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Susan Holmes Shier

Birth To Six Months

Concurrent Motor Skills

  • In prone holds head up
  • Brings hands together
  • Rolls over
  • Grasps object intentionally
  • Sits with support
  • Reaches for object
  • Brings hand to mouth
  • Shakes and plays with rattle


Expose to indoor and outdoor sounds and sound toys; isolate each sound if possible, follow by touching/holding.

Begin basic vision stimulation; incorporate with reaching, tactual stimulation, and auditory cues; keep visually attractive sound-producing objects within reach at all times.

Provide daily tactual stimulation by massage and stroking; use variety of textures and substances; during play times give interesting textures to hold and mouth including fabric, household objects, toys, food in various forms; etc.

Environmental Concepts

Expose to household activities on a daily basis with child as close to activity as possible (e.g., front carrier); give object associated with the activity to child to hold-and. explore; provide simple description during activity.

Begin including infant in errands and community activities as soon as possible; position child close to the action and arrange for-maximum involvement, hopefully hands-on.

Body Image

Provide daily movement stimulation in the form of bouncing, swinging in prone, gentle spinning, rolling, and gentle rough-housing.

Include all body parts and areas in tactual stimulation with emphasis on hands and feet; proceed slowly if this appears to be aversive; consult with OT or PT.

Space/Time Relationships

Establish predictable daily routine, i.e., the same events in the same order each day. Arrange a "defined space" in child's crib and/or playpen: place a solid row of attractive toys, household objects, textures, and other materials around the infant. These should form a perimeter located just slightly beyond infant's reach. Any random movement should result in contact with an object, preferably a noisy one. Move this perimeter of objects further away from infant as he begins to scoot or roll. Also hang objects near chest from above. Place in defined space several times each day(not just at nap times) for 15-20 minutes each.

For the low vision child begin encouraging reaching to an object viewed; use sound of object as necessary; begin with most familiar objects.

For the blind child begin preparing for reaching to a sounding object; use objects that have great meaning for infant such as bottle, favorite rattle, etc; have infant handle and explore tactually just prior to expecting him to reach for it; initially sound it while in contact with his body, later sound it on tray of high chair in front of infant.

Gross Motor

Encourage developmentally appropriate motor skills; position in variety of ways throughout the day - prone, supine, side-lying, sitting supported, infant seat, front carrier; emphasize infant getting accustomed to prone while awake.

Six To Twelve Months

Concurrent Motor Skills

  • Transfers object
  • Grasps with thumb and forefinger
  • Finger feeds
  • Builds tower of cubes (2-3)
  • Places cube in cup
  • Sits without support
  • Crawls
  • Pulls to standing
  • Finger foods
  • Creeps
  • Stands alone


Continue exposure to variety of sounds; provide direct experience; repeat exposure often.

Continue incorporating vision stimulation with reaching and other fine motor tasks (eating); encourage use of distance vision outdoors; repeat experiences often.

Continue passive tactual stimulation and massage, but also encourage more active exploration of textures; increase variety of textures, shapes, temperatures, and consistencies; encourage play with semi-wet substances.

Expose to novel smells, tastes, and textures by routinely introducing new foods or new textures and/or forms of familiar food; repeat as often as necessary to achieve acceptance.

Environmental Concepts

Encourage exploration of furniture, appliances, household products, foods, household activities; give consistent names to all objects but emphasize action words, i.e., describe to infant how she is acting upon the object.

Continue including in errands and community activities; provide for more and more direct involvement as motor skills progress.

Supervise frequent direct experience with sand, soil, mud, gravel, grass, leaves; expose to trees, shrubs, sidewalks, streets, vehicles, etc. as much as possible; emphasize what the child is doing with the object or substance.

Body Image

Continue to provide daily movement stimulation, in addition to what he can provide for himself.

Begin passive differentiated movement of body parts accompanied by simple labeling of body parts and action; begin simple hand games and finger-plays that incorporate body parts; accompany with tactual stroking/massage; emphasize eyes, nose, mouth, arm, hand, leg, foot, stomach.

Space/Time Relationships

Begin changing daily routine occasionally, but allow enough time to thoroughly adjust before introducing yet another change.

Expand infant's defined space to correspond with her gross motor skills, i.e., to playpen, then later to small corner of room; position one large toy, object, or texture on each side of her space - each should be very different from the other -fasten them permanently - continue to use loose toys and objects around perimeter in addition to the permanent landmarks.

When able to sit up use defined space idea by providing tray attached to seating; tray should have edge to prevent toys/objects from "disappearing"; allow time with several objects on tray; also when giving toys, food, or bottle to child place on tray and help her reach for it instead of placing in her hand.

For low vision child begin incorporating reaching for toy/ object viewed with vision stimulation activities; give. intermittent tactual and auditory cues to reinforce looking; incorporate with feeding, i.e., have him reach for spoon, jar, bowl, box, etc.

For the blind infant continue reaching to sound but place object on tray in front of child while sounding; continue intermittent tactual input and always permit tactual exploration before; begin encouraging localization by head-turn as reaching becomes consistent' begin decreasing auditory input to intermittent; later provide initial sound only.

When reaching to sound is well established begin object permanence activities; again, use meaningful and highly desirable objects; permit brief tactual exploration or play before requiring pursuit; begin by placing screen(washcloth) over object as she is holding it; proceed to conventional method, but keep covered object in contact with infant; later proceed to containers over object(plastic tub, square cake pan, shoe box); use immediate physical prompting initially; also initially, have her help place object under cover.

Begin using "defined spaces" in feeding by using tray with edge; consistently position dish, cup, spoon and/or bottle even if infant is not independently using these items.

Gross Motor

Continue to encourage developmentally appropriate gross motor skills; do so within familiar defined spaces (e.g., playpen) and also in open space; from very beginning encourage to walk from a specific location (landmark) to another location within 2-3 feet; encourage cruising by arranging furniture close together for ease of transfer.

For the low vision child begin incorporating motor planning with vision stimulation by having him detour around obstacles and crawling under to retrieve a desired object.

Provide daily opportunity for free movement and exploration; keep furniture in predictable arrangement: use a constant low-volume sound source for each room or area (fan, ticking clock, radio, etc.); avoid constant or even frequent medium-to-high volume TV or radio; remove articles unsafe or breakable and replace with interesting materials and household objects.

To prevent or discourage self-stimulation arrange the infant environment so he will contact interesting materials, toys, and objects almost constantly; also provide 1-on-1 sessions daily that encourage interaction with a variety of objects; keep him busy.

Twelve To Twenty-24 Months

Concurrent Motor Skills

  • Walks steadily
  • Crawls up steps and down
  • Walks up stairs with assistance
  • Climbs into adult chair
  • Runs
  • Throws ball
  • Jumps in place
  • Places several cubes in cup
  • Scribbles spontaneously
  • Builds tower of 3-7 cubes
  • Completes circle, square, triangle formboard
  • Turns pages of book singly


Expose to variety of sounds; provide direct experience; help child produce the sound himself; give simple names for sounds he hears that have meaning for him; repeat experiences often.

Continue incorporating vision stimulation with reaching and other fine motor tasks, but begin more advanced skills; incorporate use of vision with locomotor tasks (Ball play, hide and seek, egg hunt, etc.); continue use of distance vision outdoors; give simple names for objects viewed; repeat experiences often.

Continue tactual exposure by continually increasing child’s involvement in many household and outdoor events; use textures to mark her personal possessions, furniture, storage substances; encourage exploration and manipulation of object parts; through physical modeling increase child’s repertoire of hand and finger movements (e.g., with playdough); demonstrate effort of movement (e.g., gentle, hard, lightly, firmly); begin matching grossly different textures.

Expose to new and familiar smells with and without food; begin giving simple names for distinct and meaningful smells (bacon, bubble bath, mother’s cologne, pet, medicine, etc.); later begin asking to identify these smells with aid of other naturally occurring clues; teach how to sniff.

Environmental Concepts

Continue exploration of furniture, appliances, and household products; give him name for each object and describe his action on it (e.g., “Bill closed door); increase direct involvement in various household activities as motor abilities increase (e.g., have him help with different phase of dinner each night - setting table, putting vegetables in pan, pouring drinks, or cracking eggs); if he cannot do it have him feel it being done.

Continue errands and community activities; increase direct involvement; begin having child select grocery item and give money to cashier; point out sights, sounds, smells and let her touch and explore if possible.

Expand outdoor experiences and sensations (see 6-12 mos) and provide frequent mediation; give labels for and demonstrate new actions with objects and substances; begin experiences with sidewalks, driveways, curbs, streets, corners, vehicles, vehicle-behavior, and weather; simple labeling of object and action associated with it; incorporate with use of distance vision.

Body Image

Provide daily movement stimulation; teach how to use motor equipment that will provide high level of activity on his own.

Continue hand games that incorporate body parts; try hide and seek game in which child searches for small object (raisin) attached to named body part; label facial features, hair, head, neck, fingers, stomach, elbow, knee, toes, bottom, back, etc; begin asking to point to these parts; later should be able to name when asked.

Space/Time Relationships

Continue predictable daily routine with frequent minor and occasional major changes.

Expand child's defined space by using small room or corner of a larger room; continue to use landmarks within these spaces; set up defined spaces all over the house (or classroom), for example, play corner in bedroom, corner in living room, cabinet beside refrigerator that holds his own pots and pans; be sure to set up favorite toys and objects that are stored in each of these areas.

Continue to use tray on high chair (see 6-12 mos); later use placemat on table to define his space.

Practice reaching to sound using only initial and intermit Cant sound; return to continual sound to encourage greater head turn (localization); begin presenting object in space (as opposed to on body or tray) and at increasing variety of angles; continue intermittent play and tactual exploration.

Gross Motor

Encourage appropriate gross motor skills; provide regular opportunities to try merging running skills in familiar open space (yard, tennis court, gym, large garage, large open living area.)

Begin encouraging goal-directed movement, i.e., encourage child to move to a goal in mind rather than wander; if wandering, spinning, etc. persist make sure child has plenty of opportunities for appropriate motor expression (rocking horse, Sit 'n Spin, swing, trampoline, bouncing toy, etc.); initiate goal-directed movement by guiding him to familiar landmark then having him walk to his goal very close by (3 ft.); gradually increase these distances; later introduce obstacles.

Teach simple routes, 3 to 5 feet in length; only teach routes to a goal (landmark) that represents a familiar and desirable activity(bath tub, trampoline, refrigerator, record player, snack table, etc.); initially assure that the child gets to participate in at least part of that activity upon completing the route; give enough physical assistance to maintain time and space perception.

Encourage beginning motor planning by assisting with the following: opening cabinets, shutting drawers, crawling under furniture and into tight places, and crawling over obstacles; later demonstrate using stool, box, etc. to reach desired object; always reward motor exploration by discovery of desired and/or meaningful object.

Formal Techniques

Teach child to search for dropped object immediately; coactively model fairly accurate reach accompanied by quick sweeping motion; model with each hand alone; later encourage child to sweep farther and persist longer.

Teach modified sighted guide by, having child hold on to adults index finger; encourage firm grasp; work on walking in rhythm and at a faster pace; discourage pulling back; with curb greatly exaggerate your body motion and step; teach child to wait until you step first; give verbal reminders as necessary, fade.

Encourage very selective trailing; if child cannot use standard trailing try 2-handed method or use sighted guide with non-trailing hand; expect trailing with verbal reminders; use more concrete language cues, e.g., "Hand on wall:

Teach a modified upper hand and forearm technique since laterality and midline concepts are not well-established; for example: both arms out in front, palms outward, hands on top of each other; use concrete and/or simple language cues such as, "Hands out "or ' upper arm".


Use constant environmental simulation to discourage mannerisms; arrange for child to come in contact with interesting toys and objects often; expand repertoire of interactions with objects; provide movement stimulation and regular opportunities for physical exhaustion; begin mild*physical prompting accompanied by 1 or 2-word verbal reminder.

Discourage "spacing out" by intervening immediately - get child involved with motor equipment or toys and materials.

Watch for "fiddling about"", i.e., sensory-motor preoccupation such as hitting surfaces, jiggling door knobs, repeated opening and closing doors, etc; a certain amount is normal initially, if a particular habit lasts for more than 3-4 months begin discouraging; physically model appropriate associated activity, e.g., opening and closing cabinets: show him how to open, crawl in, empty contents, replace, and close door; do this each time he begins the opening and closing; use non-punitive physical prompt with simple verbal reminder also, if necessary.

Twenty-four To Thirty-six Months

Concurrent Motor Skills

  • Jumps from chair
  • Makes train of cubes
  • Walks on line
  • Tower of 8-10 cubes
  • Alternates feet on stairs
  • Adapts to reversal of form board
  • Walks on tiptoe
  • Unscrews lids
  • Hops on one foot
  • Imitates drawing vertical, horizontal, and circular line


Continue to draw attention to environmental sounds; have simple and brief discussions of sound descriptions: high, low, loud, soft, near, far, in front, behind, beside; identify sound sources, but only those that child has had hands-on experience with: cat, dog, bird, cow, horse, car, truck, air conditioner, typewriter, TV, washer/dryer, etc; begin encouraging use of sound for traveling in home and classroom: initially expect to use appropriate sound as a goal, later teach to place sound in relation to self to move to silent goal.

Continue use of distance vision with locomotor games, etc; include negotiation of uneven surfaces, obstacles, steps; begin simple analysis and identification of objects followed by tactual confirmation; encourage child to use simple description.

Continue play with novel textures and substances; teach more advanced tactual matching; begin tactual discrimination of common textures using feet and hands - ask child to name.

Expose to more smells and their sources; take on regular field trips and teach beginning associations of smells with locations: grocery store, doctors, cafeteria, bakery, zoo, gas station, etc.

Environmental Concepts

Continue child's involvement in household activities but expand extent of each task and number of tasks; have him carry out at least one task from beginning to end as soon as he is capable (e.g., undressing - including putting clothes in hamper); expand number of tasks he can do with complete independence.

Expose to unfamiliar errands and community events as well as continue familiar ones; expand involvement in the latter; begin teaching independent travel in small, familiar store; more advanced participation in purchasing; more in depth discussion of sights, sounds, smells, landmarks, etc.

Continue exposure to residential concepts and landmarks; have name familiar landmarks; guide child through beginning street-crossing: listen to traffic, discuss when to cross, use sighted guide to cross at appropriate time, help child note textures, sounds, landmarks during crossing.

Body Image

Continue providing opportunity for daily movement stimulation and physical exhaustion through: dancing, running, climbing, jumping, use of obstacle courses, tricycles, trampolines, swings, pools, playground equipment, etc; continually introduce and teach novel equipment and games.

Continue games involving naming body parts; introduce more advanced naming: wrist, waist, hips, shoulders, ankles, etc; incorporate with comprehension of spatial prepositions (in, out, behind, in front, under, etc.) by having child place her body parts in relation to her body and environmental objects; have her imitate your body position or action by doing it herself.

Space/Time Relationships

Continue using defined spaces set up all over house and at school; may be able to achieve total orientation in a small room now, although may have to frequently encourage goal-directed movement and verbally and physically remind child of location of objects in relation to landmarks; arrange defined space in corner of yard adjacent to door; if appropriate set up another area that includes favorite tree, swing set, etc.

Continue to expect child to maintain consistent spatial relationships during independent eating times.

Use verbal and physical (if necessary) reminders to encourage child to replace toys/objects, clothes, etc; continue building on object permanence by asking child to retrieve named objects within known location in large room, then later from adjacent room; introduce systematic search patterns: near space and perimeter of a room; encourage him to pursue beeper ball, then jingle ball, then finally bouncing(regular) ball.

Continue sound localization/locomotor activities; incorporate into household and classroom routine.

Continue concept of vertical space by providing more complex climbing equipment, and teaching new skills; have child stack, build, and connect increasingly small objects.

Expand child's understanding of spatial prepositions: in, out, under, on top, above, below, behind, in front, between; begin naming object-to-object relationships after child has considerable experience manipulating the objects; initially ask him to place objects as you describe, later have him tell you about how the objects are positioned.

Begin stressing activities that emphasize the sides of the body and spatial terms that reflect laterality (side-to-side, side step, beside, sideways, etc.); encourage distinction between the 2 sides of the body(do not expect heft/Right labeling yet).

Teach one-quarter and one-half turn in relation to wall; use simple, concrete language cues, such as, "Side to wall" or Back to wall"; use prop to enable tactual confirmation of alignment; later stress head, body, and feet alignment; make lessons brief and within context of daily route; use appropriate reward for age level.

Teach pointing to continual distant sound source; initially use stationary source and vary angles(encourage head turn); later have child point to approaching sound source(mechanical toy, beeper ball, car, etc.) and track across midline; use physical modeling as necessary.

Gross Motor

Support and encourage advancing gross motor skills; devise adaptations as necessary to teach these skills; assure that child has opportunity to utilize on daily basis at home and school.

Continue expecting goal-directed movement; may need to use additional sound cue at goal occasionally, but encourage to use more landmarks, direction-taking, straight-line walking, and indirect auditory clues.

Continue more advanced motor planning activities.

Build child's repertoire of body movements by physical modeling of adults and peers: dance movements, swaying, spinning, twisting, duck-walking, crab-walk, walking backwards, tumbling; no action is too meaningless to teach; teach how to move major body parts in isolation (shoulders, arms, ribcage, hips, feet, knees, head, etc.); build into child the desire to imitate peers.

Continue stressing effort of movement; incorporate with dance; teach her to use appropriate effort of movement according to type of music (rock, classical, etc.)

Begin stressing straight-line travel using squaring-off ("Back to the wall"); initially use very short distances and physical assistance to maintain direction and gait; use meaningful and valued object at goal and initially pair with auditory clue; later use landmarks or large tactual aids at goal.

Formal Techniques

Introduce individualized modification of formal dropped objects technique; use favorite familiar objects; incorporate into game, allow play with the objects; demand immediate searching, encourage persistence, and teach soliciting assistance after thorough search.

Continue sighted guide techniques, have variety of adults guide child; teach him to demonstrate proper grip to adult; improve gait and pace; introduce ascending, then descending steps with child holding railing.

Encourage use of trailing by exposing to unfamiliar indoor settings in which trailing is appropriate; have child use conventional 1-handed trailing; initially may need auditory goal to distract him from extra tactual input; expect only very brief trailing to locate a specific object within familiar settings.

Introduce narrow passage technique; use simple language; initially offer simple verbal description of situation, then fade.

Introduce beginning sighted guide door technique; if possible have child on the side closest to door, open door so that child will easily contact it, have her help hold it then close the door; introduce concepts such as pull, push, toward, and away.

Continue modified upper hand and forearm; teach 1-handed, cross body position when laterality/ midline concepts are established; consult with OT or PT, if possible.

Begin teaching simple perimeter search of small room; include much simple discussion of each landmark encountered and the activities associated with each one; repeat no less than once/week initially, later review periodically; assure that child has frequent opportunities within the classroom routine to move to all landmarks in the room (e.g., to retrieve a necessary item for the teacher, to place something in the trash, to turn on the record player, to open the window, etc.)

Introduce short, functional routes within the classroom routine and at home: utilize simple direction-taking, selective trailing, landmarks, and auditory clues; child may continue to require verbal and physical reminders for some time; only require use of route travel in situations where child cannot maintain orientation or adequate speed and efficiency; discontinue if and when he is able to use direct, free-space movement toward the objective; do not require long or complex routes that involve a great deal of trailing.

Introduce a protective device when child is demonstrating good orientation and has the occasion to travel a long, clear route (hallway, walkway, sidewalk, etc.) on a daily basis; use doll stroller or toy lawn mower (2 handles); allow child to tactually explore obstacles encountered until she has become familiar with the route; emphasize accurate correction away from the obstacle and maintaining mental image of the goal (must use meaningful location/activity as the goal, not just drill); may need to use additional auditory goals initially; later see if she can name obstacles encountered without tactual confirmation.

This document is a Resource for the Expanded Core Curriculum. Please visit the RECC.