Established care
Occupational therapy
Daily living skills, self-care, school participation, adaptive equipment
The discipline that works on what the child actually does all day — dressing, eating, writing, playing, getting through a school morning.
Either a medicines regulator has licensed it for this use, or clinical practice guidelines recommend it on the strength of controlled trials. This is the standard everything else on the scale is measured against — and for most children, the treatments at this level are the ones that will actually change their day.
Where it stands, condition by condition
The same therapy can be well supported for one problem and completely untested for another. This is the single most common place families are misled.
| Condition | Evidence | What that means here |
|---|---|---|
| Cerebral palsy and motor disability | Established care | Goal-directed occupational therapy is guideline-supported. |
| Autism — daily function and participation | Established care | Supported where goals are functional. Sensory-integration approaches as a treatment for core autism features are a separate and weaker claim. |
| Developmental coordination difficulties | Established care | Task-oriented approaches have good support. |
What it is
Occupational therapy targets participation: self-care, school tasks, play and, later, independence. It works through adapting the task, adapting the environment and teaching the skill.
A large and underrated part of it is equipment and environment — seating, cutlery, writing tools, bathroom adaptations, classroom set-up. These often change a child's day more than an extra therapy hour.
Like physiotherapy, the effective version is goal-directed and task-specific.
How it is meant to work
Two routes: the child gets better at the task, or the task gets easier. Good practice uses both, and does not treat adaptation as giving up.
Independence in self-care is also a wellbeing intervention. A twelve-year-old who can dress themselves has gained something no motor score captures.
What has actually been tested
- Task-oriented, goal-directed approaches have the strongest support — the same principle as elsewhere in rehabilitation.
- Equipment and environmental adaptation have a solid practical evidence base for participation outcomes.
- Sensory integration therapy is a separate question. Used to support participation and regulation in a specific child it is reasonable; promoted as a treatment that improves core autism features or academic skills, it outruns the evidence. The two claims are often blurred.
What we still do not know
- Optimal intensity, as everywhere in this field.
- How well clinic-room gains transfer to home and school without direct work in those settings.
Risks and costs
- Low physical risk. The risks are time, cost and equipment that is bought and then not used.
- Programmes drifting into generic activities with no measurable goal.
Questions to ask before you agree
A centre that is doing good work will welcome these questions and answer them in writing.
- What are the functional goals, and are they written in everyday language?
- Will you see my child at school or at home, not only in the clinic?
- What equipment would help now, and who funds it?
More in this section
Early detection and early intervention
The single highest-value thing in this whole field, and the one least often discussed in clinics selling treatment. Cerebral palsy can be identified in the first months of life, and that is when therapy does the most.
Established careGoal-directed, task-specific training
Not a brand of therapy but the principle underneath the ones that work: the child practises the actual task they are trying to learn, with enough repetition to matter.
Established careConstraint-induced therapy and bimanual training
For a child who uses one hand much more than the other, these are among the best-evidenced interventions in paediatric neurology — and both work, for different things.
Established carePhysiotherapy and strength training
Well supported when it is built around function and genuinely loaded — much weaker when it is passive stretching and generic exercise.
Established careSpeech, language and communication
For a child who cannot speak clearly, giving them a way to communicate is among the most consequential interventions available — and the fear that it will stop them talking is unfounded.
Established careSpasticity and tone management
Medical and surgical treatment of tone, which works best when it is tied to a functional goal rather than to a number on a tone scale.
In clinical trialsTechnology-assisted rehabilitation
Useful mainly as a way of delivering more practice, not as a treatment in its own right — and that distinction decides whether it is worth the money.
In clinical trialsNamed physiotherapy approaches
Families are usually asked to choose between brands. The evidence says the brand matters far less than whether the session is active, goal-directed and repeated often enough.
In clinical trialsSensory therapies
Two things are sold under one word. Manualised Ayres Sensory Integration has been tested in trials; the sensory add-ons sold around it mostly have not.
Established careVision and cerebral visual impairment
The most commonly missed problem in children with brain injury. A child who cannot interpret what they see is often described as inattentive, uncooperative or more delayed than they are.