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's art teacher, Ms. Anna was happy to report that Libby was asking her and letting her comb her hair in art class. Began today's session with upper case letter identification game. Able to recall and identify 95% of the upper case alphabet today. Libby is observed to continue to use a thumb wrap grasp pattern for coloring and writing unless she is prompted to use her twist and write pencil. This pencil helps her establish and maintain an open web space when writing. Instructed Libby on lowercase "h" today using Print Island handwriting program. She was taught using both auditory and visual cues. It was pointed out how this letter has the same movement as the previously learned lowercase letters in this group "r, n and m" with a fall down and climb up motion. It was further pointed out how this letter is different than the previously learned letter in this group because it is a tall "leaf" letter. Libby was able to form it correctly. Good session.