Activities for cognitive development
Activities for cognitive development refer to our ability to think, learn, and problem-solve during daily tasks. Development of these skills are foundational for helping children build their understanding of the world and prepare them for older stages in life.
Cognitive limitations, if left untreated, can lead to increasing difficulty as individuals age, jeopardizing long-term outcomes and well-being with a potential for increased risk of falls or adverse effects from situations such as confusing a sequence during cooking or medication management. Early identification of cognitive limitations is crucial in assisting caregivers with implementing appropriate modifications, activities, and supports to promote optimal participation in daily activities.
Occupational therapists elevate the significance of these skills by using validated assessments, occupational profiles, and a top-down approach to provide effective treatments supporting cognitive development across the lifespan. This article will discuss activities for cognitive development to promote skills development across the lifespan.
Infant and toddler activities for cognitive development
Infants: Infants learn by exploring their bodies, what their bodies can do, and the sensations experienced. Activities for cognitive development include encouraging looking at toys, listening to sounds, and bringing hands to their face. Children rapidly develop as they engage in these activities for cognitive development, with exercises increasing in complexity each month as they build an understanding of their daily routines.
2-6 months: Infants rely on their primary senses to learn about their bodies and the world. Babies in this age range will start to watch and visually follow the movement of their caregivers, look at an item of interest for several seconds, respond with an action such as opening their mouth for food, and begin looking at their hands with interest.
Beneficial activities for cognitive development will incorporate high-contrast, visually stimulating items for the child to explore, visually track, and bring their hands to midline for view. Encourage the child to visually track an item of interest using their full range of head control, looking up, down, left, and right.
Babies begin to reach with intent, grasp items and bring objects to their mouth, exploring items with different textures or smells. Auditory activities for cognitive development during these months include simulating using sounds or calling their name to encourage the child to look at the source of the sound of their name.
7-12 months: Babies in this age range, start demonstrating an understanding of object permanence and looking for objects placed out of sight. Children can combine items like placing blocks in a container or banging toys to make a noise. Encourage Infants to imitate simple gestures such as waving hello and bye-bye to stimulate imitation and engagement.
Stimulate sensory systems by allowing play with different textures, sounds, and colorful, high-contrast items. Around 12 months, children start to understand the functional purpose of items and goal-directed behavior. Beneficial activities for cognitive development may encourage using a spoon to eat or activating a switch on a toy.
Children will benefit from Peek-A-Boo games, hiding a toy under a blanket, or games for the child to look for a toy or sound, which also stimulates self-regulation and the concept of object permanence. Children at this stage are ready for a simple shape or peg puzzles to utilize skills of combining objects and adding an element to match simple shapes or pictures when arranging a puzzle.
18 months - 2 years: Children can combine a sequence of actions, for example, placing their favorite toy in a toy truck to push during play. Children start engaging in bimanual activities for cognitive development by opening containers, playing with switches and knobs, and playing with more than one toy at a time.
Children demonstrate independent functional use of items as required for using a cup and turning pages in a book. Functional use of items and combining sequences of actions demonstrate increasing memory and attention to engage in more complex activities.
Support development for this stage by attending to the child's play interests with a toy or item holding their attention, allowing the toddler to determine how to play with a toy, explore toy uses, and decide how long to play. Nursery rhymes that combine gestures with the song stimulate working memory and self-regulation while we wait for familiar gestures.
Preschool and early elementary activities for cognitive development
Activities for cognitive development to stimulate this stage include storytelling and asking questions about characters of “why, how, who, and where” to support the development of more complex story plots. Depending on the child’s interest, this can be achieved using plush animals or toys.
Asking questions encourages the child to retrieve, remember and manipulate information in their mind. Other activities include role-playing, encouraging the child to narrate their play to describe actions and feelings.
Organized physical activities for cognitive development such as martial arts, gymnastics, swimming, and navigating an obstacle course, stimulate emerging physical skills while requiring attention, memory, concentration, and planning. Matching and sorting games stimulate awareness of size, shape, or color, and the use of peg or simple shape puzzles stimulates visual motor skills, size discrimination, spatial awareness, and problem-solving to complete puzzles.
When children begin preschool, they start to engage in symbolic play, representing real-life experiences as they start to demonstrate abstract thinking and mental flexibility. By playing pretend, children demonstrate an increasing ability to plan and organize more complex scenarios.
Instead of only determining how long to play, now they can think about who and what is needed for a desired activity. Play becomes more elaborate as they can remember more and organize information that they can describe to others. Higher-level cognitive skills grow at a fast pace as the child nears elementary age. Modifications to these activities for cognitive development include the adult leading the activity and providing additional structural support with the use of visuals or focusing on one element of the activity at a time.
Late elementary and middle school activities for cognitive development
Activities for cognitive development to support this stage include discussing scenarios for reflection and potential consequences that can influence discussion-making. Practice hypothetical situations by asking “what if” or walking through a plan when preparing to do an activity or chore.
Adolescents face increasing responsibility, benefiting from activities to encourage organization, prioritization, and practice setting goals for action to promote participation and completion of tasks.
Reflective activities help guide adolescents to comprehend the consequences of behavior and can support functional behaviors for participation. Organization strategies include arranging school assignments into a calendar and planning how to prepare for an upcoming test.
Adolescents can create plans, become aware of time, reflect on past events, and understand that situations change over time. Thinking becomes more flexible and abstract to complement increasing reasoning skills.
Abstract thinking enables adolescents to conceptualize different solutions to the same problem, preparing them for more complex problem-solving. Adolescents are developmentally ready for sophisticated problem-solving with decreasing reliance on concrete examples, preparing them to achieve independent thought and action.
Modifications to support the development of these skills include breaking down tasks into smaller actions, helping plan how to complete each step and setting goals for how to navigate through multi-step, time-constrained, or future tasks.
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High school and adult activities for cognitive development
Activities to support the consolidation of cognitive skills for independence include tasks like navigating public transportation using a variety of contexts (map, internet, directory), making an order for online shopping, or planning a weekend.
Beneficial activities for cognitive development use goal setting, list creation, and prioritizing to stimulate cognitive skills. Teenagers become more aware of their decision-making abilities as they prepare for adulthood. Cognitive skills leading up to this stage are consolidated and used simultaneously during daily participation.
If a cognitive impairment exists, teenagers and adults may feel typical school and work environments are overwhelming and will benefit from a plan or system they can apply to promote participation in meaningful activities.
If a moderate to severe difference is present, activities for cognitive development to promote planning a single task incorporates structural supports such as a daily calendar, and auditory cues (phone alarms) for time management to support participation. Modifications to these activities include looking at how environmental supports are used to explore effective strategies for reading a schedule or map or if sensory supports are needed to help regulate overwhelming experiences.
Adapting activities for cognitive development for special populations
Activities for cognitive development for individuals who need adaptive strategies will benefit from using a client-centered approach and modifications to the environment or the activity. Evidence-supported strategies will guide effective decision-making when planning cognitive interventions by utilizing strategy training, problem-solving and task habit training.
Significant cognitive intervention programs supported in the literature include The Cognitive Orientation to daily Occupational Performance (CO-OP) Approach that uses a Goal-Plan-Do-Check (GDPC) strategy to help clients with problem-solving, The Neurofunctional Approach (NFA) which uses task habit training for individuals who have significant cognitive impairment, and The Multi-context Approach that is a strategy-based approach to guide a client into using strategies in various environments and contexts.
These strategies emphasize collaboration with the client and their family to create client-centered goals and promote the repetitive practice of cognitive strategies to enhance participation.
More impaired cognition may require increased structure, use of visual or auditory cueing, and concrete definition of steps in a sequenced activity. Sensory modifications include adjusting noise level, lighting, temperature and accommodating for how busy the environment is to support optimal self-regulation.
Please review professional resources for more information to include sensory strategies or details about cognitive programs in your interventions.
Billing for activities for cognitive development
Current evidence recognizes that occupational therapists cannot determine mild cognitive impairments using observation alone. The Choosing Wisely Campaign along with the American Occupational Therapy Association, recommend that occupational therapists providing cognitive interventions should do so with a direct application to occupational performance. This recommendation emphasizes the focus on occupational performance and that tabletop, paper and pencil tasks need to be paired with a functional activity.
Common mistakes include not documenting a clear link for how interventions directly relate to best practice recommendations and how interventions improve occupational performance. Therapists can bill these activities under the timed cognitive intervention G0515 as this is the current code recognized by Medicare Part C.
Use due diligence and check with your insurance plans to ensure G0515 is the preferred code for cognitive interventions.
Self-Care/Home Management 97535 can also include the performance of tasks that include cognitive strategies discussed above to complete home management tasks.
CPT Code 97127, the older, untimed code for cognitive intervention has been deleted as of January 1, 2020, and should not be used. Professional organizations recommend contacting insurance plans to verify which codes are preferred if there is doubt.
Conclusion
Stages in our cognitive development prime the foundation for increasing demands in roles and expectations as we age. Cognitive skills intertwine with the development of other skills including social-emotional, motor, play, psycho-social, and more which further support the importance of addressing cognitive deficits as soon as a delay is recognized.
Refer to your professional organizations for more information and guidance on using best practice strategies to boost your outcomes for cognitive interventions.
As we age, our cognitive health is used as an indicator of our overall brain health and directly influences health outcomes as older adults. Occupational therapists are well-trained to assess and provide effective recommendations supporting cognitive health across the lifespan using elements listed above.
Occupational therapists as well as other professionals working with cognitive deficits also emphasize the importance of client-centered approaches, a top-down approach and respect to how task demands interrelate.
Recommendations for further reading and review of current research include:
- The American Occupational Therapy Association (AOTA)
- The Cochrane Library
- The Choosing Wisely Campaign, an initiative of The American Board of Internal Medicine
- Harvard University's Center for the Developing Child for more information on cognitive development and related research
Resources
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More resources
- The New Sensory Processing Measure 2 (SPM-2)
- Berg Balance Scale
- Beery VMI
- Therapy private practice courses
- Ultimate teletherapy ebook
- The Ultimate Insurance Billing Guide for Therapists
- The Ultimate Guide to Starting a Private Therapy Practice
