Five Occupational Therapy Frames of Reference for Pediatric OT


Pediatric Occupational therapists use an occupational therapy frame of reference, or sometimes interchangeably called an occupational therapy model, to help conceptualize and plan interventions for the children they treat.

A frame of reference is used as a way to understand the client's current functional levels and guide treatment plans and sessions.

The theory of occupational therapy is complex and can be difficult to understand. This article will explain five pediatric occupational therapy frames of reference and how I use them in my pediatric OT practice.

There are five occupational therapy frames of reference that are often used by pediatric occupational therapy practitioners as part of an intervention plan or treatment goals for children with disabilities that we will discuss in this post:

Developmental Frame of Reference; Neuro-Developmental Treatment (NDT); Behavioral Frame of Reference; Frame for Development Handwriting Skills; Sensory Integration Frame of Reference.

Occupational Therapy Theory

A theory is a well-backed explanation of why something in the natural world is what it is or operates the way it does. For example, Newton's theory of gravity explains why objects are attracted to one another when they are dropped.

An occupational therapy theory is a guide from which the occupational therapy frames of reference and models are built.

What is a Frame of Reference in Occupational Therapy?

A frame of reference is a conceptual tool that can be used as part of occupational therapy. It also provides a plan for intervention and treatment goals to work towards change in the future.

What is the difference between an occupational therapy frame of reference and an occupational therapy theory?

An occupational therapy theory can be described as concepts that are developed over time that are based on scientific evidence, research, and clinical expertise. A theory is used to explain why certain treatments work through how they impact the brain and nervous system.

A frame of reference is using the theory as a way to understand the current situation and identify possible solutions.

Occupational Therapy Models of Practice

An Occupational therapist or occupational therapy assistant uses an occupational therapy model to help guide OT practitioners in determining and providing interventions and treatments. It is used to organize an occupational therapist's thinking about the person they are working with. The model provides for categorization and organization. It's an idea or theoretical framework around which occupational therapists think when treating their patients/clients.

What is the difference between a frame of reference and a model?

The term occupational therapy frames of reference and an occupational therapy model are often used interchangeably.

Pediatric Occupational Therapy Frames of Reference

Here are the frames of reference I used in my pediatric occupational therapy practice with young children. As a child ages, the possible frames of reference to draw from grows as well.

The following are five frames of reference that are commonly used in pediatric occupational therapy:

Developmental Frame of Reference

A developmental frame of reference is used to identify how a child's level of ability changes across time and setting, as well as the child's ability to engage in activities. When a therapist uses this frame of reference, they are looking at the developmental progression and what skills a child needs to achieve their developmental milestones.

I look at the developmental frame of reference as the overall overarching frame of reference in my practice. I have based my books, Pediatric Occupational Therapy Goals, on this frame of reference as well. I believe that for young children, development follows a predictable linear path, and therapy intervention can follow this path for almost all children through elementary age.

Pediatric OT Goals Books

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Frame of Reference for Neuro-Developmental Treatment (NDT)

Neuro-Developmental Treatment (NDT) is an evidence-based treatment for children with developmental challenges. It is used to improve motor difficulties using a variety of techniques to influence motor difficulties such as posture, alignment, muscle tone, and balance.

For the children, I treat with motor delays, born prematurely, with cerebral palsy or Down Syndrome, I use an NDT perspective in my treatment plans and interventions after considering the appropriate developmental abilities for the child.

Behavioral Frame of Reference

The behavioral frame of reference is used to identify the relationship between a child's behaviors and his or her environment. The goal of the behavioral frame of reference is to enable children with disabilities to learn new skills and behaviors through positive reinforcement strategies, self-management behaviors, and self-control.

Frame of Reference for Development of Handwriting Skills

The frame of reference focuses on the development of handwriting skills. It examines the underlying skills which go into producing legible, timely handwriting which include posture, ocular motor skills, attention, and visual-perceptual skills, and pencil grasp.

This is a great frame of reference when a therapist is learning what underlying skill deficits affect handwriting abilities. Especially for school-based OTs.

Sensory Integration Frame of Reference

The sensory integration frame of reference is used to address the needs and deficits that are related to sensory processing.  This frame of reference is developed from the work of Dr. Jean Ayers. It focuses on the child's sensory systems such as auditory, visual, gustatory, tactile, vestibular, and proprioceptive sensory systems. Sensory integration also takes into consideration sensory modulation and self-regulation, and praxis abilities.

In my practice is use parts of the sensory integration (or sensory processing) frame of reference with many of the children I treat. The sensory integration frame of reference in its purest form involves the use of one-point suspended equipment and is best suited for use in a pediatric clinic. However many parts can be used to guide treatment with children with sensory processing (SPD), feeding, attention, and motor planning difficulties. It can also be helpful when working with children with Autism Spectrum Disorder (ASD) and Developmental Coordination Disorder (DCD).

How do OTs choose specific frames of reference?

An occupational therapist selects a frame of reference based upon the child's goals, functional performance, and the intervention strategies the therapist is proficient with.


Pediatric Occupational therapists use many different frames of reference in their therapy sessions and interventions. Each serves a different purpose and best helps children with different types of difficulties and challenges.

In my practice, I use a Developmental Model as my overall frame of reference. Then the Neuro-Developmental Treatment (NDT), Behavioral, Frame of Reference for Development of Handwriting Skills, and Sensory Integration to guide my treatment plans and interventions.

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