Occupational Therapy Treatment Ideas that Work Well for Middle and High Schoolers!

Working with middle school and high schoolers as occupational therapists has some unique challenges. We must select activities that promote the necessary skills that our students need to access their educational curriculum while also being age-appropriate. 

Challenges Working with High School and Middle School Students in Occupational Therapy

Age appropriate activities

As mentioned, finding age-appropriate occupational therapy activities for high school and middle school students can be challenging.  Whether the goals are focused on sensory processing or executive functioning it is good to think “what would I do with an adult client in rehab”? Versus what would I do with a child to work on this skill?

Educationally Relevant Therapy

When I first wrote this article in March of 2020, it was a list of activities to do with high school and middle schoolers over teletherapy (you can still see that list below but I have gone away from lists of activities and now explain more about issues in the OT field.  Pinterest is a great source of additional activities!)

When I worked online in 2017 much of my caseload was middle and high schoolers.  But when I worked in-person school setting I had very few high schoolers on my caseload.  

This is one of my most searched posts and I'm pretty surprised.  But I believe that is because as OTs we struggle with what to do with students who are still on caseload beyond an age where we typically address educational deficits that interfere with “accessing their curriculum”.

One can argue that these students can, or should probably be, discharged or placed on consultative services, but that does not solve the issue that we are still spending time providing services and activities for these older students. 

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Reasons High Schoolers Receive OT services 

Sometimes students receive OT services in high school for very valid reasons.  Other times the lack of ability to discharge or move to consultation services is frustrating.  Let's explore the reasons some students stay on caseloads longer than necessary. 

Lack of ability to discharge because a school or district relies fully on standardized testing

Many of the students we see will never score at age level on standardized tests measuring visual motor skills, visual perceptual skills, or sensory processing abilities.    

Compensation and Adaptation versus Remediation

This comes down to the understanding that educational therapy is not designed to remediate all underlying deficits.  It is designed to enable students to access their educational curriculum. This may include some remediation, but it can also include compensation and adaptation strategies. 

Thus if discharge criteria is dependent upon standardized testing scores that are age appropriate a student could remain on caseload indefinitely.

Slow progress or Plateau

On the other end of the spectrum are students that are making slow progress or have hit a plateau.  These are usually students not following the general education curriculum and I encourage you to think about life skills with these students.  How can we empower them to live the most independent lives possible?  Can we support iADLs that are being taught in the classroom such as culinary activities or computer activities?

Goals for occupational therapy for high schoolers

In the ideal world, you will not have your own OT goals in the schools. You should be supporting the overall educational goals of the Individual education plan (IEP) and the overall curriculum. 

Pull-out versus Push-in versus Consultation Occupational Therapy Models

With high school and middle school students I encourage you as occupational therapy practitioners and experts, to not only consider but also advocate for the best model for your students.  Please consider if the best use of your student's school time is to be working with you outside of the classroom.  Or will they be missing valuable instructional time? 

The Push-in and Consultation models become essential to consider as our student's age.  The Push-in model is when you work with the student in the classroom setting, this can include direct intervention and collaboration with the teacher to help them modify instruction or make accommodations for students.  

The push-in model may be more appropriate for nonregular education students or students with autism.  We need to consider how a child will feel about us coming into the classroom.  Can we do so quietly and without drawing attention to our presence and reason for being there if that is what the student desires?

The Consultation model is when you are available to consult with teachers, administrators, and parents but do not provide direct services to students.  This allows for more collaboration and problem-solving between all stakeholders involved in a student's education.  Many times this is an appropriate model of service delivery.  During consultative services, I have been able to brainstorm the best way for a student to use their IEP or 504 accommodations such as speech-to-text without disturbing the students.  

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Occupational Therapy Activities for Middle School Students and High School Students

When I was working online with higher-functioning teenagers, I found the following activities to be engaging, and age-appropriate while promoting the skills these students required to meet their educational goals. 

The skills I was targeting in my sessions included:

  • fine motor skills
  • direction following and other executive functioning skills
  • visual motor abilities
  • visual perceptual abilities

Many of the goals of the students I worked with revolved around organization skills, sensory processing, and typing abilities at this age. They may also include handwriting or access to their physical environment.

Here are middle and high school occupational therapy treatment activities that work well for in-person and online virtual teletherapy sessions. Many of the ideas on our other pages work well for this age as well. 

Paper Airplanes

It is beneficial to complete these activities with both visual and video directions. Completing these activities with video direction, versus visual instructures versus demonstration use different underlying skills.


Visual Directions

Simple Origami

There are so many simple origami activities that are easy to do via teletherapy. I liked to start with paper airplanes as they are easier and move on to Origami.

Simple Dog




Other Crafts

Penny Spinners

Online Game Ideas

Tic tac toe, Connect 4, gomoku and battleship


Room Recess Games

Visual Perceptual Ideas – link to our other page

Visual-Motor Ideas – link to our other page

Modifications to Classroom Activities

I also encourage you to think about modifications to classroom activities when it no longer becomes appropriate to work on remediation activities (which is often the case with high schoolers. However in the schools I know we will see students for individual sessions beyond what may be appropriate due to situations beyond our control).

These modifications may include Google Chrome extensions such as speech-to-text.

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