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Occupational Therapy for Kids Living Internationally

By Aya Ninomiya

If your child seems to have physical, social, or emotional barriers to normal play or learning, you may need the help of an occupational therapist (OT). While most children develop naturally in areas like muscle control, balance, focus, social skills, organization, and thinking processes, some children need extra support in these areas. Pediatric occupational therapists are medical professionals that help children get their body, mind, and environment ready for everyday activities they need to accomplish. 

An OT can help your child:

  • become more comfortable with transitions and new situations.
  • experience fewer emotional episodes that interfere with school or play.
  • enhance body coordination and fine motor skills to improve handwriting, eating with utensils, or typing.
  • increase their ability to stay focused or organized.
  • follow a thinking process or remember steps. 
  • make and keep friendships and decrease social anxiety.
  • decrease unusual sensitivity to sounds or touch.  
  • catch up developmentally in basic life and self-help skills.

Occupational therapists most commonly work with kids experiencing difficulties due to autism spectrum disorder, attention deficit disorders, cerebral palsy, anxiety, and developmental delays. So your child may be evaluated by an occupational therapist as part of a group of assessments to identify these kinds of special needs. Read more about this at World Family Education’s page Special Assessments for Kids Living Internationally

What to Expect from an Occupational Therapist

The occupational therapy process begins with a referral from a parent or teacher in which a concern is outlined and information on the child’s development and educational history is gathered from parents and teachers. The OT will then schedule an interview and/or observation with the child to begin the assessment which includes standardized methods and tools. OTs are trained to look for patterns and hidden cues that could be easily overlooked.

The occupational therapist will work with parents and teachers to develop goals and make a plan to meet them. The OT designs engaging and meaningful real-life activities that promote improvement in a combination of skills related to sensory, communication, visual, movement, and social development. This is why therapy sessions with children often look like play for increased engagement and high retention.


  • Child is blindfolded and asked to identify characteristics of a mystery object, then identify it (improves sensory processing, focus, attention, and impulsivity).
  • Child practices buttoning various clothing items (improves fine motor skills, vision and perception, independence in self-care, executive functioning, and confidence). 
  • Child and adult roleplay various social interactions (strengthens communication, relationship building, problem solving, resilience for unexpected, and social confidence).
  • Child and peer suggest and practice self-regulation techniques for picture book characters in distress (strengthens emotional identification, self-regulation, self-esteem, social skills, and problem-solving skills).
  • Child attends and participates in a morning movement group at the beginning of the school day (improves focus, attention, body coordination, sensory processing, and learning capacity).

If occupational therapy is done in a clinic or hospital setting, the OT may be the primary person to do therapy activities. If the therapy is school or home based, parents, teachers or other professionals may be trained to do some of the therapy activities. This helps keep the activities in natural contexts and is more meaningful to the child. 

The occupational therapy will regularly measure and review the child’s progress and make adjustments to the goals and strategies. When the child meets all goals, therapy can be discontinued. 

Occupational therapy differs from physical therapy which typically addresses a medical condition and focuses on building strength and endurance, managing pain, increasing range of motion in joints and developing large muscle movements. 

Accessing Occupational Therapy Internationally

Occupational therapy can take place in hospitals, rehabilitation centers, and clinics. But increasingly, children are more effectively learning skills and practicing strategies in their natural environments where they spend their days — home, school, and community. This context allows the OT to directly identify needs, risks, and barriers that children experience, and develop a realistic plan of therapy. 

Occupational therapy is different in every country. There are different training expectations and registration requirements for countries where OT is recognized.

An OT practitioner should have current registration with a recognized board of practitioners. While engaging with the globally mobile community, a qualified OT should be transparent about their registration, licensing, and training history. Professional associations make sure registered members continue to educate themselves in best practices and current evidence. 

There is no complete international listing of occupational therapists, so you will need to look locally to find therapists near you. International schools in your area should be able to give some recommendations. You can also check with your company and with local parent groups for recommendations. World Family Education also works to collect information on services such as occupational therapy, so you can check our page Special Needs Resources by Location.  

Many medical insurance plans do not cover occupational therapy services, especially outside of one’s home country. Therefore, OT fees are often paid out of pocket. However, there may be financial aid available to you through your company or even your embassy. Some private-practice OTs offer a sliding scale (lower fee) or pro bono (no fee) services which you may qualify for. 

With the use of technology, families living in remote areas can access occupational therapy without needing to travel far or minimizing consistency. In collaboration with on-site caregivers, OTs can observe the child in their most comfortable state without a stranger in the room and provide guidance for improving support. 

Here are some things for parents to consider in a cross-cultural situation:

  • What language should sessions be conducted in? Home language? School language?
  • Do you have access to specialized equipment and materials in the resident country? How can you access this?
  • For teletherapy, do you have a stable internet connection and reliable computer setup? 
  • How can you prioritize and make OT sessions fit best into the child and family’s schedule?
  • How much parent and teacher involvement is realistically possible? Is one parent responsible? Could both parents make it to meetings?

If you are struggling to keep up with the needs of your child or if you’re feeling alone while parenting and feel stuck, please reach out to a health professional. Even if your initial contact is not a good match, a responsible professional will refer you to the person that can best support you, your child, and your family. 

Aya Ninomiya is an occupational therapy consultant with a TCK background. She supports globally mobile kids with special needs and their families as they settle into their new location. Her services are offered in English and Japanese.

You can find her at


American Occupational Therapy Association — Learn About OT For Children & Youth

What can an occupational therapy consultant do for your child?

World Federation of Occupational Therapy