“Can you screen this student? Their fine motor skills seem weak.”
“They have sensory concerns.”
“Their handwriting is really messy.”
“They can’t stay on task.”
If you’re a school-based occupational therapist, you’ve probably received referrals that sound something like these.
The concern may be valid, but it doesn’t necessarily tell you what the student is having difficulty doing at school.
Before beginning an occupational therapy screening, it can be helpful to clarify the referral concern. Asking a few targeted questions can help you understand the student’s functional performance, determine which school activities are affected, and decide what information you actually need to gather during the screening process.
A focused referral question can also keep your screening from becoming an attempt to assess every possible fine motor, visual motor, sensory, executive functioning, and self-care skill.
Instead, you can start with a much more useful question:
What is the student having difficulty doing, and what information do I need to better understand why?
If you’re looking for more information about the overall screening process, my Occupational Therapy Screening in Schools: A Practical Guide for School-Based OTs provides a broader look at school-based OT screening, what it can include, and how screening differs from a more comprehensive evaluation.
Why Clarify an OT Referral Before Screening?
A referral concern is a starting point, not a conclusion.
Consider a referral for “poor handwriting.”
That could describe a student who:
- has difficulty forming letters
- writes very slowly
- has inconsistent spacing
- has difficulty keeping letters on the line
- struggles to copy information from a classroom model
- loses their place while copying
- has difficulty organizing written work on the page
- knows what they want to write but cannot produce it efficiently
- spends so much effort on handwriting that completing written assignments is difficult
- writes successfully when given additional time or different paper
Those concerns may require very different observations, screening tasks, and supports.
The same problem occurs with broad concerns such as “fine motor,” “sensory,” “attention,” “visual motor,” or “self-care.”
Before deciding what to screen, clarify what the concern looks like during the student’s actual school day.
Start With the Functional School Concern
One of the most useful questions to ask is:
What is the student having difficulty doing at school?
Try to move the conversation from a broad skill label toward an observable school activity.
Instead of:
“The student has poor fine motor skills.”
Clarify:
“The student has difficulty opening classroom containers and managing small manipulatives during centers.”
Instead of:
“The student has sensory issues.”
Clarify:
“During assemblies, the student frequently covers their ears and asks to leave the gym.”
Instead of:
“The student has poor handwriting.”
Clarify:
“During independent writing, the student needs significantly more time than classmates to complete a short written response.”
Now you have something you can investigate.
The goal is not to decide what is “wrong” with the student based on the referral. It is to understand the interaction among the student, task, environment, expectations, and available supports.
Questions to Ask Before a School-Based OT Screening
You don’t necessarily need a lengthy referral interview before every screening.
A handful of well-chosen questions may give you much more useful information than a generic request to “tell me about the student.”
1. What Specific School Task Is Difficult?
Ask the teacher or referring team member to describe what they are seeing.
For example:
- What activity is the student completing?
- What part of the activity appears difficult?
- What does the difficulty actually look like?
- What is the student able to do successfully?
- At what point does the task become difficult?
This helps separate the occupation or school activity from assumptions about the underlying cause.
A student struggling to complete a worksheet, for example, does not automatically have a fine motor problem.
The barrier could involve visual access, understanding directions, task initiation, written output, organization, motor demands, environmental distractions, regulation, or several factors interacting together.
2. When Does the Concern Occur?
Context matters.
Ask:
- Does this happen throughout the school day or during particular activities?
- Does it occur during independent work?
- During whole-group instruction?
- During centers?
- During transitions?
- During art?
- At lunch?
- During arrival or dismissal?
- During longer written assignments?
- At a particular time of day?
Patterns can help determine what you should observe.
If handwriting concerns primarily occur during lengthy independent writing but not during short copying tasks, that is useful information.
If difficulty managing clothing occurs primarily during a rushed bathroom transition, that is different from difficulty with the same clothing when time and support are available.
3. How Is the Concern Affecting School Participation?
This is one of the most important questions.
A student may perform a skill differently from peers without that difference significantly interfering with participation.
Ask how the concern affects:
- access to classroom activities
- task completion
- independence
- efficiency
- participation
- use of classroom materials
- transitions
- written communication
- self-care routines
- engagement in learning
This keeps the screening connected to educational participation rather than focusing only on isolated performance differences.
If you decide that direct observation would help clarify the concern, my School-Based OT Classroom Observation guide goes more deeply into what an OT can observe within the student’s natural classroom environment.
Questions to Ask About Handwriting Referrals
“Poor handwriting” is one of the most common school-based OT concerns and one of the least specific.
Before screening, ask what aspect of writing is creating difficulty.
Questions might include:
- Is the concern letter formation?
- Letter size?
- Alignment?
- Spacing?
- Legibility?
- Writing speed?
- Copying?
- Written endurance?
- Remembering letter forms?
- Organizing work on the page?
- Keeping up with classroom expectations?
- Completing written assignments?
- Using an efficient grasp or posture?
- Is handwriting different during copying versus independent writing?
- Does performance change with different paper, visual supports, models, or additional time?
Also consider whether the difficulty is truly handwriting-specific.
For example, a student who does not complete written work may be experiencing difficulty with task initiation, language formulation, working memory, attention, organization, or understanding the assignment rather than, or in addition to, the motor act of writing.
That distinction matters when deciding what to screen.
Questions to Ask About Fine Motor Concerns
“Fine motor delay” can describe many different functional concerns.
Ask:
Which tools or school materials are difficult for the student to use?
Consider:
- pencils
- crayons
- markers
- scissors
- glue
- rulers
- manipulatives
- fasteners
- folders
- containers
- technology
- classroom supplies
Then clarify what happens.
Does the student have difficulty:
- stabilizing materials?
- manipulating small objects?
- opening or closing materials?
- coordinating both hands?
- adjusting objects within the hand?
- using tools efficiently?
- maintaining participation during longer tasks?
The answer helps you determine whether a broader screening is appropriate or whether you need to look more closely at a particular functional task.
Questions to Ask About Scissor Skills
A referral that says “can’t cut” needs more information.
Ask:
- What type of cutting task is expected?
- Can the student open and close the scissors?
- Can they maintain an effective scissor position?
- Can they stabilize and move the paper with the assisting hand?
- Can they cut forward?
- Can they stay near a line?
- Can they change direction?
- Is the challenge primarily accuracy, coordination, endurance, safety, or understanding the task?
- What happens when the cutting demand becomes more complex?
A student who has difficulty opening and closing scissors presents a different screening question than a student who can cut but has difficulty coordinating paper rotation around a shape.
Questions to Ask About “Sensory Concerns”
“Sensory” is another referral category that can become extremely broad.
Instead of beginning with:
“Does this student have sensory processing difficulties?”
Start with what is happening during participation.
Ask:
- What is the student doing that is creating concern?
- During which activities does it happen?
- What happens immediately before the response?
- What environmental demands are present?
- Is the environment noisy, visually busy, crowded, unpredictable, or physically demanding?
- What does the student appear to be communicating through their behavior?
- What does the student say about the experience, when they are able to tell us?
- What strategies does the student already use?
- What supports appear to help?
- Are there situations in which the student participates successfully?
This keeps the discussion centered on supporting participation rather than labeling a behavior as “sensory” before gathering enough information.
Questions to Ask About Attention or “Staying on Task”
“Can’t attend” can also mean many things.
Consider asking:
- Does the student understand the directions?
- Can they identify what they are supposed to do first?
- Can they locate the necessary materials?
- Can they begin the task?
- Can they continue once they have started?
- Do they lose their place?
- Does the difficulty increase with multi-step activities?
- Does the student know when the task is finished?
- Can they return to the activity after an interruption?
- Does performance change when directions are shortened or presented visually?
- Does movement affect participation?
- Does the student participate differently during preferred or familiar activities?
These questions can help you determine whether your screening needs to explore areas such as executive functioning, classroom organization, environmental demands, sensory regulation, visual access, motor demands, or another aspect of participation.
Questions to Ask About Self-Care and School Routines
School-based self-care concerns should also be tied to actual school expectations.
Instead of simply documenting “difficulty dressing,” determine what the student needs to do during the school day.
For example:
- managing a coat
- managing a backpack
- opening lunch containers
- using bathroom clothing
- washing and drying hands
- managing shoes
- handling fasteners
- organizing personal belongings
Then ask:
- Which step is difficult?
- What can the student do independently?
- How much assistance is currently provided?
- What type of assistance is needed?
- Is the difficulty consistent?
- Does additional time change performance?
- Does changing the setup or sequence help?
- Is the current expectation necessary for school participation?
Breaking the routine into steps can make the referral much more useful.
Ask What Has Already Been Tried
Before introducing another strategy, find out what is already happening.
Ask:
- What supports are currently available?
- Has anyone changed the materials?
- Have visual directions been tried?
- Has the task been broken into smaller steps?
- Has the amount of written work been adjusted?
- Has positioning been changed?
- Has additional time been provided?
- Has the environment been changed?
- What happens when adult prompting is reduced or increased?
- Has the student developed their own strategy?
Most importantly:
What helped?
A support that improves participation provides useful information.
Instead of viewing accommodations as something that makes a screening less valid, consider what the student’s response to support tells you about performance.
Ask About Strengths, Too
Referral conversations can quickly become lists of things a student cannot do.
Make space for strengths.
Ask:
- What does the student do well?
- When are they most successful?
- What activities do they enjoy?
- What tools do they prefer?
- What strategies have they developed independently?
- When does the concern NOT occur?
- What helps the student participate?
This information matters.
If a student struggles to produce handwritten work but communicates complex ideas efficiently through typing, that is important.
If a student has difficulty with a classroom routine in one environment but completes it successfully somewhere else, that is important too.
Differences across environments can help identify barriers and supports.
A Simple OT Referral Framework
When a referral feels vague, try organizing the information into five questions:
1. What Is the Student Expected to Do?
Identify the functional school task.
2. What Is Happening Now?
Describe observable performance rather than using a broad label.
3. How Is It Affecting Participation?
Determine the educational or functional impact.
4. Under What Conditions Does the Difficulty Occur?
Consider the task, environment, time, supports, and expectations.
5. What Has Already Helped?
Identify accommodations, strategies, environmental changes, or student-developed approaches that improve participation.
Once you can answer those questions, it becomes much easier to decide what your occupational therapy screening actually needs to investigate.
From Referral Question to OT Screening
Here is what this might look like in practice.
Referral Concern: “Messy Handwriting”
After clarification:
During independent classroom writing, the student’s letter size and alignment become increasingly inconsistent as the assignment continues, and the student frequently does not complete the expected amount of written work within the available time.
Now your screening has direction.
You may want to compare:
- shorter versus longer writing
- copying versus independent writing
- different paper formats
- performance at the beginning versus end of a task
- level of prompting
- positioning
- writing efficiency
- supports that improve participation
Referral Concern: “Fine Motor Problems”
After clarification:
The student independently uses pencils and crayons but requires adult assistance to open containers, manipulate classroom fasteners, and manage materials during multi-step classroom projects.
That suggests a different screening focus.
Referral Concern: “Sensory Issues”
After clarification:
The student participates successfully during most classroom routines but frequently leaves their seat, covers their ears, and requests a break during louder whole-group activities. Participation improves when the student has access to a quieter location.
Again, you now have a functional question to investigate rather than a broad label.
You Don’t Have to Screen Everything
One of the benefits of clarifying the referral is that you may not need to screen every possible OT-related skill.
If the concern involves cutting, your screening might focus more closely on:
- scissor use
- bilateral coordination
- paper management
- visual motor demands
- positioning
- functional cutting tasks
- supports that improve performance
If the primary concern is managing classroom routines, spending most of your screening session on handwriting may not answer the referral question.
A school-based OT screening should help you gather the information needed to understand the student’s participation and determine appropriate next steps.
Need a Structured School-Based OT Screener?
If you frequently find yourself trying to organize all of this information during school-based OT screenings, having a structured screening tool can make the process much easier.
My K–2 School-Based OT Screener was designed specifically for school-based practice and goes beyond handwriting and fine motor skills.
It includes areas such as:
- handwriting
- scissor skills
- tool use
- visual motor and visual perceptual skills
- executive functioning and organization
- sensory processing and regulation
- positioning and motor participation
- functional school routines and self-care
It also includes classroom observation forms, more in-depth screening sections, student tasks, supports/accommodations to trial, and space to help organize next steps.
If you need tools across multiple areas of school-based practice, you can also explore my OT Screening & Data Collection Bundle, which brings together resources for screening, baseline data collection, progress monitoring, consultation, and documentation.
What Happens After You Clarify the Referral?
Once you understand the functional concern, the next step is deciding what information you need to gather.
You might:
- observe the student during the activity
- review work samples
- gather additional teacher or caregiver input
- talk with the student
- trial accommodations or supports
- complete targeted screening activities
- collect baseline data
For a complete walkthrough of the screening process, read my Occupational Therapy Screening in Schools: A Practical Guide for School-Based OTs.
And if classroom observation is part of your screening, continue with my School-Based OT Classroom Observation guide.
Together, referral clarification, classroom observation, targeted screening, and functional data can help you develop a clearer picture of what is affecting the student’s school participation.
Final Thoughts
A vague referral doesn’t mean the concern isn’t important.
It means we need more information.
“Poor handwriting,” “fine motor concerns,” “sensory issues,” and “difficulty attending” are starting points.
As school-based occupational therapists, we can help teams move from broad labels toward more useful questions:
What is the student trying to do?
What is making that school activity difficult?
When does the difficulty occur?
How is it affecting participation?
What is already helping?
Those questions give us a better foundation for deciding what to observe, what to screen, what supports to trial, and what information we still need.
Ultimately, that keeps school-based OT screening focused where it belongs: supporting meaningful participation in the student’s educational environment.
