What is the role of the occupational therapist in the assessment and treatment of children with special needs?

by Joanna Buttfield, Occupational Therapist, Kidsense, Unley

The overall goal of occupational therapy (OT) is to ensure that children have age appropriate levels of skill in all areas of life, including self care skills, social skills, academic performance, leisure and self-management. The underlying skills that support these are fine and gross motor skills, sensory processing that influences attention, and learning and cognitive skills.

To achieve this, occupational therapy considers the ‘big picture’ and the ‘small picture’ in which children live. Occupational therapists do not focus purely on a child’s academic abilities (such as handwriting), but on their ability to manage wider life skills including getting themselves ready for school, social interaction during school, self-management skills including organisation and time management (including planning homework and project completion), participating appropriately in after-school sports, managing family chores and getting to sleep appropriately at night. Where issues occur in one area (such as school), it is not uncommon for them to occur in other areas also.

The role of occupational therapy in assessment

The key role of the occupational therapist is to determine physical (muscle), sensory, psycho-social and, to a lesser extent, specific cognitive issues contributing to educational as well as wider life challenges, including play and social skills, self care and self management.

Assessment is conducted via standardised tests, that compare the child's performance to that of others of the same age, and clinical observation of the way in which tasks are performed, namely, tabletop (fine motor) activities and gross motor (whole body) activities to observe the underlying skill requirements. Parent and teacher report and clinical observation of sensory reactions to the environment, self care skills, play skills and social skills are also taken into consideration.

Areas of investigation

Assessment typically investigates:

  • Fine motor skills (including handwriting or age appropriate pencil skills, cutting, puzzle completion, construction)
  • Gross motor skills (including balance, endurance, posture at the table or on the mat)
  • Self organisation (including planning and sequencing task completion, task materials necessary, personal material management including hats, lunchbox, jumper)
  • Self care skills including toileting, eating, getting ready for school
  • Attention and concentration (where this is due to ineffective processing of sensory information in the environment around them)

In the course of assessment, occupational therapists may refer children to other professionals to focus on other specific areas of need. Commonly involved professional referrals include Physiotherapy, Speech Pathology, Psychology, Audiology, and Paediatrics.


For many children, assessment is merely the beginning of the journey to identify the areas that need further assistance. Subsequent treatment is often required to address the issues detected during the assessment. Treatment is likely to involve the child, their parent and classroom/kindergarten teacher.

Students commonly requiring occupational therapy

Occupational therapists are not typically directly involved in the diagnosis of special needs, but are integral team members in the investigation of such issues, referral to appropriate assessing professionals, and in the on-going treatment and management of children with identified additional needs. Common developmental diagnoses addressed by occupational therapist include:

  • Autism Spectrum disorders (Autism and Asperger Syndrome)
  • Attention Deficit/Hyperactivity Disorders
  • Global Developmental Delay
  • Dyspraxia / Developmental Co-ordination Disorder
  • Specific Learning Difficulties

It is also common for occupational therapists to work with children with emotional, behavioural, communication and intellectual needs.

Accessing services

Occupational therapists are typically located within public hospitals, community health care centres, and private practices. To access services in public hospitals, referral by a GP or paediatrician is required. A referral is not usually needed to access the services of an occupational therapist in private practice.


A comprehensive occupational therapy assessment varies in duration according to the issues of concern, from 1½ hours to three hours. The cost varies according to time taken and the degree of reporting required. When seeking private occupational therapy assessment, varying levels of rebate are available for assessment and treatment. Some Medicare programs will assist with partial subsidy of subsequent treatments. There is no charge in community health centres or public hospitals.

Click on the links below to see the roles of other specialists
Speech Pathologist
Class Teacher
Occupational Therapist
Educational Psychologist

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