Reflexes
What reflex is a precursor to eye-hand-coordination in an infant. What is it called?
A. Plantar Grasp
B. Palmar Grasp
C. Galant
D. Asymmetrical Tonic Neck Reflex (ATNR)
D. Asymmetrical Tonic Neck Reflex
An OTR® is working with a 2½-year-old child on age-appropriate fine motor skills. Which activity would be most appropriate to support development?
A. Unbuttoning large buttons
B. Lacing a shoe
C. Cutting out shapes with scissors
D. Drawing stick figures
Correct Answer: A. Unbuttoning large buttons
This question is testing developmental milestones and whether the activity is age-appropriate for a 2½-year-old child.
At approximately 2–3 years of age, children begin developing:
Unbuttoning large buttons is a realistic and developmentally appropriate fine motor task for this age group.
An OTR® is working with a child who has a diagnosis of myelomeningocele spina bifida. Which ADL is MOST likely to be difficult for a child with this condition?
A. Grooming at the sink
B. Feeding oneself lunch
C. Upper-body bathing
D. Toileting at school
Correct Answer: D. Toileting at school
Rationale:
Children with myelomeningocele spina bifida commonly have neurogenic bowel and bladder dysfunction, making toileting one of the most challenging ADLs. They may require catheterization, scheduled toileting programs, and other supports to manage bladder and bowel function independently.
A 5-year-old child refuses swings, becomes anxious on playground equipment, and cries when feet leave the ground.
Which sensory issue is MOST likely present?
A. Vestibular under-responsivity
B. Gravitational insecurity
C. Sensory seeking
D. Proprioceptive dysfunction
✅ Correct Answer: B. Gravitational insecurity
Simple Rationale
The key clues are:
These behaviors are classic signs of gravitational insecurity, a type of vestibular over-responsivity in which a child becomes fearful or anxious when movement challenges their sense of balance.
Children with gravitational insecurity often:
An OTR® working in a school system has been asked to help the education team plan for Tier 1 of a Response to Intervention (RtI) model. Which role is MOST appropriate for an OTR at Tier 1 of RtI?
A. Develop a social skills program for children with behavioral concerns
B. Provide direct services to children in special education
C. Provide a presentation to teachers on multisensory handwriting strategies
D. Integrate technology for children with autism
Correct Answer: C. Provide a presentation to teachers on multisensory handwriting strategies
Rationale
Tier 1 RtI focuses on universal supports provided to all students in the general education setting.
At Tier 1, OT practitioners often:
Providing a presentation on multisensory handwriting strategies helps teachers implement supports that can benefit an entire classroom.
A 10-month-old child extends her head while flexing her hips and knees when placed in a crawling position. What reflex is being displayed?
A. Moro reflex
B. Asymmetric Tonic Neck Reflex (ATNR)
C. Swimming Reflex
D. Symmetric Tonic Neck Reflex (STNR)
D. STNR
- Emerges at 4-6 months of age to 8-12 months of age
- Observe by placing infant in crawling position/prone over knees and extend/flex child's head (Flex head = UE flex/LE extend OR Extend head = UE extend/LE flex)
- Breaks up total extensor posture, and facilitates quadruped position
A child has recently begun walking independently. Which gross motor skill would MOST likely develop next?
A. Riding a tricycle
B. Jumping with both feet
C. Running
D. Hopping on one foot
Answer: C. Running
Rationale: Running develops shortly after independent walking.
❌ Riding tricycle = around 3 years.
❌ Jumping = around 2 years.
❌ Hopping = around 4 years.
An OTR is preparing an intervention plan for a student in second grade who has attention deficit hyperactivity disorder.
The student has difficulties getting ready for school, often misplaces homework assignments, and forgets to bring assignments from home to school. The OTR plans to help the student learn strategies to use in preparation for going to school each day. Which activity would be MOST EFFECTIVE for supporting initial progress toward this objective?
Select the best response.
A. Ask the student's parents to assist the student in completing a school needs checklist each morning.
B. Have the student follow a step-by-step instruction sheet during a class art project.
C. Help the student develop an organizational checklist to use as part of a treasure hunt game.
Correct Answer: C. Help the student develop an organizational checklist to use as part of a treasure hunt game.
Rationale:
The student's problem is organization and remembering materials, which are executive functioning skills often affected by ADHD. A treasure hunt game allows the student to learn and practice using a checklist in a fun, age-appropriate way before using it in real-life school routines.
A 4-year-old child has extreme food selectivity. One of the intervention priorities is to increase the types of foods the child is willing to eat.
Which strategy would be MOST BENEFICIAL for modifying the child's behavior to support progress toward this objective?
A. Reward the child for performing a routine sensory program including tactile stimulation around the lips and tongue
B. Post a schedule of the expected duration of meals and snacks in a location easily viewed by the child
C. Develop a food chain that alternates between eating preferred foods and tasting previously rejected foods
Correct Answer: C. Develop a food chain that alternates between eating preferred foods and tasting previously rejected foods
Rationale: The goal for this child is to help them increase the types of foods they are will to eat. Our focus should be on helping the child build tolerance to different types of foods. We would have the child begin by eating preferred foods and then gradually expose the child to foods they don’t prefer to increase their tolerance. This would help with reducing their anxiety around new foods and increase acceptance over time.
A student who is 6-years old has cerebral palsy and delays in typical progressing mobility skills. The student is referred to occupational therapy by the classroom teacher at the local elementary school. Which area of performance should be a priority for the school based OT to assess during the initial evaluation?
A. Fine motor and grasping abilities for writing familiar letters
B. Visual perceptual abilities for recognizing and copying shapes
C. Flexibility and spontaneity in play and circle time interactions
D. Motor patterns for transitioning from a chair to the floor
Correct Answer: D. Motor patterns for transitioning from a chair to the floor
The key clues are:
Before a student can participate in classroom activities, the OT must determine whether the student can access the educational environment safely and independently.
Transitions such as:
are essential school functions that directly affect participation throughout the school day.
Since the referral specifically identifies mobility delays, the priority assessment should focus on how those motor limitations affect participation in school routines.
A school-age child has a profound hearing impairment. The child demonstrates normal postural reactions for walking, running in place, and skipping but is unable to maintain balance when moving in various directions on a platform swing. What conclusion can the OTR make based on these observations?
A. Conflicting sensory input is inhibiting appropriate vestibular reactions
B. Low muscle tone prevents the child from responding to transitional movements
C. Persistent primitive reflexes are interfering with transitional movement patterns
D. The child lacks anticipatory control required for higher-level motor skills
A. Conflicting sensory input is inhibiting appropriate vestibular reactions.
Rationale: The swing challenges the vestibular system, and the child may over-rely on vision or somatosensory cues, leading to imbalance.
Which play activity is MOST appropriate for a typically developing 4-year-old child?
A. Solitary stacking of blocks
B. Parallel play beside peers
C. Cooperative pretend play
D. Sensorimotor exploration
Answer: C. Cooperative pretend play
Rationale: Preschoolers engage in imaginative cooperative play with peers.
❌ Solitary play = infancy.
❌ Parallel play = toddlers.
❌ Sensorimotor play = infants.
Ethan, 5, with spastic diplegic CP, demonstrates pelvic posterior tilt, rounded shoulders, and downward gaze during seated play. During evaluation, he uses his hands for stability instead of manipulating toys.
Which interpretation best describes how postural deficits impact occupational performance?
A. Postural tone imbalance limits trunk stability needed for bilateral hand use.
B. Overactive fine motor control limits postural equilibrium.
C. Low cognitive engagement prevents sustained play activity.
Correct Answer: A
Rationale:
Posterior tilt + propping = poor postural tone → limits hand use. Cognitive or fine motor issues not evidenced.Connect posture → trunk stability → occupational function.
Mason, 5, with hemiplegic CP and sensory processing challenges, demonstrates frequent avoidance of playground equipment due to fear of imbalance. He demonstrates good gross motor ability on structured tasks in therapy but becomes hesitant in unstructured play. Which intervention BEST supports functional playground participation?
A. Encourage independent playground exploration without adult guidance.
B. Provide graded exposure to playground equipment, combining vestibular-proprioceptive input with visual and verbal cues for safety.
C. Focus solely on clinic-based gross motor exercises to improve balance before playground exposure.
Correct Answer: B
Rationale: Graded exposure with sensory support bridges clinic skills to real-life functional participation. Independent exploration or clinic-only practice may limit generalization and engagement.
An OT is determining appropriate assistive technology to enhance a sixth grader's participation in history class. The student has good listening comprehension skills, but delays in fluency directly impact engagement in classroom presentations.
What accommodation is MOST appropriate to support the student's completion of presentations?
A. Voice recognition software
B. Text-to-speech feature
C. Abbreviation expansion
Correct Answer: B. Text-to-speech feature
Why?
The key clue is:
"Delays in fluency directly impact engagement in classroom presentations."
In educational settings, reading fluency deficits can make it difficult for a student to read presentation notes, scripts, slides, or research materials efficiently during preparation and delivery of a presentation.
A text-to-speech (TTS) feature:
You are an OT practitioner providing early intervention services to infants in a home-health setting. After a thorough evaluation of a 20-month-old child, the OTR® identifies that the child has retained primitive reflexes which are inhibiting some of their play occupations. The child specifically demonstrates an increase in flexor tone in their extremity on the skull side when reaching for toys. Using the NDT approach, which intervention would BEST focus on integrating this primitive reflex while promoting functional movement necessary for occupational performance?
A. Place the child in quadruped and focus on facilitating reciprocal movements through therapeutic handling
B. Facilitate transitioning from a prone prop to ring sit position using the child's pelvis and shoulders as key points of control
C. Place the child in a quadruped position and focus on unilateral reaching while using therapeutic handling and joint compression
D. Tap along the child's biceps on the affected UE
Correct Answer: C. Place the child in a quadruped position and focus on unilateral reaching while using therapeutic handling and joint compression
Rationale
This child has a retained ATNR (increased flexor tone on skill side) and by using positioning and weight bearing in quadruped, the ATNR is inhibited by normalizing tonal changes through weightbearing (joint compression)
- This intervention also incorporates an occupation based approach of reaching which is necessary for play
A 12-month-old child is expected to demonstrate which grasp pattern?
A. Ulnar palmar grasp
B. Radial palmar grasp
C. Inferior pincer grasp
D. Neat pincer grasp
Answer: D. Neat pincer grasp
Rationale: Neat pincer grasp develops around 12 months.
❌ Ulnar palmar = earlier infancy.
❌ Radial palmar = around 7 months.
❌ Inferior pincer = around 9 months.
A 10-year-old with autism is able to use two-word phrases to communicate their needs and wants. The OT plans to use a sensory integration approach to provide proprioceptive input. During the occupational therapy session, the OT invited the child to help set up an obstacle course but the child refuses, saying, “You do it.” to the OT.
What action should the OTR take in this situation?
A. Encourage the child to participate by saying, “I know you can do it, give it a try.”
B. Model trying to move big equipment, saying, “It’s too heavy for me. I need help.”
C. Simplify the verbal instructions and demonstrate how to navigate the obstacle course
Correct Answer: B. Model trying to move big equipment, saying, “It’s too heavy for me. I need help.”
Rationale:
The goal of a sensory integration (SI) approach is to provide proprioceptive input through active participation in a meaningful activity.
By modeling that the equipment is heavy and asking for help, the OT creates a natural opportunity for the child to participate in moving the equipment. This encourages engagement without forcing the child and incorporates the desired proprioceptive input into the activity.
Liam, 6, with ASD, becomes increasingly agitated during small-group snack and craft activities, frequently leaving his seat, and demonstrates tactile sensitivities when handling shared materials. He can complete table-top tasks independently with one-step visual cues.Which intervention BEST promotes classroom participation while considering sensory needs?
A. Require Liam to complete all table-top tasks independently, gradually increasing the duration of group activities.
B. Provide structured sensory breaks (vestibular-proprioceptive input) immediately before group activities and use visual schedules to cue participation.
C. Have Liam participate in group tasks only with one-on-one adult hand-over-hand guidance.
Correct Answer: B. Provide structured sensory breaks (vestibular-proprioceptive input) immediately before group activities and use visual schedules to cue participation.
Rationale: Sensory regulation before participation addresses underlying sensory-seeking behaviors that interfere with engagement. Independent participation without support may increase frustration; constant hand-over-hand guidance limits skill acquisition.
A student in elementary school has experienced significant childhood trauma and lives in a foster home. The student becomes frustrated when asked to complete cognitively and physically challenging tasks and does not participate in classroom activities unless directly instructed by an adult.
Which intervention method would be MOST BENEFICIAL for promoting the student's academic success and social interaction within the school environment?
A. Engage the student in interactive curriculum-based competitive games
B. Have the teacher use a behavior modification program with the student
C. Include the student in a coping skills and stress management class
D. Involve the student in a structured goal-oriented activity group
Correct Answer: D. Involve the student in a structured goal-oriented activity group
Simple Rationale
The student has a history of trauma, becomes easily frustrated, and struggles to participate independently.
A structured goal-oriented activity group provides:
This approach supports both academic participation and social engagement while creating a safe and supportive environment for a student affected by trauma.
Shelly is a 4-year-old girl with spastic quadriplegic CP. When Shelly hears loud noises, she automatically reacts by extending her neck and upper spine, retracting her scapulae and moving her arms into shoulder extension and elbow flexion. Which primitive reflex is MOST likely causing Shelly to react in this manner?
A. Moro reflex
B. Asymmetric Tonic Neck reflex
C. Tonic Labyrinthine reflex
D. Landau reflex
A Moro reflex
- This reflex, also known as the "startle reflex," causing this type of reaction in response to sudden changes in stimuli
- This reflex normally integrates by 6 months, however, can persist in children with CP
The parents of a 2-year-old child with bilateral congenital upper extremity amputations express concern to the homecare OT about their child’s complete disinterest in toilet training. At which point should the OT advise the parents to begin toilet training?
A. When the child indicates discomfort with being wet or soiled.
B. Immediately, because toileting is a developmentally appropriate task
C. When the child is 3 years old, as this is the typical developmental age for toileting
D. By placing the child on a “potty” chair for 5 minutes per hour each day.
Correct Answer: A. When the child indicated discomfort with being wet or soiled
The first toileting skill developed is a child’s recognition of being when or soiled as uncomfortable.
All children develop differently and typical developmental time tables include a range of ages for skill development, but most children are independent in toileting by 5. However, these ranges vary even more for children with congenital disabilities
An OTR is evaluating a preschool child who demonstrates severe speech impairment, poor balance, frequent smiling and laughter, and hand-flapping. Which safety consideration is MOST important to address during intervention planning?
A. Avoiding excessive neck flexion during gross motor activities
B. Monitoring for seizure activity during treatment sessions
C. Limiting physical activity to prevent muscle overuse fatigue
D. Protecting insensate skin areas during wheelchair mobility
B. Monitoring for seizure activity during treatment sessions
Rationale:
The symptoms described are classic for Angelman syndrome:
Children with Angelman syndrome have a high incidence of seizures, making seizure monitoring one of the most important safety considerations during OT intervention.
During a school-based occupational therapy evaluation, a 6-year-old student presents with the following challenges: difficulty localizing tactile input without visual cues, frequent dropping of materials during tabletop activities, inconsistent grasp during handwriting tasks, and inefficient motor planning during obstacle course navigation. The child often relies heavily on visual monitoring to complete tasks and becomes frustrated when asked to complete activities without looking at their hands. Based on these findings, which of the following sensory processing issues is MOST likely contributing to the child's functional difficulties?
A. Gravitational insecurity and vestibular problems.
B. Sensory discrimination and proprioceptive problems
C. Tactile defensiveness
D. Dyspraxia
B. Sensory discrimination and proprioceptive problems
Rationale:
The key clues are:
These are classic signs of poor sensory discrimination, especially proprioceptive discrimination.
Children with proprioceptive difficulties often:
An OTR® is conducting an initial school-based evaluation for a 9-year-old student who requires full-time assistance to follow events listed on a picture schedule. The teacher reports that the student is more focused and attentive when using the schedule.
Which actions are MOST important for the OTR to complete as part of the initial evaluation? (Select all that apply.)
A. Administer the Sensory Processing Measure (SPM)
B. Ask the student's parents to complete the Ages & Stages Questionnaire
C. Track the number of times the student displays stereotypical behaviors
D. Consult with the pediatrician regarding pharmaceutical interventions
E. Obtain a copy of the student's most recent Individualized Education Program (IEP)
F. Observe the student in the classroom during reading time
Correct Answers:
A. Administer the Sensory Processing Measure (SPM)
E. Obtain a copy of the student's most recent IEP
F. Observe the student in the classroom during reading time
Rationales
✅ A. Administer the Sensory Processing Measure (SPM)
The SPM assesses:
Since the student requires significant support to stay focused and follow routines, sensory processing may be affecting participation. The SPM provides valuable information during the initial evaluation.
✅ E. Obtain a copy of the student's most recent IEP
Reviewing the IEP helps the OT understand:
This information is essential during an initial school-based evaluation.
✅ F. Observe the student in the classroom during reading time
Observation in the natural environment allows the OT to: