Therapy Thursday: Sequencing steps to help your child

Posted Thursday September 08, 2011 by Melissa

Sequencing Shoes

Step 1. Open my eyes.

Step 2. Sit up.

Step 3. Swing my legs off the bed.

Step 4. Stand up.

What if just understanding how to get up in the morning took someone leading us through each of those steps? What if we couldn’t understand how to eat, go to the bathroom, put on our shoes, or other mundane tasks unless someone constantly walked us through each minute step?

But most of us can and that is the power of sequencing in our brain. You and I can break large or small activities down into the steps needed to accomplish them without even thinking. Even very young children can quickly learn and perform the steps needed for different tasks.

But in most children with MPS and similar conditions, their brains function differently. The damage that doctors and parents do not totally understand affects the way in which our children process information. They often have extreme difficulty with sequencing – attributable to many factors, many of which get worse over time as the disease progresses:

  1. Cognitive processing: lacking the processing skills to look at a task and break it down to discrete steps.
  2. Fine motor coordination: problems in grasping and manipulating objects that are often necessary for the skill (like scissors to cut, blocks to stack, and shoes to put on).
  3. Memory: problems with retaining the steps for a task even though it has been shown to them and they’ve performed it with help many times.
  4. Attention span: even if the child can sequence and remember and physically perform the steps, often it takes them much longer and with a shortened attention span already, they cannot maintain the attention necessary to complete all the steps.

All of these factors come into play with Case. Even though the clinical trial has improved his cognitive and other skills, he still struggles with all of these issues.

Take, for example, putting on shoes. We have been working on this task for over a year. A year. He works on it at school. He works on it in occupational therapy. We work on it at home.

He still has not mastered it consistently.

Sequencing Shoes

Case's shoe sequencing chart

So I did what I should have done many moons ago. I created a sequencing chart that I hope will help him stay focused and remember the steps involved in this task. I laminated it and put it on the wall at the bottom of the steps where we sit every morning to work on these steps. I’m sending one to school as well. I post it below in case it is helpful in any way to another family struggling with issues like these.

I’ll keep you updated about *when* (not if) he finally masters the shoe battle.


For more information on understanding sequencing/graphic charting and examples of charts to help your child with sequencing daily tasks, visit:

Examples of blank chart structures can also be found many places online, including:

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4 Responses to “Therapy Thursday: Sequencing steps to help your child”

  1. Another good strategy, especially with young children, is reverse sequencing. You start by having the child do the last step independently so that he can feel successful. As he masters each step, you move backwards to the previous step, so as he learns he is successful each time. Does that make sense? I love your chart!

    • That’s such a good strategy Robin! That’s similar to what we did with puzzles by starting with only a few pieces out and slowly having more and more pieces missing. I guess all of these strategies kind of come together!

  2. I use backwards chaining as well for this, it helps increase the child’s confidence and decrease frustration. I think this visual schedule is a terrific addition to follow along with even if you are prompting the steps. Thanks 🙂

  3. […] schedule (which was gradually replaced with the iPad’s Proloquo2Go) and now we use it for sequencing charts, his daily schedule that he can check things off, writing and drawing practice sheets, etc. There […]