Libby was seen in an office for a 45-minute treatment session with focus of session on improving her fine motor skills especially in the area of grasp patterns, ocular motor skills (saccades), self care skills, handwriting, as well as improving her flexibility for wearing different clothing and wearing her hair different ways. Began session going over her sticker/reward chart. Libby's mother, Amanda, shared pictures and information about what Libby tried over the past week to earn sticker on her chart. She earned 5 stickers for wearing shorts and a dress on 5 different occasions. Began fine motor play with using strawberry picker to pick up small fuzzy balls. Libby required cues to use three fingers (thumb, index and middle finger). This activity aims at building strength in the hands and the intrinsic muscles for hand strength for holding writing utensils with a sustained tripod grasp. Libby put her hair up and wore it up throughout our session only asking to put it back down once. OT had Libby try different pencil grasps on her writing utensil but she did not like how they felt. She is observed to use a thump wrap grasp pattern on her pencil when writing which causes her web space to collapse. Lastly, instructed Libby on lowercase letter "n" and reviewed letter "r". Good session and good progress.