intervention activities

8/2/2019 Intervention Activities

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INTERVENTION ACTIVITIESList of deficits treated by these activities:

GROSS MOTOR (pp. 2-4)

FINE MOTOR (pp. 5-9) COORDINATION (pp. 5-8) GRIP STRENGTH (p. 9)

SENSORY (pp. 10-12)

DEVELOPMENT (p. 10) PROPRIOCEPTION (p. 11) TACTILE DEFENSIVE (p. 12)

COGNITIVE (pp. 13-20) ATTENTION & MEMORY (pp.13-15) PROBLEM SOLVING (pp. 16-18) SEQUENCING (pp. 19, 20)

EMOTIONAL (pp. 21-35) EMOTIONAL REGULATION / IMPULSE CONTROL (pp. 21-24) EMOTIONAL EXPRESSION / IDENTIFICATION (pp. 25-31) MOTIVATION (pp. 32, 33) RESPONDING TO INTERNAL STIMULI (pp. 34, 35)

SOCIAL (pp. 36-59) ANXIETY (pp. 36-39) AVOIDANCE / INITIATION (pp. 40-45) COMMUNICATION (pp. 46-51) INAPPROPRIATE INTERACTION (pp. 52-57) PARTICIPATION (pp. 58, 59)



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GROSS MOTOR

Back to Back Relay Race – stopwatchDeficit: Proprioception, CoordinationActivity: Build an obstacle course out of what is in the room stairs, chairs, walls, rocks if outside,tables). Establish rules and give a demonstration of how to run the course. Clients will standback to back and wrap arms together to hold the position. An obstacle course will be createddepending on your client's ability to coordinate. Teams of two will take turns being timed on thecourse to compare with other teams. Team with lowest time wins.Upgrade: Blindfold part of each team, don't allow them to talk, or make the course longer.Downgrade: Shorten the racing field, less obstacles.

Beach Ball Deficit: Gross motor, Range of MotionActivity: Throwing the ball back and forth (while answering questions)Downgrade: Catching and throwing is easier than rallying back and forth or catching/hitting aball that is thrown to the side or low.

Blind Man's Obstacle Course - Mines can be made out of anything, paper, tin cans etc. Clotheslines are made out of yarn hung across the room, or tied on to a large object. Stair case can beused, or mound of pillows will substitute just as easily. Deficit: CoordinationActivity: Clients’ are broken up into teams of two, one team member is blind folded and theother team member must talk them through the mine field followed by a series of clothes lines,and then a rock climb (stair case suggested on all fours crawling position) Teams are timed.Upgrade: More obstacles, both members must finish the course before time is called.Downgrade: Less obstacles, team members can switch in the middle of the game if necessary.

Bubbles- bubblesDeficit: Gross motor deficits to increase ROMActivity: The therapist can instruct the seated patient to pop all of the bubbles before they hiteye level. This will cause the patient to reach above their head and quickly pop all of the bubblesbefore they descend.Downgrade: The therapist can tell the patient to pop all of the bubbles before they hit the floor.This will give them more time to pop the bubbles and will be easier if they cannot reach veryhigh.

Cards Deficit: GM or FM ROMActivity: Therapist will scatter cards on the table- patient will pick up each card individually.Upgrade: the therapist can instruct the patient to close their eyes, so he/she must rely on tactileperception to feel for where the cards are placed. This could treat a sensory deficit as well.



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CardsDeficit: GM or FM deficits, EnduranceActivity: make the client stand while playing gameUpgrade: place the draw deck or the main “pile” of the game on the opposite side of the tableforcing the client to increase ROM, reaching, stability and balance, and trunk rotation.

Cards Deficits: Motor ROM, anxiety, inappropriate interaction, communication, emotional expressionActivity: 2 person team building a house of cardsDowngrade: Build something smaller or less difficult.

Dice Game - dice (Also requires a list o f activities that have associated numbers. Ex: roll a “3” sowork on laundry, next roll a “6” so build and complete an obstacle course in pediatric setting) Deficit: In-hand Manipulation, Fine & Gross Motor skills, Positioning, Timing, Visual.Activity: Roll the dice 3 times to decide which activities to do during treatment.Downgrade: Use only 1 instead of the pair if having difficulty controlling.

Inflated balloonDeficit: Motor – ROM, balanceActivity: Client will keep the balloon in the air by hitting it back and forth with the therapistwhile standing and maintaining balance.Downgrade: Client performs activity while sitting.Upgrade: Client can only use weak or affected arm.

Island Game - Tape that will not damage flooring. Wooden boards wide enough to balance onbut not too heavy. You can improvise items in the room/outdoors or use tape to make theislands and main land. Depending on the group hot lava balls made out of light bean bags can bethrown at rule breakers or for an added element of fun. The original Island should be just bigenough for the group to stand on uncomfortably, it will encourage them to want to get off of itand also improve personal space issues.Deficit: GM Coordination, BalanceActivity: Group will all be on the same team. No one is allowed to talk but may gesture non-verbally. Depending on the group you may select some of the people to have disability(blindfolded) or you may use that for disciplining those who violate the no talking rule. Tell thegroup that they live on a small island and the volcano has erupted filling the once lovely oceaninto hot lava that if they touch it they will burn up and reappear on the island. There is a way tosafety on the main land but they have to find a way to get to it with the materials provided.There are 3 small islands on the way that only have room for one person at a time. They have 2

wooden beams to make bridges out of to make it to the small island leading to the main land. Asa team they must all make it to the main land together. Game will be timed and comparethe amount of time it took to save everyone to the next time.Upgrade: Give some group members disabilities, Lava rocks, more islands between the mainland and other obstacles (whirlpool, predators, rock slides etc.)Downgrade: Allow them to talk.



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Masking TapeDeficit : Gross and fine motor coordination and endurance, Problem-solving. Activity: using the tape lay out a grid or game board (like tic-tac-toe) Downgrade: have a specified, small area or pattern for the clients to use/follow.

Pairs of socks - Various pairs of socks of different designs/colorsDeficit: Motor – ROMActivity: Client will bend down from a seated position to put socks on feet.Downgrade: Client will use sock aid to help put socks on.

Shoes - shoes with lacesDeficit: Fine motor skills, Visual, Joint Mobility, Bending, ReachingActivity: Putting on the shoes, reaching for the laces, tying the lacesDowngrade: Using a shoe with Velcro or a slip on shoe.

Shuffle Caps - shuffle caps/bottle caps, and tapeDeficit: Motor skills – gross motor skills; involving large muscles of the body in order to movethe body; includes muscle tone and strengthActivity: Create a scoring triangle with tape at the end of a table and tape a starting line at theopposite end. Have the players take turns sliding their caps from behind the starting line. Seehow far they can slide their cap, and they can even knock their opponent’s out of the triangle orright off the table.Upgrade: Take quadrants in the finish triangle and designate the score for each section. Also,the player loses points for sliding off the table.

Utensil Set Deficit: Gross Motor – Range of MotionActivity: Hold utensils one at a time on one side of the client’s body in front of them. Havethem use opposite arm to reach for utensil.Upgrade: Move the position you are holding the utensils at higher and lower and changedirections frequently.

Water BottleDeficit: Gross motorActivity: with the bottles filled with water or another substance (and capped), use the bottles as

weights and do upper body exercises with them.Upgrade: have the client walk, balance on a therapy ball while holding weights in both arms.



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FINE MOTOR (Coordination, Grip Strength)

CoordinationBag of Coins - Ziploc bag and various coinsDeficit: Cognitive, FM CoordinationActivity: The therapist can have the patient make various amounts of change by combining thecoins. For example, the therapist can say “Make me 67 cents.” The client would then have tosort through the various coins, adding the values and make the appropriate amount of change.Downgrade: Therapist can first have the patient go through the entire bag of coins, namethe value of the coins, then have the patient place them in separate piles (pennies, etc..)

BalloonDeficit: Fine motor, Hand-manipulation, Sensory-tactile sensation Activity : form a funnel (out of a piece of paper or actual funnel) and fill balloon with rice, sand,beads or another miscellaneous item stress ball, rattle, ball. Upgrade: Place the items in various locations on the table and floor to promote gross motoractivity: reaching, trunk rotation, and increased ROM.

CardsDeficit: GM or FM deficits, EnduranceActivity: make the client stand while playing gameUpgrade: place the draw deck or the main “pile” of the game on the opposite side of the tableforcing the client to increase ROM, reaching, stability and balance, and trunk rotation.

Cards Deficits: Motor ROM, FM coordination, anxiety, inappropriate interaction, communication,emotional expressionActivity: 2 person team building a house of cardsDowngrade: Build something smaller or less difficult

Coins and bank - Coins and a small plastic bankDeficit: Motor – fine motorActivity: Client picks up each coin off the table using a pincer grasp and places coin in the palmof other hand. Client uses palm to finger translation to move coin to pincer grasp and placescoin in bank slot. Client alternates arm use.Downgrade: Therapist pla ces coin in the palm of client’s hand. Client won’t have to pick up off table or transfer to other arm.



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Connect Four Deficit: Motor – Fine Motor CoordinationActivity: Playing a game of connect four with the pieces spread out all over the tables so theclient has to both pick them up and put them in the slot.Downgrade: Therapist hands the client a piece so they only have to place it in the slot.

Color & Number BookDeficit: Motor skills – fine motor skills; can be defined as small muscle movements and thosethat occur in the finger and in coordination with the eyesActivity: Each book is consists of pieces of colored paper with a color, number, or both writtenon the pages. Take the star stickers and place the appropriate colored star on thecorresponding sheet of paper. If there is a number written – places that many colored stickers.Upgrade: You can have the client place a certain size star / number of stars on thecorresponding colored paper in the book.

Crossword PuzzleDeficit: Motor – Fine Motor Coordination - GripActivity: Solving crossword puzzles by circling the found word with a pen or pencil.Downgrade: Allow the client to use a highlighter to identify the word instead of a pen or pencil.

Dice Game - dice (Also requires a list of activities that have associated numbers. Ex: roll a “3” sowork on laundry, next roll a “6” so build and complete an obstacle course in pediatric setting) Deficit: In-hand Manipulation, Fine & Gross Motor skills, Positioning, Timing, Visual.Activity: Roll the dice 3 times to decide which activities to do during treatment.Downgrade: Use only 1 instead of the pair if having difficulty controlling.

Duct Tape – instructions to make a walletDeficit: Emotional Regulation, FM Coordination, Personal Interaction, Communication,Emotional Expression, AnxietyActivity: Making a duct tape walletDowngrade: Simplify structure; make a simpler version of the wallet.

Farkle Dice Game – need instructionsDeficit: Impulse control, FM coordination, Personal interaction. Avoidance, InappropriateInteraction, Emotional ExpressionActivity: dice gameDowngrade: Allow players to continue using all 6 dice as opposed to removing point- worthydice after each roll.



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Finger Paint, Glitter, GlueDeficit: Social Emotional, FM CoordinationActivity: finger painting with paint, glue, and glitter – have to share what they do. It can beabout anything.Upgrade: the initial purpose is for them to interact with others and share. It can be madeharder by making them paint something that is important to them, something that burdensthem, etc.

Lanyard - How to make see word document labeled: Making a LanyardDeficit: Fine Motor CoordinationUpgrade: move on to more difficult stitchesDowngrade: create a three string braid.

MagazineDeficit : Fine motor skills, Coordination

Activity: work on turning the pages, find words and have the client cut them out, etc.Downgrade: use magazines/books with thicker pages so it’s easier to see and feel.

Money - cash and coinsDeficit: Fine motor skills, In-hand manipulationActivity: Practice manipulating money to and from wallet, in client’s own hand, and exchangingbetween clients to therapists hands.Upgrade: Using only one hand, sliding coins into jars through slits like on piggy bank (kids) orinto the soda/snack machine slot.

Origami - Directions to fold paper to make fun designs, origami paper, or typing paperDeficit: FM coordinationActivity: Fold to make a square and cut off half, you can incorporate coloring before finally folds.Consult Internet for directions and select group difficulty appropriate for group level.Upgrade: Go on to more difficult structures.Downgrade: Stick with easy to make structures and focus on coloring or using stickers.

Origami – PaperDeficit: Fine MotorActivity: Follow directions in order to create different origami models. Ex: HatUpgrade: Give more instructions for harder models; fold paper into more challenging objectsEx: bird- requires folding into smaller pieces. Some models require more than 1 piece of paper.Downgrade: Teach origami models that require fewer steps to follow



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Ping Pong - ping pong ball and cupDeficits: Strength Regulation, FM CoordinationActivity: The therapist can instruct the patient to bounce the ping pong ball into a cup. Thepatient will have to control the strength used to complete this taskDowngrade: The therapist can instruct the patient to use enough strength to bounce the ballonce on the table. This will enable the patient to learn how to control strength.

Shoes - shoes with lacesDeficit: Fine motor skills, Visual, Joint Mobility, Bending, ReachingActivity: Putting on the shoes, reaching for the laces, tying the lacesDowngrade: Using a shoe with Velcro or a slip on shoe.

Speed Stacking Cups - Plastic Cups Deficit: Coordination

Activity: Speed stack cups into a pyramid formation. Stacking can be timed.Upgrade : Use more cups to make larger pyramids; set time limit and compete with others.Downgrade: Use less cups to make smaller pyramids

Water Bottle Deficit: Sensory processing, fine motor coordination, problem-solving Activity: have the client work to fill the bottle with a liquid or a miscellaneous item like rice andwork on pouring; problem-solve how to make an object fit into the bottle. Downgrade: cut the top off the bottle so the opening is larger.

Writing Activity - pen and paper/checkbookDeficit: Fine motor skills, In-hand Manipulation, VisualActivity: Writing checks, letters, cards, alphabet, etc.Downgrade: Use a wider pen or a pen with a grip holder.



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Grip Strength

Cards

Deficit: To improve a gross or fine motor deficit: to increase ROM and improve graspActivity: The therapist can scatter cards all over the table and have the patient reach and graspeach card individually to make a neat pile.Upgrade: the therapist can instruct the patient to close their eyes, so he/she must rely on tactileperception to feel for where the cards are placed.

Coins and bank - Coins and a small plastic bankDeficit: Motor – fine motorActivity: Client picks up each coin off the table using a pincer grasp and places coin in the palmof other hand. Client uses palm to finger translation to move coin to pincer grasp and placescoin in bank slot. Client alternates arm use.Downgrade: Therapist places coin in the palm of client’s hand. Client won’t have to pick up off table or transfer to other arm.

MagazineDeficit: Improve the client’s grasp, in -hand manipulation, and bimanual manipulation.Activity: The therapist can instruct the patient to make a collage. First, the client will have totear pictures and letters out of the magazine. Then, the client will paste the pictures onto apiece of paper.Upgrade: the therapist can add a step between tearing out the pictures and pasting them down,which would be to trim the edges of the pictures with a pair of scissors.

Pill bottle and weekly pill box with beans - Pill bottle, weekly pill box with morning and

afternoon sections for each day, various packages of different beans (red, pinto, black).Deficit: Motor – fine motor, hand strengthActivity: Client will open pill bottle and will open each pill box. Client will pick up beans fromtable by using a pincer grasp and will place each bean in a box. Client will then close the boxes.Downgrade: Therapist will open pill bottle for client.

Pick Up Straws - Drinking StrawsDeficit: Grip, CoordinationActivity: Hold straws right side up on a table then let them fall into a pile. Take turns removingindividual straws without disrupting the pile. The first to disrupt the pile loses.Upgrade: Use small straws or utensils like coffee stirrers; Use different color straws and each

color can be worth a different number of points. The person with the most points can win.Downgrade: Use bigger straws.

Writing Activity - pen and paper/checkbookDeficit: Fine motor skills, In-hand Manipulation, VisualActivity: Writing checks, letters, cards, alphabet, etc.Downgrade: Use a wider pen or a pen with a grip holder.



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SENSORY(Development, Proprioception, Tactile Defensive)

Development

Bath SpongeDeficit: Sensory – SensationActivity: Move sponge along body including arms and legs to test for sensation (I have sincelearned that the proper way to test for sensation is the Semmes Weinstein microfilament test – but this could still be an activity maybe to point out to the client where they can and can’t feelso that can be extra careful with those areas).Upgrade: Have client close eyes while doing activity and see if they can still accurately identifypoint of sensation.

Bag of Coins - Ziploc bag and various coinsDeficit: Tactile and other sensory deficitsActivity: The therapist could have the patient feel the different edges and sides of the coin todifferentiate one coin from another.

Color & Number BookDeficit: Sensory skills – sight and touch; sensory development can be encouraged by stimuli Activity: Each book is consists of pieces of colored paper with a color, number, or both writtenon the pages. Take the star stickers and place the appropriate colored star on thecorresponding sheet of paper. If there is a number written – places that many colored stickers.Downgrade: To make it easier – the client can just identify the colors of the pages of the book

or the sizes and colors of stickers. Or, they could count the number of a certain color of stars onthe sticker sheet.

Puff Balls – small colored pom-pomsDeficit: Sensory skills – sight and sound; sensory development can be encouraged by stimuliActivity : Place all the balls in a pile on the table and place a container on the other side of thetable. Have the client pick up the tongs and use them to pick up one puff ball at a time andplace them in the container.Downgrade: To make it easier – have the client use their hands and not the tongs; touching thepuff balls may help the client as well.



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Proprioception

Back to Back Relay Race – stopwatchDeficit: Proprioception, CoordinationActivity: Build an obstacle course out of what is in the room stairs, chairs, walls, rocks if outside,tables). Establish rules and give a demonstration of how to run the course. Clients will standback to back and wrap arms together to hold the position. An obstacle course will be createddepending on your client's ability to coordinate. Teams of two will take turns being timed on thecourse to compare with other teams. Team with lowest time wins.Upgrade: Blindfold part of each team, don't allow them to talk, or make the course longer.Downgrade: Shorten the racing field, less obstacles.

Blind Man's Obstacle Course - Mines can be made out of anything, paper, tin cans etc. Clotheslines are made out of yarn hung across the room, or tied on to a large object. Stair case can beused, or mound of pillows will substitute just as easily.Deficit: Proprioceptive, CoordinationActivity: Clients’ are broken up into teams of two, one team member is blind folded and theother team member must talk them through the mine field followed by a series of clothes lines,and then a rock climb (stair case suggested on all fours crawling position) Teams are timed.Upgrade: More obstacles, both members must finish the course before time is called.Downgrade: Less obstacles, team members can switch in the middle of the game if necessary.

Island Game - Tape that will not damage flooring. Wooden boards wide enough to balance on

but not too heavy. You can improvise items in the room/outdoors or use tape to make theislands and main land. Depending on the group hot lava balls made out of light bean bags can bethrown at rule breakers or for an added element of fun. The original Island should be just bigenough for the group to stand on uncomfortably, it will encourage them to want to get off of itand also improve personal space issues.Deficit: GM Coordination, Balance, ProprioceptionActivity: Group will all be on the same team. No one is allowed to talk but may gesture non-verbally. Depending on the group you may select some of the people to have disability(blindfolded) or you may use that for disciplining those who violate the no talking rule. Tell thegroup that they live on a small island and the volcano has erupted filling the once lovely oceaninto hot lava that if they touch it they will burn up and reappear on the island. There is a way to

safety on the main land but they have to find a way to get to it with the materials provided.There are 3 small islands on the way that only have room for one person at a time. They have 2wooden beams to make bridges out of to make it to the small island leading to the main land. Asa team they must all make it to the main land together. Game will be timed and comparethe amount of time it took to save everyone to the next time.Upgrade: Give some group members disabilities, Lava rocks, more islands between the mainland and other obstacles (whirlpool, predators, rock slides etc.)Downgrade: Allow them to talk.



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Tactile Defensive

Bag of Coins - Ziploc bag and various coins

Deficit: Tactile and other sensory deficitsActivity: The therapist could have the patient feel the different edges and sides of the coin todifferentiate one coin from another.

Cards- deck of cardsDeficit: Sensory- tactileActivity: The therapist can scatter cards all over the table and have the patient reach and graspeach card individually to make a neat pile.Upgrade: the therapist can instruct the patient to close their eyes, so he/she must rely on tactileperception to feel for where the cards are placed.

Finger Paint, Glitter, GlueDeficit: SensoryActivity: finger painting with paint, glue, and glitter – have to share what they do. It can beabout anything. Ex: Something that is important, something they wish they could change,something they love to do, etc. You can also use your finger for the glue.Upgrade: Not sticking your finger in the glue or not using the glitter

Money - cash and coinsDeficit: Fine motor skills, In-hand manipulation, SensoryActivity: Practice manipulating money to and from wallet, in client’s own hand, and exchanging

between clients to therapists hands.Upgrade: Using only one hand, sliding coins into jars through slits like on piggy bank (kids) orinto the soda/snack machine slot.

Stress Ball- Balloon and Plastic water bottleDeficit: Sensory, TactileActivity: Fill a water bottle half way with the contents chosen to be in the stress ball like flour orsand. Attach the balloon to the water bottle, pour in the contents, and then tie off the balloon.Practice squeezing the stress ball.Upgrade: Make two stress balls instead of one. Also, practice different breathing techniques tocoincide with the squeezing; Use more than one material for the stress ball like birdseed, salt,

rice, sand, or marbles.



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COGNITIVE (Attention & Memory, Problem Solving,

Sequencing)

Attention & Memory BalloonDeficit: Neglect, Attention Activity : Tossing a balloon back and forth between the client and therapist (or other client).Focus on the side being neglected or injured. Upgrade: Hang the balloon on a string from the ceiling or a high object and have the client reachto hit it. Promotes greater ROM, reaching, eye tracking, and concentration.

Beach BallDeficit: CognitiveActivity: Every time you catch the beach ball, you have to name a sate, a capital, something youdo in the morning to get ready, a type of flower, etc.Modification: You can make the questions easier or harder. You can also do this activity with agroup of people.

BingoDeficit: Cognitive skills – receptive memory; the ability to note the physical features of astimulus and be able to recognize it at a later timeActivity: Give a bingo card and pencil to all members of the group that are playing this game.Instruct them that once the game starts, they are to go around the room and find someone whomatches the description as the line on their bingo card. Once they have a full card – they are to

shout bingo!Upgrade: Take the cards away at the end of the game and ask clients who was the correctanswer to a specific question

Bubbles- bubblesDeficit: AttentionActivity: If the patient has trouble keeping their attention focused on one thing, the therapistcan ask the client to count the amount of bubbles make with each blowUpgrade: the therapist can tell the patient that they will blow three times. So, the client has toremember what number they were on from the first blow and start from that number on thesecond and third blow. For example, the therapist blew six bubbles from the first blow, threefrom the second blow, and eight from the third blow. So, the client would report seventeentotal bubbles made from the three blows.

Cards Deficit: Cognitive/perceptual – Attention, MemoryActivity: Client will play a memory matching game with therapist. All cards will be turned facedown and spread across the table in rows and columns. Therapist and client will take turns tofind pairs that match and will turn the cards back over if not a match.Downgrade: Decrease the number of cards used for the game.



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Cards- Blackjack Deficit: CognitiveActivity: Play a game of Blackjack with therapist as dealer. Dealer shows one of his or her cardsand the client tries to get their hand closer to 21.Downgrade: Have both of the dealer’s cards showing.

Cards- Old Maid, War, and ConcentrationDeficit: CognitiveActivity: Old Maid, War, and Concentration - rules attachedDowngrade: They could not keep a running tally to make it easier and just play by who winswhat round.

Crossword Puzzle Deficit: Cognitive – Attention - memoryActivity: Solving crossword puzzles by circling the words found.Downgrade: Use easier crossword puzzles with two or three letter words only

Dice Game – pair of diceDeficit: Attention, Memory, Awareness, RecognitionActivity: Using the numbers on the dice to learn and practice addition, subtraction, etc.Downgrade: Use dice with pictures or numbers instead of dots.

MagazineDeficit : Cognitive deficits —memory, sequencing, problem-solving, following directions. Activity: ask the client to find a “ pink dress ” and cut it out. Upgrade: give the client a list or more than one action to do at a time vs. just one or two.

MagazineDeficit: MemoryActivity: The therapist can instruct the patient to read an article, paying attention to details.After the article is read, the therapist can ask the client to report three facts from the article.Upgrade: The therapist can ask the client to recall five or more facts from the article. To improvesocial skills in communication, the therapist can ask the client their opinion of an article anddiscuss different points of view that others may take when reading the same article.

Origami – Paper Deficit: AttentionActivity: Listening and following direction in order to create different origami models; fold andmanipulate the paper into an object like a hatUpgrade: Give more instructions for harder models; fold paper into more challenging objectslike a bird which requires folding the paper into smaller pieces. Some origami models requiremore than one piece of paper.Downgrade: Teach origami models that require fewer steps to follow.



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Pill bottle and weekly pill box with beans - Pill bottle, weekly pill box with morning andafternoon sections for each day, various packages of different beans (red, pinto, black).Deficit: Cognitive/perceptual – memoryActivity: Therapist will verbally instruct client on how many red beans to put in each morning orafternoon space for each day of the week.Downgrade: Therapist will provide client with both verbal and written/picture instructions.Upgrade: Client will use different types of beans (kidney, pinto, black, etc.) to representdifferent pills. Therapists will vary the amounts of each bean needed for each box.

Ping Pong - ping pong ball and cupDeficits: Attention and memoryActivity: If the patient has trouble with neglecting insignificant factors in the surroundings, thetherapist can bounce an orange ball and a white ball and instruct the client to only pay attentionto the orange ball. The, the therapist can tell the client to count how many bounces the orangeball took before stopping. This will make the patient neglect the white ball and focus his/herattention on the orange ball and the number of bounces.

Upgrade: the therapist can add more colored balls to the mix.

Utensil SetDeficit: Cognitive - MemoryActivity: As client is doing ROM activity, have them identify which specific utensil you areholding and what it is used for.Downgrade: Give them verbal cues if they are unable to come up with what the utensil is orwhat it is used for.

TP game Deficit: Cognitive Skills – the ability to concentrate and attend to a task for a period of timeActivity: Pass around a roll of toilet paper and ask each client to rip some off, but don’t tell themwhy or how much to take. Then, let the clients know that they need to reveal a fact for howevermany sheets of toilet paper they ripped off.Downgrade: To make this easier – You could have the clients come up with a word to describethemselves for each sheet of toilet paper they ripped off

Writing Activity - pen and paper/checkbookDeficit: Judgment, Attention, MotivationActivity: Work on budget planning, paying bills, and managing household tasks.Downgrade: Provide examples for client or prompt if having trouble making correct decisions.

Word Search/Puzzle Book:Deficit: CognitiveActivity: Doing one of the puzzles in the bookDowngrade: Some puzzles in the book are easier than others. You could also use a ruler to helpthem see one line at a time. You can use any straight edge.



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Problem Solving

Bag of Coins - Ziploc bag and various coinsDeficit: CognitiveActivity: The therapist can have the patient make various amounts of change by combining thecoins. For example, the therapist can say “Make me 67 cents.” The client would then have tosort through the various coins, adding the values and make the appropriate amount of change.Downgrade: the therapist can first have the patient go through the entire bag of coins, namethe value of the coins, and then have the patient place it into a pile with other coins with thesame value.

Cards- Pity PatDeficit: Problem Solving Activity: Each person is dealt five cards. The deck has one card flipped over next to it. Try tomatch and then discard pairs by taking turns flipping over one card from the deck. When a pairis made, discard one of the cards from your hand. The discarded card can be used as a match forsomeone else. Whoever discards all their cards first wins the game.Upgrade: Play the game in teams so partners have to work together to create pairsDowngrade: Create a simple matching game by spreading out all the cards and flipping themover to create matches.

Island Game - Tape that will not damage flooring. Wooden boards wide enough to balance onbut not too heavy. You can improvise items in the room/outdoors or use tape to make theislands and main land. Depending on the group hot lava balls made out of light bean bags can bethrown at rule breakers or for an added element of fun. The original Island should be just bigenough for the group to stand on uncomfortably, it will encourage them to want to get off of itand also improve personal space issues.Deficit: Problem solving, AttentionActivity: Group will all be on the same team. No one is allowed to talk but may gesture non-verbally. Depending on the group you may select some of the people to have disability(blindfolded) or you may use that for disciplining those who violate the no talking rule. Tell thegroup that they live on a small island and the volcano has erupted filling the once lovely oceaninto hot lava that if they touch it they will burn up and reappear on the island. There is a way tosafety on the main land but they have to find a way to get to it with the materials provided.

There are 3 small islands on the way that only have room for one person at a time. They have 2wooden beams to make bridges out of to make it to the small island leading to the main land. Asa team they must all make it to the main land together. Game will be timed and comparethe amount of time it took to save everyone to the next time.Upgrade: Give some group members disabilities, Lava rocks, more islands between the mainland and other obstacles (whirlpool, predators, rock slides etc.)Downgrade: Allow them to talk.



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Lanyard - How to make see word document labeled: Making a LanyardDeficit: Problem Solving, SequencingUpgrade: move on to more difficult stitchesDowngrade: create a three string braid.

Money - cash and coinsDeficit: Problem-solvingActivity: Work on math skills, organizing different bills and coins by category, have options tobuy snacks, stickers, etc. and have the client mimicked a store experience.Upgrade: Have the client calculate the amount of change they should receive back (Ex: a drinkcosts $1.75, so the client would give $2.00, the client would have to figure out that the change is$0.25 and make 25 cents with coins).

Pairs of socks - Various pairs of socks of different designs/colorsDeficit: Cognitive/perceptual – matching, sortingActivity: Client will sort different colors/types of socks, match pairs, and fold.Upgrade: Increase the number and variety of socks to be sorted.

Pick Up Straws - Drinking StrawsDeficit: Problem SolvingActivity: Hold straws right side up on a table then let them fall into a pile. Take turns removingindividual straws without disrupting the pile. The first to disrupt the pile loses.Upgrade: Use small straws or utensils like coffee stirrers; Use different color straws and each

color can be worth a different number of points. The person with the most points can win.Downgrade: Use bigger straws.

Shoes - shoes with lacesDeficit: Attention, Problem SolvingActivity: Allow the client to figure out the best way to put on a tie the shoe through problemsolving. Pay special attention to each step and build to a more complex skill with each step.Downgrade: Using a Velcro shoe.

Water BottleDeficit: Problem-solving, Sensory processing, Fine motor coordination Activity: have the client work to fill the bottle with a liquid or a miscellaneous item like rice andwork on pouring; problem-solve how to make an object fit into the bottle. Downgrade: cut the top off the bottle so the opening is larger.



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Writing Activity - pen and paper/checkbookDeficit: Problem Solving, Attention, MotivationActivity: Work on budget planning, paying bills, and managing household tasks.Downgrade: Provide examples for client or prompt if having trouble making correct decisions.

Who am I - index card, Sharpie. You can glue pictures of famous people on index cards and/or just write their names on the cards.Deficit: Problem SolvingActivity : Each member of the group takes turns choosing a card from the pile of nonfictionalfamous people that can be dead or alive. It cannot be someone they know personally or a familymember. Ex: George Washington, Jude Law, Madonna. The person selecting the card will notsee the card but the rest of the group will know who it is. The person will ask yes or noquestions to determine who the person is on the card. The Group can only reply with yes or noanswers. Therapist will keep track of how many question it took for the person to figure out whothe person is and the one with the lowest number of questions is the winner.Upgrade: Make choices to pick from less well known, have limited amount of questions allowedto be asked (10), allow group to choose a person for the client.Downgrade: Choose person from genres, such as fairy tales, Star Wars, allow group to giveexplanations, not just yes and no.



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Sequencing

Cards Deficit: Cognitive- to improve sorting and orderingActivity: The therapist can have the patient sort spades, hearts, clubs, and diamonds. Thetherapist can also have the patient order the cards by number.Upgrade: the therapist can demand that the person use memory by flipping the cards over andhaving him/her matching the cards by numbers. This will make the patient rely on memory tolocate appropriate cards and thus will increase cognitive ability. This matching game can alsoimprove emotional deficits by making the client control emotions if they get frustrated by notbeing able to find a match.

Cards

Deficits: Sequencing , GM ROM, FM coordination, anxiety, inappropriate interaction,communication, emotional expressionActivity: 2 person team building a house of cardsDowngrade: Build something smaller or less difficult Upgrade: Playing Black Jack

Coins and bank - Coins and a small plastic bankDeficit: Cognitive/perceptual – matching, sequencing, addingActivity: Client will sort and group coins by type. Client will sequence groups of coins in order of how much they are worth. Client will add and subtract coins to equal different amounts.Downgrade: Therapist groups the coins by type and tells client how much each is worth.

Connect Four Deficit: Social-Emotional – Impulse ControlActivity: Playing a game of connect four with another person.Downgrade: Set a time limit- both players must make a move within a certain amount of time.

Duct Tape – instructions to make a walletDeficit: Emotional Regulation, FM Coordination, Personal Interaction, Communication,Emotional Expression, Anxiety, Sequencing

Activity: Making a duct tape walletDowngrade: Simplify structure; make a simpler version of the wallet.

Lanyard - How to make see word document labeled: Making a LanyardDeficit: Problem Solving, SequencingUpgrade: move on to more difficult stitchesDowngrade: create a three string braid.



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MagazineDeficit : Cognitive deficits —memory, sequencing, problem-solving, following directions. Activity: ask the client to find a “ pink dress ” and cut it out. Upgrade: give the client a list or more than one action to do at a time vs. just one or two.

Origami - Directions to fold paper to make fun designs, origami paper, or typing paperDeficit: SequencingActivity: Fold to make a square and cut off half, you can incorporate coloring before finally folds.Consult Internet for directions and select group difficulty appropriate for group level.Upgrade: Go on to more difficult structures.Downgrade: Stick with easy to make structures and focus on coloring or using stickers.

Origami paperDeficit: Impulse controlActivity: Origami cat – fold paper from corner to corner, fold down top corner, fold up bottomcorners, draw a face on the cat.Downgrade: Have folds drawn on paper, use paper less likely to tear and cause frustration.Upgrade: Have clients do more elaborate projects or paper sculptures which increases thechance of frustration.

Puff Balls Deficit: Cognitive skills – logical thinking and sequential thought Activity: Place all the balls in a pile on the table and place a container on the other side of the table. Have the client pick up the tongs and use them to pick up one puff ball at a timeand place them in the container.Upgrade : To make it harder – place all colors of puff balls in a pile, but have the client only pickup a certain color ball

Shoes - shoes with lacesDeficit: Sequencing, Attention, Problem SolvingActivity: Allow the client to figure out the best way to put on a tie the shoe through problemsolving. Pay special attention to each step and build to a more complex skill with each step.Downgrade: Using a Velcro shoe.

Speed Stacking Cups - Plastic Cups Deficit: Cognitive/Perceptual; Timing and OrganizationActivity: Speed stack cups into a pyramid formation. Stacking can be timed.Upgrade : use more cups to make larger pyramids; set a specific time to create the pyramid andcompete with othersDowngrade: use less cups to make smaller pyramids.



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EMOTIONAL (Emotional Regulation/Impulse control,

Emotional Expression/Identification, Motivation, Responding toInternal Stimuli)

Emotional Regulation / Impulse control Balloon Ball Deficit: Impulse controlActivity: Space ball – form a circle; the object is to keep the ball in ‘space” and not let it touchthe ground; clients should call out the name of the person they are batting the balloon ball to.

Downgrade: Clients will do the activity seated so they are less likely to jump in front of others orkick the ball.Upgrade: Clients will do the activity standing, but they must stand in the same spot and notmove their feet.

Balloon Bop - balloonDeficit: Impulse control and responding to external stimuli.Activity: All of the participants stand in a circle. One person begins by tossing a balloon in theair. That person calls another participant’s name and a body part that the participant will use tohit the balloon and k eep it in the air. For example, Fred tosses the balloon and says “Andy.Heel.” Andy must hit the balloon with his heel before it touches the ground. Then Andy callsanother participant’s name and a body part.Upgrade: In addition to saying the person’ s name and a body part, the participant must alsoindicate how to hit the balloon, such as “Andy. Heel. Soft.”

Bubbles- bubblesDeficit: Impulse ControlActivity: The therapist can instruct the client to pop only one bubble from each blow. The clientwill have to control their impulse to pop more than one bubble.

Connect Four Deficit: Social-Emotional – Impulse ControlActivity: Playing a game of connect four with another person.

Downgrade: Set a time limit - both players must make a move within a certain amount of time.

CardsDeficit: Social emotional deficit – Personal Interaction, Communication, Impulse ControlActivity: Clients will play Go Fish or other card games that require communication amongplayers. Clients will play in a group and will take turns asking other group members for cards.Upgrade: Client must make eye contact with and say the name of the person they are asking fora card.



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Cards- Sevens Deficit: Emotional – Impulse ControlActivity: Playing the card game Sevens in a group. Discuss with the group prior to playing thegame the importance of taking turns and impulse control.Downgrade: Play the card game Sevens with only two people instead of a group so players haveto wait less time to take their turn.

Cards- Crazy 8’s Deficit: Emotional Regulation, ImpulsivityActivity: Crazy 8’s - The dealer deals five cards to each player. The undelt stock is placed facedown on the table, and the top card of the stock is turned face up and placed beside the stockto start the discard pile. Starting with the player to dealer's left, each player in turn must eitherplay a legal card face up on top of the discard pile, or draw a card from the undelt stock. Thefollowing plays are legal. If the top card of the discard pile is not an eight, you may play any cardwhich matches the rank or suit of the previous card (for example if the top card was the king of hearts you could play any king or any heart). An eight may be played on any card, and the playerof the eight must nominate a suit. If an eight is on top of the pile, you must play either another

eight or any card of the suit nominated by the person who played the eight. The first player whogets rid of all their cards wins.Upgrade: Add more people to the game. The client will have to wait longer to take his/her turnand will have to follow the suit set by more than just one person.Downgrade: The therapist only plays with one client. The therapist would then deal seven cardsto both her/himself and the client. This would decrease the length of time the client would haveto wait to take his turn. Also, he would only have to follow the suit set by the therapist.

Dirty Laundry - Materials/how to make: print out templates provided, markers, scissors, indexcards, glue stick. Cut out people and clothes from template and glue to index cards for stability,color if desire, or have clients color if desired. Write out scenarios

-Clothes pile (random clothes items, socks, pants, dress, under garments)-People pile (different kinds of people, teacher, doctors, men and women etc.)-Destination pile (where the people are going, so you know what clothes they need, ex: Party,wedding, Alaska vacation, the beach.)-Question pile (Ex: name 3 sports that you enjoy, or name 3 things you are excellent at)Deficit: Impulse Control, Communication, Emotional Expression, Identification Activity: All clothes go in a bag to be randomly selected. Each player will randomly select fromthe People Pile and the Destination pile depending on the group you may elect to give themmultiple people, or put the group into teams. Taking turns 1st player will select from theQuestion Pile, and read it out loud, then answer it about them self not showing anyone elsetheir answer. (Ex: Name 3 sports that you enjoy) The rest of the group will write down whatthey think the 1st player has written down, (ex: baseball, football and golf). If the groupmembers are able to get what the 1st player has written down then they get an item of clothingfor each correct answer to dress their people. Player one is allowed to collect a piece of clothing for each incorrect answer. The first player that is able to dress their people correctly fortheir destination wins. Make modifications as necessary.Upgrade: Give each player more people to dress and more destinations to for them to go toDowngrade: Play in teams, drop the Question pile and work on just dressing the people fordestination as a group.



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Duct Tape – instructions to make a walletDeficit: Emotional Regulation, FM Coordination, Personal Interaction, Communication,Emotional Expression, AnxietyActivity: Making a duct tape walletDowngrade: Simplify structure; make a simpler version of the wallet.

Farkle Dice Game – need instructionsDeficit: Impulse control, FM coordination, Personal interaction. Avoidance, InappropriateInteraction, Emotional ExpressionActivity: dice gameDowngrade: Allow players to continue using all 6 dice as opposed to removing point-worthydice after each roll.

Holiday/Celebration Picture Book - Make a booklet out of computer paper. Put a picture of anobject on each page representing different holiday. Ex. Pumpkin, menorah, Christmas tree,Easter basket, Fireworks, American flag (search Google images)Deficit: Emotional regulation – Emotional Identification and ExpressionActivity: Client will recognize holidays represented in picture book and will recall familytraditions for the holidays recognized. Client will identify and describe how these memoriesmake him/her feel.Upgrade: Client will describe one favorite holiday tradition in detail, identify the familymembers or friends who are part of this tradition, and describe how they memory if this personand event makes him/her feel.

Hot Potato - A small ballDeficit: Impulse controlActivity: Sit in a circle and pass the ball along to music. When the music stops, the person withthe ball is out of the game.Upgrade: Have more people play the game to practice appropriate interactions.Downgrade: Have everyone stay in the game instead of being out.

Origami - Directions to fold paper to make fun designs, origami paper, or typing paperDeficit: Impulse control, communication emotional identification, expression.Activity: Fold to make a square and cut off half, you can incorporate coloring before finally folds.Consult Internet for directions and select group difficulty appropriate for group level.Upgrade: Go on to more difficult structures.Downgrade: Stick with easy to make structures and focus on coloring or using stickers.

Origami paperDeficit: Impulse controlActivity: Origami cat – fold paper from corner to corner, fold down top corner, fold up bottomcorners, draw a face on the cat.Downgrade: Have folds drawn on paper, use paper less likely to tear and cause frustration.Upgrade: Have clients do more elaborate projects or paper sculptures which increases thechance of frustration.



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Ping Pong - ping pong ball and cupDeficits: Impulse control, emotional regulationActivity: The client has to practice emotional control by not getting frustrated with not beingable to bounce the ball into the cup or count the number of bounces taken by the orange ball.

Scrabble Slam CardsDeficit: Emotional Regulation, Impulse ControlActivity: Play “scrabble slam” Downgrade: Each time a letter is put down a certain amount of seconds has to pass beforeanother card can be put down.

Word Search/Puzzle BookDeficit: Social Emotional- Impulse ControlActivity: Doing one of the puzzles in the bookDowngrade: the person has to find one word or solve one part of the puzzle. Then, they let the

person next to them do 1 part. They could also do the same puzzle at the same time.

Would you rather – cards with questions written on themDeficit: Impulse controlActivity: client draws a card from an envelope or bag, and then explains his/her answer. There isno right or wrong answer. Ex. Would you rather be invisible or be able to fly? This game can beplayed in large or small groups as an icebreaker. This activity promotes group discussion andvoicing opinions for each person's answer. This game also involves taking turns which requiresimpulse control. Many questions require the player to open up more to the group by explaininghis/her answer. The answers also show what the client finds important and why.

Upgrade: each client makes up his/her own would you rather question to ask the group.

Wrong changed Deficit: Emotional Regulation, Anger managementActivity: The client brings the priced bags to the therapist that is acting as the clerk. When theclient gives the clerk his/her money she short -changes them, or takes a VERY long time gettingtheir change , the therapist may even drop the client’s c hange on the floor as she hands it tothem. They client had to suppress his anger and appropriately react to the frustrating situation.Upgrade: The therapist will further irritate the client by refusing to believe that he/she short-changed them.Downgrade: A second therapist assists the client by verbally cuing him/her to employ relaxationtechniques (such as deep breathing).



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Emotional Expression / Identification

Animals- pictures of different animals

Deficit: Emotional IdentificationActivity: Therapist should print pictures of animals (ex. cat, dog, hippo, tiger, butterfly, etc.)Description: client will pick which animal best describes themselves and why. This can beperformed in a small group. This activity requires the client to communicate in a group setting.Each client will take turns which also requires impulse control. This activity also requires theclient(s) to decide which animal best represents themselves. This involves the client(s) revealinghow they perceive themselves to the group.Upgrade: Client picks 2 animals. One that best represents themselves and one that leastrepresents themselves.

BalloonDeficit: Emotional Identification, Emotional Expression, Motivation Activity : Client must try and keep balloon in the air for a specified period of time withoutbecoming frustrated/angry/giving up. Client then describes how it felt for them to have to holdin any frustrations and how the activity made them feel as a whole. Upgrade: Have client play with multiple people and control emotions appropriately.

Band-AidDeficit: Emotional ExpressionActivity: In a group setting, instruct client to place a Band-Aid on the part of their body that hurtthe last time they were sad. Discuss as a group, the importance of identifying emotions and theaffect they have on our bodies and things we can do to make them better.Upgrade: Have client identify another emotion that may have an effect on that part of theirbody such as anger or anxiety and additional strategies they can use to make it better.

"The Blue Day Book" by Bradley Trevor GreiveDeficit: Emotional IdentificationActivity: use book to assist in conversation about the client's feelings and emotions. Picturesand phrases in the book can give them ideas/suggestions for different emotions that they maybe able to relate to but have a different time identifying. The book can be used as a guidethrough the conversation about identifying emotions.Upgrade: the therapist can ask the client to choose 5 specific pictures/phrases in the book thatthey feel relate to how they are feeling that day during therapy. This will help facilitatediscussion.

CandlesDeficit: Emotional identificationActivity: Candle making – melt wax, add color and scent, pour wax into mold, let stand 5minutes, insert wick and allow to completely cool. Have clients choose colors/scents to expressmood and emotions.Downgrade: Suggest emotions/moods that might be represented by different colors and scents.Upgrade: Have clients discuss why certain colors or scents illicit certain emotions and if thisrelates to previous events in their lives.



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CardsDeficit: self-awareness, emotional expression Activity: client writes 52 positive things about themselves on each card, then binds themtogether to have a little self-motivation book to carry around. Upgrade: Clients write cards for one another.

Calendar Deficit: Emotional – Emotional ExpressionActivity: Have client select a date on the calendar that has a special meaning to them; one thatis associated with positive feelings. Next have them explain to the group the date they pickedand why it is special to them.Upgrade: Have client pick an additional date, or month, or time period that is associated withnegative feelings and have them explain it to the group.

Charades Game

Deficit: initiation, avoidance, inappropriate interaction, personal interaction, communication,emotional expressionActivity: CharadesDowngrade: Lengthen time limitations

Conversational Flash Cards - old magazines, index cards, glue, pen. Make cards from picturesand write questions on the back of each. Ex: A picture of a bear catching a fish in a stream.Deficit: Impulse control, Communication, Emotional Identification, Expression.Activity: The therapist will select the card that the group will discuss. See Example Bear & Fish,each person in the group will take turns describing what they see, & how they feel about thepicture. Therapist can also read the premade questions on the back of the card to help centerthe responses on a particular subject. If you want to prevent the clients from copying eachother’s answers, the clients could write their answers down and read them during their turn.Find pictures that invoke emotions, story lines and situations you are trying to have your groupdiscuss. Glue them on the index card and write questions that remind you of what focus youwould like to take with this picture/subject.Upgrade: Read more difficult questions, and have them write their responses.Downgrade: Just go around the room and share comments about the pictures.

Describe yourself as a Beverage - pen and paperDeficit: Emotional Identification, Expression, Impulse Control, Communication.

Activity: Ask the group to select a beverage that describes them. Give them an example of whatyou are expecting. They might need a little time to think about it and it might be a good idea tohave them write it. It took me a minute. (Ex: I am like a crown and coke. Strong and to the pointbut not overpowering. Effervescent, sweet and relaxing. Familiar but not typical with pleasantafter taste. Top shelf quality but still accessible. I am like cough syrup. Only good in small doses,bad after taste that’s difficult to remove. O verly sweet with a twang. Make you feel better.) Upgrade: Must draw a picture, could have to also describe them self as a sandwich.Downgrade: Give client a list of beverages to choose from



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Dice- need instructions to the card game SpoonsDeficit: Emotional regulationActivity : Card game “spoons” (using dice) Upgrade: Have a larger group of people, so the outcome is less predictable.

Empty boxDeficit: Emotional expression Activity: Gather the group into a circle. Leader will hold empty box and says "to make this boxrepresent me I would fill it with (______) ex. chocolate candy and then tape it shut because it isdifficult for me to open up but once I do there are many wonderful surprises". The leader thenpasses the box on, and the next person completes the sentence. This can be used in a smallgroup setting. This activity provides a chance for a client to open up to others in a group setting.This activity may also help clients to learn more about others. Because there is not right orwrong answer, clients are encouraged to participate appropriately in a safe setting. This activityalso helps the group and each individual to learn the perspective each person holds about

him/herself. This is appropriate for people who have difficulty expressing their feelings directly.Upgrade: change what the box represents. (Ex: This box represents how I control my anger orhow I feel when I am happy)

Eye-Spy Alphabet GameDeficit: Impulse ControlActivity: Starting with “A” and working to “Z”, take turns picking items around the room or whileon a walk outside that. Emphasize that they must take turns.Downgrade: Supply cards with a letter from the alphabet on each card so they know whichletters they are answering instead of shouting out for each letter. Help with sharing & waitingfor turns.

Group DiscussionDeficit: Emotional Regulation, Emotional expressionActivity: The therapist writes down different emotions (anger, sadness, fear, loneliness,hopelessness, happiness, joy, excited, etc.) and spreads these words out on a table in front of the clients. The client’s then choose a word that expresses how they currently feel. The therapist then leads a discussion about why each client chose that emotion and what leadto them feeling that emotion. If the emotion is a negative emotion, the client then throws theemotion away in the plastic cup once it has been discussed. If the emotion is a positive emotionthey keep the emotion to remind them of that positive feeling throughout the day.

Upgrade: Clients have to pick more than one emotion to represent how they feltthroughout the past several days.Downgrade: Client has to pick emotion and say the emotion out loud, but does not have todescribe the events that led to that emotion.



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Fear in a hat - A hat, pencil, and paper are neededDeficit: Emotional ExpressionActivity: Fear in a HatIntroduce the topic of fear and explain how it is normal and natural at thisstage of program that people are experiencing all sorts of anxieties, worries andfears about what might happen. Ask everyone to complete this sentence on apiece of paper: “In this group/program, the worst thing that could happen tome would be…” OR “I am most afraid that...” Collect the pieces of paper,drop them in a hat, and then have each person pull a piece of paper and readabout someone's fear. Each group member reads the fear of another groupmember and elaborates and what he/she feels that person is most afraid of inthis group/situation. No one is to comment on what the person says, justlisten and move on to the next person.Upgrade: Reader repeats the sentence with different, simple words that express thefeeling. Ask the reader for specific words they think of after reading this fear.

Inflated balloonDeficit: Social/emotional – Personal Interaction, CommunicationActivity: Clients will participate in a group activity of hitting balloon around among members.Clients must say the name of the person they are hitting to.Upgrade: Client has to say the other pers on’s name and make eye contact.

Island Game - Tape that will not damage flooring. Wooden boards wide enough to balance onbut not too heavy. You can improvise items in the room/outdoors or use tape to make theislands and main land. Depending on the group hot lava balls made out of light bean bags can bethrown at rule breakers or for an added element of fun. The original Island should be just big

enough for the group to stand on uncomfortably, it will encourage them to want to get off of itand also improve personal space issues.Deficit: Impulse Control, Non-Verbal Communication, Emotional Identification, TurnTaking, Leading and Following, TeamworkActivity: Group will all be on the same team. No one is allowed to talk but may gesture non-verbally. Depending on the group you may select some of the people to have disability(blindfolded) or you may use that for disciplining those who violate the no talking rule. Tell thegroup that they live on a small island and the volcano has erupted filling the once lovely oceaninto hot lava that if they touch it they will burn up and reappear on the island. There is a way tosafety on the main land but they have to find a way to get to it with the materials provided.There are 3 small islands on the way that only have room for one person at a time. They have 2wooden beams to make bridges out of to make it to the small island leading to the main land. Asa team they must all make it to the main land together. Game will be timed and comparethe amount of time it took to save everyone to the next time.Upgrade: Give some group members disabilities, Lava rocks, more islands between the mainland and other obstacles (whirlpool, predators, rock slides etc.)Downgrade: Allow them to talk.



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Lanyard - How to make see word document labeled: Making a LanyardDeficit: Impulse control, Communication, Emotional Identification, Expression.Upgrade: move on to more difficult stitchesDowngrade: create a three string braid.

Mardi Gras BeadsDeficit: Emotional Expression, Communication Activity : Assign each different colored bead an emotional meaning; ask clients to “wear” theiremotions by picking what they are feeling that day. Then discuss why they may be feeling acertain way. Upgrade: give the clients a minimum or maximum number of emotions that they mus t “wear”and discuss different days.

News ArticleDeficit: Inappropriate Emotional Expression, Emotional Identification

Activity: Client is provided with an article or story, and is asked how he/she would handle thesituation, how it makes them feel, and if they had a life experience that it relates to. Downgrade: Client visually expresses how it makes him /her feel by drawing or writing.

Newspaper Comic Section – newspaper comic section Deficit: Emotional regulation – Communication, Emotional IdentificationActivity: Clients will look at the faces and conversations of the characters in the comic strip anddiscuss which emotions they think the characters are feeling (sad, happy, confused, scared, etc.)Upgrade: Based off of the emotions they identified in the comic strip, clients will describe whatsituations make them feel these emotions themselves.

Magazine Stories – MagazineDeficit: Emotional expression.Activity: The therapist will hold up a picture from a magazine; this picture can be an ad or aphoto, but the picture should be real photograph. Then, each participant must create a story orscenario about the person(s) in the photo.Downgrade: Each participant must simply state an emotion that the person(s) in the photo isfeeling.

PenDeficit : Emotional Expression and Emotional Identification

Activity : Have client keep a journal in which they write about their day and about whichsituations led to specific emotions. Explain to the client to describe the physical and internalfeelings of the emotion, what lead to the emotion, and actions that followed the initiation of theemotion.Downgrade: instead of the client keeping a journal him/herself, the therapist could assist clientin identifying the emotion after the client explains his/her experience to the therapist. Theclient and the therapist collaborate together on keeping up with the journal.



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Photo AlbumDeficit: Personal Interaction and Emotional ExpressionActivity: Client will go through photo album (if they have one) and will choose a person theywish to say something to but think doing so will be difficult for them. The client will thenpractice telling this person what he/she wishes to express. If client does not have his/her ownphoto album, the therapist can simply ask the client to think of a particular person they wish tointeract with or express feelings to and have the client practice doing so.Upgrade: discussing the dilemma with interacting with people or expressing emotions in a groupsetting. Clients will be asked to think of a particular situation they find uneasy and clients willgive each other ideas and suggestions.

Photo Album – a small photo album. Help client obtain pictures, if possible.Deficit: Emotional regulation – personal interaction, communication, emotional expressionActivity: Client will fill album with pictures of the people who are most important to him/her.Client will name his/her favorite thing about that person and what each person does that makesthe client happy to be around him/her.

Upgrade: Client will call each person to tell him/her why he/she is important or special.

Post-itDeficit: Emotional Regulation/ Emotional IdentificationActivity: Group Discussion- Therapist will role play a scenario in which he/she experiencesdifferent emotions. Each client will have a pencil and post-it noteOnce the therapist has acted out a scenario the clients will write what emotion they believe shewas experiencing. Then, they will stick the emotion on the therapist’s body. The therapist will gothrough each suggested emotion and discuss with the group the true emotion she wasrepresenting.

Upgrade: Instead of the therapist acting out scenarios, the clients will discuss situations inwhich they became emotional. At the end of each client’s story, the other group members willwrite down what emotion they thought the client was portraying.Downgrade: Therapist gives the clie nt’s only two emotions to choose from. One being thecorrect answer and the other being the opposite emotion she is displaying (i.e. happy vs. sad).

Post-ItsDeficit: self-awareness, motivation, emotional responsivenessActivity: clients must write one thing they like about a fellow client on a post it and place itunder the person’s name (on a board, wall, table, etc.). After reading what their peers say aboutthem they discuss how it makes them feel, and see if they can give a positive example aboutthemselves that would make their peer write what they did. Downgrade : have client do this with him/herself and the therapist only.



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Thank you card - a thank you card and a penDeficit: Emotional regulation – Personal interaction, Communication, Emotional ExpressionActivity: Clients will discuss a time when someone told them thank you and how it felt to bethanked. Clients will discuss the importance of treating people with respect and how it makesthem feel to be treated nicely by others. Clients will practice using manners and being polite toeach other in group.Upgrade: Following previous discussion, clients will think of an important person in their livesthat they would like to thank for a particular reason. Client will write a short thank you note tothat person.

TP gameDeficit : Social Emotional- Changes in a person's emotions, relations with others, self-concept, and personality, which is a stable way of thinking, feeling, and behavingActivity: Pass around a roll of toilet paper and ask each client to rip some off, but don’t tell them

why or how much to take. Then, let the clients know that they need to reveal a fact for howevermany sheets of toilet paper they ripped off.Upgrade: Go around the room and have the clients repeat facts that other people said aboutthemselves



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Motivation

Balloon Juggle & Sort Challenge - Several different colors of balloons are neededDeficit: Inappropriate InteractionActivity: Inflate one balloon per person and have them keep it up in the air.This gets the group moving and cooperating.Upgrade: You can inflate several more balloons than patients in the group.Then, toss them all up in the air and then challenge them to collect as many asthey can. And, the therapist could ask them to retrieve certain colors.

"The Blue Day Book" by Bradley Trevor GreiveDeficit: Motivation/ Depression Activity: the book can be used to facilitate a discussion about staying motivated despite feelingdepressed. The book helps to remind people of the little things in life that can bring us joy. Thebook can give them suggestions on ways to brighten their days. The book will ultimatelyfacilitate discussion about things in life that motivates us.Upgrade : client can read the book before the session and be prepared to discuss his/herthoughts on it, on suggestions they found useful, if its words helped to motivate them, etc.

Cards- War – Deck of CardsDeficit: MotivationActivity : Shuffle and deal all cards. Players put down one card and the player with the highestcard collects all the cards put down. The winner is the one who collects the entire deck.

Upgrade: Create an incentive to win which will increase motivation to win; Mix together twodecks of cards to make the activity last longer.

Charades - Various scenarios written on slips of paper in an envelope (I suggest havingoccupation based scenarios. Ex: mechanic, doctor, chef, waiter /waitress, artist, teacher, dancer,plumber, parent, fisher, baseball player, preacher, magician, football player, diver, pilot,gardener).Deficit: Personal Interaction, MotivationActivity: take turns acting out (without verbal cues) a scenario chosen from the envelope. Have

the therapist participate or others clients. Take turns between one person acting out and theother person/group to guess the scenario.Downgrade: Allow some verbal cues to help acting out scenarios.



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Photo albumDeficit: MotivationActivity: client will choose a picture that motivates him/her to do his/her best during therapy.Client will be encouraged to choose a picture that he/she can look at every day to remind themof the importance of living their life to the fullest. Suggestions for the picture can be given: achild, a parent, a sibling, a pet, a picture of the client at a happier time in his/her life, etc. If client does not have own photo album to choose from, they can use a magazine, drawsomething, or write someone's name down such as someone who is inspirational to them,famous people, or fellow clients. The client can then frame this picture to place in a spot inhis/her home where he/she will see it every day.Upgrade: Client can make a collage of people/pictures from their album that motivate themand share with the therapist.

Robot's Lunch Break - bread, peanut butter, jelly, plates, knives, napkins, cups and beverages.You can include anything you want the robot to make. A long table, maybe a bench is best.Deficit: Motivation, Impulse control, Emotional Identification/Expression, Turn takingActivity : Select two people to be robots, depending on group s’ cognitive ability, two therapistscan be the robots. Divide group into two teams which will line up on opposite side of the so theycan all see the robots. Select a food item to be created for the group to enjoy (Ex: peanut butterand jelly sandwiches). At the end of the activity, even the losers will enjoy the spoils. Robotscannot operate without instructions. If the instructions are too detailed, the robot won't knowwhat to do and will stop. Team members will take turns going down the line giving instructionsto the robot, like pick up jar, put hand on lid, twist lid, etc. Take the lid off the jar is too complexfor a robot. The team that can get their robot to make all their sandwiches wins. The other team

must keep going until all sandwiches are made. NO one eats until Robots have completed task.Upgrade: Incorporate drinks, and possible robot repair work.Downgrade : Make a simpler food.

Thank you card - a thank you card and a penDeficit: Emotional regulation – Personal interaction, Communication, Emotional ExpressionActivity: Clients will discuss a time when someone told them thank you and how it felt to bethanked. Clients will discuss the importance of treating people with respect and how it makesthem feel to be treated nicely by others. Clients will practice using manners and being polite toeach other in group.Upgrade: Following previous discussion, clients will think of an important person in their livesthat they would like to thank for a particular reason. Client will write a short thank you note tothat person.



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Responding to Internal Stimuli CD Deficit: responding to internal stimuli and relaxing.

Activity: Client will listen to CD with headphones to help drown out internal stimuli such asauditory hallucinations. Clients can choose music that they find relaxing to assist with regulatingtheir emotions at times when they feel stressed.Upgrade: Client can participate in an activity while listening to music to see if internal stimuli issomewhat drowned out. Therapist and client will identify and address internal stimuli and ratethe effectiveness of the technique.

Crayons and PaperDeficit: Emotional Regulation, Understanding Internal EmotionsActivity: Draw their “happy place” or “happy item” (something that calms and relaxes them) Upgrade: Explain or discuss how they can use this item or place when they are stressed,overwhelmed, frustrated, etc.

Charades GameDeficit: initiation, avoidance, inappropriate interaction, personal interaction, communication,emotional expressionActivity: CharadesDowngrade: Lengthen time limitations

Dirty Laundry - Materials/how to make: print out templates provided, markers, scissors, indexcards, glue stick. Cut out people and clothes from template and glue to index cards for stability,color if desire, or have clients color if desired. Write out scenarios-Clothes pile (random clothes items, socks, pants, dress, under garments)-People pile (different kinds of people, teacher, doctors, men and women etc.)-Destination pile (where the people are going, so you know what clothes they need)-Question pile (Ex: name 3 sports that you enjoy, name 3 things you are excellent at)Deficit: Responding to Internal Stimuli, Communication, Emotional Expression, Identification Activity: All clothes go in a bag to be randomly selected. Each player will randomly select fromthe People Pile and the Destination pile depending on the group you may elect to give themmultiple people, or put the group into teams. Taking turns 1st player will select from theQuestion Pile, and read it out loud, then answer it about them self not showing anyone elsetheir answer. (Ex: Name 3 sports that you enjoy)The rest of the group will write down what theythink the 1st player has written down, (ex: baseball, football and golf). If the group members

are able to get what the 1st player has written down then they get an item of clothing for eachcorrect answer to dress their people. Player one is allowed to collect a piece of clothing for eachincorrect answer. First player to dress their people correctly for their destination wins.Upgrade: Give each player more people to dress and more destinations to for them to go toDowngrade: Play in teams, drop the Question pile and work on just dressing the people fordestination as a group.



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Expression of feelings - descriptive words/emotions on slips of paper in an envelope (panic,rapid heart rate, joy, withdrawal from others, distressing dreams, guilt, angry, decreased sexualdrive, agitation/irritability, feeling overwhelmed, hopelessness, nervous, lack of confidence).Deficit: Emotional Expression, Responding to Internal StimuliActivity: Pick a slip of paper from envelope. Talk with group about how they feel when theyexperience the emotion or feeling on the piece of paper.Upgrade: Have them draw a picture of a body and have them mark where they feel thatemotion. Compare where other feels the same emotion on their bodies.

Yin Yoga Poses Instruction Sheet Deficit: Emotional – Responding to Internal StimuliActivity: Lead clients through a series of yin yoga postures. Instruct clients to take notice whenthey are feeling uncomfortable or overwhelmed in a posture and teach them breathingtechniques to get through it. Have a group discussion about how this technique can be

applied in everyday situations where they may feel overwhelmed or uncomfortable.Downgrade: Only perform two of the yin yoga poses and breathing techniques instead of thewhole series.



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Social (Anxiety, Avoidance/Initiation, Communication,

Inappropriate Interaction, Participation)

Anxiety CalendarDeficit: Social, AnxietyActivity: Have client select a date on a calendar that they know could possible cause someanxiety in a social situation and have a group discussion about possible solutions. For example,a client may select a date in which they know their family members or friends will visit and theymay anticipate experiencing anxiety related to that.Upgrade: Have client discuss with group past experiences that have caused them to experiencesocial anxiety as well.

Cards Deficits: Sequencing , GM ROM, FM coordination, Anxiety, Inappropriate Interaction,Communication, Emotional ExpressionActivity: 2 person team building a house of cardsDowngrade: Build something smaller or less difficult Upgrade: Playing Black Jack

Candles – wax, dye, scents, moldDeficit: AnxietyActivity: Candle making – melt wax, add color and scent, pour wax into mold, let stand 5

minutes, insert wick and allow to completely cool. Have clients choose colors that representanxious feelings.Downgrade: Suggest colors and situations that might represent or cause feelings of anxiousness.Upgrade: Have clients discuss what colors represent feelings of anxiousness and why. Havethem relate these feelings to everyday situations in their lives.

Cards- SpoonsDeficit: Social participation, AnxietyActivity: Card game “Spoons” directions atta ched Downgrade: Slow the pace- certain amount of time before his or her turn is over.

Charades - Various scenarios written on slips of paper in an envelope (I suggest havingoccupation based scenarios. Ex: mechanic, doctor, chef, waiter/waitress, artist, teacher, dancer,plumber, parent, fisher, baseball player, preacher, magician, football player, diver, pilot).Deficit: Anxiety, Social ParticipationActivity: Take turns acting out (without verbal cues) a scenario chosen from the envelope. Havethe therapist participate or others clients. Take turns between one person acting out and theother person/group to guess the scenario.Downgrade: Allow more than 1 person to act out the scenario to minimize all attention beingplaced on that one person and decrease that person’s anxiety.



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CDDeficit: Social, AnxietyActivity: Music will be played and clients will be encouraged to dance. Therapist will also danceand try to engage those with social anxiety. Hopefully not having to speak will lessen theiranxiety about this social activity while giving them the chance to interact with other during a funactivity. If everyone is dancing, those with social anxiety will fell less singled out. (Another ideamay be to teach a line dance to help clients to fell more inclined to participate in the dancing.)Upgrade: Each client chooses a song from the CD for the group to dance to and must explainwhy he/she chose the song. Why do they like it? Does it mean something to them?

Conversational Flash Cards - old magazines, index cards, glue, pen. Make cards from picturesand write questions on the back of each. Ex: A picture of a bear catching a fish in a stream.Deficit: Social Participation: Work on turn taking, social anxiety.Activity: The therapist will select the card that the group will discuss. See Example Bear and Fish,each person in the group will take turn describing what they see, how they feel about the

picture. Therapist can also read the premade questions on the back of the card to help centerthe responses on a particular subject. If you want to prevent the clients from copying eachother’s answers, they could write their response down and then read them during their turn.Find pictures that invoke emotions, story lines and situations you are trying to have your groupdiscuss. Glue them on the index card and write questions that remind you of what focus youwould like to take with this picture/subject.Upgrade: Read more difficult questions, and have them write their responses.Downgrade: Just go around the room and share comments about the pictures

Describe yourself as a Beverage - pen and paperDeficit: Social anxietyActivity: Ask the group to select a beverage that describes them. Give them an example of whatyou are expecting. They might need a little time to think about it and it might be a good idea tohave them write it. (Example: I am like a crown and coke. Strong and to the point but notoverpowering. Effervescent, sweet and relaxing. Familiar but not typical with pleasant aftertaste. Top shelf quality but still accessible.) (I am like cough syrup. Only good in small doses, badafter taste that is difficult to remove. Overly sweet with a twang. Make you feel better.) Upgrade: Must draw a picture, could have to also describe them self as a sandwich.Downgrade: Give client a list of beverages to choose from.

Eye-Spy Alphabet GameDeficit: Anxiety, Social Participation Activity: Starting with “A” and working to “Z”, take turns picking items around the room or whileon a walk outside that. Repeat the letters from before as the game progresses through alphabetto increase requirements of each person and provide more responsibility per turn.Downgrade: Do not have to require each person to repeat the previous letters if they arestruggling to participate with just one letter.



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Group Discussion - Plastic cup, pencil, and several strips of paper.Deficit: Social Participation, AnxietyActivity: Every group member writes down a time when they have felt anxious/nervous.The group members fold up the paper and place it in the cup. The therapist reads each scenarioaloud and leads a group discussion about different coping strategies that could decrease anxietyin each given scenario.Upgrade: The clients have to pull from the cup and read the scenario aloud. Then, the client hasto think of a coping strategy for the given scenario and shares this strategy with the group.Downgrade: The therapist writes down the anxiety provoking situations and has the client’sread the scenarios aloud. Then the therapist provides the coping strategies with little input fromthe clients.

Island Game - Tape that will not damage flooring. Wooden boards wide enough to balance onbut not too heavy. You can improvise items in the room/outdoors or use tape to make theislands and main land. Depending on the group hot lava balls made out of light bean bags can bethrown at rule breakers or for an added element of fun. The original Island should be just big

enough for the group to stand on uncomfortably, it will encourage them to want to get off of itand also improve personal space issues.Deficit: Avoidance, Anxiety, Inappropriate InteractionActivity: Group will all be on the same team. No one is allowed to talk but may gesture non-verbally. Depending on the group you may select some of the people to have disability(blindfolded) or you may use that for disciplining those who violate the no talking rule. Tell thegroup that they live on a small island and the volcano has erupted filling the once lovely oceaninto hot lava that if they touch it they will burn up and reappear on the island. There is a way tosafety on the main land but they have to find a way to get to it with the materials provided.There are 3 small islands on the way that only have room for one person at a time. They have 2wooden beams to make bridges out of to make it to the small island leading to the main land. As

a team they must all make it to the main land together. Game will be timed and comparethe amount of time it took to save everyone to the next time.Upgrade: Give some group members disabilities, Lava rocks, more islands between the mainland and other obstacles (whirlpool, predators, rock slides etc.)Downgrade: Allow them to talk.

Scrabble Slam CardsDeficit: Social participation, AnxietyActivity: Play “scrabble slam” Downgrade: make each client have to use a certain amount of time so it’s not as fast paced.

Survival Scenario – Paper and pencil are neededDeficit: AnxietyActivity: Tell the group that they going to play a game. Ask the group the question: “If youwere stran ded on a desert island, what would be the 12 most useful items needed to survive?”Have them write down their answersUpgrade: After they come up with their answers, then rank them in order of importance.



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Who am I - index card, Sharpie. You can glue pictures of famous people on index cards and/or just write their names on the cards.Deficit: Social AnxietyActivity : Each member of the group takes turns choosing a card from the pile of nonfictionalfamous people that can be dead or alive. It cannot be someone they know personally or a familymember. Ex: George Washington, Jude Law, Madonna. The person selecting the card will notsee the card but the rest of the group will know who it is. The person will ask yes or noquestions to determine who the person is on the card. The Group can only reply with yes or noanswers. Therapist will keep track of how many question it took for the person to figure out whothe person is and the one with the lowest number of questions is the winner.Upgrade: Make choices to pick from less well known, have limited amount of questions allowedto be asked (10), allow group to choose a person for the client.Downgrade: Choose person from genres, such as fairy tales, Star Wars, allow group to giveexplanations, not just yes and no.



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CardsDeficit: initiation, avoidance Activity: play a card game with other clients and/or therapists. Upgrade: have the clients say something interesting about them each time it is their turn.

Crayons and PaperDeficit: InitiationActivity: Draw their “happy place” or “happy item” (something that calms and relaxes them) Upgrade: Client has to explain it for a certain amount of time.

Complement Game - Piece of paper and a pen/pencilDeficit: Communication Activity: All of the participants sit in a circle and write their names on the top of a blank, ruledsheet of paper. Next, each participant passes their piece of paper to the person to the left of them. When the participant receives the sheet of paper from their neighbor, they write a

complement about the person, such as “You always make me laugh or you have pretty hair.”Each participant will have 1 minute to write the complement. When the minute has passed, theywill pass the paper to the left and receive a new piece of paper. This will continue until thepapers travel back to their original owners. Then, each person will read the list of complements.After everyone has read the list, they will share with the group one characteristic that theydidn’t know or didn’t reali ze they possessed.Downgrade: Simply list a physical or personal characteristic of the person whose name is listedon the sheet of paper, such as “tall” or “funny”.

Dots & Boxes - Paper and pencilsDeficit: InitiationActivity: Set up a grid of dots on a piece of paper. Take turns drawing lines from dot to dot. Thegoal is to create a box. Whoever creates a box puts their first initial in the box to claim it. Theperson with the most boxes at the end wins.Upgrade: Create a larger grid to force more initiation by the client; Have more people play thegame which causes more interaction with others.

Empty boxDeficit: Initiation Activity: Gather the group into a circle. Leader will hold empty box and says "to make this boxrepresent me I would fill it with (______) ex. chocolate candy and then tape it shut because it is

difficult for me to open up but once I do there are many wonderful surprises". The leader thenpasses the box on, and the next person completes the sentence. This can be used in a smallgroup setting. This activity provides a chance for a client to open up to others in a group setting.This activity may also help clients to learn more about others. Because there is not right orwrong answer, clients are encouraged to participate appropriately in a safe setting.Upgrade: change what the box represents. (Ex: This box represents how I control my anger orhow I feel when I am happy).



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Expression of feelings - descriptive words/emotions on slips of paper in an envelope (panic,rapid heart rate, joy, withdrawal from others, distressing dreams, guilt, angry, decreased sexualdrive, agitation/irritability, feeling overwhelmed, hopelessness, nervous, lack of confidence).Deficit: AvoidanceActivity: Pick a slip of paper from the envelope; discuss with the group about how they feelwhen experiencing that certain emotion. Brainstorm a good coping mechanism they can use toreturn back to a normal feeling.Upgrade: Talk about past situations that made them feel that same way.

Fear in a hat - A hat, pencil, and paper are neededDeficit: AvoidanceActivity: Fear in a HatIntroduce the topic of fear and explain how it is normal and natural at this stage of programthat people are experiencing all sorts of anxieties, worries and fears about what might happen.Ask everyone to complete this sentence on a piece of paper: “In this group/program, theworst thing that could happen to me would be…” OR “I am most afra id that...” Collect the piecesof paper, drop them in a hat, and then have each person pull a piece of paper and read aboutsomeone's fear. Each group member reads the fear of another group member and elaboratesand what he/she feels that person is most afraid of in this group/situation. No one is tocomment on what the person says, just listen and move on to the next person.Upgrade: Have the reader elaborate on the fear and ask them some questions.Ask them how they feel about this fear, do they have the same fear, or what thisperson could do about their fear.

Hats Off – hat or paper bagDeficit: InitiationActivity: This can be performed in a small group setting. Each member should write a fearhe/she has on a sheet of paper anonymously. Each person will place his/her sheet of paper in a

bag and draw from the hat. (I used a bag). Each client will then pick a paper from the bag, read itout loud, and discuss why that person may be afraid of that particular thing. This activityrequires clients to interact with one another about topics that may make them feel vulnerableor uncomfortable. This opens communication in the group and promotes discussion and how tounderstand another group member's feelings.Upgrade: have each client read his/her own fear and out loud to the group and discuss it.

Holiday/Celebration Picture Book Make a booklet out of computer paper. Put a picture of anobject on each page representing different holiday. Ex. Pumpkin, menorah, Christmas tree,Easter basket, Fireworks, American flag (search Google images)Deficit: Social participation – initiationActivity: In a group setting, clients will flip through picture book and identify holidays frompictures. The group will discuss how different families celebrate different holidays (noteveryone celebrates the same things). Each client will describe their favoriteholiday/celebration.Downgrade: Therapist will identify each picture for the group and will prompt the group withquestions about eat



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Inspiration Collage - Magazines, a piece of paper, glue, and scissors are neededDeficit: InitiationActivity: to the group that they are going to make a collage featuring their personalinspirations, and explain that inspirations are ideas that influence, encourage, and motivate you.Provide several magazines to cut. Also, let them know to bring photos they are willing to cutand images that they have drawn themselves. Have them paste what represents their personalinspirations on a piece of paper.Downgrade: Instead of presenting in front of the group, have people pair off and discusstheir collages. They can take turns choosing an inspiration from their own project to describe tothe other group member.

Island Game - Tape that will not damage flooring. Wooden boards wide enough to balance onbut not too heavy. You can improvise items in the room/outdoors or use tape to make theislands and main land. Depending on the group hot lava balls made out of light bean bags can bethrown at rule breakers or for an added element of fun. The original Island should be just bigenough for the group to stand on uncomfortably, it will encourage them to want to get off of itand also improve personal space issues.

Deficit: Avoidance, Anxiety, Inappropriate InteractionActivity: Group will all be on the same team. No one is allowed to talk but may gesture non-verbally. Depending on the group you may select some of the people to have disability(blindfolded) or you may use that for disciplining those who violate the no talking rule. Tell thegroup that they live on a small island and the volcano has erupted filling the once lovely oceaninto hot lava that if they touch it they will burn up and reappear on the island. There is a way tosafety on the main land but they have to find a way to get to it with the materials provided.There are 3 small islands on the way that only have room for one person at a time. They have 2wooden beams to make bridges out of to make it to the small island leading to the main land. Asa team they must all make it to the main land together. Game will be timed and comparethe amount of time it took to save everyone to the next time.

Upgrade: Give some group members disabilities, Lava rocks, more islands between the mainland and other obstacles (whirlpool, predators, rock slides etc.)Downgrade: Allow them to talk.

Magazine Stories – MagazineDeficit: InitiationActivity: The therapist will hold up a picture from a magazine; this picture can be an ad or aphoto, but the picture should be real photograph. Then, each participant must create a story orscenario about the person(s) in the photo.Downgrade: Each participant must simply state an emotion that the person(s) in the photo isfeeling.

Mardi Gras BeadsDeficit: anxiety, inappropriate interaction, avoidance Activity : have group create a large wall mural using the beads.Downgrade: have a color-coded pattern for the clients to follow that symbolizes something thegroup has been focusing on.



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New Orleans MagazineDeficit: Social – InitiationActivity: Have clients flip through the New Orleans magazine and select one thing thatrepresents something they love about New Orleans. As a group, have the clients take turnsexplaining what that thing is and why they love it. Do not force clients to speak in a particularorder; rather, let them initiate the interaction when they feel ready.Downgrade: Have the client just say what it is that they like rather than explaining why.

Newspaper Activity - newspaper clippingsDeficit: Initiation, Social ParticipationActivity: Each client will make a collage from the clippings. Clients will get into groups of 2 andask each other why they used what they used and what it means to them.Downgrade: Prompt clients to start conversation and during discussion with others.

Origami paper

Deficit: InitiationActivity: Origami – fold paper to make animal shapes or other items. Decorate with faces orother embellishments. Have client share all supplies.Downgrade: Decide the group into pairs and have them share supplies as a pair.Upgrade: Have clients take the initiative to find instructions or decide what origami “sculptures”they would like to do as a group. Have clients teach a group how to do origami.

PenDeficit: AvoidanceActivity: have client write a letter to someone in their life with whom he/she has had a falling

out/disagreement that has led to avoidance of this particular person and the situation. (Canalso just have them write a letter to a friend or family member to have the client simply expressto his person how they have been doing and feeling.Downgrade: The client writes a letter to the person of his/her choice but not actually send it.Just do the activity as an exercise.

Photo Album – a small photo album. Help client obtain pictures, if possible.Deficit: Social participation – Initiation; AvoidanceActivity: Clients will fill albums with pictures of the people who are most important to them.Client will put each person’s name and phone number with h is/her picture. Client will make aschedule of when to call each person.Downgrade : Client will email or write a letter to each person, rather than calling.

Post-ItsDeficit: initiation, communication, interactionActivity: Each client has a post it note stuck to his/her head without seeing what is written on it.The clients must ask one another questions to determine who or what is written on their noteand find who has its match.Downgrade : play with a smaller number of people like 4-6.



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PuzzleDeficit: Avoidance and teamworkActivity: Each participant gets a pile of puzzle pieces. Once everyone has received their pile, theparticipants must work as a team to put the puzzle together. After the puzzle is completed, eachmember will have to identify one thing that worked with the assembly of the puzzle and oneway the whole process could have been improved.Downgrade: Each participant gets a piece to a puzzle (20 pieces or less puzzles work best). Onceeveryone receives a piece, they must all state what they think the final picture will look like.Then, the therapist will assist them in putting the puzzle together to figure out if their guesseswere correct.

Sale advertisements - Any store adds from a newspaper. Ex: Target, Best Buy.Deficit: Social participation – avoidance, anxiety, inappropriate interactionActivity: Client will flip through store advertisements and plan a pretend shopping trip. Clientwill answer questions such as, “What stores would you go to? What would you buy? Whowould go with you? What would happen in the store? What would you say to the cashier?” etc.Upgrade: Client will go on the shopping trip that he/she planned, accompanied by therapist, and

will purchase one small item to practice social interaction with store employees.

SeedsDeficit: InitiationActivity: Terrarium – spread a layer of gravel on bottom of jar, add charcoal chips and soil, addseeds to soil, mist regularly. There should be less trowels and packets of seeds than clients sothey must share.Downgrade: Divide the group into pairs and have them share supplies as a pair.Upgrade: The group plans a garden, decides what should be planted, and follow through withplanting the garden.

Thank you card - a thank you card and a penDeficit: Social participation – Avoidance, Inappropriate InteractionActivity: Clients will discuss why thank you cards are used and what should be written in them.Clients will discuss the importance of saying thank you to people that help them. Clients willpractice helping, complimenting, and thank each other in the group.Upgrade: Following previous discussion, clients will think of an important person in their livesthat they would like to thank for a particular reason. Client will write a short thank you note tothat person.

Would you rather - cards with questions written on themDeficit: InitiationActivity: client draws a card from an envelope or bag, and then explains his/her answer. There isno right or wrong answer. Ex. Would you rather be invisible or able to fly? This game can beplayed in large or small groups as an icebreaker. This activity promotes group discussion andvoicing opinions for each person's answer.Upgrade: each client makes up his/her own would you rather question to ask the group.



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CommunicationAlphabet I-SpyDeficit: Communication

Activity: Take turns naming different objects in the room. The objects must be named inalphabetical order. Say one item per letter.Upgrade: Take turns naming all the A’s in the room, then B’s, etc. Downgrade: Don’t have the clients name in alphabetical order. All letters still used once.

Back to Back Relay Race – stopwatchDeficit: Impulse Control, Communication, TeamworkActivity: Build an obstacle course out of what is in the room stairs, chairs, walls, rocks if outside,tables). Establish rules and give a demonstration of how to run the course. Clients will standback to back and wrap arms together to hold the position. An obstacle course will be createddepending on your client's ability to coordinate. Teams of two will take turns being timed on thecourse to compare with other teams. Team with lowest time wins.Upgrade: Blindfold part of each team, don't allow them to talk, or make the course longer.Downgrade: Shorten the racing field, less obstacles.

BallDeficit: Social participation, CommunicationActivity: Give them a topic and every time they hit the ball, they have to name something fromthe topic (Ex: breakfast items) and not repeat any.Downgrade: Let them repeat an answer once, twice, etc.

BalloonDeficit: Social, Listening SkillsActivity: Each client says their name and a fun fact. One person tosses the balloon up andeither says a name or a fact, and the corresponding person has to catch the ball.Upgrade: have the client recite a name and fun fact.

BalloonDeficit: CommunicationActivity: Each client says their name and a fun fact. One person tosses the balloon up andeither says a name or a fact, and the corresponding person has to catch the ball.Upgrade: Give them a certain number of times they have to name a fact/name.

Blind Man's Obstacle Course - Mines can be made out of anything, paper, tin cans etc. Clothes

lines are made out of yarn hung across the room, or tied on to a large object. Stair case can beused, or mound of pillows will substitute just as easily.Deficit: Communication, Teamwork, Impulse ControlActivity: Clients’ are broken up into teams of two, one team member is blind folded and theother team member must talk them through the mine field followed by a series of clothes lines,and then a rock climb (stair case suggested on all fours crawling position) Teams are timed.Upgrade: More obstacles, both members must finish the course before time is called.Downgrade: Less obstacles, team members can switch in the middle of the game if necessary.



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Bingo Deficit: Communication skills – engaging with others while focusing on your emotions,relations with others, and personalityActivity: Give a bingo card and pencil to all members of the group that are playing this game.Instruct them that once the game starts, they are to go around the room and findsomeone who matches the description as the line on their bingo card. Once they have a fullcard – they are to shout bingo! Upgrade: To make it harder – when you find a person who fits the description, have thatperson write their own name on the sheet

CardsDeficit: Social, Emotional, Communication Activity: playing a game like War with multiple clients or in a client-therapist environment.Focus on games that the clients like to play or would like to learn to play. Upgrade: to increase communication, ask each player to ask another player a question during

his/her turn.

Cards – BlackjackDeficit: Social-Emotional – Personal Interaction – CommunicationActivity: Play a game of Blackjack with therapist as dealer. Have client indicate with handmotions if they want to hit or stay during game.Upgrade: Have client make eye contact and verbally indicate if they want to hit or stay.

CharadesDeficit: CommunicationActivity: Have group identify important skills for communication (body language, listening, etc.)and barriers to communication (hearing, eyesight, anxiety, etc.); use these skills and barriers toplay charades.Downgrade: Have skills and barriers listed so clients don’t have to think of them. Upgrade: Have clients discuss why each item is a skill or barrier and why.

Collage - Magazines, scissors, glue, and paperDeficit: Emotional Regulation, CommunicationActivity: Clients will cut out words and pictures that they feel describe who they are as a personand glue them to a piece of paper. Once the collage is finished, each client will have to tell the

group how the images represent themselves.Upgrade: Client’s exchange collages and they have to interpret what one another’s imagesrepresent.Downgrade: Client makes collage by him/herself and then describes what the images representto only the therapist.



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Complement Game - Piece of paper and a pen/pencilDeficit: Communication Activity: All of the participants sit in a circle and write their names on the top of a blank, ruledsheet of paper. Next, each participant passes their piece of paper to the person to the left of them. When the participant receives the sheet of paper from their neighbor, they write acomplement about the person, such as “You always make me laugh or you have pretty hair.”Each participant will have 1 minute to write the complement. When the minute has passed, theywill pass the paper to the left and receive a new piece of paper. This will continue until thepapers travel back to their original owners. Then, each person will read the list of complements.After everyone has read the list, they will share with the group one characteristic that theydidn’t know or didn’t realize they possessed.Downgrade: Simply list a physical or personal characteristic of the person whose name is listedon the sheet of paper, such as “tall” or “funny”.

Describe yourself as a Beverage - pen and paperDeficit: Emotional Identification, Expression, Impulse Control, Communication.Activity: Ask the group to select a beverage that describes them. Give them an example of whatyou are expecting. They might need a little time to think about it and it might be a good idea tohave them write it. It took me a minute. (Ex: I am like a crown and coke. Strong and to the pointbut not overpowering. Effervescent, sweet and relaxing. Familiar but not typical with pleasantafter taste. Top shelf quality but still accessible.) (I am like cough syrup, only good in small doses,bad after taste that is difficult to remove. Overly sweet with a twang. Make you feel better.) Upgrade: Must draw a picture, could have to also describe them self as a sandwich.Downgrade: Give client a list of beverages to choose from.

FlowerDeficit treated: Personal Interaction and CommunicationActivity: in a group, the clients will practice giving each other appropriate compliments to oneanother while passing the flower around in a circle.Downgrade: therapist could practice this skill alone with the client first so that the client doesn'tfeel overwhelmed when doing so during the group.

Inspiration Collage - Magazines, a piece of paper, glue, and scissors are neededDeficit: CommunicationActivity: to the group that they are going to make a collage featuring their personal

inspirations, and explain that inspirations are ideas that influence, encourage, and motivate you.Provide several magazines to cut. Also, let them know to bring photos they are willing to cutand images that they have drawn themselves. Have them paste what represents their personalinspirations on a piece of paper.Upgrade: After someone shares their collage, have members of the group goaround the circle and ask questions about why a certain image or word was puton their project. The person presenting can explain why the images are aninspiration to them.



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Mardi Gras BeadsDeficit: communication, emotional expression Activity : assign each different colored b ead an emotional meaning; ask clients to “wear” theiremotions by picking what they are feeling that day. Then discuss why they may be feeling acertain way. Upgrade: give the clients a minimum or maximum number of emotions that they must “wear”and discuss different days.

Masking TapeDeficit : Social, Emotional, Communication Activity: Involve multiple clients participate in a tic-tac-toe game after laying out the gridpattern, have the clients work together to figure out how to set up for the game, and make arule that requires the clients to interact during the game. Upgrade: Ask the clients to personally ask their peers to help and play with them.

New Orleans Magazine Deficit: Emotional – CommunicationActivity: Have clients flip through the New Orleans magazine and select one thing thatrepresents something they love about New Orleans. As a group take turns explaining what thatthing is and why they love it. Encourage clients to be as detailed as possible in communicatingwhy they love it perhaps linking it with a past memory.Upgrade: Allow other group members to ask questions of the person speaking requiring furthercommunication.

Newspaper Comic Section – newspaper comic section Deficit: Emotional regulation – Communication, Emotional IdentificationActivity: Clients will look at the faces and conversations of the characters in the comic strip anddiscuss which emotions they think the characters are feeling (sad, happy, confused, scared,etc.).Upgrade: Based off of the emotions they identified in the comic strip, clients will describe whatsituations make them feel these emotions themselves.

News ArticleDeficit: Communication, anxiety Activity: Clients are provided with an article. They must come up with questions and discuss thearticle with their peers. Upgrade: Clients find and bring their own story/article to discuss with the group



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Newspaper Activity - newspaper clippingsDeficit: Personal Interaction, CommunicationActivity: Each client will make a collage from the clippings. Share with the group about whatthey used and what each item means.Upgrade: Share collages in smaller groups for more individual interaction and longerconversations.

PuzzleDeficit: Communication and persisting when frustrated.Activity: Each participant gets a pile of puzzle pieces. Once everyone has received their pile, theparticipants must work as a team to put the puzzle together. After the puzzle is completed, eachmember will have to identify one thing that worked with the assembly of the puzzle and oneway the whole process could have been improved.Downgrade: Each participant gets a piece to a puzzle (20 pieces or less puzzles work best). Onceeveryone receives a piece, they must all state what they think the final picture will look like.Then, the therapist will assist them in putting the puzzle together to figure out if their guesses

were correct.

Robot's Lunch Break - bread, peanut butter, jelly, plates, knives, napkins, cups and beverages.You can include anything you want the robot to make. A long table, maybe a bench is best.Deficit: Impulse control, Communication, Emotional Identification/Expression, Turn takingActivity : Select two people to be robots, depending on group s’ cognitive ability, two therapistscan be the robots. Divide group into two teams which will line up on opposite side of the so theycan all see the robots. Select a food item to be created for the group to enjoy (Ex: peanut butterand jelly sandwiches). At the end of the activity, even the losers will enjoy the spoils. Robotscannot operate without instructions. If the instructions are too detailed, the robot won't know

what to do and will stop. Team members will take turns going down the line giving instructionsto the robot, like pick up jar, put hand on lid, twist lid, etc. Take the lid off the jar is too complexfor a robot. The team that can get their robot to make all their sandwiches wins. The other teammust keep going until all sandwiches are made. NO one eats until Robots have completed task.Upgrade: Incorporate drinks, and possible robot repair work.Downgrade : Make a simpler food.

Sale advertisements - Any store adds from a newspaper. Ex: Target, Best Buy.Deficit: Emotional regulation – impulse control, personal interaction, communicationActivity: In a group session, clients will pair up with a “friend” from the group and together willplan a pretend shopping trip. Clients will together pick one store they would like to go to, andthey will each choose one item they would like to buy. Clients will have a group discussionabout which item they each picked and why they chose it. Upgrade: Clients as a pair will have to decide on just one item to buy together that they willshare. Clients will have a group discussion about how they compromised to decide on one itemto purchase. Clients will discuss how it feels to work together with someone else.



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Shimmer poms - small pom-poms (different colors)Deficit: CommunicationActivity: This activity should be performed in a small group. Clients will pick a shimmer pom(colored pom) from the bag. Each colored pom represents a question the client should answer.The colors and matching questions are on a separate card. (Ex. blue pom = what are you mosttalented at? green pom = what is your most embarrassing moment?) This activity requiresclients to communicate in a group setting. The answers to questions may be funny orinteresting, and promote group discussion and interaction with other clients. This activity alsorequires clients to initiate and answer questions appropriately. For example, clients thatperseverate on certain topics will have to answer questions appropriately and use self-control.Upgrade: Clients will pick 3 colored poms and answer 3 questions

Story Telling Deficit: CommunicationActivity: Tell a story by having one person initiate one opening sentence. This will go on untilthere is full story progression and an ending.

Upgrade: Have everyone say more than one sentence.Downgrade: Tell a story in a “Mad Libs” type manner where the OT says most of the story andlets the client fill in one word blanks.

Survival Scenario – Paper and pencil, and chalk/dry erase board are neededDeficit: CommunicationActivity: Tell the group that they going to play a game. Ask the group the question: “If youwere stranded on a desert island, what would be the 12 most useful items needed to survive?”Have them write down their answersUpgrade: After the patients come up with their answers, have the group share all of theiranswers and the therapist write them on the board. As a group, they need to discuss theanswers and come up with a final list of 12 – after discussing options from every one’ssuggestions.

Who am I - index card, Sharpie. You can glue pictures of famous people on index cards and/or just write their names on the cards.Deficit: Impulse control, CommunicationActivity : Each member of the group takes turns choosing a card from the pile of nonfictionalfamous people that can be dead or alive. It cannot be someone they know personally or a familymember. Ex: George Washington, Jude Law, Madonna. The person selecting the card will notsee the card but the rest of the group will know who it is. The person will ask yes or noquestions to determine who the person is on the card. The Group can only reply with yes or noanswers. Therapist will keep track of how many question it took for the person to figure out whothe person is and the one with the lowest number of questions is the winner.Upgrade: Make choices to pick from less well known, have limited amount of questions allowedto be asked (10), allow group to choose a person for the client.Downgrade: Choose person from genres, such as fairy tales, Star Wars, allow group to giveexplanations, not just yes and no.



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Inappropriate Interaction

Alphabet I-SpyDeficit: Inappropriate InteractionActivity: Take turns naming different objects in the room. The objects must be named inalphabetical order. Say one item per letter.Upgrade: Take turns naming all the A’s in the room, then B’s, etc. Downgrade: Don’t have the clients name objects in alphabetica l order. All letters must be usedonce though.

Bag of Coins - Ziploc bag and various coinsDeficit: Social

Activity: The therapist can partake in a role-playing activity where the patient acts as a storeclerk and the therapist acts as a customer. The patient would have to gather money, giveappropriate change back to the therapist, and appropriately communicate with the customerwhile doing these tasks. This activity would be a great way to prepare the patient for workactivities.Downgrade: the therapist could tell the patient how much change to give back, so the patientwould not have to subtract and perform the math problems associated with making change.

Balloon Juggle & Sort Challenge - Several different colors of balloons are needed Deficit: Inappropriate InteractionActivity: Inflate one balloon per person and have them keep it up in the air.This gets the group moving and cooperating.Upgrade: Once they’ve got the hang of it, y ou can make this activity harder.Either add in more balloons, tell them they cannot use their hands to keep theballoons up, or add in colored balloons and have them sort them out.

Blind Man's Obstacle Course - Mines can be made out of anything, paper, tin cans etc. Clotheslines are made out of yarn hung across the room, or tied on to a large object. Stair case can beused, or mound of pillows will substitute just as easily.Deficit: Inappropriate Interaction, Communication, Teamwork, Impulse ControlActivity: Clients’ are broken up into teams of two, one team member is blind folded and theother team member must talk them through the mine field followed by a series of clothes lines,and then a rock climb (stair case suggested on all fours crawling position) Teams are timed.Upgrade: More obstacles, both members must finish the course before time is called.Downgrade: Less obstacles, team members can switch in the middle of the game if necessary.



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Cards- War – Deck of CardsDeficit: Inappropriate interactionActivity : Shuffle and deal all cards. Players put down one card and the player with the highestcard collects all the cards put down. The one who ends up collecting the entire deck wins.Upgrade: Create an incentive to win which will increase motivation to win; Mix together twodecks of cards to make the activity last longer.

Cards-Sevens Deficit: Social – Inappropriate InteractionActivity: Playing the card game Sevens in a group. Discuss with the group prior to playing thegame about appropriate interactions with one another. For example, discuss rules about notlooking at other player’s cards, respecting other player’s personal space, and propercommunication.Downgrade: Play the card game Sevens with only two people instead of a group so players onlyhave to worry about interacting with one other person.

Cards- Pity Pat

Deficit: InteractionActivity: Each person is dealt five cards. The deck has one card flipped over next to it. Try tomatch and then discard pairs by taking turns flipping over one card from the deck. When a pairis made, discard one of the cards from your hand. The discarded card can be used as a match forsomeone else. Whoever discards all their cards first wins the game.Upgrade: Play the game in teams so partners have to work together to create pairsDowngrade: Create a simple matching game by spreading out all the cards and flipping themover to create matches.

CharadesDeficit: Inappropriate interaction

Activity: Have group identify appropriate interactions (personal space, appropriate comments,etc.) and inappropriate interactions (personal space, intense eye contact, inappropriatecomments, etc.); use these interactions to play charades.Downgrade: Have appropriate and inappropriate interactions listed so clients do not have tothink of them.Upgrade: Have clients discuss appropriate and inappropriate interactions and why they areappropriate or inappropriate.

Collage - Magazines, scissors, glue, and paperDeficit: Social Participation, Social interactionActivity: Therapist places limited number of materials in the center of the table. Since there willnot be enough scissors, glue, and magazines for every client they will have to ask to borrowthem from one another. The clients will cut out pictures and phrases that they find appealingand glue them to a piece of paper.Upgrade: Increase the number of client’s and decrea ses the number of materials available. Thiswill require the clients to interact with more people as well as practice patience and turn taking.Downgrade: Therapist engages in activity with only one client. The client then only has to askthe therapist to borrow materials.



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Complement Game - Piece of paper and a pen/pencilDeficit: Inappropriate interactionActivity: All of the participants sit in a circle and write their names on the top of a blank, ruledsheet of paper. Next, each participant passes their piece of paper to the person to the left of them. When the participant receives the sheet of paper from their neighbor, they write acomplement about the person, such as “You always make me laugh or you have pretty hair.”Each participant will have 1 minute to write the complement. When the minute has passed, theywill pass the paper to the left and receive a new piece of paper. This will continue until thepapers travel back to their original owners. Then, each person will read the list of complements.After everyone has read the list, they will share with the group one characteristic that theydidn’t know or didn’t realize they possessed.Downgrade: Simply list a physical or personal characteristic of the person whose name is listedon the sheet of paper, such as “tall” or “funny”.

Crayons and PaperDeficit: Personal Interaction

Activity: Walk around outside and either draw or gather items they like (texture, color, smell,shape, memory, etc.) and explain it to the group.Modification: Client is to explain all of the items, one of the items, or give them a time limit .

Dirty Laundry - Materials/how to make: print out templates provided, markers, scissors, indexcards, glue stick. Cut out people and clothes from template and glue to index cards for stability,color if desire, or have clients color if desired. Write out scenarios-Clothes pile (random clothes items, socks, pants, dress, and underwear)-People pile (different kinds of people, teacher, doctors, men and women etc.)-Destination pile (where the people are going, so you know what clothes they need, ex: Party,

wedding, Alaska vacation, the beach.)-Question pile, questions you have them answer like: name 3 sports that you enjoy, or name 3things you are excellent at)Deficit: Social Participation: Turn taking, Inappropriate Interaction, Socially correct decisions. Itis an opportunity to deal with uncomfortable conversation in safe environment.Activity: All clothes go in a bag to be randomly selected. Each player will randomly select fromthe People Pile and the Destination pile depending on the group you may elect to give themmultiple people, or put the group into teams. Taking turns 1st player will select from theQuestion Pile, and read it out loud, then answer it about them self not showing anyone elsetheir answer. (Ex: Name 3 sports that you enjoy) The rest of the group will write down what they think the 1st player has written down, (ex:baseball, football and golf). If the group members are able to get what the 1st player has writtendown then they get an item of clothing for each correct answer to dress their people. Player oneis allowed to collect a piece of clothing for each incorrect answer. The first player that is able todress their people correctly for their destination wins. Make any modifications if necessary tosuit the group.Upgrade: Give each player more people to dress and more destinations to for them to go toDowngrade: Play in teams, drop the Question pile and work on just dressing the people fordestination as a group.



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Dots & Boxes - Paper and pencilsDeficit: Person interactionActivity: Set up a grid of dots on a piece of paper. Take turns drawing lines from dot to dot. Thegoal is to create a box. Whoever creates a box puts their first initial in the box to claim it. Theperson with the most boxes at the end wins.Upgrade: Create a larger grid to force more initiation by the client; Have more people play thegame which causes more interaction with others.

Flower Deficit: Inappropriate InteractionActivity: this activity will be done in a group. The therapist will lead a discussion aboutappropriate compliments and inappropriate compliments with examples of each. The clients willthen practice complimenting one another appropriately while passing the flower to the personwhom they have complimented.Downgrade: clients simply give suggestions of appropriate compliments without actuallycomplimenting one another.

Grocery Shopping - Bag of flour, sugar, and noodlesDeficit: Social Participation- Inappropriate interactionActivity: Each bag will be priced. The client will choose which bag he/she wants to purchase. Theclient will have to appropriately inter act with the “clerk” (therapist ) when she asks “How areyou?” The client will then have to pay t he clerk and tell her goodbye in an appropriate manner.Upgrade: Two clients will participate in the activity. One client will be the clerk and the otherthe shopper. The therapist will provide minimal verbal cues.Downgrade: The shopper will not be required to verbally communicate with the clerk but willhave to maintain an appropriate distance from the clerk.

Hats Off – hat or paper bagDeficit: Inappropriate interactionActivity: This can be performed in a small group setting. Each member should write a fearhe/she has on a sheet of paper anonymously. Each person will place his/her sheet of paper in abag and draw from the hat. (I used a bag). Each client will then pick a paper from the bag, read itout loud, and discusses why that person may be afraid of that particular thing.This activity requires clients to identify their own fears, and to feel comfortable writing them,and discussing them in a group. This may help clients learn more about one another andunderstanding each other's fears. This will increase self-awareness of clients as well.Upgrade : have each client read his/her own fear and out loud to the group and discuss it.

Hot Potato - A small ballDeficit: Inappropriate interactionActivity: Sit in a circle and pass the ball along to music. When the music stops, the person withthe ball is out of the game.Upgrade: Have more people play the game to practice appropriate interactions.Downgrade: Have everyone stay in the game instead of being out.



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Mirror ImageDeficit: Inappropriate InteractionActivity: Put people into pairs and have them stand face to face. One person makesmovements and the other person acts as the ‘mirror image’ and mime’s their movements as if they were a full length mirrorUpgrade: Have one person do a movement and the other person mirrors them. Then, have theperson who mirrored give immediate verbal feedback about what they movement wasrepresenting.

Newspaper Comic Section – newspaper comic section Deficit: Social participation – initiation, anxiety, inappropriate interaction Activity: Clients will read/look at newspaper comics and choose their favorite comic strip.Clients will have group discussion about their favorite and how it relates to them. Clients willdiscuss what they would do if they were in the same situation as the characters.Upgrade: Following the previous discussion, clients as a group will come up with a short comicstrip story about their day and include each group member in the story.

Post-its Deficit: Social Participation, Inappropriate interaction- Casual CommunicationActivity: Therapist writes down the names of group members on a post-it note and sticks it to awall. Half of the client’s the pick names from the wall. The client must then find and introducehim/herself to the individual they picked. The clients will have to carry on casual “small talk”with each other for 10 minutes.Upgrade: Only do the activity with group members who have never met each other before andincrease the amount of time they have to talk.Downgrade: Have the clients pick the names of therapists. The therapist will then verballycue the client throughout the activity to remind them to stand at an appropriate distance or toredirect them to appropriate conversation.

SeedsDeficit: Personal interactionActivity: Terrarium – spread a layer of gravel on bottom of jar, add charcoal chips and soil, addseeds to soil, mist regularly. There should be less trowels and packets of seeds than clients sothey must share.Downgrade: Divide the group into pairs and have them share supplies as a pair.Upgrade: The group plans a garden, decides what should be planted, and follow through withplanting the garden.

Shimmer poms - small pom-poms (different colors)Deficit: Inappropriate interactionActivity: This activity should be performed in a small group. Clients will pick a shimmer pom(colored pom) from the bag. Each colored pom represents a question the client should answer.The colors and matching questions are on a separate card. Ex. blue pom = what are you mosttalented at? green pom = what is your most embarrassing moment? This activity requires clientsto communicate in a group setting. The answers to questions may be funny or interesting, andpromote group discussion and interaction with other clients.Upgrade: clients will pick 3 colored poms and answer 3 questions



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Shoe ID Game- Shoe Deficit: Inappropriate interactionActivity: This game works best with a larger group of people (10 or more). First, have theparticipants remove one shoe and place it in a pile in the center of the room. Next, have theparticipants select a shoe that does not belong to them. Then, the participants need to find theowner of the shoe. Once the owner is found, the participant needs to “interview” the shoe’sowner. Once all the shoes' owners have been found, the participants will each share with thegroup three new facts they gathered from interviewing the shoe’s owner.Upgrade: Instead of a simple interview, the participants will have a list of 10 deep, insightfulquestions that they must ask to the shoe owner. After discussing the 10 questions, theparticipant must share with the group the 3 most interesting responses. The participant mustalso share some new insight that they gathered from talking with the show owner.

Shuffle Caps Deficit: Socioemotional skills – having the capacity to effectively interact between groups of people at a great level/speedActivity: Create a scoring triangle with tape at the end of a table and tape a starting line at theopposite end. Have the players take turns sliding their caps from behind the starting line. Seehow far they can slide their cap, and they can even knock their opponent’s out o f the triangle orright off the table.Upgrade: Have the client share something with the group before sliding each cap.



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Participation

Cards- Old Maid, War, and ConcentrationDeficit: Social EmotionalActivity: Old Maid, War, and Concentration the rules are attached.Upgrade: They have to be able to play with a group and have people actually win or lose.Involving more people in the game would make it an upgrade.

Cards - KEMPSDeficit: Social Participation, EgocentrismActivity: KEMPS First decide who is playing with whom. Then each two player team privately agrees a signal thatthey can secretly use to tell each other when they have four of a kind. The signal can be a bodymovement, a gesture or a hand signal, but words are not allowed. The dealer deals four cards toevery player. After everyone has looked at their cards, the dealer deals four more cards, one at atime, in a row face up in the middle. When the last card has been turned up, any player can pickup one (or more) of the face up cards from the middle and immediately discard a differentcard(s) face up in its place. Players do not take turns. A player who picks up more than one cardmust discard an equal number of different cards, to reduce their hand back to four cards.Players continue replacing cards, as often as they want to, until no one wants any of the fourface up cards. The dealer then sweeps these four cards away, and deals out four new cards onthe table. Play then continues as before. This is repeated until the deck is gone or someone yells"KEMPS“or "STOP KEMPS". (REMEMBER- you call KEMPS when your partner secretly signals toyou that he/she has 4 of a kind)Upgrade: Add more players to the game. With more players there will be more stimuli anddistractions requiring the players to pay closer attention to their teammate’s non -verbal cues.Downgrade: Make the players take turns. Taking turns will decrease the external stimuli andthe partners can concentrate on just looking for their partners secret sign immediately aftertheir partner takes their turn.

Crayons and PaperDeficit: Social ParticipationActivity: Walk around outside and either draw or gather items they like (texture, color, smell,shape, memory, etc.) and explain it to the group.

Upgrade: Each client can only make a certain amount of comments & must raise their hand.



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Finger Paint, Glitter, GlueDeficit: Social Emotional, FM CoordinationActivity: finger painting with paint, glue, and glitter – have to share what they do. It can beabout anything.Upgrade: the initial purpose is for them to interact with others and share. It can be madeharder by making them paint something that is important to them, something that burdensthem, etc.

Newspaper Activity - newspaper clippingsDeficit: Social ParticipationActivity: Each client will make a collage from the clippings. Clients will get into groups of 2 andask each other why they used what they used and what it means to them.Downgrade: Prompt clients to start conversation and during discussion with others.

Story TellingDeficit: Participation and InitiationActivity: Tell a story by having one person initiate one opening sentence. This will go on untilthere is full story progression and an ending.Upgrade: Have everyone say more than one sentence.Downgrade: Tell a story in a “Mad Libs” type manner where the OT says most of the story andlets the client fill in one word blanks.

Yin Yoga Poses Instruction SheetDeficit: Social – Participation and InteractionActivity: Lead clients through a series of yin yoga postures. Instruct clients to take notice whenthey are feeling uncomfortable or overwhelmed in a posture and teach them breathingtechniques to get through it. Have the clients’ partner off and explain to one another whatposes made them feel uncomfortable or overwhelmed and how they managed to get throughthem.Upgrade: Have the clients explain a real life situation that made them uncomfortable oroverwhelmed and how they go through it.

intervention activities

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