Libby was seen in her room for a 45-minute treatment session with the focus of therapy on fine motor skills specifically grasp patterns, ocular motor skills (saccades), self care skills, and handwriting. OT has also focused on sensory processing and having Libby be more comfortable with wearing a variety of clothes (weather appropriate) and different hairstyles (only wants to wear her hair one way which is down). Libby continues to be encouraged with a sticker chart to wear different clothes and her hair different ways. Libby was feeling "under the weather" during today's treatment session. Her nose was running and she had a slight cough. Today we started our session with a Halloween " I Spy" activity to work on visual perceptual skills (visual discrimination) and ocular motor skills (specifically tracking left to right). Libby needed assistance to find a few hidden objects and needed moderate-to- maximum verbal cueing to scan using a left to right top to bottom sequence. She would typically look from the right side of the paper to the left and start in bottom or middle. It is beneficial to teach a top to bottom and left to right sequence because these eye movements are needed for reading. Reviewed previously learned letters from "Print Island" today - r,n and m. Had her write each several times to instill a correct formation motor memory. She has a tendency to write her letter from the bottom up versus top down. Worked on writing numbers today as well. Gave her auditory cues for proper letter formations. For example, "across the sky and down from heaven this is how we make a seven", "down and around with a hat like this, number five you can not miss". Even though Libby was not feeling 100% she worked well during her treatment session today.