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INTERVENTION ACTIVITIES
List 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)

GROSS MOTOR
Back to Back Relay Race stopwatch Deficit: Proprioception, Coordination Activity: 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 stand back to back and wrap arms together to hold the position. An obstacle course will be created depending on your client's ability to coordinate. Teams of two will take turns being timed on the course 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 Motion Activity: Throwing the ball back and forth (while answering questions) Downgrade: Catching and throwing is easier than rallying back and forth or catching/hitting a ball that is thrown to the side or low. 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 be used, or mound of pillows will substitute just as easily. Deficit: Coordination Activity: Clients are broken up into teams of two, one team member is blind folded and the other 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- bubbles Deficit: Gross motor deficits to increase ROM Activity: The therapist can instruct the seated patient to pop all of the bubbles before they hit eye level. This will cause the patient to reach above their head and quickly pop all of the bubbles before 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 very high. Cards Deficit: GM or FM ROM Activity: 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 tactile perception to feel for where the cards are placed. This could treat a sensory deficit as well.

3 Cards Deficit: GM or FM deficits, Endurance Activity: make the client stand while playing game Upgrade: place the draw deck or the main pile of the game on the opposite side of the table forcing the client to increase ROM, reaching, stability and balance, and trunk rotation. Cards Deficits: Motor ROM, anxiety, inappropriate interaction, communication, emotional expression Activity: 2 person team building a house of cards Downgrade: Build something smaller or less difficult. Dice Game - dice (Also requires a list of activities that have associated numbers. Ex: roll a 3 so work 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 balloon Deficit: Motor ROM, balance Activity: Client will keep the balloon in the air by hitting it back and forth with the therapist while 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 on but not too heavy. You can improvise items in the room/outdoors or use tape to make the islands and main land. Depending on the group hot lava balls made out of light bean bags can be thrown 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 it and also improve personal space issues. Deficit: GM Coordination, Balance Activity: Group will all be on the same team. No one is allowed to talk but may gesture nonverbally. 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 the group that they live on a small island and the volcano has erupted filling the once lovely ocean into 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 2 wooden 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 compare the amount of time it took to save everyone to the next time. Upgrade: Give some group members disabilities, Lava rocks, more islands between the main land and other obstacles (whirlpool, predators, rock slides etc.) Downgrade: Allow them to talk.

4 Masking Tape Deficit: 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/colors Deficit: Motor ROM Activity: 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 laces Deficit: Fine motor skills, Visual, Joint Mobility, Bending, Reaching Activity: Putting on the shoes, reaching for the laces, tying the laces Downgrade: Using a shoe with Velcro or a slip on shoe.

Shuffle Caps - shuffle caps/bottle caps, and tape Deficit: Motor skills gross motor skills; involving large muscles of the body in order to move the body; includes muscle tone and strength Activity: Create a scoring triangle with tape at the end of a table and tape a starting line at the opposite end. Have the players take turns sliding their caps from behind the starting line. See how far they can slide their cap, and they can even knock their opponents out of the triangle or right 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 Motion Activity: Hold utensils one at a time on one side of the clients body in front of them. Have them use opposite arm to reach for utensil. Upgrade: Move the position you are holding the utensils at higher and lower and change directions frequently. Water Bottle Deficit: Gross motor Activity: 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.

FINE MOTOR (Coordination, Grip Strength)

Coordination
Bag of Coins - Ziploc bag and various coins Deficit: Cognitive, FM Coordination Activity: The therapist can have the patient make various amounts of change by combining the coins. For example, the therapist can say Make me 67 cents. The client would then have to sort 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, name the value of the coins, then have the patient place them in separate piles (pennies, etc..)

Balloon Deficit: 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 motor activity: reaching, trunk rotation, and increased ROM. Cards Deficit: GM or FM deficits, Endurance Activity: make the client stand while playing game Upgrade: place the draw deck or the main pile of the game on the opposite side of the table forcing the client to increase ROM, reaching, stability and balance, and trunk rotation. Cards Deficits: Motor ROM, FM coordination, anxiety, inappropriate interaction, communication, emotional expression Activity: 2 person team building a house of cards Downgrade: Build something smaller or less difficult

Coins and bank - Coins and a small plastic bank Deficit: Motor fine motor Activity: Client picks up each coin off the table using a pincer grasp and places coin in the palm of other hand. Client uses palm to finger translation to move coin to pincer grasp and places coin in bank slot. Client alternates arm use. Downgrade: Therapist places coin in the palm of clients hand. Client wont have to pick up off table or transfer to other arm.

6 Connect Four Deficit: Motor Fine Motor Coordination Activity: Playing a game of connect four with the pieces spread out all over the tables so the client 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 Book Deficit: Motor skills fine motor skills; can be defined as small muscle movements and those that occur in the finger and in coordination with the eyes Activity: Each book is consists of pieces of colored paper with a color, number, or both written on the pages. Take the star stickers and place the appropriate colored star on the corresponding 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 the corresponding colored paper in the book.

Crossword Puzzle Deficit: Motor Fine Motor Coordination - Grip Activity: 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 so work 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 wallet Deficit: Emotional Regulation, FM Coordination, Personal Interaction, Communication, Emotional Expression, Anxiety Activity: Making a duct tape wallet Downgrade: Simplify structure; make a simpler version of the wallet.

Farkle Dice Game need instructions Deficit: Impulse control, FM coordination, Personal interaction. Avoidance, Inappropriate Interaction, Emotional Expression Activity: dice game Downgrade: Allow players to continue using all 6 dice as opposed to removing point- worthy dice after each roll.

7 Finger Paint, Glitter, Glue Deficit: Social Emotional, FM Coordination Activity: finger painting with paint, glue, and glitter have to share what they do. It can be about anything. Upgrade: the initial purpose is for them to interact with others and share. It can be made harder by making them paint something that is important to them, something that burdens them, etc.

Lanyard - How to make see word document labeled: Making a Lanyard Deficit: Fine Motor Coordination Upgrade: move on to more difficult stitches Downgrade: create a three string braid.

Magazine Deficit: 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 its easier to see and feel.

Money - cash and coins Deficit: Fine motor skills, In-hand manipulation Activity: Practice manipulating money to and from wallet, in clients 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) or into the soda/snack machine slot.

Origami - Directions to fold paper to make fun designs, origami paper, or typing paper Deficit: FM coordination 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 Paper Deficit: Fine Motor Activity: Follow directions in order to create different origami models. Ex: Hat Upgrade: Give more instructions for harder models; fold paper into more challenging objects Ex: 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

Ping Pong - ping pong ball and cup Deficits: Strength Regulation, FM Coordination Activity: The therapist can instruct the patient to bounce the ping pong ball into a cup. The patient will have to control the strength used to complete this task Downgrade: The therapist can instruct the patient to use enough strength to bounce the ball once on the table. This will enable the patient to learn how to control strength.

Shoes - shoes with laces Deficit: Fine motor skills, Visual, Joint Mobility, Bending, Reaching Activity: Putting on the shoes, reaching for the laces, tying the laces Downgrade: 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 and work 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/checkbook Deficit: Fine motor skills, In-hand Manipulation, Visual Activity: Writing checks, letters, cards, alphabet, etc. Downgrade: Use a wider pen or a pen with a grip holder.

Grip Strength
Cards Deficit: To improve a gross or fine motor deficit: to increase ROM and improve grasp Activity: The therapist can scatter cards all over the table and have the patient reach and grasp each card individually to make a neat pile. Upgrade: the therapist can instruct the patient to close their eyes, so he/she must rely on tactile perception to feel for where the cards are placed. Coins and bank - Coins and a small plastic bank Deficit: Motor fine motor Activity: Client picks up each coin off the table using a pincer grasp and places coin in the palm of other hand. Client uses palm to finger translation to move coin to pincer grasp and places coin in bank slot. Client alternates arm use. Downgrade: Therapist places coin in the palm of clients hand. Client wont have to pick up off table or transfer to other arm. Magazine Deficit: Improve the clients grasp, in-hand manipulation, and bimanual manipulation. Activity: The therapist can instruct the patient to make a collage. First, the client will have to tear pictures and letters out of the magazine. Then, the client will paste the pictures onto a piece 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 strength Activity: Client will open pill bottle and will open each pill box. Client will pick up beans from table 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 Straws Deficit: Grip, Coordination Activity: Hold straws right side up on a table then let them fall into a pile. Take turns removing individual 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/checkbook Deficit: Fine motor skills, In-hand Manipulation, Visual Activity: 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 Sponge Deficit: Sensory Sensation Activity: Move sponge along body including arms and legs to test for sensation (I have since learned 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 cant feel so that can be extra careful with those areas). Upgrade: Have client close eyes while doing activity and see if they can still accurately identify point of sensation. Bag of Coins - Ziploc bag and various coins Deficit: Tactile and other sensory deficits Activity: The therapist could have the patient feel the different edges and sides of the coin to differentiate one coin from another. Color & Number Book Deficit: 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 written on the pages. Take the star stickers and place the appropriate colored star on the corresponding 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 on the sticker sheet. Puff Balls small colored pom-poms Deficit: Sensory skills sight and sound; sensory development can be encouraged by stimuli 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 time and place them in the container. Downgrade: To make it easier have the client use their hands and not the tongs; touching the puff balls may help the client as well.

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Proprioception
Back to Back Relay Race stopwatch Deficit: Proprioception, Coordination Activity: 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 stand back to back and wrap arms together to hold the position. An obstacle course will be created depending on your client's ability to coordinate. Teams of two will take turns being timed on the course 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. Clothes lines are made out of yarn hung across the room, or tied on to a large object. Stair case can be used, or mound of pillows will substitute just as easily. Deficit: Proprioceptive, Coordination Activity: Clients are broken up into teams of two, one team member is blind folded and the other 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 the islands and main land. Depending on the group hot lava balls made out of light bean bags can be thrown 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 it and also improve personal space issues. Deficit: GM Coordination, Balance, Proprioception Activity: Group will all be on the same team. No one is allowed to talk but may gesture nonverbally. 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 the group that they live on a small island and the volcano has erupted filling the once lovely ocean into 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 2 wooden 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 compare the amount of time it took to save everyone to the next time. Upgrade: Give some group members disabilities, Lava rocks, more islands between the main land 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 deficits Activity: The therapist could have the patient feel the different edges and sides of the coin to differentiate one coin from another.

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

Finger Paint, Glitter, Glue Deficit: Sensory Activity: finger painting with paint, glue, and glitter have to share what they do. It can be about 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 coins Deficit: Fine motor skills, In-hand manipulation, Sensory Activity: Practice manipulating money to and from wallet, in clients 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) or into the soda/snack machine slot. Stress Ball- Balloon and Plastic water bottle Deficit: Sensory, Tactile Activity: Fill a water bottle half way with the contents chosen to be in the stress ball like flour or sand. 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 to coincide 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

Balloon Deficit: 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 reach to hit it. Promotes greater ROM, reaching, eye tracking, and concentration. Beach Ball Deficit: Cognitive Activity: Every time you catch the beach ball, you have to name a sate, a capital, something you do 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 a group of people. Bingo Deficit: Cognitive skills receptive memory; the ability to note the physical features of a stimulus and be able to recognize it at a later time Activity: 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 who matches 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 correct answer to a specific question Bubbles- bubbles Deficit: Attention Activity: If the patient has trouble keeping their attention focused on one thing, the therapist can ask the client to count the amount of bubbles make with each blow Upgrade: the therapist can tell the patient that they will blow three times. So, the client has to remember what number they were on from the first blow and start from that number on the second and third blow. For example, the therapist blew six bubbles from the first blow, three from the second blow, and eight from the third blow. So, the client would report seventeen total bubbles made from the three blows. Cards Deficit: Cognitive/perceptual Attention, Memory Activity: Client will play a memory matching game with therapist. All cards will be turned face down and spread across the table in rows and columns. Therapist and client will take turns to find pairs that match and will turn the cards back over if not a match. Downgrade: Decrease the number of cards used for the game.

14 Cards- Blackjack Deficit: Cognitive Activity: Play a game of Blackjack with therapist as dealer. Dealer shows one of his or her cards and the client tries to get their hand closer to 21. Downgrade: Have both of the dealers cards showing.

Cards- Old Maid, War, and Concentration Deficit: Cognitive Activity: Old Maid, War, and Concentration - rules attached Downgrade: They could not keep a running tally to make it easier and just play by who wins what round. Crossword Puzzle Deficit: Cognitive Attention - memory Activity: Solving crossword puzzles by circling the words found. Downgrade: Use easier crossword puzzles with two or three letter words only Dice Game pair of dice Deficit: Attention, Memory, Awareness, Recognition Activity: Using the numbers on the dice to learn and practice addition, subtraction, etc. Downgrade: Use dice with pictures or numbers instead of dots. Magazine Deficit: Cognitive deficitsmemory, 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. Magazine Deficit: Memory Activity: 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 improve social skills in communication, the therapist can ask the client their opinion of an article and discuss different points of view that others may take when reading the same article. Origami Paper Deficit: Attention Activity: Listening and following direction in order to create different origami models; fold and manipulate the paper into an object like a hat Upgrade: Give more instructions for harder models; fold paper into more challenging objects like a bird which requires folding the paper into smaller pieces. Some origami models require more than one piece of paper. Downgrade: Teach origami models that require fewer steps to follow.

15 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: Cognitive/perceptual memory Activity: Therapist will verbally instruct client on how many red beans to put in each morning or afternoon 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 represent different pills. Therapists will vary the amounts of each bean needed for each box. Ping Pong - ping pong ball and cup Deficits: Attention and memory Activity: If the patient has trouble with neglecting insignificant factors in the surroundings, the therapist can bounce an orange ball and a white ball and instruct the client to only pay attention to the orange ball. The, the therapist can tell the client to count how many bounces the orange ball took before stopping. This will make the patient neglect the white ball and focus his/her attention on the orange ball and the number of bounces. Upgrade: the therapist can add more colored balls to the mix. Utensil Set Deficit: Cognitive - Memory Activity: As client is doing ROM activity, have them identify which specific utensil you are holding and what it is used for. Downgrade: Give them verbal cues if they are unable to come up with what the utensil is or what it is used for. TP game Deficit: Cognitive Skills the ability to concentrate and attend to a task for a period of time Activity: Pass around a roll of toilet paper and ask each client to rip some off, but dont tell them why or how much to take. Then, let the clients know that they need to reveal a fact for however many sheets of toilet paper they ripped off. Downgrade: To make this easier You could have the clients come up with a word to describe themselves for each sheet of toilet paper they ripped off

Writing Activity - pen and paper/checkbook Deficit: Judgment, Attention, Motivation Activity: 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: Cognitive Activity: Doing one of the puzzles in the book Downgrade: Some puzzles in the book are easier than others. You could also use a ruler to help them 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 coins Deficit: Cognitive Activity: The therapist can have the patient make various amounts of change by combining the coins. For example, the therapist can say Make me 67 cents. The client would then have to sort 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, name the value of the coins, and then have the patient place it into a pile with other coins with the same value.

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

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 the islands and main land. Depending on the group hot lava balls made out of light bean bags can be thrown 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 it and also improve personal space issues. Deficit: Problem solving, Attention Activity: Group will all be on the same team. No one is allowed to talk but may gesture nonverbally. 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 the group that they live on a small island and the volcano has erupted filling the once lovely ocean into 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 2 wooden 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 compare the amount of time it took to save everyone to the next time. Upgrade: Give some group members disabilities, Lava rocks, more islands between the main land 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 Lanyard Deficit: Problem Solving, Sequencing Upgrade: move on to more difficult stitches Downgrade: create a three string braid.

Money - cash and coins Deficit: Problem-solving Activity: Work on math skills, organizing different bills and coins by category, have options to buy 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 drink costs $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/colors Deficit: Cognitive/perceptual matching, sorting Activity: 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 Straws Deficit: Problem Solving Activity: Hold straws right side up on a table then let them fall into a pile. Take turns removing individual 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 laces Deficit: Attention, Problem Solving Activity: Allow the client to figure out the best way to put on a tie the shoe through problem solving. Pay special attention to each step and build to a more complex skill with each step. Downgrade: Using a Velcro shoe.

Water Bottle Deficit: 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 and work 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/checkbook Deficit: Problem Solving, Attention, Motivation Activity: 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 Solving Activity: Each member of the group takes turns choosing a card from the pile of nonfictional famous people that can be dead or alive. It cannot be someone they know personally or a family member. Ex: George Washington, Jude Law, Madonna. The person selecting the card will not see the card but the rest of the group will know who it is. The person will ask yes or no questions to determine who the person is on the card. The Group can only reply with yes or no answers. Therapist will keep track of how many question it took for the person to figure out who the 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 allowed to 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 give explanations, not just yes and no.

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Sequencing
Cards Deficit: Cognitive- to improve sorting and ordering Activity: The therapist can have the patient sort spades, hearts, clubs, and diamonds. The therapist 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 and having him/her matching the cards by numbers. This will make the patient rely on memory to locate appropriate cards and thus will increase cognitive ability. This matching game can also improve emotional deficits by making the client control emotions if they get frustrated by not being able to find a match. Cards Deficits: Sequencing, GM ROM, FM coordination, anxiety, inappropriate interaction, communication, emotional expression Activity: 2 person team building a house of cards Downgrade: Build something smaller or less difficult Upgrade: Playing Black Jack

Coins and bank - Coins and a small plastic bank Deficit: Cognitive/perceptual matching, sequencing, adding Activity: 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 Control Activity: 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 wallet Deficit: Emotional Regulation, FM Coordination, Personal Interaction, Communication, Emotional Expression, Anxiety, Sequencing Activity: Making a duct tape wallet Downgrade: Simplify structure; make a simpler version of the wallet.

Lanyard - How to make see word document labeled: Making a Lanyard Deficit: Problem Solving, Sequencing Upgrade: move on to more difficult stitches Downgrade: create a three string braid.

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Magazine Deficit: Cognitive deficitsmemory, 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 paper Deficit: Sequencing 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 paper Deficit: Impulse control Activity: Origami cat fold paper from corner to corner, fold down top corner, fold up bottom corners, 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 the chance 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 time and place them in the container. Upgrade: To make it harder place all colors of puff balls in a pile, but have the client only pick up a certain color ball Shoes - shoes with laces Deficit: Sequencing, Attention, Problem Solving Activity: Allow the client to figure out the best way to put on a tie the shoe through problem solving. 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 Organization Activity: 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 and compete with others Downgrade: use less cups to make smaller pyramids.

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EMOTIONAL (Emotional Regulation/Impulse control,

Emotional Expression/Identification, Motivation, Responding to Internal Stimuli)

Emotional Regulation / Impulse control

Balloon Ball Deficit: Impulse control Activity: Space ball form a circle; the object is to keep the ball in space and not let it touch the 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 or kick the ball. Upgrade: Clients will do the activity standing, but they must stand in the same spot and not move their feet. Balloon Bop- balloon Deficit: Impulse control and responding to external stimuli. Activity: All of the participants stand in a circle. One person begins by tossing a balloon in the air. That person calls another participants name and a body part that the participant will use to hit the balloon and keep 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 calls another participants name and a body part. Upgrade: In addition to saying the persons name and a body part, the participant must also indicate how to hit the balloon, such as Andy. Heel. Soft. Bubbles- bubbles Deficit: Impulse Control Activity: The therapist can instruct the client to pop only one bubble from each blow. The client will have to control their impulse to pop more than one bubble. Connect Four Deficit: Social-Emotional Impulse Control Activity: 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. Cards Deficit: Social emotional deficit Personal Interaction, Communication, Impulse Control Activity: Clients will play Go Fish or other card games that require communication among players. 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 for a card.

22 Cards- Sevens Deficit: Emotional Impulse Control Activity: Playing the card game Sevens in a group. Discuss with the group prior to playing the game the importance of taking turns and impulse control. Downgrade: Play the card game Sevens with only two people instead of a group so players have to wait less time to take their turn. Cards- Crazy 8s Deficit: Emotional Regulation, Impulsivity Activity: Crazy 8s- The dealer deals five cards to each player. The undelt stock is placed face down on the table, and the top card of the stock is turned face up and placed beside the stock to start the discard pile. Starting with the player to dealer's left, each player in turn must either play a legal card face up on top of the discard pile, or draw a card from the undelt stock. The following plays are legal. If the top card of the discard pile is not an eight, you may play any card which 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 player of 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 who gets rid of all their cards wins. Upgrade: Add more people to the game. The client will have to wait longer to take his/her turn and 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 cards to both her/himself and the client. This would decrease the length of time the client would have to 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, index cards, 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 from the People Pile and the Destination pile depending on the group you may elect to give them multiple people, or put the group into teams. Taking turns 1st player will select from the Question Pile, and read it out loud, then answer it about them self not showing anyone else their 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 written down then they get an item of clothing for 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 for their destination wins. Make modifications as necessary. Upgrade: Give each player more people to dress and more destinations to for them to go to Downgrade: Play in teams, drop the Question pile and work on just dressing the people for destination as a group.

23 Duct Tape instructions to make a wallet Deficit: Emotional Regulation, FM Coordination, Personal Interaction, Communication, Emotional Expression, Anxiety Activity: Making a duct tape wallet Downgrade: Simplify structure; make a simpler version of the wallet. Farkle Dice Game need instructions Deficit: Impulse control, FM coordination, Personal interaction. Avoidance, Inappropriate Interaction, Emotional Expression Activity: dice game Downgrade: Allow players to continue using all 6 dice as opposed to removing point-worthy dice after each roll. Holiday/Celebration Picture Book - Make a booklet out of computer paper. Put a picture of an object 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 Expression Activity: Client will recognize holidays represented in picture book and will recall family traditions for the holidays recognized. Client will identify and describe how these memories make him/her feel. Upgrade: Client will describe one favorite holiday tradition in detail, identify the family members or friends who are part of this tradition, and describe how they memory if this person and event makes him/her feel. Hot Potato - A small ball Deficit: Impulse control Activity: Sit in a circle and pass the ball along to music. When the music stops, the person with the 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 paper Deficit: 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 paper Deficit: Impulse control Activity: Origami cat fold paper from corner to corner, fold down top corner, fold up bottom corners, 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 the chance of frustration.

24 Ping Pong - ping pong ball and cup Deficits: Impulse control, emotional regulation Activity: The client has to practice emotional control by not getting frustrated with not being able to bounce the ball into the cup or count the number of bounces taken by the orange ball.

Scrabble Slam Cards Deficit: Emotional Regulation, Impulse Control Activity: Play scrabble slam Downgrade: Each time a letter is put down a certain amount of seconds has to pass before another card can be put down.

Word Search/Puzzle Book Deficit: Social Emotional- Impulse Control Activity: Doing one of the puzzles in the book Downgrade: 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 them Deficit: Impulse control Activity: client draws a card from an envelope or bag, and then explains his/her answer. There is no right or wrong answer. Ex. Would you rather be invisible or be able to fly? This game can be played in large or small groups as an icebreaker. This activity promotes group discussion and voicing opinions for each person's answer. This game also involves taking turns which requires impulse control. Many questions require the player to open up more to the group by explaining his/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 management Activity: The client brings the priced bags to the therapist that is acting as the clerk. When the client gives the clerk his/her money she short -changes them, or takes a VERY long time getting their change, the therapist may even drop the clients change on the floor as she hands it to them. 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 shortchanged them. Downgrade: A second therapist assists the client by verbally cuing him/her to employ relaxation techniques (such as deep breathing).

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Emotional Expression / Identification

Animals- pictures of different animals Deficit: Emotional Identification Activity: 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 be performed 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 the client(s) to decide which animal best represents themselves. This involves the client(s) revealing how they perceive themselves to the group. Upgrade: Client picks 2 animals. One that best represents themselves and one that least represents themselves. Balloon Deficit: Emotional Identification, Emotional Expression, Motivation Activity: Client must try and keep balloon in the air for a specified period of time without becoming frustrated/angry/giving up. Client then describes how it felt for them to have to hold in any frustrations and how the activity made them feel as a whole. Upgrade: Have client play with multiple people and control emotions appropriately. Band-Aid Deficit: Emotional Expression Activity: In a group setting, instruct client to place a Band-Aid on the part of their body that hurt the last time they were sad. Discuss as a group, the importance of identifying emotions and the affect 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 their body such as anger or anxiety and additional strategies they can use to make it better. "The Blue Day Book" by Bradley Trevor Greive Deficit: Emotional Identification Activity: use book to assist in conversation about the client's feelings and emotions. Pictures and phrases in the book can give them ideas/suggestions for different emotions that they may be able to relate to but have a different time identifying. The book can be used as a guide through the conversation about identifying emotions. Upgrade: the therapist can ask the client to choose 5 specific pictures/phrases in the book that they feel relate to how they are feeling that day during therapy. This will help facilitate discussion. Candles Deficit: Emotional identification Activity: 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/scents to express mood 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 this relates to previous events in their lives.

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

Calendar Deficit: Emotional Emotional Expression Activity: Have client select a date on the calendar that has a special meaning to them; one that is associated with positive feelings. Next have them explain to the group the date they picked and why it is special to them. Upgrade: Have client pick an additional date, or month, or time period that is associated with negative feelings and have them explain it to the group. Charades Game Deficit: initiation, avoidance, inappropriate interaction, personal interaction, communication, emotional expression Activity: Charades Downgrade: Lengthen time limitations

Conversational Flash Cards - old magazines, index cards, glue, pen. Make cards from pictures and 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 the picture. Therapist can also read the premade questions on the back of the card to help center the responses on a particular subject. If you want to prevent the clients from copying each others 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 group discuss. Glue them on the index card and write questions that remind you of what focus you would 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 paper Deficit: Emotional Identification, Expression, Impulse Control, Communication. Activity: Ask the group to select a beverage that describes them. Give them an example of what you are expecting. They might need a little time to think about it and it might be a good idea to have them write it. It took me a minute. (Ex: I am like a crown and coke. Strong and to the point but not overpowering. Effervescent, sweet and relaxing. Familiar but not typical with pleasant after taste. Top shelf quality but still accessible. I am like cough syrup. Only good in small doses, bad after taste thats 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

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Dice- need instructions to the card game Spoons Deficit: Emotional regulation Activity: Card game spoons (using dice) Upgrade: Have a larger group of people, so the outcome is less predictable.

Empty box Deficit: Emotional expression Activity: Gather the group into a circle. Leader will hold empty box and says "to make this box represent 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 then passes the box on, and the next person completes the sentence. This can be used in a small group 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 or wrong answer, clients are encouraged to participate appropriately in a safe setting. This activity also 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 or how I feel when I am happy) Eye-Spy Alphabet Game Deficit: Impulse Control Activity: Starting with A and working to Z, take turns picking items around the room or while on 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 which letters they are answering instead of shouting out for each letter. Help with sharing & waiting for turns.

Group Discussion Deficit: Emotional Regulation, Emotional expression Activity: 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 clients 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 lead to them feeling that emotion. If the emotion is a negative emotion, the client then throws the emotion away in the plastic cup once it has been discussed. If the emotion is a positive emotion they 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 felt throughout the past several days. Downgrade: Client has to pick emotion and say the emotion out loud, but does not have to describe the events that led to that emotion.

28 Fear in a hat - A hat, pencil, and paper are needed Deficit: Emotional Expression Activity: Fear in a Hat Introduce the topic of fear and explain how it is normal and natural at this stage of program that 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, the worst thing that could happen to me 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 read about someone's fear. Each group member reads the fear of another group member and elaborates and what he/she feels that person is most afraid of in this group/situation. No one is to comment on what the person says, just listen and move on to the next person. Upgrade: Reader repeats the sentence with different, simple words that express the feeling. Ask the reader for specific words they think of after reading this fear.

Inflated balloon Deficit: Social/emotional Personal Interaction, Communication Activity: 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 persons name and make eye contact.

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 the islands and main land. Depending on the group hot lava balls made out of light bean bags can be thrown 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 it and also improve personal space issues. Deficit: Impulse Control, Non-Verbal Communication, Emotional Identification, Turn Taking, Leading and Following, Teamwork Activity: Group will all be on the same team. No one is allowed to talk but may gesture nonverbally. 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 the group that they live on a small island and the volcano has erupted filling the once lovely ocean into 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 2 wooden 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 compare the amount of time it took to save everyone to the next time. Upgrade: Give some group members disabilities, Lava rocks, more islands between the main land and other obstacles (whirlpool, predators, rock slides etc.) Downgrade: Allow them to talk.

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

Mardi Gras Beads Deficit: Emotional Expression, Communication Activity: Assign each different colored bead an emotional meaning; ask clients to wear their emotions by picking what they are feeling that day. Then discuss why they may be feeling a certain way. Upgrade: give the clients a minimum or maximum number of emotions that they must wear and discuss different days. News Article Deficit: Inappropriate Emotional Expression, Emotional Identification Activity: Client is provided with an article or story, and is asked how he/she would handle the situation, 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 Identification Activity: Clients will look at the faces and conversations of the characters in the comic strip and discuss 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 what situations make them feel these emotions themselves.

Magazine Stories Magazine Deficit: Emotional expression. Activity: The therapist will hold up a picture from a magazine; this picture can be an ad or a photo, but the picture should be real photograph. Then, each participant must create a story or scenario about the person(s) in the photo. Downgrade: Each participant must simply state an emotion that the person(s) in the photo is feeling. Pen Deficit: Emotional Expression and Emotional Identification Activity: Have client keep a journal in which they write about their day and about which situations led to specific emotions. Explain to the client to describe the physical and internal feelings of the emotion, what lead to the emotion, and actions that followed the initiation of the emotion. Downgrade: instead of the client keeping a journal him/herself, the therapist could assist client in identifying the emotion after the client explains his/her experience to the therapist. The client and the therapist collaborate together on keeping up with the journal.

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Photo Album Deficit: Personal Interaction and Emotional Expression Activity: Client will go through photo album (if they have one) and will choose a person they wish to say something to but think doing so will be difficult for them. The client will then practice telling this person what he/she wishes to express. If client does not have his/her own photo album, the therapist can simply ask the client to think of a particular person they wish to interact 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 group setting. Clients will be asked to think of a particular situation they find uneasy and clients will give each other ideas and suggestions. Photo Album a small photo album. Help client obtain pictures, if possible. Deficit: Emotional regulation personal interaction, communication, emotional expression Activity: 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 makes the 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-it Deficit: Emotional Regulation/ Emotional Identification Activity: Group Discussion- Therapist will role play a scenario in which he/she experiences different emotions. Each client will have a pencil and post-it note Once the therapist has acted out a scenario the clients will write what emotion they believe she was experiencing. Then, they will stick the emotion on the therapists body. The therapist will go through each suggested emotion and discuss with the group the true emotion she was representing. Upgrade: Instead of the therapist acting out scenarios, the clients will discuss situations in which they became emotional. At the end of each clients story, the other group members will write down what emotion they thought the client was portraying. Downgrade: Therapist gives the clients only two emotions to choose from. One being the correct answer and the other being the opposite emotion she is displaying (i.e. happy vs. sad).

Post-Its Deficit: self-awareness, motivation, emotional responsiveness Activity: clients must write one thing they like about a fellow client on a post it and place it under the persons name (on a board, wall, table, etc.). After reading what their peers say about them they discuss how it makes them feel, and see if they can give a positive example about themselves 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 pen Deficit: Emotional regulation Personal interaction, Communication, Emotional Expression Activity: Clients will discuss a time when someone told them thank you and how it felt to be thanked. Clients will discuss the importance of treating people with respect and how it makes them feel to be treated nicely by others. Clients will practice using manners and being polite to each other in group. Upgrade: Following previous discussion, clients will think of an important person in their lives that they would like to thank for a particular reason. Client will write a short thank you note to that person.

TP game Deficit: Social Emotional- Changes in a person's emotions, relations with others, selfconcept, and personality, which is a stable way of thinking, feeling, and behaving Activity: Pass around a roll of toilet paper and ask each client to rip some off, but dont tell them why or how much to take. Then, let the clients know that they need to reveal a fact for however many sheets of toilet paper they ripped off. Upgrade: Go around the room and have the clients repeat facts that other people said about themselves

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Motivation
Balloon Juggle & Sort Challenge - Several different colors of balloons are needed Deficit: Inappropriate Interaction Activity: 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 as they can. And, the therapist could ask them to retrieve certain colors.

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

Cards- War Deck of Cards Deficit: Motivation Activity: Shuffle and deal all cards. Players put down one card and the player with the highest card 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 two decks of cards to make the activity last longer.

Charades - Various scenarios written on slips of paper in an envelope (I suggest having occupation 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, Motivation Activity: 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 the other person/group to guess the scenario. Downgrade: Allow some verbal cues to help acting out scenarios.

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Photo album Deficit: Motivation Activity: 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 them of the importance of living their life to the fullest. Suggestions for the picture can be given: a child, 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, draw something, 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 in his/her home where he/she will see it every day. Upgrade: Client can make a collage of people/pictures from their album that motivate them and 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 taking Activity: Select two people to be robots, depending on groups cognitive ability, two therapists can be the robots. Divide group into two teams which will line up on opposite side of the so they can all see the robots. Select a food item to be created for the group to enjoy (Ex: peanut butter and jelly sandwiches). At the end of the activity, even the losers will enjoy the spoils. Robots cannot 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 instructions to the robot, like pick up jar, put hand on lid, twist lid, etc. Take the lid off the jar is too complex for 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 pen Deficit: Emotional regulation Personal interaction, Communication, Emotional Expression Activity: Clients will discuss a time when someone told them thank you and how it felt to be thanked. Clients will discuss the importance of treating people with respect and how it makes them feel to be treated nicely by others. Clients will practice using manners and being polite to each other in group. Upgrade: Following previous discussion, clients will think of an important person in their lives that they would like to thank for a particular reason. Client will write a short thank you note to that 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 as auditory hallucinations. Clients can choose music that they find relaxing to assist with regulating their emotions at times when they feel stressed. Upgrade: Client can participate in an activity while listening to music to see if internal stimuli is somewhat drowned out. Therapist and client will identify and address internal stimuli and rate the effectiveness of the technique. Crayons and Paper Deficit: Emotional Regulation, Understanding Internal Emotions Activity: 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 Game Deficit: initiation, avoidance, inappropriate interaction, personal interaction, communication, emotional expression Activity: Charades Downgrade: Lengthen time limitations

Dirty Laundry - Materials/how to make: print out templates provided, markers, scissors, index cards, 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 from the People Pile and the Destination pile depending on the group you may elect to give them multiple people, or put the group into teams. Taking turns 1st player will select from the Question Pile, and read it out loud, then answer it about them self not showing anyone else their 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 written down then they get an item of clothing for each correct answer to dress their people. Player one is allowed to collect a piece of clothing for each incorrect 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 to Downgrade: Play in teams, drop the Question pile and work on just dressing the people for destination 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 sexual drive, agitation/irritability, feeling overwhelmed, hopelessness, nervous, lack of confidence). Deficit: Emotional Expression, Responding to Internal Stimuli Activity: Pick a slip of paper from envelope. Talk with group about how they feel when they experience 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 that emotion. Compare where other feels the same emotion on their bodies.

Yin Yoga Poses Instruction Sheet Deficit: Emotional Responding to Internal Stimuli Activity: Lead clients through a series of yin yoga postures. Instruct clients to take notice when they are feeling uncomfortable or overwhelmed in a posture and teach them breathing techniques 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 the whole series.

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Social (Anxiety, Avoidance/Initiation, Communication,

Inappropriate Interaction, Participation)

Anxiety
Calendar Deficit: Social, Anxiety Activity: Have client select a date on a calendar that they know could possible cause some anxiety 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 they may anticipate experiencing anxiety related to that. Upgrade: Have client discuss with group past experiences that have caused them to experience social anxiety as well. Cards Deficits: Sequencing, GM ROM, FM coordination, Anxiety, Inappropriate Interaction, Communication, Emotional Expression Activity: 2 person team building a house of cards Downgrade: Build something smaller or less difficult Upgrade: Playing Black Jack Candles wax, dye, scents, mold Deficit: Anxiety Activity: 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 represent anxious 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. Have them relate these feelings to everyday situations in their lives. Cards- Spoons Deficit: Social participation, Anxiety Activity: Card game Spoons directions attached 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 having occupation 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 Participation Activity: 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 the other person/group to guess the scenario. Downgrade: Allow more than 1 person to act out the scenario to minimize all attention being placed on that one person and decrease that persons anxiety.

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CD Deficit: Social, Anxiety Activity: Music will be played and clients will be encouraged to dance. Therapist will also dance and try to engage those with social anxiety. Hopefully not having to speak will lessen their anxiety about this social activity while giving them the chance to interact with other during a fun activity. If everyone is dancing, those with social anxiety will fell less singled out. (Another idea may 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 explain why 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 pictures and 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 center the responses on a particular subject. If you want to prevent the clients from copying each others 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 group discuss. Glue them on the index card and write questions that remind you of what focus you would 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 paper Deficit: Social anxiety Activity: Ask the group to select a beverage that describes them. Give them an example of what you are expecting. They might need a little time to think about it and it might be a good idea to have them write it. (Example: I am like a crown and coke. Strong and to the point but not overpowering. Effervescent, sweet and relaxing. Familiar but not typical with pleasant after 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. Eye-Spy Alphabet Game Deficit: Anxiety, Social Participation Activity: Starting with A and working to Z, take turns picking items around the room or while on a walk outside that. Repeat the letters from before as the game progresses through alphabet to 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 are struggling to participate with just one letter.

38 Group Discussion - Plastic cup, pencil, and several strips of paper. Deficit: Social Participation, Anxiety Activity: 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 scenario aloud and leads a group discussion about different coping strategies that could decrease anxiety in each given scenario. Upgrade: The clients have to pull from the cup and read the scenario aloud. Then, the client has to 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 clients read the scenarios aloud. Then the therapist provides the coping strategies with little input from the clients.

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 the islands and main land. Depending on the group hot lava balls made out of light bean bags can be thrown 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 it and also improve personal space issues. Deficit: Avoidance, Anxiety, Inappropriate Interaction Activity: Group will all be on the same team. No one is allowed to talk but may gesture nonverbally. 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 the group that they live on a small island and the volcano has erupted filling the once lovely ocean into 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 2 wooden 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 compare the amount of time it took to save everyone to the next time. Upgrade: Give some group members disabilities, Lava rocks, more islands between the main land and other obstacles (whirlpool, predators, rock slides etc.) Downgrade: Allow them to talk. Scrabble Slam Cards Deficit: Social participation, Anxiety Activity: Play scrabble slam Downgrade: make each client have to use a certain amount of time so its not as fast paced. Survival Scenario Paper and pencil are needed Deficit: Anxiety Activity: Tell the group that they going to play a game. Ask the group the question: If you were stranded on a desert island, what would be the 12 most useful items needed to survive? Have them write down their answers Upgrade: After they come up with their answers, then rank them in order of importance.

39 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 Anxiety Activity: Each member of the group takes turns choosing a card from the pile of nonfictional famous people that can be dead or alive. It cannot be someone they know personally or a family member. Ex: George Washington, Jude Law, Madonna. The person selecting the card will not see the card but the rest of the group will know who it is. The person will ask yes or no questions to determine who the person is on the card. The Group can only reply with yes or no answers. Therapist will keep track of how many question it took for the person to figure out who the 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 allowed to 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 give explanations, not just yes and no.

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Avoidance / Initiation
Animals- pictures of different animals Deficit: Avoidance Activity: 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 be performed 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. Emotional regulation: this activity requires the client(s) to decide which animal best represents themselves. This involves the client(s) revealing how they perceive themselves to the group. Upgrade: client picks 2 animals. One that represents them the most and one that least represents themselves. Balloon Ball Deficit: Initiation Space ball form a circle; the object is to keep the ball in space and not let it touch the ground; clients should call out the name of the person they are batting the balloon ball to. Downgrade client will make eye contact and bat the ball without calling a name. Upgrade client will call a name and say one positive comment about that person. Balloon Deficit: anxiety, initiation Activity: 1- balloon has different questions on it and the clients throw it back and forth to one another. Whoever catches it must answer the question their thumb lands on or ask it to another client. 2- Balloon could also have clients names on it, and whoever catches it must ask that person a question of his/her own. Upgrade: use a bigger object (ex: beach ball) with more questions or conversational topics on it. Balloon Bop- balloon Deficit: Avoidance Activity: All of the participants stand in a circle. One person begins by tossing a balloon in the air. That person calls another participants name and a body part that the participant will use to hit the balloon and keep 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 calls another participants name and a body part. Upgrade: In addition to saying the persons name and a body part, the participant must also indicate how to hit the balloon, such as Andy. Heel. Soft. Band-Aid Deficit: Social Avoidance Activity: In a group setting, instruct client to place a Band-Aid on the part of their body that hurt the last time they were sad. Have each group member explain where they hurt when they feel sad and why. Discuss as a group the importance of sharing our emotions with one another and not avoiding talking about them. Upgrade: Have client identify another emotion that may have an effect on that part of their body such as anger or anxiety and explain this one to the group as well.

41 Cards Deficit: 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 Paper Deficit: Initiation Activity: 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/pencil Deficit: Communication Activity: All of the participants sit in a circle and write their names on the top of a blank, ruled sheet 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, they will pass the paper to the left and receive a new piece of paper. This will continue until the papers 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 they didnt know or didnt realize they possessed. Downgrade: Simply list a physical or personal characteristic of the person whose name is listed on the sheet of paper, such as tall or funny.

Dots & Boxes- Paper and pencils Deficit: Initiation Activity: Set up a grid of dots on a piece of paper. Take turns drawing lines from dot to dot. The goal is to create a box. Whoever creates a box puts their first initial in the box to claim it. The person with the most boxes at the end wins. Upgrade: Create a larger grid to force more initiation by the client; Have more people play the game which causes more interaction with others. Empty box Deficit: Initiation Activity: Gather the group into a circle. Leader will hold empty box and says "to make this box represent 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 then passes the box on, and the next person completes the sentence. This can be used in a small group 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 or wrong 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 or how I feel when I am happy).

42 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 sexual drive, agitation/irritability, feeling overwhelmed, hopelessness, nervous, lack of confidence). Deficit: Avoidance Activity: Pick a slip of paper from the envelope; discuss with the group about how they feel when experiencing that certain emotion. Brainstorm a good coping mechanism they can use to return 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 needed Deficit: Avoidance Activity: Fear in a Hat Introduce the topic of fear and explain how it is normal and natural at this stage of program that 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, the worst thing that could happen to me 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 read about someone's fear. Each group member reads the fear of another group member and elaborates and what he/she feels that person is most afraid of in this group/situation. No one is to comment 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 this person could do about their fear. Hats Off hat or paper bag Deficit: Initiation Activity: This can be performed in a small group setting. Each member should write a fear he/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 it out loud, and discuss why that person may be afraid of that particular thing. This activity requires clients to interact with one another about topics that may make them feel vulnerable or uncomfortable. This opens communication in the group and promotes discussion and how to understand 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 an object on each page representing different holiday. Ex. Pumpkin, menorah, Christmas tree, Easter basket, Fireworks, American flag (search Google images) Deficit: Social participation initiation Activity: In a group setting, clients will flip through picture book and identify holidays from pictures. The group will discuss how different families celebrate different holidays (not everyone celebrates the same things). Each client will describe their favorite holiday/celebration. Downgrade: Therapist will identify each picture for the group and will prompt the group with questions about eat

43 Inspiration Collage - Magazines, a piece of paper, glue, and scissors are needed Deficit: Initiation Activity: 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 cut and images that they have drawn themselves. Have them paste what represents their personal inspirations on a piece of paper. Downgrade: Instead of presenting in front of the group, have people pair off and discuss their collages. They can take turns choosing an inspiration from their own project to describe to the other group member. 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 the islands and main land. Depending on the group hot lava balls made out of light bean bags can be thrown 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 it and also improve personal space issues. Deficit: Avoidance, Anxiety, Inappropriate Interaction Activity: Group will all be on the same team. No one is allowed to talk but may gesture nonverbally. 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 the group that they live on a small island and the volcano has erupted filling the once lovely ocean into 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 2 wooden 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 compare the amount of time it took to save everyone to the next time. Upgrade: Give some group members disabilities, Lava rocks, more islands between the main land and other obstacles (whirlpool, predators, rock slides etc.) Downgrade: Allow them to talk.

Magazine Stories Magazine Deficit: Initiation Activity: The therapist will hold up a picture from a magazine; this picture can be an ad or a photo, but the picture should be real photograph. Then, each participant must create a story or scenario about the person(s) in the photo. Downgrade: Each participant must simply state an emotion that the person(s) in the photo is feeling.

Mardi Gras Beads Deficit: 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 the group has been focusing on.

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New Orleans Magazine Deficit: Social Initiation Activity: Have clients flip through the New Orleans magazine and select one thing that represents something they love about New Orleans. As a group, have the clients take turns explaining what that thing is and why they love it. Do not force clients to speak in a particular order; 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 clippings Deficit: Initiation, Social Participation Activity: Each client will make a collage from the clippings. Clients will get into groups of 2 and ask 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: Initiation Activity: Origami fold paper to make animal shapes or other items. Decorate with faces or other 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.

Pen Deficit: Avoidance Activity: 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. (Can also just have them write a letter to a friend or family member to have the client simply express to 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; Avoidance Activity: Clients will fill albums with pictures of the people who are most important to them. Client will put each persons name and phone number with his/her picture. Client will make a schedule of when to call each person. Downgrade: Client will email or write a letter to each person, rather than calling. Post-Its Deficit: initiation, communication, interaction Activity: 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 note and find who has its match. Downgrade: play with a smaller number of people like 4-6.

45 Puzzle Deficit: Avoidance and teamwork Activity: Each participant gets a pile of puzzle pieces. Once everyone has received their pile, the participants must work as a team to put the puzzle together. After the puzzle is completed, each member will have to identify one thing that worked with the assembly of the puzzle and one way the whole process could have been improved. Downgrade: Each participant gets a piece to a puzzle (20 pieces or less puzzles work best). Once everyone 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. Sale advertisements - Any store adds from a newspaper. Ex: Target, Best Buy. Deficit: Social participation avoidance, anxiety, inappropriate interaction Activity: Client will flip through store advertisements and plan a pretend shopping trip. Client will answer questions such as, What stores would you go to? What would you buy? Who would 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. Seeds Deficit: Initiation Activity: Terrarium spread a layer of gravel on bottom of jar, add charcoal chips and soil, add seeds to soil, mist regularly. There should be less trowels and packets of seeds than clients so they 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 with planting the garden. Thank you card - a thank you card and a pen Deficit: Social participation Avoidance, Inappropriate Interaction Activity: 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 will practice helping, complimenting, and thank each other in the group. Upgrade: Following previous discussion, clients will think of an important person in their lives that they would like to thank for a particular reason. Client will write a short thank you note to that person. Would you rather - cards with questions written on them Deficit: Initiation Activity: client draws a card from an envelope or bag, and then explains his/her answer. There is no right or wrong answer. Ex. Would you rather be invisible or able to fly? This game can be played in large or small groups as an icebreaker. This activity promotes group discussion and voicing 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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Communication
Alphabet I-Spy Deficit: Communication Activity: Take turns naming different objects in the room. The objects must be named in alphabetical order. Say one item per letter. Upgrade: Take turns naming all the As in the room, then Bs, etc. Downgrade: Dont have the clients name in alphabetical order. All letters still used once. Back to Back Relay Race stopwatch Deficit: Impulse Control, Communication, Teamwork Activity: 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 stand back to back and wrap arms together to hold the position. An obstacle course will be created depending on your client's ability to coordinate. Teams of two will take turns being timed on the course 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. Ball Deficit: Social participation, Communication Activity: Give them a topic and every time they hit the ball, they have to name something from the topic (Ex: breakfast items) and not repeat any. Downgrade: Let them repeat an answer once, twice, etc. Balloon Deficit: Social, Listening Skills Activity: Each client says their name and a fun fact. One person tosses the balloon up and either 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. Balloon Deficit: Communication Activity: Each client says their name and a fun fact. One person tosses the balloon up and either 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 be used, or mound of pillows will substitute just as easily. Deficit: Communication, Teamwork, Impulse Control Activity: Clients are broken up into teams of two, one team member is blind folded and the other 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 personality Activity: 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 who matches the description as the line on their bingo card. Once they have a full card they are to shout bingo! Upgrade: To make it harder when you find a person who fits the description, have that person write their own name on the sheet

Cards Deficit: 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 Blackjack Deficit: Social-Emotional Personal Interaction Communication Activity: Play a game of Blackjack with therapist as dealer. Have client indicate with hand motions 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. Charades Deficit: Communication Activity: Have group identify important skills for communication (body language, listening, etc.) and barriers to communication (hearing, eyesight, anxiety, etc.); use these skills and barriers to play charades. Downgrade: Have skills and barriers listed so clients dont have to think of them. Upgrade: Have clients discuss why each item is a skill or barrier and why.

Collage - Magazines, scissors, glue, and paper Deficit: Emotional Regulation, Communication Activity: Clients will cut out words and pictures that they feel describe who they are as a person and 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: Clients exchange collages and they have to interpret what one anothers images represent. Downgrade: Client makes collage by him/herself and then describes what the images represent to only the therapist.

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Complement Game- Piece of paper and a pen/pencil Deficit: Communication Activity: All of the participants sit in a circle and write their names on the top of a blank, ruled sheet 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, they will pass the paper to the left and receive a new piece of paper. This will continue until the papers 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 they didnt know or didnt realize they possessed. Downgrade: Simply list a physical or personal characteristic of the person whose name is listed on the sheet of paper, such as tall or funny.

Describe yourself as a Beverage - pen and paper Deficit: Emotional Identification, Expression, Impulse Control, Communication. Activity: Ask the group to select a beverage that describes them. Give them an example of what you are expecting. They might need a little time to think about it and it might be a good idea to have them write it. It took me a minute. (Ex: I am like a crown and coke. Strong and to the point but not overpowering. Effervescent, sweet and relaxing. Familiar but not typical with pleasant after 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. Flower Deficit treated: Personal Interaction and Communication Activity: in a group, the clients will practice giving each other appropriate compliments to one another while passing the flower around in a circle. Downgrade: therapist could practice this skill alone with the client first so that the client doesn't feel overwhelmed when doing so during the group.

Inspiration Collage - Magazines, a piece of paper, glue, and scissors are needed Deficit: Communication Activity: 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 cut and images that they have drawn themselves. Have them paste what represents their personal inspirations on a piece of paper. Upgrade: After someone shares their collage, have members of the group go around the circle and ask questions about why a certain image or word was put on their project. The person presenting can explain why the images are an inspiration to them.

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Mardi Gras Beads Deficit: communication, emotional expression Activity: assign each different colored bead an emotional meaning; ask clients to wear their emotions by picking what they are feeling that day. Then discuss why they may be feeling a certain way. Upgrade: give the clients a minimum or maximum number of emotions that they must wear and discuss different days. Masking Tape Deficit: Social, Emotional, Communication Activity: Involve multiple clients participate in a tic-tac-toe game after laying out the grid pattern, have the clients work together to figure out how to set up for the game, and make a rule 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 Communication Activity: Have clients flip through the New Orleans magazine and select one thing that represents something they love about New Orleans. As a group take turns explaining what that thing is and why they love it. Encourage clients to be as detailed as possible in communicating why they love it perhaps linking it with a past memory. Upgrade: Allow other group members to ask questions of the person speaking requiring further communication.

Newspaper Comic Section newspaper comic section Deficit: Emotional regulation Communication, Emotional Identification Activity: Clients will look at the faces and conversations of the characters in the comic strip and discuss 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 what situations make them feel these emotions themselves. News Article Deficit: Communication, anxiety Activity: Clients are provided with an article. They must come up with questions and discuss the article with their peers. Upgrade: Clients find and bring their own story/article to discuss with the group

50 Newspaper Activity - newspaper clippings Deficit: Personal Interaction, Communication Activity: Each client will make a collage from the clippings. Share with the group about what they used and what each item means. Upgrade: Share collages in smaller groups for more individual interaction and longer conversations.

Puzzle Deficit: Communication and persisting when frustrated. Activity: Each participant gets a pile of puzzle pieces. Once everyone has received their pile, the participants must work as a team to put the puzzle together. After the puzzle is completed, each member will have to identify one thing that worked with the assembly of the puzzle and one way the whole process could have been improved. Downgrade: Each participant gets a piece to a puzzle (20 pieces or less puzzles work best). Once everyone 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 taking Activity: Select two people to be robots, depending on groups cognitive ability, two therapists can be the robots. Divide group into two teams which will line up on opposite side of the so they can all see the robots. Select a food item to be created for the group to enjoy (Ex: peanut butter and jelly sandwiches). At the end of the activity, even the losers will enjoy the spoils. Robots cannot 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 instructions to the robot, like pick up jar, put hand on lid, twist lid, etc. Take the lid off the jar is too complex for 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.

Sale advertisements - Any store adds from a newspaper. Ex: Target, Best Buy. Deficit: Emotional regulation impulse control, personal interaction, communication Activity: In a group session, clients will pair up with a friend from the group and together will plan a pretend shopping trip. Clients will together pick one store they would like to go to, and they will each choose one item they would like to buy. Clients will have a group discussion about 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 will share. Clients will have a group discussion about how they compromised to decide on one item to purchase. Clients will discuss how it feels to work together with someone else.

51 Shimmer poms- small pom-poms (different colors) Deficit: Communication Activity: 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 most talented at? green pom = what is your most embarrassing moment?) This activity requires clients to communicate in a group setting. The answers to questions may be funny or interesting, and promote group discussion and interaction with other clients. This activity also requires clients to initiate and answer questions appropriately. For example, clients that perseverate 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: Communication Activity: Tell a story by having one person initiate one opening sentence. This will go on until there 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 and lets the client fill in one word blanks. Survival Scenario Paper and pencil, and chalk/dry erase board are needed Deficit: Communication Activity: Tell the group that they going to play a game. Ask the group the question: If you were stranded on a desert island, what would be the 12 most useful items needed to survive? Have them write down their answers Upgrade: After the patients come up with their answers, have the group share all of their answers and the therapist write them on the board. As a group, they need to discuss the answers and come up with a final list of 12 after discussing options from everyones suggestions.

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, Communication Activity: Each member of the group takes turns choosing a card from the pile of nonfictional famous people that can be dead or alive. It cannot be someone they know personally or a family member. Ex: George Washington, Jude Law, Madonna. The person selecting the card will not see the card but the rest of the group will know who it is. The person will ask yes or no questions to determine who the person is on the card. The Group can only reply with yes or no answers. Therapist will keep track of how many question it took for the person to figure out who the 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 allowed to 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 give explanations, not just yes and no.

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Inappropriate Interaction
Alphabet I-Spy Deficit: Inappropriate Interaction Activity: Take turns naming different objects in the room. The objects must be named in alphabetical order. Say one item per letter. Upgrade: Take turns naming all the As in the room, then Bs, etc. Downgrade: Dont have the clients name objects in alphabetical order. All letters must be used once though.

Bag of Coins - Ziploc bag and various coins Deficit: Social Activity: The therapist can partake in a role-playing activity where the patient acts as a store clerk and the therapist acts as a customer. The patient would have to gather money, give appropriate change back to the therapist, and appropriately communicate with the customer while doing these tasks. This activity would be a great way to prepare the patient for work activities. Downgrade: the therapist could tell the patient how much change to give back, so the patient would 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 Interaction Activity: Inflate one balloon per person and have them keep it up in the air. This gets the group moving and cooperating. Upgrade: Once theyve got the hang of it, you can make this activity harder. Either add in more balloons, tell them they cannot use their hands to keep the balloons 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. Clothes lines are made out of yarn hung across the room, or tied on to a large object. Stair case can be used, or mound of pillows will substitute just as easily. Deficit: Inappropriate Interaction, Communication, Teamwork, Impulse Control Activity: Clients are broken up into teams of two, one team member is blind folded and the other 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.

53 Cards- War Deck of Cards Deficit: Inappropriate interaction Activity: Shuffle and deal all cards. Players put down one card and the player with the highest card 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 two decks of cards to make the activity last longer. Cards-Sevens Deficit: Social Inappropriate Interaction Activity: Playing the card game Sevens in a group. Discuss with the group prior to playing the game about appropriate interactions with one another. For example, discuss rules about not looking at other players cards, respecting other players personal space, and proper communication. Downgrade: Play the card game Sevens with only two people instead of a group so players only have to worry about interacting with one other person. Cards- Pity Pat Deficit: Interaction Activity: Each person is dealt five cards. The deck has one card flipped over next to it. Try to match and then discard pairs by taking turns flipping over one card from the deck. When a pair is made, discard one of the cards from your hand. The discarded card can be used as a match for someone else. Whoever discards all their cards first wins the game. Upgrade: Play the game in teams so partners have to work together to create pairs Downgrade: Create a simple matching game by spreading out all the cards and flipping them over to create matches. Charades Deficit: Inappropriate interaction Activity: Have group identify appropriate interactions (personal space, appropriate comments, etc.) and inappropriate interactions (personal space, intense eye contact, inappropriate comments, etc.); use these interactions to play charades. Downgrade: Have appropriate and inappropriate interactions listed so clients do not have to think of them. Upgrade: Have clients discuss appropriate and inappropriate interactions and why they are appropriate or inappropriate. Collage - Magazines, scissors, glue, and paper Deficit: Social Participation, Social interaction Activity: Therapist places limited number of materials in the center of the table. Since there will not be enough scissors, glue, and magazines for every client they will have to ask to borrow them from one another. The clients will cut out pictures and phrases that they find appealing and glue them to a piece of paper. Upgrade: Increase the number of clients and decreases the number of materials available. This will 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 ask the therapist to borrow materials.

54 Complement Game- Piece of paper and a pen/pencil Deficit: Inappropriate interaction Activity: All of the participants sit in a circle and write their names on the top of a blank, ruled sheet 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, they will pass the paper to the left and receive a new piece of paper. This will continue until the papers 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 they didnt know or didnt realize they possessed. Downgrade: Simply list a physical or personal characteristic of the person whose name is listed on the sheet of paper, such as tall or funny.

Crayons and Paper Deficit: 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, index cards, 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 3 things you are excellent at) Deficit: Social Participation: Turn taking, Inappropriate Interaction, Socially correct decisions. It is 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 from the People Pile and the Destination pile depending on the group you may elect to give them multiple people, or put the group into teams. Taking turns 1st player will select from the Question Pile, and read it out loud, then answer it about them self not showing anyone else their 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 written down then they get an item of clothing for 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 for their destination wins. Make any modifications if necessary to suit the group. Upgrade: Give each player more people to dress and more destinations to for them to go to Downgrade: Play in teams, drop the Question pile and work on just dressing the people for destination as a group.

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Dots & Boxes- Paper and pencils Deficit: Person interaction Activity: Set up a grid of dots on a piece of paper. Take turns drawing lines from dot to dot. The goal is to create a box. Whoever creates a box puts their first initial in the box to claim it. The person with the most boxes at the end wins. Upgrade: Create a larger grid to force more initiation by the client; Have more people play the game which causes more interaction with others. Flower Deficit: Inappropriate Interaction Activity: this activity will be done in a group. The therapist will lead a discussion about appropriate compliments and inappropriate compliments with examples of each. The clients will then practice complimenting one another appropriately while passing the flower to the person whom they have complimented. Downgrade: clients simply give suggestions of appropriate compliments without actually complimenting one another. Grocery Shopping - Bag of flour, sugar, and noodles Deficit: Social Participation- Inappropriate interaction Activity: Each bag will be priced. The client will choose which bag he/she wants to purchase. The client will have to appropriately interact with the clerk (therapist) when she asks How are you? The client will then have to pay the 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 other the shopper. The therapist will provide minimal verbal cues. Downgrade: The shopper will not be required to verbally communicate with the clerk but will have to maintain an appropriate distance from the clerk. Hats Off hat or paper bag Deficit: Inappropriate interaction Activity: This can be performed in a small group setting. Each member should write a fear he/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 it out 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 and understanding 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 ball Deficit: Inappropriate interaction Activity: Sit in a circle and pass the ball along to music. When the music stops, the person with the 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.

56 Mirror Image Deficit: Inappropriate Interaction Activity: Put people into pairs and have them stand face to face. One person makes movements and the other person acts as the mirror image and mimes their movements as if they were a full length mirror Upgrade: Have one person do a movement and the other person mirrors them. Then, have the person who mirrored give immediate verbal feedback about what they movement was representing. 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 will discuss 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 comic strip story about their day and include each group member in the story. Post-its Deficit: Social Participation, Inappropriate interaction- Casual Communication Activity: Therapist writes down the names of group members on a post-it note and sticks it to a wall. Half of the clients the pick names from the wall. The client must then find and introduce him/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 and increase the amount of time they have to talk. Downgrade: Have the clients pick the names of therapists. The therapist will then verbally cue the client throughout the activity to remind them to stand at an appropriate distance or to redirect them to appropriate conversation. Seeds Deficit: Personal interaction Activity: Terrarium spread a layer of gravel on bottom of jar, add charcoal chips and soil, add seeds to soil, mist regularly. There should be less trowels and packets of seeds than clients so they 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 with planting the garden. Shimmer poms- small pom-poms (different colors) Deficit: Inappropriate interaction Activity: 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 most talented at? green pom = what is your most embarrassing moment? This activity requires clients to communicate in a group setting. The answers to questions may be funny or interesting, and promote 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 interaction Activity: This game works best with a larger group of people (10 or more). First, have the participants remove one shoe and place it in a pile in the center of the room. Next, have the participants select a shoe that does not belong to them. Then, the participants need to find the owner of the shoe. Once the owner is found, the participant needs to interview the shoes owner. Once all the shoes' owners have been found, the participants will each share with the group three new facts they gathered from interviewing the shoes owner. Upgrade: Instead of a simple interview, the participants will have a list of 10 deep, insightful questions that they must ask to the shoe owner. After discussing the 10 questions, the participant must share with the group the 3 most interesting responses. The participant must also 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/speed Activity: Create a scoring triangle with tape at the end of a table and tape a starting line at the opposite end. Have the players take turns sliding their caps from behind the starting line. See how far they can slide their cap, and they can even knock their opponents out of the triangle or right 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 Concentration Deficit: Social Emotional Activity: 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 - KEMPS Deficit: Social Participation, Egocentrism Activity: KEMPS First decide who is playing with whom. Then each two player team privately agrees a signal that they can secretly use to tell each other when they have four of a kind. The signal can be a body movement, a gesture or a hand signal, but words are not allowed. The dealer deals four cards to every player. After everyone has looked at their cards, the dealer deals four more cards, one at a time, in a row face up in the middle. When the last card has been turned up, any player can pick up one (or more) of the face up cards from the middle and immediately discard a different card(s) face up in its place. Players do not take turns. A player who picks up more than one card must 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 four face up cards. The dealer then sweeps these four cards away, and deals out four new cards on the 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 to you that he/she has 4 of a kind) Upgrade: Add more players to the game. With more players there will be more stimuli and distractions requiring the players to pay closer attention to their teammates non-verbal cues. Downgrade: Make the players take turns. Taking turns will decrease the external stimuli and the partners can concentrate on just looking for their partners secret sign immediately after their partner takes their turn.

Crayons and Paper Deficit: Social Participation Activity: 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, Glue Deficit: Social Emotional, FM Coordination Activity: finger painting with paint, glue, and glitter have to share what they do. It can be about anything. Upgrade: the initial purpose is for them to interact with others and share. It can be made harder by making them paint something that is important to them, something that burdens them, etc. Newspaper Activity - newspaper clippings Deficit: Social Participation Activity: Each client will make a collage from the clippings. Clients will get into groups of 2 and ask 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 Telling Deficit: Participation and Initiation Activity: Tell a story by having one person initiate one opening sentence. This will go on until there 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 and lets the client fill in one word blanks. Yin Yoga Poses Instruction Sheet Deficit: Social Participation and Interaction Activity: Lead clients through a series of yin yoga postures. Instruct clients to take notice when they are feeling uncomfortable or overwhelmed in a posture and teach them breathing techniques to get through it. Have the clients partner off and explain to one another what poses made them feel uncomfortable or overwhelmed and how they managed to get through them. Upgrade: Have the clients explain a real life situation that made them uncomfortable or overwhelmed and how they go through it.