Paediatric Occupational Therapy and the NDIS: A Guide for Families

Paediatric occupational therapy (NDIS) helps children take part in the everyday activities that matter to them. For a child, those “occupations” can include getting dressed, playing, using classroom materials, joining family routines, organising belongings, participating at kinder or school, and managing everyday tasks in ways that work for them.

Under the NDIS, occupational therapy may be funded when it is an appropriate disability-related therapy support that helps a child build or maintain functional skills and participation. But paediatric OT is not automatically NDIS-funded, and a child does not necessarily need an NDIS plan before a family can seek professional advice about developmental or participation concerns.

There is also an important change underway. Thriving Kids began rolling out in October 2026 for children aged 8 and under with developmental delay and/or autism with low to moderate support needs. However, current NDIS access arrangements continue until 1 January 2028. Families with existing NDIS plans should continue using the supports in those plans unless their circumstances or plan change through the usual processes.

This guide explains what paediatric occupational therapy involves, when an OT may be useful, what assessment and therapy can look like, how current NDIS and early childhood pathways work, what Thriving Kids means in Victoria, and what to consider when choosing an OT for your child.

What is paediatric occupational therapy?

Paediatric occupational therapy focuses on helping children participate in meaningful everyday activities.

An Occupational Therapist, or OT, looks at the relationship between three things:

• the child and their strengths, needs and preferences
• the activity they are trying to do
• the environment in which the activity happens

That matters because the solution is not always to “teach the child a skill”. Sometimes the most useful approach is changing the task, adjusting the environment, providing suitable equipment, changing how an adult supports the activity, or finding another way for the child to participate.

Good paediatric OT should therefore begin with a real-life question such as “What does this child want or need to be able to do more comfortably, independently or successfully?” rather than trying to make a child fit a predetermined developmental programme.

What can a paediatric Occupational Therapist help with?

The exact scope depends on the OT’s experience and the child’s individual circumstances, but paediatric occupational therapy may address areas such as:

• dressing, buttons, zips and other self-care routines
• participation in toileting routines within appropriate professional scope
• mealtime participation and practical adaptations
• play and age-appropriate leisure activities
• drawing, handwriting and other fine-motor tasks where relevant
• organisation and planning for everyday activities
• participating in kinder or school routines
• moving between activities and managing transitions
• environmental barriers affecting participation
• sensory preferences and environmental adjustments
• functional movement, positioning or coordination within OT scope
• practical strategies for families and educators
• assistive technology or task modifications where appropriate

Not every child who finds one of these activities difficult needs therapy. The question is whether the difficulty is meaningfully affecting participation and whether an OT’s particular expertise is relevant.

When might a family consider paediatric OT?

You do not need to diagnose the problem yourself before asking for advice.

A family might speak with an OT when a child is finding an everyday activity difficult, uncomfortable or inaccessible. For example:

• getting dressed is consistently difficult because of the physical demands of clothing fasteners
• the child has trouble organising the steps involved in a morning routine
• the physical demands of handwriting make classroom participation difficult
• certain environments are overwhelming and practical environmental changes may help
• the child needs another way to access play or community activities
• equipment or a task adaptation might make an everyday activity safer or more accessible

These situations are examples of functional participation questions, not diagnostic signs of autism, ADHD or another condition.

If you have broader concerns about your child’s development, current NDIS guidance recommends starting with a health or education professional such as a GP, child health nurse or early childhood educator. For younger children, an NDIS early childhood partner may also help connect the family with appropriate supports.

Paediatric OT is about participation, not simply exercises

Children learn through doing things that matter to them.

That is why a paediatric OT session may sometimes look like play, craft, movement, dressing practice or another ordinary activity rather than a traditional clinical exercise.

The important question is not whether the activity looks therapeutic. It is whether there is a meaningful purpose behind it.

For example, building something with small pieces might be used because a child wants to participate more independently in classroom craft activities. Practising opening containers might relate to accessing lunch independently. Rearranging a morning routine might reduce unnecessary barriers to getting ready for school.

Play itself is also an important childhood occupation. It does not need to be justified only as a way to practise another skill.

How can OT approach sensory differences?

Children experience sensory information differently. Noise, lighting, clothing textures, movement, crowded spaces, smells or physical contact may make some environments easier or harder to participate in.

An OT may explore:

• which sensory experiences the child seeks, enjoys or avoids
• when sensory demands interfere with an activity the child wants or needs to do
• whether the environment can be adjusted
• whether routines or task demands can be changed
• what strategies the child finds acceptable and useful

Sensory preferences alone do not automatically require treatment.

It is also important not to treat every activity marketed as “sensory therapy” as equally evidence-based. The NDIA’s autism intervention evidence review shows that evidence varies across sensory-based approaches and outcomes. No single intervention works for every autistic child.

A useful OT approach should connect any proposed strategy to the child’s functional goals, preferences and available evidence rather than promising that a particular sensory technique will universally improve regulation or development.

Paediatric occupational therapy and autism

Autistic children have diverse abilities, preferences and support needs. An autism diagnosis by itself does not tell an OT what a particular child needs.

Where occupational therapy is relevant, goals might involve:

• participating in self-care routines
• making an environment more accessible
• developing practical ways to manage transitions
• supporting meaningful play or leisure
• adapting tasks to the child’s communication or sensory preferences
• finding ways for the child to express choices and participate more independently

A neurodiversity-affirming approach does not treat harmless autistic characteristics as behaviours that must be removed. Therapy should not be designed simply to make a child appear non-autistic, force eye contact or suppress harmless self-regulation.

NDIS funding is also not automatic because a child has an autism diagnosis. Funding decisions depend on the child’s circumstances, eligibility, functional support needs and current NDIS requirements.

Paediatric OT and ADHD

For a child with ADHD, an OT may sometimes work on practical participation issues involving routines, organisation, transitions, task setup, environmental demands or self-regulation.

For example, the focus might be making a morning routine easier to follow or changing how a complex school task is organised.

Occupational therapy is not a substitute for medical assessment or ADHD medication where those are relevant. ADHD also does not automatically establish NDIS eligibility or paediatric OT funding.

Developmental delay and other disability-related needs

Paediatric OTs also work with children whose needs may relate to developmental delay, physical disability, coordination difficulties or other disability-related functional challenges.

The useful starting point remains the same: understand what the child is trying to do and what is making participation difficult.

Two children with the same diagnosis may require very different support. Likewise, two children with different diagnoses may have similar functional goals.

What happens at a first paediatric OT assessment?

An initial assessment should help the OT understand the child in the context of everyday life.

The process may involve:

Talking about what matters

The OT may ask the child and family about routines, strengths, interests, current difficulties and priorities.

Depending on the child’s age and communication style, the child might answer directly, demonstrate activities, use visual choices or communicate preferences in another way.

Observing everyday activities

The OT may observe relevant tasks through play, self-care activities, drawing, movement or another functional activity.

The goal is not to test the child for the sake of testing. Observation should help answer a practical question.

Understanding the environment

The OT may explore whether something in the home, kinder, school or community environment is contributing to the difficulty.

Gathering information from other people

With appropriate consent, information from parents, educators and other health professionals can help build a fuller picture of how the child participates across different settings.

Using structured assessments where useful

An OT may use standardised or structured assessment tools where they are relevant. There is no single assessment that every child must complete.

Agreeing what happens next

The assessment may lead to therapy goals, environmental recommendations, practical strategies, another specialist referral, further assessment or a decision that ongoing OT is not the most useful next step.

Is a paediatric OT assessment the same as a Functional Capacity Assessment?

No.

An initial paediatric OT assessment may explore a specific participation issue or help establish therapy goals.

A Functional Capacity Assessment (FCA) is a more comprehensive assessment of how disability affects everyday functioning and support needs. Not every child receiving paediatric OT needs an FCA.

If the referral question specifically involves broader functional evidence for the NDIS, see Aligned Assist’s NDIS Functional Capacity Assessment guide.

What does paediatric OT look like after assessment?

Ongoing therapy should connect back to meaningful goals.

Depending on the child, that might involve:

• practising an everyday routine
• modifying a task
• changing the physical or sensory environment
• trying a different way to access an activity
• supporting the child to develop a functional skill
• sharing strategies with authorised family members or educators
• reviewing what is and is not working

There is no responsible universal prescription such as “every child needs weekly OT for six months”.

Frequency and duration should relate to the child’s goals, evidence, circumstances, available funding and response to support.

Can parents, carers and educators be involved?

Yes, where appropriate and with the necessary consent.

Adults who know a child well can provide useful information about routines and environments. They may also help make agreed adjustments between therapy sessions.

However, the child should not disappear from the decision-making process.

Current NDIS quality guidance says providers should respect children’s rights to expression, self-determination and decision-making. How this works will depend on the child’s age, communication and legal arrangements, but their views should be sought in ways they can understand and use.

A parent, carer or teacher should not automatically be given clinical information simply because they know the child. Information sharing should follow consent and privacy requirements.

Where can paediatric occupational therapy happen?

Depending on the therapy goal and provider arrangements, paediatric OT may occur in settings such as:

• the child’s home
• a clinic or therapy setting
• kinder or school
• a community environment
• telehealth where clinically appropriate

The most useful setting depends on the goal.

If the question concerns a morning dressing routine, the home environment may provide important context. If it concerns classroom access, understanding the school environment may matter. Other goals may be addressed effectively elsewhere.

School and kinder visits also depend on provider availability, funding and the education setting’s own access and consent arrangements.

How does paediatric OT differ from other supports?

Different professions can work towards overlapping goals, but they bring different perspectives.

Support	Typical focus
Occupational Therapy	Everyday activities, participation, task performance, environments, routines and practical adaptations.
Speech Pathology	Communication and, where relevant, swallowing and mealtime-related professional assessment.
Physiotherapy	Movement, physical function and related therapeutic goals.
Psychology	Psychological assessment, mental health and psychological intervention within professional scope.
Positive Behaviour Support	Specialist assessment and behaviour support where behaviours of concern and relevant support needs are present.

These boundaries are not absolute. Professionals may collaborate where a child’s goals cross several areas.

Paediatric OT should not be used to replace another profession simply because OT funding happens to be available.

Can the NDIS fund paediatric occupational therapy?

Yes, in some circumstances.

Current NDIS guidance includes occupational therapy among the allied health therapy supports that may be funded.

NDIS therapy supports must be evidence-based and aimed at improving or maintaining functional skills and independence in everyday activities.

Funding is individual. Paediatric OT is not automatically funded because:

• a child has autism
• a child has ADHD
• a teacher recommends OT
• a GP writes a referral
• a parent believes therapy would be useful

The NDIA determines what NDIS supports are included in the child’s plan.

Current NDIS guidance also describes therapy supports as stated supports. Funding identified for that therapy support cannot simply be exchanged for an unrelated service.

If your child already has an NDIS plan, check what therapy supports are actually funded rather than assuming all allied health services can be claimed from the same budget.

For a broader explanation of NDIS budgets, see Aligned Assist’s Understanding NDIS Funding guide.

How much does NDIS-funded paediatric OT cost?

There is no universal Aligned Assist paediatric OT fee stated in this guide.

Provider charges can depend on the service agreement, type of work undertaken, funding arrangement, travel, reporting and other applicable claiming rules.

Under the current NDIS Pricing Schedule effective 24 September 2026, the national maximum price for an Occupational Therapist direct therapy service is $193.99 per hour where NDIS maximum price limits apply.

Those maximum price limits apply to NDIA-managed and plan-managed participants. They are regulatory maximums, not a statement that every provider charges $193.99 or that every paediatric OT activity is billed identically.

Before starting, ask the provider about:

• their actual hourly rate
• assessment charges
• report-writing or other non-face-to-face work
• travel where relevant
• cancellation terms
• how progress reviews are charged

What is the NDIS early childhood approach?

The NDIS early childhood approach is designed to help younger children with developmental needs or disability connect with appropriate support as early as possible.

Current NDIA guidance says the approach is for children younger than 9 with developmental delay or disability.

There are several important distinctions.

Early connections do not require NDIS eligibility

Early connections can help families connect with information, community and mainstream services, peer support and other appropriate assistance even when the child is not an NDIS participant.

Early supports are specifically relevant to some children under 6

Current NDIA guidance says children younger than 6 with developmental concerns may be able to receive a short period of early supports.

Developmental concerns are not the same as meeting the NDIS Act definition of developmental delay.

A diagnosis is not always required to get early childhood help

Current NDIA guidance says children younger than 6 do not need a diagnosis to access the early childhood approach.

That does not mean every child under 6 automatically becomes an NDIS participant.

Children aged 9 and over use a different NDIS partner pathway

Children aged 9 and over work with a Local Area Coordinator or other my NDIS contact rather than an early childhood partner.

You can read the current NDIS early childhood approach guidance for the official pathway.

What is Thriving Kids, and what has changed in October 2026?

Thriving Kids has begun rolling out, but it has not replaced the NDIS early childhood arrangements today.

Thriving Kids is a joint Australian, state and territory government initiative for children aged 8 and under with developmental delay and/or autism with low to moderate support needs, and their families.

The rollout began on 1 October 2026. The full range of supports is planned to be in place from 1 January 2028.

In Victoria, supports already beginning through the rollout include:

• information and guidance for families
• expanded parent support
• additional publicly funded autism assessments
• training to strengthen inclusion in early childhood education

Targeted allied health supports are expected to begin at the first six Victorian locations from January 2027: Bendigo, Hobsons Bay, Hume, Loddon, Maribyrnong and Melton.

That does not mean those allied health services are already universally available across Victoria in October 2026.

What happens to the NDIS before 2028?

Victorian and Australian Government guidance is clear that there are no changes to how children access the NDIS before 1 January 2028.

If your child already has an NDIS plan, that plan continues unless it changes through the normal plan reassessment process.

Families can also continue applying for NDIS access under the current arrangements before 1 January 2028.

Children with permanent and significant disability, including children with developmental delay and/or autism with high support needs who meet the future requirements, are intended to remain within the NDIS.

Families should therefore not stop current OT or other funded supports simply because Thriving Kids has started rolling out.

For current Victorian information, see Thriving Kids Victoria.

Which pathway should a family consider now?

Situation	Practical starting point	What to check
Concern about a young child’s development but no NDIS plan	Speak with a GP, maternal and child health professional, educator or early childhood partner.	Whether early connections, early supports, mainstream services or an NDIS access pathway may be relevant.
Child under 9 with disability or developmental needs	An NDIS early childhood partner can help the family understand support pathways.	The child’s age, circumstances, developmental or disability needs and current NDIS requirements.
Child already has NDIS-funded therapy supports	Check the actual plan and funded therapy support.	Whether OT is included and what the service agreement and funding allow.
Child aged 9 or older with NDIS support needs	Use the child’s current my NDIS contact or Local Area Coordinator pathway.	The child’s plan, current therapy funding and relevant goals.
Family asking about Thriving Kids in Victoria	Check current Victorian Thriving Kids information.	What is actually available now in the family’s area, rather than assuming all 2028 services have started.

This table is a practical guide, not an NDIS eligibility decision.

What doesn’t the NDIS usually fund as paediatric OT?

The NDIS funds disability supports within its legal responsibilities. It does not replace every health, education, parenting or childcare service.

Examples of things that may fall outside NDIS therapy funding include:

• ordinary school teaching or tutoring
• general childcare
• medical diagnosis or treatment that belongs to the health system
• ordinary consumer products without a disability-related NDIS support basis
• activities labelled “therapy” without sufficient evidence of functional benefit

Context matters. A difficulty happening at school does not automatically mean the support is an education responsibility, and it does not automatically mean it belongs to the NDIS either.

The relevant system depends on what the support is actually intended to do.

How do OT reports relate to the NDIS?

An OT report may document information such as:

• the child’s functional participation needs
• goals being addressed
• assessment findings
• progress over time
• environmental barriers
• relevant recommendations

Not every therapy session requires a formal report.

An OT report is also not automatically a diagnostic report and does not approve NDIS funding. The NDIA remains responsible for funding decisions.

What about assistive technology for children?

An OT may sometimes consider equipment or practical environmental adaptations as part of a child’s functional support needs.

The right evidence depends on the particular technology, its cost, its risk and the professional expertise required.

Not every sensory product, tablet, educational device or children’s product is automatically an NDIS-funded assistive technology item.

For the specific equipment assessment and evidence pathway, see Aligned Assist’s NDIS Assistive Technology Assessments guide.

Is paediatric OT the same as Positive Behaviour Support?

No.

An OT may work on routines, environments, participation and self-regulation that overlap with situations in which behaviour is discussed.

Positive Behaviour Support has a different specialist role, particularly where behaviours of concern and regulated behaviour-support responsibilities are involved.

It is important not to turn harmless neurodivergent behaviour into a “behaviour problem” simply because it looks different.

Where specialist behaviour support is genuinely relevant, the roles should be clear and coordinated rather than one profession attempting to replace another.

How should families choose a paediatric Occupational Therapist?

Look beyond the words “paediatric OT” in a provider biography.

Useful questions include:

• Is the Occupational Therapist currently registered with AHPRA?
• What experience do they have with the child’s actual participation needs?
• How do they involve children in setting goals and making choices?
• Is their approach child-centred and neurodiversity-affirming?
• How do they decide which assessments or interventions are appropriate?
• How do they explain evidence behind the strategies they recommend?
• How do they work with families, educators and other professionals when consent is provided?
• How do they communicate with children who use different communication styles?
• How are progress and continued suitability reviewed?
• What are their fees, reporting charges, travel arrangements and cancellation terms?
• What appointment formats are actually available?

You can verify an Occupational Therapist’s registration through the AHPRA public register.

Questions to ask before starting paediatric OT

1. What participation problem are we trying to address?
2. How will my child’s preferences and goals be included?
3. What will the first assessment involve?
4. How will you decide whether ongoing OT is appropriate?
5. What evidence supports the approach you are recommending?
6. Can my child decline or stop an activity they are uncomfortable with?
7. How will you involve parents, carers or educators where appropriate?
8. How will we know whether the support is helping with the agreed goal?
9. How often will goals and therapy suitability be reviewed?
10. What will sessions, reports, travel and other work cost?
11. What happens if we decide this therapist or approach is not the right fit?

What if paediatric OT is not a good fit?

Therapy should be reviewable.

If something is not working, families can ask:

• whether the goal is still meaningful
• whether the activity or environment should change
• whether another therapy format may be more appropriate
• whether another professional is better placed to address the issue
• whether a second opinion would help

You can also raise concerns directly with the provider, review the service agreement or change practitioners where appropriate.

Concerns about professional conduct may be relevant to AHPRA. Concerns about an NDIS provider’s safety, quality or compliance may be relevant to the NDIS Quality and Safeguards Commission. A disagreement about an NDIA funding decision is a separate matter and follows NDIS review processes.

Is paediatric OT the next step?

You do not need to begin with a diagnosis or a predetermined therapy programme.

A useful sequence is:

1. Start with the activity. What does the child want or need to participate in?
2. Understand the barrier. Is the difficulty primarily about the task, environment, functional ability or something else?
3. Consider simpler supports. Could an environmental adjustment, mainstream service or practical change address the issue?
4. Seek appropriate professional advice. A GP, early childhood professional, educator or allied health practitioner may help identify the right pathway.
5. Check NDIS funding if the child has a plan. Confirm what therapy supports are actually included.
6. Choose an OT with relevant expertise. Ask about assessment, evidence, costs and how the child’s voice will be included.
7. Review whether it is working. Support should remain connected to meaningful participation rather than continuing automatically.

Paediatric Occupational Therapy in Melbourne

For Melbourne families, practical provider considerations include more than distance.

It can be useful to check:

• whether the OT’s paediatric experience matches the child’s needs
• what appointment settings are actually available
• whether home, kinder or school-based assessment is relevant and available
• whether the therapist can collaborate with existing professionals where consent is provided
• current appointment capacity
• communication and language needs
• fees and NDIS plan-management arrangements

The same NDIS rules apply nationally. Melbourne location does not create a separate eligibility pathway.

Discussing Paediatric OT with Aligned Assist

Aligned Assist is a registered NDIS provider in Melbourne with Occupational Therapy capability.

Current Aligned Assist practitioner information identifies Neethu Thampi as a Paediatric Occupational Therapist whose advertised focus includes sensory, developmental and functional participation needs for children.

The appropriate practitioner still depends on the referral question. A paediatric therapy enquiry is different from an adult Functional Capacity Assessment, an Assistive Technology Assessment or a specialist assessment outside an OT’s scope.

If you are a family or professional referrer, you can contact Aligned Assist to discuss:

• the everyday activity or participation concern
• the child’s goals and preferences
• whether the child has an existing NDIS plan
• the purpose of any requested assessment or report
• practitioner suitability
• current capacity and next steps

You can also view Aligned Assist’s broader Therapeutic Supports in Melbourne.

• Call: 1300 927 248
• Email: info@alignedassist.com.au
• Enquire: Contact Aligned Assist
• Professional referral: Submit an NDIS referral

Frequently asked questions about paediatric occupational therapy and the NDIS

What does a paediatric Occupational Therapist do?

A paediatric OT helps children participate in meaningful everyday activities such as self-care, play, school routines and community life. Support may involve developing skills, adapting an activity, changing the environment or helping adults support participation differently.

When should my child see an OT?

An OT may be worth considering when an everyday activity that matters to the child is consistently difficult or inaccessible and Occupational Therapy expertise appears relevant. You do not need to diagnose the problem yourself before asking for professional advice.

Does the NDIS fund paediatric occupational therapy?

It can. Occupational Therapy is one of the therapy supports the NDIS may fund where it meets current NDIS requirements and is included appropriately in the child’s plan. Funding is individual and is not automatic because of a particular diagnosis.

Does my child need a diagnosis to get early childhood support?

Not always. Current NDIA guidance says children younger than 6 do not need a diagnosis to access the early childhood approach, and early connections can be available even when a child is not eligible for the NDIS. NDIS eligibility is a separate decision.

Can a child without an NDIS plan see an Occupational Therapist?

Yes. Paediatric occupational therapy is not limited to NDIS participants. The available referral and payment options depend on the provider and the family’s circumstances.

Can an OT help with sensory differences?

An OT may help understand how sensory experiences affect meaningful daily activities and explore environmental or practical strategies. Evidence differs between specific sensory interventions, so recommendations should be linked to clear functional goals and appropriate evidence.

Is paediatric OT the same as a Functional Capacity Assessment?

No. Paediatric OT can include assessment and ongoing therapy around specific participation goals. An FCA is a more comprehensive assessment of functional capacity and support needs and is not automatically required for every child receiving OT.

What is Thriving Kids?

Thriving Kids is a new Commonwealth, state and territory initiative for children aged 8 and under with developmental delay and/or autism with low to moderate support needs and their families. It began rolling out in October 2026, with the full range of supports planned for 1 January 2028.

Does Thriving Kids replace my child’s NDIS plan now?

No. Current government guidance says there are no changes to NDIS access before 1 January 2028. Existing plans continue unless they change through the usual reassessment process.

How do I choose a paediatric OT in Melbourne?

Look for current AHPRA registration, relevant paediatric experience, a child-centred and evidence-informed approach, clear communication, transparent fees and an assessment process that considers the child’s real participation goals rather than diagnosis alone.