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Occupational Therapy (OT) in educational settings supports students who face challenges with daily functioning and participation in school activities. OT services are not tied to one single disability but instead address a range of needs that interfere with a child’s ability to access the curriculum. Occupational Therapy is considered a ‘related service’ under IDEA, meaning it is provided when a student’s disability impairs access to the general education curriculum.

Eligibility is determined through evaluation and the IEP process.

Below are the primary disability classifications that often benefit from OT support, along with explanations for why OT is appropriate for each:

1. Autism Spectrum Disorder (ASD)

Why OT is involved:
Students with ASD may struggle with sensory processing, fine motor coordination, daily routines, and self-regulation. Occupational therapists help these students build independence in tasks like writing, using classroom materials, transitioning between activities, and managing sensory input (e.g., noise, texture, lighting).

2. Specific Learning Disabilities (SLD)

Why OT is involved:
Although SLD primarily affects academic areas like reading, writing, and math, OT can support students who also have related difficulties with fine motor skills (e.g., handwriting, cutting) or organizational tasks. OT interventions help improve written expression, pencil grip, visual-motor integration, and classroom task management.

3. Orthopedic Impairments

Why OT is involved:
These students have physical conditions that affect mobility, strength, or coordination (e.g., cerebral palsy, muscular dystrophy). OT assists with adapting classroom tools, using assistive technology, and finding alternative ways for students to complete tasks independently.

4. Other Health Impairments (OHI)

Why OT is involved:
Students with diagnoses such as ADHD, epilepsy, or chronic illnesses may have difficulty with attention, stamina, and sensory regulation. OT helps them manage fatigue, maintain focus, and develop executive functioning strategies to navigate the school day effectively.

5. Developmental Delay (for younger students, typically ages 3–9)

Why OT is involved:
Delays in motor development, sensory processing, or self-help skills may impact participation in early learning settings. OT supports skill-building in areas such as dressing, feeding, using classroom tools, and interacting with peers.

6. Intellectual Disabilities

Why OT is involved:
These students may need support with adaptive behavior, self-care routines, and fine motor tasks. OT helps promote independence in daily living skills that support learning both in and outside the classroom (e.g., using utensils, managing personal items, following multi-step routines).

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Student Example 1: Aaron – Kindergarten, Sensory Processing & Fine Motor Delays

Profile: Aaron is a bright, verbal 5-year-old who struggles to stay seated during classroom activities. He avoids tasks like coloring and cutting and becomes easily overwhelmed by loud noises or crowded spaces.

Occupational Therapy Focus: Sensory regulation and fine motor development
Academic Support Activities:

Use of weighted pencils and pencil grips to improve writing endurance

Pre-writing tracing activities embedded in multisensory stations (e.g., tracing letters in sand or shaving cream)

“Push-pin” letter boards and tweezers to strengthen hand muscles for pencil control

Physical Development Activities:

Obstacle courses and yoga-based movement breaks to support body awareness and core strength

Scissor-cutting practice using loop scissors and gradually progressing to standard scissors

Sensory bins (rice, beans) to promote tactile exploration and reduce sensory defensiveness

Social-Emotional Activities:

Visual cue cards and sensory break cards to help Aaron self-advocate

Use of a calm-down box with tactile tools (e.g., stress balls, putty)

Structured peer activities (e.g., passing items in a game) to support turn-taking and reduce anxiety in group settings

Student Example 2: Lila – Grade 2, ADHD & Executive Function Challenges

Profile: Lila has difficulty staying organized, following multi-step instructions, and completing classwork on time. Her handwriting is messy, and she often forgets or loses materials.

Occupational Therapy Focus: Organization, fine motor coordination, and self-regulation
Academic Support Activities:

Visual schedules and color-coded folders to support task completion

Use of slant boards and lined paper for improved writing legibility

Keyboarding practice for assignments requiring longer written output

Physical Development Activities:

Hand-strengthening exercises using therapy putty and hole punches

“Write-draw-pass” relay games to reinforce bilateral coordination and sequencing

Movement-based tasks (e.g., beanbag toss spelling) to integrate attention with motor planning

Social-Emotional Activities:

Check-in/check-out routine with the OT to set daily goals

Role-play and visual scripts to practice staying calm and asking for help

Mindfulness exercises such as breathing with a Hoberman sphere or grounding techniques during transitions

Student Example 3: Naomi – Grade 5, Sensory Processing Disorder (SPD)

Profile: Naomi is an intelligent and creative fifth grader who becomes easily overwhelmed by noise, crowded spaces, and unexpected changes in routine. She avoids group work, refuses to participate in assemblies, and often shuts down or becomes tearful during transitions. She also has difficulty with tasks requiring fine motor coordination, such as handwriting and using classroom tools.

Occupational Therapy Focus: Sensory regulation, fine motor skills, and emotional resilience
Academic Support Activities:

Scheduled “sensory diet” breaks throughout the day to help Naomi remain focused during learning tasks

Use of a slant board, pencil grips, and adaptive paper to improve handwriting legibility and comfort

Implementation of a visual schedule and a “first-then” strategy to support task initiation and follow-through

Physical Development Activities:

Tactile play-based tasks like lacing cards, theraputty, and pegboards to strengthen hand muscles and coordination

Proprioceptive input activities such as wall push-ups and carrying weighted items to help regulate energy levels

Practice with everyday classroom tools (e.g., scissors, rulers, staplers) to increase functional independence

Social-Emotional Activities:

Use of a calm-down corner with sensory tools (e.g., noise-reducing headphones, fidget options, breathing visuals)

Structured role-play with the OT to rehearse peer interactions, group participation, and coping with change

Co-created emotion charts to help Naomi recognize her feelings and advocate for breaks or support when needed

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How Diagnostic Assessments Inform OT Services

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How Diagnostic Assessments Inform OT Services

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1. Fine Motor and Academic Functioning – Achievement Tests

Assessments like the Woodcock-Johnson IV or WIAT-III can reveal discrepancies between a student's cognitive ability and their written academic output. For example, a student might perform well verbally but produce very limited written work. This gap often signals underlying fine motor difficulties. An Occupational Therapist can then assess pencil grip, hand strength, and motor planning to see if the student’s academic challenges stem from motor issues rather than learning disabilities.

Example:
Lila, a second grader, scored average on reading comprehension but significantly below average in written expression. The OT followed up with a fine motor screening and found reduced finger strength and poor pencil control. These results justified the need for OT services focusing on handwriting skills and alternative writing tools.

2. Cognitive and Executive Function – Intelligence Tests

Tools like the WISC-V can identify strengths and weaknesses in working memory, processing speed, and visual-motor integration. When a student has a high verbal IQ but low scores in visual-spatial or processing speed domains, it often translates into classroom struggles with organization, note-taking, and task completion. An OT may be brought in to support with executive functioning strategies and physical supports like visual checklists or adapted materials.

Example:
Aaron, a kindergartner with sensory sensitivities and attention challenges, showed average verbal skills but low visual-motor integration on his cognitive assessment. This pointed to a need for OT to help him develop classroom routines, improve his tool use, and tolerate sensory input in a group setting.

3. Sensory and Regulation Challenges – Behavior Rating Scales & Observations

Behavior rating tools such as the BASC-3 and Sensory Profile 2 offer insight into how sensory sensitivities, attention, and emotional regulation affect a student’s ability to function in school. These assessments, completed by both teachers and parents, help identify patterns like emotional overreactions, withdrawal, or heightened reactivity to environmental stimuli. When these patterns disrupt a student’s participation in daily routines, OT is often recommended to support sensory regulation and self-management.

Example:
Naomi, a fifth-grade student, was referred for evaluation due to frequent emotional outbursts, refusal to enter noisy environments (like the cafeteria or assemblies), and difficulty with handwriting. The BASC-3 results showed clinically significant scores in anxiety and adaptability, while the Sensory Profile indicated hypersensitivity to auditory and tactile input. Although her academic scores were average, her ability to participate was significantly impacted by sensory challenges.

Importantly, a diagnosis alone does not qualify a student for speech therapy or related services; assessment data must demonstrate that the student’s functional difficulties impact academic or behavioral performance in school settings. This ensures that services are targeted, evidence-based, and connected to the student’s educational access and success.

The data supported the need for Occupational Therapy to address self-regulation, sensory accommodations, and fine motor coordination. The OT worked with Naomi on developing coping strategies (e.g., noise-canceling headphones, movement breaks), desensitization to classroom textures, and strengthening her hand muscles to improve her confidence and independence during written tasks.

Importantly, a diagnosis alone does not qualify a student for OT; assessment data must demonstrate that the student’s functional difficulties impact academic or behavioral performance in school settings.

The link between diagnostic assessments and the need for Occupational Therapy is both practical and intentional. Whether it's through a standardized academic test, cognitive profile, or behavior rating scale, the goal is to understand why a student is struggling—and whether those struggles relate to motor skills, sensory needs, or functional independence. OT then steps in to bridge the gap, equipping students with tools and strategies that allow them to participate more fully in school life.

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Speech Therapy

Types of Speech and Language Disorders Treated

1. Articulation Disorders

What it is: Difficulty forming specific speech sounds correctly.

Example: A child says “wed” instead of “red.”

Impact: Affects intelligibility and self-confidence.

Most commonly, Speech and Language Impairment (SLI). May also be seen in students with Autism Spectrum Disorder (ASD) or Developmental Delay (DD) if articulation errors interfere with classroom communication.

2. Phonological Disorders

What it is: Patterns of sound errors that affect entire sound classes.

Example: Replacing all “k” sounds with “t” sounds (e.g., “tat” for “cat”).

3. Fluency Disorders

What it is: Disruptions in the flow of speech such as stuttering or cluttering.

Signs: Repetitions (“b-b-ball”), prolongations (“ssssnake”), or blocks.

Disability Classification: Most commonly classified under Speech and Language Impairment (SLI). May also be relevant for students with Emotional Disturbance (ED) if anxiety significantly contributes to fluency difficulties.

4. Voice Disorders

What it is: Abnormal pitch, volume, or voice quality.

Causes: Overuse, injury, or medical conditions (e.g., vocal nodules, paralysis).

5. Receptive Language Disorders

What it is: Difficulty understanding spoken or written language.

Impact: Struggles following directions, answering questions, or understanding stories.

6. Expressive Language Disorders

What it is: Difficulty using language to express thoughts.

Signs: Limited vocabulary, poor sentence structure, or difficulty naming objects.

7. Pragmatic (Social) Language Disorders

What it is: Challenges using language appropriately in social settings.

Examples: Not taking turns in conversation, interrupting, misunderstanding tone or sarcasm.

Common in: Autism Spectrum Disorder (ASD)

Disability Classification: Frequently associated with Autism Spectrum Disorder (ASD) and sometimes classified under Speech and Language Impairment (SLI) when pragmatic challenges are the primary concern.

8. AAC (Augmentative and Alternative Communication) Needs

What it is: Supports for students who are non-verbal or minimally verbal.

Tools include: PECS (Picture Exchange Communication System), speech-generating devices, sign language.

Speech Therapy Methods and Techniques

Method Purpose Example Activity Articulation Drills Teach correct sound placement“Say and repeat” with mirrors and visualsLanguage ExpansionModel grammatically correct sentences“You said ‘dog eat’ — let’s say ‘The dog is eating.’”Visual SupportsHelp students understand and produce languagePicture cards, storyboards, visual schedulesSocial Stories and Role-PlayImprove pragmatic (social) skillsPractice greetings, turn-taking, eye contactStory Retelling & SequencingBuild narrative and expressive language“First, next, then, last” story mapsFluency TechniquesHelp students manage stuttering or pacingSlow speech, breathing strategies, timing cues AAC TrainingBuild independence using assistive techPractice requesting or labeling with a device

Therapy Settings in Schools

Pull-Out Sessions: Student works one-on-one or in a small group outside the classroom.

Push-In Support: SLP joins the class to support the student in real-time.

Co-Teaching: SLP collaborates with classroom teachers during lessons.

Consultation: SLP advises teachers or aides on strategies to support the student throughout the day.

Educational Impact of Speech Therapy

Speech and language difficulties can affect:

Literacy: Struggles with reading comprehension, spelling, and writing.

Math: Difficulty understanding word problems or explaining answers.

Social Development: Trouble making friends or working in groups.

Behavior: Frustration due to communication challenges may lead to acting out or withdrawal.

Self-Esteem: Students may feel embarrassed or isolated if they can’t express themselves clearly.

SLPs work closely with classroom teachers and families to ensure speech therapy goals are aligned with academic progress and IEP targets.

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Real-Life Case Study: Speech Therapy

Student Profile:

Name: Adam

Age: 6 years old

Grade: 1st Grade

Diagnosis: Speech and Language Impairment (SLI)

Background: Adam is a bright and curious student who enjoys science and storybooks. However, he struggles with articulation and expressive language. His speech is often unclear, and he uses short, incomplete sentences when speaking. He becomes frustrated when others can’t understand him, which leads to social withdrawal during group activities.

Challenges:

Difficulty producing “r,” “th,” and “sh” sounds

Limited vocabulary and sentence structure

Trouble retelling events or stories

Hesitation to speak in front of the class

Speech Therapy Plan:

Frequency: 2 times a week, 30-minute sessions

Type: Small group pull-out and classroom push-in support

The choice of therapy format (pull-out and push-in) was guided by Adam’s CELF-5 and GFTA-3 results, showing articulation errors in conversational speech and expressive delays in academic contexts. Push-in support during language-rich class times helped promote generalization.

Goals:

1. Accurately produce target speech sounds in structured and conversational speech

2. Use complete 4–6 word sentences during storytelling and classroom sharing

3. Improve confidence when speaking with peers and adults

Activities Used:

Articulation games using picture cards and mirrors

Story sequencing with visual aids to practice longer sentence formation

Turn-taking games to build conversational flow

Positive reinforcement when Adam volunteers to speak in class

Progress After 12 Weeks:

Improved articulation of “r” and “sh” sounds

Increased use of full sentences

Greater classroom participation—Adam now raises his hand in group discussions and shares stories during circle time

Teachers and parents report improved confidence and communication at home

Student Profile 2:

Jayden – Grade 2, Fluency Disorder (Stuttering)
Diagnosis: Speech and Language Impairment
Challenges: Jayden exhibits frequent sound repetitions and blocks when speaking, especially under stress. He avoids answering questions in class and becomes embarrassed when asked to read aloud.

Therapy Plan: Fluency strategies such as slowed speech, breathing exercises, and use of pacing boards.

Activities:

Paired reading with a fluency-friendly peer

Breathing bubble visual and pacing strips for oral presentations

Structured storytelling with sentence starters

Goals: Reduce frequency of stuttering events and increase classroom participation in verbal activities.

Student Profile 3: Leila – Grade 1, Non-verbal, uses AAC device
Diagnosis: Autism Spectrum Disorder with expressive language delay
Challenges: Leila does not use verbal speech. She uses an AAC tablet and PECS system inconsistently. She gets frustrated when her needs aren't met quickly.
Therapy Plan: AAC training to build independence and vocabulary
Activities:

Device modeling with a peer and adult partner

Functional communication tasks like snack request routines

Visual choice boards for classroom tasks
Goals: Use AAC to request, label, and greet peers with 80% accuracy across settings

🧪 Diagnostic Tools Used in Speech Assessments

1. Goldman-Fristoe Test of Articulation–3 (GFTA-3)

Purpose: Assesses how well a student produces consonant sounds in different positions (beginning, middle, end of words)

Use: Identifies specific sound errors and helps develop articulation goals

2. Clinical Evaluation of Language Fundamentals (CELF-5)

Purpose: Measures a child’s ability in receptive and expressive language, including sentence structure, vocabulary, and following directions

Use: Provides standardized scores to guide IEP goals and eligibility

3. Peabody Picture Vocabulary Test (PPVT-5)

Purpose: Assesses receptive vocabulary by asking students to point to pictures based on spoken words

Use: Evaluates language comprehension and vocabulary range

4. Expressive Vocabulary Test (EVT-3)

Purpose: Measures how well students can name and label objects or express ideas using correct vocabulary

Use: Identifies delays in expressive language development

5. Language Samples and Observation

Purpose: Informal assessment of natural speech during conversation, storytelling, or classroom participation

Use: Provides context-based evidence of strengths and challenges

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Diagnostic Tools Used in Speech Assessments

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Diagnostic Tools Used in Speech Assessments

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🧪 Diagnostic Tools Used in Speech Assessments

1. Goldman-Fristoe Test of Articulation–3 (GFTA-3)

Purpose: Assesses how well a student produces consonant sounds in different positions (beginning, middle, end of words)

Use: Identifies specific sound errors and helps develop articulation goals

2. Clinical Evaluation of Language Fundamentals (CELF-5)

Purpose: Measures a child’s ability in receptive and expressive language, including sentence structure, vocabulary, and following directions

Use: Provides standardized scores to guide IEP goals and eligibility

3. Peabody Picture Vocabulary Test (PPVT-5)

Purpose: Assesses receptive vocabulary by asking students to point to pictures based on spoken words

Use: Evaluates language comprehension and vocabulary range

4. Expressive Vocabulary Test (EVT-3)

Purpose: Measures how well students can name and label objects or express ideas using correct vocabulary

Use: Identifies delays in expressive language development

5. Language Samples and Observation

Purpose: Informal assessment of natural speech during conversation, storytelling, or classroom participation

Use: Provides context-based evidence of strengths and challenges

🗣️ Speech Therapy

Purpose of Assessments:
Diagnostic speech and language assessments help identify specific communication challenges, such as sound production errors, limited vocabulary, poor sentence structure, or social communication deficits.

Common Tools Used:

GFTA-3 (Goldman-Fristoe Test of Articulation): Identifies sound errors in speech.

CELF-5 (Clinical Evaluation of Language Fundamentals): Measures language comprehension and expression.

PPVT-5 and EVT-3: Assess vocabulary and naming abilities.

Language Samples & Observations: Provide real-world insight into how the student communicates.

How It Informs Services:
Results from these assessments determine:

If the student qualifies for speech therapy under IDEA

What areas to target in the IEP (e.g., articulation, expressive language)

The frequency and setting of speech sessions

Goals tailored to the student’s academic and social needs

✋ Occupational Therapy

Purpose of Assessments:
OT assessments identify difficulties in fine motor skills, sensory regulation, and daily living activities that affect learning and classroom participation.

Common Tools Used:

BOT-2 (Bruininks-Oseretsky Test): Assesses motor coordination and manual dexterity.

Sensory Profile: Screens for sensory processing challenges.

Teacher Checklists and Observations: Document difficulties with handwriting, self-care, and classroom routines.

How It Informs Services:
Assessment results help:

Determine OT eligibility in the IEP

Set functional goals (e.g., pencil grip, sensory breaks)

Match therapy approaches to the student’s needs

Support classroom modifications (e.g., seating, tools)

🦵 Physical Therapy

Purpose of Assessments:
PT assessments focus on gross motor development, strength, balance, mobility, and physical access to the school environment.

Common Tools Used:

GMFM (Gross Motor Function Measure): Measures physical skills in children with motor delays.

PEDI (Pediatric Evaluation of Disability Inventory): Assesses daily mobility and functional independence.

PT Observations: Evaluate gait, posture, and classroom movement.

How It Informs Services:
These evaluations:

Confirm PT eligibility under IDEA

Establish baseline performance and growth goals

Guide the use of adaptive equipment (e.g., walkers, braces)

Inform school accommodations like movement breaks or modified PE

Summary:

Diagnostic assessments are essential for:

Identifying student needs

Determining eligibility for related services

Setting personalized, measurable goals in the IEP

Ensuring therapy services directly support academic and developmental growth

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Speech-language pathologists frequently use single word and connected speech tests to assess children’s speech production.

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Definition and Purpose: Under the IDEA regulations, counseling is a related service – a supportive service provided if needed for a child with a disability to benefit from special education. IDEA explicitly defines “counseling services” as those provided by qualified social workers, psychologists, guidance counselors, or other qualified personnel. The purpose of school-based counseling is to address social-emotional or behavioral issues that interfere with a student’s educational success, helping the child access learning and meet IEP goals. According to the American School Counselor Association, counseling in schools supports children’s academic achievement and personal/social development by helping them with self-knowledge, decision making, coping skills, and responsibility. In short, counseling as a related service is geared toward improving a student’s emotional and behavioral functioning so they can learn alongside peers and progress in the curriculum. Counseling services are considered a related service under IDEA. These services are provided when a student’s emotional, behavioral, or social challenges (often classified under ED, ASD, or OHI) adversely impact educational performance and require mental health support to benefit from special education.

Delivery Settings (How and Where): School counseling services can be delivered in various settings and formats depending on student needs. Often, the counselor (or school psychologist or social worker) works one-on-one with a student in a private setting on specific goals (individual counseling). In other cases, students participate in small group counseling (e.g. friendship groups or social skills groups) to practice interactions or coping strategies with peers. Counseling can also be provided within the classroom (“push-in” support) or through consultation with teachers – for example, the counselor might observe the student in class or co-teach social-emotional lessons (an indirect service in which the counselor advises staff on strategies). Crucially, services should be delivered in the least restrictive environment, meaning counselors often try to support the child in regular class settings when appropriate. The IEP team will specify the frequency, duration, and location of counseling (e.g. 30 minutes weekly in the counseling office, or 15 minutes in-class support twice a week) in the IEP document. This flexibility allows counseling to occur through pull-out sessions, push-in assistance during class, or even at recess or lunch groups, depending on what best helps the child.

Target Students and Disability Areas: While any student with an IEP may receive counseling if needed, it is most commonly provided for students whose disabilities involve social-emotional or behavioral challenges. For elementary ages, this often includes children classified with Emotional Disturbance (ED) (who have significant emotional/behavioral difficulties affecting school performance), children on the Autism Spectrum (who may need help with social skills, emotional regulation, and coping with changes), and students with ADHD or anxiety (often served under Other Health Impairment or ED) who struggle with attention, impulse control, worry, or peer interactions. These populations benefit from counseling to learn skills like anger management, coping with anxiety, improving social understanding, or adjusting to routine changes. In fact, federal guidance notes that students identified with an emotional disturbance may have IEPs that include counseling or psychological services as part of their support. Counselors in schools focus on issues that impede learning – for example, helping a child with ADHD develop self-regulation strategies so they can focus in class, or helping an anxious child build confidence to participate. By addressing emotional and behavioral barriers, counseling enables these students to access their education on an equal footing with their peers. School counselors also collaborate with teachers and families to support behavior plans and a consistent approach across settings.

Types of Counseling Provided: School-based counseling for elementary students can take many forms, tailored to student needs:

Behavioral Counseling: Working on specific behavior issues and positive behavior supports. For example, a counselor might implement a behavior intervention plan or teach a child how to use a reward chart and self-monitor their behavior. The focus is on improving classroom conduct and replacing problem behaviors with positive ones.

Emotional Regulation Therapy: Helping students recognize and manage their feelings. This often involves teaching coping strategies (like deep breathing for anxiety or “stop and think” techniques for anger) and practicing them. The counselor may use role-play or visuals to help young children understand emotions and learn calming techniques so they can handle frustration or transitions without a meltdown. Counselors may also include movement-based activities, such as brain breaks, yoga, or mindfulness walks, to support physical self-regulation and stress relief—especially for students who express emotions through physical restlessness or need proprioceptive input to calm.

Peer Interaction & Conflict Resolution: Teaching social skills and conflict resolution is key for many elementary students. Counselors might run social skills groups where children practice sharing, taking turns, conversation skills, and handling disagreements. They also may mediate peer conflicts and coach students in problem-solving steps (“Stop, talk, make a plan”) to resolve arguments. This type of counseling builds better peer relationships and a positive classroom climate.

Transition Planning Support: Even at the elementary level, counselors help students with changes and transitions. This could mean preparing a student with autism for daily transitions between activities, or, in later elementary years, facilitating the move from elementary to middle school. Counselors also work on life transitions in a developmentally appropriate way – for instance, helping a child develop self-advocacy as they get older or introducing basic career awareness in upper elementary grades. (For older students, transition planning becomes more formal, focusing on post-secondary goals, but at the elementary stage, it might simply involve building adaptability and planning for the next educational steps.)

Overall, counseling services in elementary schools are flexibly designed. They might address immediate issues like calming a student who is upset, as well as long-term skills like emotional literacy and social competence. The unifying goal is to provide whatever developmental or therapeutic support a child needs so that their emotional/behavioral challenges do not hinder their learning progress. Counseling as a related service works in tandem with academic instruction to educate the “whole child,” supporting their mental and emotional well-being as part of providing a Free Appropriate Public Education.

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Case 1

Student Profile:

Name: George

Age: 5 years old

Grade: Kindergarten K2

Diagnosis: Autism Spectrum Disorder (ASD)

Background:
George is a kind and inquisitive kindergarten student diagnosed with Autism Spectrum Disorder. He demonstrates average cognitive ability and some basic communication skills but struggles with expressive language and interpreting social and environmental cues. He often uses single words or scripted phrases and finds it difficult to describe how he feels or ask for help appropriately. George tends to play alone and misses social cues from classmates—he doesn’t notice when others talk to him and rarely responds appropriately.

One of the more critical issues affecting George’s functioning is his difficulty with environmental awareness and body cues. For example, George has been observed leaving the bathroom without pulling up his pants, seemingly unaware of social expectations. He also frequently fails to observe classroom routines without adult prompting, which leads to safety concerns, hygiene issues, missed instructional time, and social isolation.

The IEP team determined that George qualifies for services under the Autism category. His behavioral and social-emotional challenges, including limited self-awareness, expressive communication deficits, and poor observation of environmental expectations, impede his ability to access the kindergarten curriculum and participate meaningfully in group activities. The team concluded that school counseling was necessary to develop George’s emotional regulation, body/self-awareness, and basic social engagement skills.

Challenges:

Limited expressive communication; often uses minimal or repetitive language

Difficulty interpreting emotions or understanding when others are speaking to him

Poor observation and self-care skills (e.g., exiting the bathroom with clothing out of place)

Avoidance of peer interaction and group activities

Trouble with transitions and understanding classroom routines

Counseling Plan:

Frequency: 30 minutes/week (individual), 20 minutes/month (small group), biweekly teacher consultation

Service Provider: School Counselor

Setting: Pull-out sessions and small-group peer modeling

Additional Support: Indirect services provided to the classroom teacher for collaboration and strategy consistency

Goals:

1. Self-Awareness and Observation:
George will respond to visual or verbal cues to complete self-care routines (e.g., adjusting clothing, washing hands, following bathroom protocol) in 4 out of 5 observed occasions with no more than one adult prompt.

2. Expressive Communication:
George will use 3–5 word phrases to express needs or feelings (e.g., “I need help,” “I’m done”) during structured counseling sessions in 4 out of 5 trials.

3. Social Engagement:
During small-group counseling, George will initiate or respond to a peer interaction using appropriate verbal or nonverbal communication (e.g., greeting, eye contact) in at least 3 of 5 opportunities.

Activities Used:

Social stories focusing on hygiene routines, daily transitions, and self-care

“First-then” visual charts to sequence tasks (e.g., “First toilet, then pull up pants”)

Emotion identification games using mirrors and picture cards

“Feelings Check-In” board to prompt labeling and discussion of feelings

Peer modeling games with role-play for greetings, turn-taking, and asking for help

Adult modeling and cueing during bathroom routines with a fade-out plan over time

Progress After 2 Months:

George now consistently uses a visual schedule to complete hygiene tasks and responds to cues 80% of the time

He has begun combining short phrases (e.g., “All done,” “Need help”) during counseling and occasionally in class routines

In group counseling sessions, George is imitating peer greetings and has participated in at least two shared games

Teachers report fewer hygiene-related incidents, greater independent self-care, and more frequent social referencing

The IEP team plans to increase small-group sessions slightly to continue building social reciprocity

Real-Life Case Study: Counseling Services – Case 2

Student Profile:

Name: Bella

Age: 7 years old

Grade: 2nd Grade

Diagnosis: Emotional Disturbance (ED)

Background:
Bella is a bright and capable second-grade student who qualifies for special education services under the Emotional Disturbance (ED) classification. Despite scoring within the average range on WISC-V and Woodcock-Johnson IV cognitive and academic achievement assessments, Bella’s academic progress is hindered by severe anxiety, emotional outbursts, and poor self-esteem.

Bella’s anxiety becomes heightened during transitions, assessments, and unstructured settings. She may cry, shut down, or say negative things like “I’m dumb.” At times, her distress escalates into explosive behavior—she might throw classroom materials, yell, or attempt to leave the room without permission. These episodes occur 3–4 times per week and have resulted in frequent classroom removals, missed instruction, and chronic school avoidance (e.g., numerous nurse visits and requests to stay home).

The school evaluation also included behavior rating scales (ASEBA/CBCL, teacher observations) confirming that Bella’s anxiety and emotional dysregulation “adversely affect her educational performance,” fulfilling IDEA’s eligibility criteria for ED. The IEP team determined that school-based counseling was essential for Bella to access her education and develop emotional regulation and coping strategies.

Challenges:

Extreme test anxiety leading to task refusal and classroom avoidance

Emotional outbursts (e.g., yelling, throwing, fleeing) when facing frustration or unexpected change

Negative self-talk (“I’m dumb”) and low self-worth

Social withdrawal and difficulty participating in cooperative activities

Counseling Plan:

Frequency: 45 minutes/week (individual), 15-minute daily check-ins, 1x/week small-group “lunch bunch”

Service Provider: School Social Worker

Setting: Pull-out counseling sessions, classroom check-ins, and peer group lunch meetings

Additional Support: Teacher collaboration and home-school communication to maintain consistency

Goals:

1. Anxiety Management:
Bella will independently use a learned coping strategy (e.g., deep breathing, “break” card, calm corner) when anxious in 4 out of 5 observed episodes.

2. Emotional Expression:
Bella will use appropriate verbal strategies to express frustration instead of physical behaviors (e.g., throwing, yelling) in at least 80% of observed incidents, as tracked by behavior logs.

3. Social Participation:
Bella will engage in cooperative peer activities (e.g., reading circle, science project) for at least 15 minutes with no more than one prompt on 4 out of 5 school days.

Activities Used:

CBT-based counseling sessions to help Bella identify and reframe “worried thoughts” vs. “realistic thoughts”

Daily calm-down toolbox practice (e.g., stress ball, coloring, music, sensory items)

Role-playing common stressful school situations (e.g., making a mistake, being called on)

“Feelings journal” to record emotional events and effective coping strategies

Weekly peer lunch groups for social skills training and confidence-building through structured games

Visual supports (calm-down charts, self-reflection cards) integrated into her classroom

Progress After 2 Months:

Bella now independently uses her “break card” and has not fled the classroom in three consecutive weeks

Emotional outbursts have decreased from 3–4 times per week to 1–2, and her self-talk has become more neutral or positive

She completed a cooperative group science activity, staying engaged for 25 minutes with only one redirection

During assessments, Bella applied her deep breathing strategy and remained seated through completion

Her participation in the lunch group has improved her peer relationships; she now initiates conversation and shares during discussions

Teachers report that she exhibits stronger emotional resilience and stays in class for longer durations without requiring teacher assistance.

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Diagostic Assessment Tools used in Counseling Referral

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Diagostic Assessment Tools used in Counseling Referral

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Importantly, a diagnosis alone does not qualify a student for counseling services. Assessment data must show that emotional or behavioral difficulties significantly interfere with the child’s academic or functional performance in the school setting. This ensures that counseling supports are data-driven, necessary, and directly connected to the student’s ability to benefit from instruction. Identifying the need for counseling services in an IEP is a data-driven process. Schools use a variety of diagnostic and assessment tools during the special education evaluation to determine a child’s needs, including whether social-emotional support is warranted. The decision to add counseling as a related service typically comes from the multidisciplinary team’s review of evaluation results. Key assessment tools that inform this decision at the elementary level include cognitive tests, academic achievement tests, and behavioral/social-emotional rating scales:

Cognitive and Academic Assessments (WISC & WJ-IV): The Wechsler Intelligence Scale for Children (WISC) and the Woodcock-Johnson IV (WJ-IV) are common standardized tests used in evaluations. The WISC-V is an individually administered intelligence test for children that provides an overall IQ and index scores for areas like verbal comprehension, working memory, and processing speed. The WJ-IV has both Tests of Cognitive Abilities and Tests of Achievement; at the elementary level, the WJ-IV Tests of Achievement are often given to measure the child’s academic skills in reading, math, writing, etc. These tools help the team understand a student’s learning profile – essentially, what the child can do cognitively and academically in an optimal one-on-one setting. Discrepancies between a child’s cognitive potential and their classroom performance can reveal emotional or behavioral barriers. For example, if a student’s WISC-V scores show average/high cognitive ability but the Woodcock-Johnson achievement tests show low academic achievement, the team will investigate why. If a learning disability is ruled out, the gap might be due to factors like anxiety, inattention, or oppositional behavior impacting the child’s work in class. Similarly, observations during testing are informative: perhaps the child could only sustain attention for a few minutes on the WISC, or became tearful during a challenging task on the WJ – signs that anxiety or ADHD may be present. In Bella’s case above, her evaluation noted that her cognitive and achievement scores were intact when she was calm and one-on-one, suggesting her academic struggles were not due to an inability to learn but rather due to emotional dysregulation. Such findings point the IEP team toward the need for counseling interventions to address those non-academic barriers. In summary, psychoeducational testing results are interpreted holistically – they measure the child’s abilities and performance, and when those results show unexplained weaknesses or behavioral observations, the team considers emotional/behavioral supports. As one source describes, this comprehensive testing “assesses a child’s cognitive, academic, and emotional functioning” to identify issues like anxiety or other challenges that impact academic performance. WISC and WJ scores thus provide a baseline and often help rule in or out conditions: for instance, they might confirm the child does not have an intellectual or academic learning deficit, prompting the school psychologist to explore whether emotional factors (which wouldn’t show up in those scores) are the primary concern. This data-driven approach helps ensure that counseling is provided not just on a hunch, but because testing indicates it’s needed for the child’s success.

Behavioral and Social-Emotional Assessments (ASEBA and other tools): To specifically evaluate a child’s emotional and behavioral functioning, schools use standardized behavior rating scales and checklists. One widely used system is the ASEBA (Achenbach System of Empirically Based Assessment), which includes the Child Behavior Checklist (CBCL) for parents, the Teacher Report Form (TRF) for teachers, and in some cases a self-report (Youth Self-Report, usually for older children). These instruments are essentially questionnaires that rate a variety of behaviors and feelings. The CBCL, for example, has around 100 items asking whether the child shows issues like anxiety, depression, aggression, attention problems, etc., in the past 2 months. The teacher form similarly captures classroom behavior (e.g. “restless,” “doesn’t get along with others,” “cries frequently”). Scores from ASEBA compare the child’s behavior ratings to normative data, flagging any clinically significant problems. For instance, Bella’s mother and teacher might have filled out the ASEBA forms, which showed elevated scores in the Anxious/Depressed syndrome and the Aggressive Behavior syndrome. The CBCL/ASEBA results would concretely identify that Bella’s anxiety and aggression levels are well above average for her age, supporting an ED classification and the need for mental health services at school. These kinds of tools objectively quantify the child’s emotional and behavioral issues. For example, if the ASEBA identifies elevated scores in aggression or withdrawal, counseling goals may include conflict resolution or social skills groups. If the BASC-3 shows high anxiety, goals might focus on coping strategies like self-calming or thought reframing. Other common behavior assessments include the Behavior Assessment System for Children (BASC-3) and Conners Rating Scales (often for ADHD symptoms). All serve a similar purpose: to gather input from those who know the child (parents, teachers, sometimes the student) about social-emotional functioning. In Aiden’s case, the team might have used a preschool behavior checklist or autism-specific rating scale to document his difficulties with change and peer interaction. Results from these assessments directly inform the counseling plan – for example, if the ratings show high anxiety, the counseling goals will target anxiety reduction; if they show social skills deficits, counseling might focus on peer play skills. These tools also give a baseline to later measure progress (e.g. improvement in scores after a year of intervention).

Interpreting Results in the IEP Team: Once the evaluations are complete, the multidisciplinary IEP team (which includes parents, teachers, a school psychologist, related service providers, and others) meets to review the data. If the assessments indicate emotional or behavioral needs, the team will discuss adding counseling services. IDEA’s regulations note that related service providers (like counselors) contribute their expertise in this meeting to recommend services that will help the student reach their IEP goals. For instance, the school psychologist might explain that the child’s ASEBA results meet criteria for an emotional disturbance, or that observations during testing showed the child could benefit from learning coping strategies. The team must establish why counseling is necessary, typically by linking assessment findings to educational impact. A key question is, “Does this child require counseling support to make meaningful progress in school?” If yes, it becomes part of the IEP. They will then specify details: whether counseling will be direct or consultative, how often it will occur, and the start date, all of which are recorded in the IEP’s related services section. The assessment data provides the justification – for example, “Given the student’s clinically significant anxiety (per standardized behavior ratings) and the observed impact on classroom performance, the team recommends counseling services to address these needs.” It’s worth noting that for certain disability categories, counseling is almost inherently considered: Students with Emotional Disturbance often have counseling or psychological services in their IEPs as an integral support. But even for students in other categories (e.g. autism or OHI for ADHD), the decision comes down to the evidence of need. The IEP team documents the rationale in the present levels or notes – e.g. “Evaluation results (WISC-V, WJ-IV, BASC-3) indicate that Jack’s academic difficulties are largely due to attention and self-regulation deficits; the team determines that school counseling is required to help him develop these skills and benefit from instruction.” This aligns with the IDEA definition of related services: they must be necessary for the child to benefit from special education. Once in place, counseling goals (derived from assessment insights) are added to the IEP, and progress on those goals is tracked just like academic goals. The team will periodically reassess the student’s emotional/behavioral status (through follow-up observations or behavior checklists) to see if the counseling service should be continued, modified, or faded. In essence, diagnostic tools guide the IEP team in understanding a child’s full profile and ensure that if counseling is included, it is backed by concrete data showing a need. This data-driven, team-based approach ensures that related services like counseling are used appropriately, providing critical support to elementary students whose emotional and behavioral challenges must be addressed so they can learn and thrive in school.

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·      Batshaw, M. L., Roizen, N. J., & Lotrecchiano, G. R. (2019). Children with disabilities (8th ed.). Paul H. Brookes Publishing.

·      Friend, M., & Bursuck, W. D. (2022). Including students with special needs: A practical guide for classroom teachers (9th ed.). Pearson.

·      Gresham, F. M., & Elliott, S. N. (2008). Social Skills Improvement System (SSIS) Rating Scales. Pearson Assessments.

·      Individuals with Disabilities Education Act (IDEA), 20 U.S.C. §1400 (2004). https://sites.ed.gov/idea/

·      McLeskey, J., Rosenberg, M. S., & Westling, D. L. (2022). Inclusion: Effective practices for all students (4th ed.). Pearson.

·      Murawski, W. W., & Spencer, S. (2016). Collaborative teaching in elementary schools: Making the co-teaching marriage work! Corwin Press.

·      Pearson Assessments. (2020). Goldman-Fristoe Test of Articulation – 3rd Edition (GFTA-3). https://www.pearsonassessments.com

·      Semrud-Clikeman, M., & Ellison, P. A. T. (2009). Child neuropsychology: Assessment and interventions for neurodevelopmental disorders (2nd ed.). Springer.

·      Snyder, P., & Bickel, D. (2022). Occupational therapy and physical therapy: Essential related services in schools. In M. L. Batshaw et al. (Eds.), Children with disabilities (8th ed.). Brookes Publishing.