher or your child’s fellow classmates.

5.    Can your child sit still for at least 20 minutes?

Academic success requires good attention and concentration. A fidgety child, or a child who is easily bored will struggle to sit long enough in class to pay attention and complete their school work.

Pencil grasp, remembering letters and numbers, knowing the days of the week, and colouring in the lines will usually all come with time. When starting Prep it is far more important that your child has mastered the skills mentioned above.

If your child is struggling with any of these things, now is a good time to think about how you can help your child to develop these skills. If you are not sure how to go about it, an occupational therapist can help.

(Article originally posted as Guest Post at

Author Bio:

Dr Nicole Grant is a paediatric Occupational Therapist, and Director of Brisbane-based Gateway Therapies (