Intervention Visits, IFSP Development, Practical Strategies

Put Away the 1 inch Cubes!

One inch cubes…the staple of every assessment kit in early intervention. What is so important about stacking 1 inch cubes?? Is it really important that a toddler is able to stack a tower of these tiny blocks?? Should you actually teach a child to do this? My answer to this last question is NO. Here’s why.

Stacking 1 in cubes is a test item on cognitive and fine motor assessments because of what it tells us about a child’s abilities. If a child can stack a tower of cubes, he has the abilities to manipulate the small cubes with his little fat fingers and palm which is not an easy task. He can use his eye-hand coordination to pick up the cubes and keep them in his grasp. He can then motor plan how to combine cubes in a vertical plane, placing them on top of each other so that they remain balanced in place. He is able to follow the direction and pay attention long enough to complete the task. He may have held a cube in each hand at the same time, transferred a cube from one hand to the other. Stacking cubes is an activity we use to help a child demonstrate these abilities that I’ve just mentioned (and there are probably more). It’s not an extremely important developmental task unto itself. So why do IFSPs still have goals about “stacking a 5 block tower?”

It’s easy to misinterpret the importance of items on a test. Early interventionists must learn to separate out the underlying developmental abilities from the test item because when a child misses a test item, we need to figure out why, what skills and abilities does the child not have yet? If he could not stack the blocks, maybe he isn’t attending long enough? Maybe he knows what to do but can’t motor plan how to do it? Maybe he’s struggling with spatial tasks? Maybe his grasp is immature? Maybe he wasn’t sitting in a stable enough position to coordinate such a fine motor activity? We then want to think about how problems with these abilities impacts his daily life and find ways to help him address these issues – rather than having him practice stacking 1-in cubes.

It’s very likely that you will support a toddler who has trouble with stacking blocks. Here are a few strategies for working on stacking, grasping, eye-hand coordination, etc. that might help – without the assistance of 1 inch cubes:

Stable Positioning

Be sure the child is sitting in a stable position with trunk control so that he can use his hands for play, particularly if there are concerns with his muscle tone. Encourage him to sit on his bottom rather than in squatting. Have him try sitting in a high chair to play.

Grasping Practice

Throughout the day, the parent could make items of different sizes available for the child to grasp and move. Have the child help clean up his left over food after snack by putting it in a bowl. Offer snacks of different (safe) sizes to practice grasping. Clean up small and large toys at the end of the day. Help the child turn pages in a book. Help him manipulate the small doors, buttons, and switches on interactive toys.

Work Backwards to Teach Eye-Hand Coordination

Help the child be successful at activities that require him to motor plan and use his eye-hand coordination. If he likes the many toys that have balls or shapes to fit in holes, put the item barely in the hole and let him push it the rest of the way in. Once he can do this, put the item near the hole and help him fit it in. Work backwards to teach him how to do the steps involved in putting fitting the shapes in the hole (or mail in the plastic mail slot, car in the garage, etc).

Stacking and Building Games

Stacking games can be fun but they don’t have to be done with 1 inch cubes. Encourage the parent to let the child play in the cabinet stacking veggie cans, pudding boxes, cups, etc.  Give stacking a purpose such as building a bridge for his cars to go under (or crash into – way more fun). Some children never stack cubes and develop to be just fine. For others, it can be an important sign of other concerns that can be addressed through naturalistic intervention.

I hope this post helps you think about the link between assessment items, IFSP goals, and intervention activities. When considering assessment results and writing IFSP goals with families, think about what a missed skill tells you about the child’s development. Break that skill down into its parts and think broadly. Target the underlying skills and abilities the child needs to learn. Develop strategies with the family that address these learning needs using different, interesting materials in lots of different ways. Use the 1 inch cubes for the assessment then put them back in the bag!

What are your thoughts on stacking blocks and development? How do you use information from the assessment to inform intervention?

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17 Comments to “Put Away the 1 inch Cubes!”

  1. I nearly had this same conversation with a family yesterday, as they thought they had to “teach” this child how to build a block tower. Although we do measure if he is able to do this on our standardized test, we were explaining (the OT and myself as SC) that he needs to get to many smaller steps that INVOLVE the process of stacking blocks versus just practicing the actual stacking. They don’t seem to understand that. I might take out this article! Sometimes things go better in paper versus explanations as they can read and let it “sink in” at their leisure.
    PS, love the blog, it gets me thinking!

    • What great timing! 🙂 I’m glad to hear that you were having this conversation because it really is an important distinction for practitioners AND parents to understand. I think parents want their children to “pass the test” and it sounds like the family you support is trying very hard to help their child. I hope the “paper” version helps them!

      And thanks for the positive feedback, Lauren! I love it that the blog gets you thinking!

  2. This is a good reminder not to take individual test items too seriously. Test scores are the SUMMATION of test items. Only those summated scores have validity and reliability. The individual items don’t. Actually, the items are important for those scores. If you forget to administer an item, for example, your test score is compromised. If the child fails the item, however, the score is still (relatively) good. That’s the other thing. Tests for children under 3 are not that accurate, which makes any one item even less important. Programming from test items is indeed a bad practice. Thank you for this reminder.

    • Well said! Each test item is just part of the big picture. Understanding the purpose of each test item and what it shows us about development was a big ah-ha moment for me as a new interventionist. It was easy to use the actual test items as a guide for goals and intervention, which, as you said, is not good practice. Thank you for taking this further and explaining the test items in the context of the assessment itself.

  3. This made me think of a similar experience. “Back in the day” when we still took toy bags to family homes, one of my staff members informed me that she had been taking a shape sorter (the same one) to a family’s home each week for several months. The early interventionist was DELIGHTED that the child had finally managed to get the square into the sorter. I asked her to take a different shape sorter out on the next visit. Alas, the child had no clue how to get THAT square into THAT sorter. We needed to have a lengthy discussion about “teaching to the test” and what the underlying skill really was.

    • Yes, teaching to the test or “to the toy” is not really learning. I’ve seen this same thing happen with a pegboard, puzzles and even books, when the interventionist works in the same book week after week and the child can point to pics only in that one book. We know “real” learning is happening when skills transfer to other situations, people, places, etc!

  4. Great article! In a training on meaningful assessment, I’ve had participants do an activity where they break down a test item into it’s underlying functional skills as you’ve done here – and then challenge them to think of when during the day would a child need to use those skills. Children who can put a ring on the ring stack might use those same skills to hang their bag up on a hook by their cubby at daycare. Sometimes it helps parents when we think of when we use some of those same skills with fancy sounding jargon – like using pronation and supination of the wrist while flipping pancakes or stereognosis is the silly sounding word for my ability to reach into my black hole of a purse without looking and find my car keys! Thinking about underlying skills and functional use during daily routines can help all of us focus much less on those one inch cubes!!

    • I love your training idea, Amy! You’re right, thinking about how the underlying skills are learned in everyday activities really does help link the assessment to real life. And whoa…stereognosis…what a whopper of a term! I love your explanation. Makes me wonder why anyone ever “invented” that big term in the first place when it can be explained so simply as you did! 🙂

  5. I second this regarding a child being able to pull a toy behind them while walking. Important to gauge balance and ability etc, but not important as a skill to teach.

    • Yes, that’s a great example, Sarah! It’s a skill that has multiple purposes during assessment but is not a critical/functional skills that needs to be reflected in IFSP outcomes or specifically taught.

  6. I am the mother of a 27-year-old who has autism, cortical vision impairment, and development delays. As I was researching for a blog post I was writing, I came across this blog post about 1-inch cubes.

    The content of your post is very meaningful. Long ago, I was one of those parents who misunderstood and thought the assessment was unfair because my daughter hadn’t had an opportunity to learn how to manipulate the blocks. I love the comparison that is made to teaching the test. One thing I struggled with then, and now to some degree, is the vision factor. Is the same assessment made regardless of vision impairment? Or, would it potentially be a developmental delay even if the only reason a skill couldn’t be performed was lack of exposure due to vision?

    • Great question, Natali. No, a child’s performance on a skill like this should not be scored as showing a delay if the only reason the child is unable to complete the activity is due to a visual impairment. What should happen is that the assessment team should use a test that is appropriate for a child with a visual impairment, so items like stacking blocks, that are highly visual, would not be part of the assessment. There are tools that we can use that are either intended for children with visual impairments or that have guidance about how to adapt items so that they are more meaningful. When a child has a visual impairment, the assessor should try to determine if the child’s impairment is hindering her ability to perform the task, or if the child has an underlying cognitive delay which affects her abilities. It really does take good clinical judgment to determine the difference. I hope this helps answer your question.

      I’m glad you found our blog! Your insights are very welcome so thanks for posting. I hope your daughter is doing well!

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