A child with Down syndrome is having difficulty developing s…

A child with Down syndrome is having difficulty developing skilled hand use for dressing and eating with utensils.  The child can use a gross palmar grasp for chopped finger foods but struggles to use a cylindrical/fisted grasp to hold a standard adult spoon and to scoop chopped food with spoon.  He has a tantrum when his mother tries to make him use utensils at mealtime. The COTA appropriately grades the activity down by (choose 3)