NDIA Accountability Project

Submission 195 — Office of the National Rural Health Commissioner — Inquiry into the Thriving Kids initiative

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Australian Government Office of the National Rural Health Commissioner

Submission into the Thriving Kids initiative

Office of the National Rural Health Commissioner

Acknowledgement of Country

The National Rural Health Commissioner (the Commissioner) and her Office acknowledges the Traditional Owners and Custodians of Country throughout Australia. The Commissioner recognises and deeply respects the strength and resilience of Aboriginal and Torres Strait Islander people and their continuing connections and relationships to community, rivers, land, and sea.

The Commissioner and her Office pay respect to Elders past, present, and emerging and extend that respect to all Traditional Custodians of this land and Aboriginal and Torres Strait Islander people reading this document.

The Office of the National Rural Health Commissioner

The National Rural Health Commissioner is an independent, statutory office holder, appointed under Part VA of the Health Insurance Act 1973 (the Act). The Office of the National Rural Health Commissioner (the Office) works with regional, rural and remote communities, the health sector, universities, specialist training colleges and across all levels of government to improve rural health policies and ensure there remains a strong focus on the needs of rural communities.

Disclaimer

The National Rural Health Commissioner is a statutory appointment that is independent of the Australian Government Department of Health, Disability and Ageing. The views expressed in this document do not represent an official position of the Commonwealth Department of Health, Disability and Ageing or the Australian Government. Publication of this document does not necessarily reflect the views of the Department of Health, Disability and Ageing or indicate a commitment to a particular course of action.

Office of the National Rural Health Commissioner

Thank you for the opportunity to provide a submission into the recently announced Thriving Kids initiative. Please see enclosed response from the Office of the National Rural Health Commissioner.

Summary of key considerations

Early childhood is a pivotal phase of rapid brain development that shapes lifelong outcomes. For children with disabilities and developmental delays, this period offers a vital opportunity to build foundational skills. Tailored early supports can significantly improve developmental progress and quality of life. However, success depends on identifying needs early and ensuring timely access to appropriate intervention services to prevent issues from escalating. Children need access not only to preventative health and developmental screening measures but also, where concerns are identified, to timely comprehensive assessment and therapy to support optimal child development.

Around 7 million people live across rural and remote Australia, where significant health inequities persist, particularly in remote and very remote regions compared to urban areas. Children and families in these areas often face intersecting social, economic, and environmental challenges that adversely impact health and development. They are also more likely to experience developmental vulnerability compared to their city counterparts. Access to appropriate early childhood services is limited, making it harder to address these challenges. These challenges are even more pronounced for First Nations children and their families, who, while more likely to live in urban and regional areas overall, represent a higher proportion of the total population in remote communities.

Children with disabilities or developmental delays in rural and remote Australia face significant barriers to accessing early intervention services. These include limited and inconsistent service availability, a lack of culturally appropriate and responsive services, limited infrastructure, long travel distances, extended wait times and severe workforce shortages, particularly in allied health with ongoing significant and multifaceted barriers to recruitment and retention.

Rural and remote areas, particularly remote and very remote communities are often known as ‘thin markets’, characterised by a limited number of health professionals and low population volume. This, coupled with increased costs of service delivery and an often-widespread geographic footprint, can compromise viability of the health service. Consequently, traditional models such as reliance on Fee-For-Service billing via Australia’s Medicare Billing Scheme are often inadequate for these thin markets and further exacerbate inequities.

Recommendations

  1. Actively involve rural and remote service providers, clinicians and consumers in the co-design of models of care with rural and remote representation on the Thriving Kids Advisory Group. The design of fit-for-purpose service models can only benefit from the lived experience and expertise in service delivery for both rural and remote areas.
  2. The Thriving Kids initiative needs to recognise that supporting optimal development for children at risk of mild to moderate developmental delays involves multiple touchpoints, including preventative health, screening, assessment, and therapy. The current model appears to have a focus on parent-led identification of delays and parent management. While empowering families is important, Thriving Kids should incorporate structured pathways to professional assessment and therapy by qualified health professionals to reduce the risks of delays being overlooked or inadequately addressed (see Attachment A for summary of evidence-based therapy approaches).

Office of the National Rural Health Commissioner

  1. The government could explore alternative funding approaches under the Thriving Kids model to address thin market challenges. Options such as block funding or salaried employment for allied health professionals, could support the delivery of services that are no or low cost to clients in rural and remote communities.
    • This is likely to look different in rural, remote and very remote communities. For example, in a rural town, block funding or salaried employment could support a resident allied health professional provide services in their town/community. While in remote and very remote communities, it is likely that outreach models or virtual models of care will also need to be made available, noting that a fully virtual model may not be clinically appropriate.
  2. In order to support and sustain a distributed health workforce across rural and remote communities, funded initiatives will be required that understand contextual and community differences.
    • In rural and remote communities, it is likely the workforce will incorporate a broader multidisciplinary team approach, including Aboriginal and Torres Strait Islander Health Workers and Practitioners.
    • As highlighted above, in remote and very remote communities, it is likely outreach and virtual models of care will need to occur in conjunction with the local health service to support access to services. However, it is important that these services remain integrated and there is high interoperability between the service providers.
    • To grow the health workforce in rural and remote Australia, the government should consider enhancing evidence-based approaches such as selecting students from rural backgrounds, offering extended clinical placements and place-based training models in rural settings, recognising and rewarding advanced generalist skills, and providing ongoing professional development and career progression opportunities.

Office of the National Rural Health Commissioner

Background information

Examine evidence-based information and resources that could assist parents identify if their child has mild to moderate development delay and support parents to provide support to these children

Early childhood represents a critical period of heightened developmental plasticity, with lasting effects on a child’s life trajectory [1]. The early years are especially vital for children with disabilities, developmental delays, or neurodivergence. This stage presents a unique opportunity to foster the development of essential skills and establish learning foundations that support future growth and independence [2, 3].

Tailored, early developmental supports for children with disabilities and developmental delays can significantly influence a child’s progress, enhancing their quality of life [2]. However, achieving optimal outcomes depends on the early recognition of a child’s need for development support and timely access to the appropriate services [3]. Timely access to early childhood intervention services can address presenting concerns from the onset, before they further escalate and impact on lifelong outcomes [3-5].

The Office notes that the model proposed under Thriving Kids appears to place a significant expectation on parents to self-manage their child’s mild to moderate developmental delay. This is reflected in language such as “support parents to provide support to these children,” which suggests a reliance on informal, parent-led strategies.

Additionally, the information provided to date seems to emphasise screening and monitoring of delays rather than recognising the discrete components of preventative health, screening, assessment and therapy. Screening tools are useful for identifying children at risk, but they need to be complemented by professional evaluation and targeted therapy to address developmental concerns effectively. Prevention, screening and early intervention is all part of a continuum of care and should not occur in isolation.

Children under 8 years of age with moderate delays including autism benefit from structured, ongoing intervention from trained health professionals. Attachment A summarises evidence supporting the effectiveness of speech pathology, occupational therapy, physiotherapy, and multidisciplinary approaches for children with moderate developmental delays.

While the Office acknowledges the value of supporting developmental skills within a child’s everyday environments, such as playgroups, early childhood education settings, and schools, it is also important to recognise that comprehensive assessment and therapy may also need to be delivered by a qualified health professional outside of these contexts. Digital and phone-based supports may have a role in allied health service provision; particularly in the remote context; however, they are not always suitable for conducting assessments or delivering ongoing care.

The Office notes that Occupational Therapy Australia (OTA) and Speech Pathology Australia (SPA) have joined forces to ensure key allied health services are recognised as an essential element of early childhood foundational supports, calling on state and federal governments to commit to commissioning and funding services to enable access to occupational therapy and speech pathology. The Australian Government’s National Early Childhood Program (NECP) also highlight the importance of early, intensive, and structured therapy for children with developmental concerns.

Identify equity and intersectional issues, in particular, children who identify as First Nations and culturally and linguistically diverse

Approximately 7 million people live across the vast and diverse landscape of rural and remote Australia [6]. Unfortunately, there is a well-known disparity in health equity for people living in rural and remote Australia compared with those living in urban areas [6]. This disparity is even more pronounced in remote and very remote areas [7].

Australian Government

Office of the National Rural Health Commissioner

Children and their families growing up in rural and remote Australia, particularly remote Australia are more likely to be affected by overlapping social, economic and environmental challenges that adversely affect their health and development [1, 6, 7]. Additionally, they face limited access to appropriate services that can help mitigate and address the impact of adversity in early childhood [8-12]. This is further compounded for First Nations children and their families living in rural and remote communities [1, 12, 13]. While First Nations people are more likely to live in urban and regional areas, the proportion of the total population who identify as First Nations people is higher in remote and very remote areas [14].

Compared to major cities and inner/outer regional areas, children from remote and very remote locations are more likely to be developmentally vulnerable across all five domains of the Australian Early Development Census (AEDC). The AEDC is a national measure of children’s development upon commencing their first year of full-time school [15]. First Nations children in particular, experience disproportionately higher rates of adverse developmental outcomes [15].

Table 1 2024 AEDC Results: Percentage of developmental vulnerability- National trend, First Nations Children, Geographic location comparisons

AEDC Domain National trend First Nations children Remote and very remote Inner/outer regional Major cities
Physical health and wellbeing 10.0 22.3 19.1 11.9 9.1
Social Competence 10.7 20.2 16.2 11.8 10.2
Emotional maturity 10.0 18.5 15.2 11.5 9.3
Language and cognitive skills (school based)** 7.7 21.9 19.1 9.1 6.9
Communication skills and general knowledge 8.9 17.3 15 8.7 8.8

Table adapted from the AEDC National Report 2024 [15]

  • largest gap in developmental vulnerability for remote and very remote children compared to children living in major cities

Children with disabilities and/or developmental delays in rural and remote communities

Children with disabilities and/or developmental delays living in rural and remote areas of Australia, along with their families, encounter numerous and overlapping challenges when trying to access early childhood intervention services due to their geographic isolation. These challenges include, but are not limited to:

  • Inadequate existing services for example due to infrequent and inconsistent services and service delivery barriers [9, 10].

Office of the National Rural Health Commissioner

  • Racism among service providers, language barriers [13] and lack of quality, culturally appropriate and responsive services in these areas [1, 3, 12].
  • Difficulty navigating the early intervention system [3].
  • Workforce shortages and challenges such as attraction and retention, burnout and lack of adequate support [3, 10, 11] .
  • Workforce shortages among allied health professionals such as speech, physio and occupational therapy [8, 9, 16] and paediatricians, including those in mental health [1] as well as those who can provide culturally sensitive supports for First Nations children and families [3].
  • Long travel distances and the personal and financial costs associated with it for the family [9, 11].
  • Extended wait times [8, 9, 16] while people with high priority needs may get access to therapy services, children who were not high priority might be waiting years to access these services and then may no longer be eligible for the service [8].

Both families and professionals often need to travel considerable distances to access or deliver services. Most paediatricians and allied health providers working with children aged 0–12 are based in major towns/cities, and it’s common for families to travel more than 100 kilometres each way to reach suitable care. For those without access to private transport, the journey can be even longer and more complex, as direct public transport routes to service providers are often unavailable [1].

These factors contribute to significant difficulties in obtaining therapy and result in a high level of unmet needs in these communities [1]. Consequently, these factors need to be considered in the Thriving Kids initiative, especially given the wording that “the program will be delivered by scaling and building on existing mainstream and community services that can better support families and children in settings they are already connected”.

If the services are not there, or are already very inaccessible, additional consideration needs to occur to determine how children aged 8 and under and their families living in rural and remote areas will get the support they need and not be further disadvantaged.

Infrastructure and venue of care

In the Thriving Kids overview, the fact sheet highlights the program utilising settings that families and children are already connected such as child and maternity health, GPs, playgroups, early childhood education and care, schools as well as digital and phone-based supports. In rural and remote communities there is often a lack of available infrastructure and equipment which influences which services can be provided in each location [17, 18]. Therefore, there can be very limited physical and infrastructure resources in the community that support early childhood screening and intervention.

Contextual differences between rural, remote and very remote communities

Discussions about rural and remote Australia often group remote and very remote areas under the broader term “rural,” overlooking the significant diversity across these regions [7]. There are substantial differences between and within rural, remote, and very remote communities, including geography, population characteristics, infrastructure, health status, and socioeconomic conditions. These variations greatly influence both individual and community health outcomes, as well as access to health services [7].

Rural towns (particularly medium to large towns) often have a wider range and greater volume of health professionals living in or near these towns. In general, rural communities are also more likely to have easier access to health services in larger settlements due to better roads, public transport and smaller distances

Office of the National Rural Health Commissioner

between settlements compared to more remote areas [19]. Additionally, they are more likely to have the population to support more discrete and specialised health care services as well as have integrated primary health care services that are delivered by multi-disciplinary teams of health professionals that provide a coordinated, single point of access to a range of integrated services that otherwise would not be available to the town as a discrete service. For example, this can include Multi-purpose Services and multi-disciplinary primary health care teams [20, 21].

In more remote areas with more dispersed and isolated populations, outreach and visiting services are often key features of health care delivery. Small population sizes in these communities cannot often sustain or support a full range of local health professionals. Visiting services can therefore help improve access to services that may not be available otherwise[21-23]. However, this can come with challenges including poor coordination with the local health service and other visiting services, short visits and the potential for local health services to be downgraded and eroded over time [24, 25].

For these remote and smaller populated areas, virtual outreach, telehealth and other similar services can support understaffed health services and offer increased flexibility of health care delivery and access to services, including some allied health services [20, 26]. It can help with access to timely services and reducing travel time [26]. While these modalities can provide a valuable service that can enhance local service delivery, it is not always the appropriate option. For example, consideration needs to account for practical limitations such as unreliable mobile phone reception/poor internet connectivity as well as if it is clinically appropriate. Also key is the digital interoperability required for the delivery of integrated services. Many allied health professionals are often unable to access interoperable clinical systems to share information and provide advice. Digital uplift and support to ensure security, privacy and software capacity will also be imperative.

Playgroups, early childhood education and care, schools

In the 2024 Play Australia Children’s survey, 100% of respondents in rural and remote areas identified significant barriers to accessing early childhood and wellbeing program for children 0-12 years of age [27]. The barriers to accessing these programs included the tyranny of distance between communities, smaller populations, limited services and social isolation [27].

Access to quality early childhood education and care (ECEC) is critical. However, accessing this care can be significantly challenging for many families living in rural and remote communities [28-30]. In 2022, the Mitchel Institute in their report Deserts and Oases: How accessible is childcare in Australia? found that families living in outer regional (61.3%), remote (85.3%) and very remote (77.8%) areas were much more likely to be living in a childcare desert than their major city counterparts (28.8%) [29]. A childcare desert occurs when there is either a total absence of services or insufficient places to meet demand (i.e. where there are more than three children per childcare place) [29]. Stories from families living in rural and remote communities have also been shared in the 2023 Choiceless report by the Parenthood, with some parents describing not having access to ECEC care in their community for nearly 7 years and other families describing the nearest service requiring a minimum daily roundtrip of 200km+ [30]. Lack of or limited access to this important service, not only impacts on childhood development and opportunities for screening and support, but also significantly impacts workforce participation including for key health professionals [28] and other essential workforce [30].

Identify gaps in workforce support and training required to deliver Thriving Kids

Attracting health professionals into rural and remote areas remains a challenge. While the number of health professionals in Australia are growing, there is still a significant imbalance in service access between metropolitan and rural areas. Recruitment and retention barriers are multifaceted, and include issues such as

Office of the National Rural Health Commissioner

professional isolation, limited resources, complex service demands and time and distance barriers to accessing support [31].

Governments have in recent years introduced a number of reforms aimed at improving access to allied health services in rural areas, however current evidence identifies that there are not significant numbers of allied health professionals on the ground to provide the services. With critical workforce shortages now, demand will not be met without deliberate and sustained commitment to workforce development and distribution [32].

The Office notes reference to the use of the Medicare Benefits Schedule (MBS) to support Thriving Kids. Current funding models such as reliance on Fee-For-Service billing via Australia’s Medicare Billing Scheme and the National Disability Insurance Scheme (where income is directly dependent on practitioner availability and preparedness to provide services) are often inadequate for rural and remote communities and further exacerbate inequities [7, 17, 33]. This funding mechanism therefore is unlikely to be effective to universally fund allied health services in rural and remote areas, which are often considered “thin markets” due to the limited number of health professionals available. In many of these communities, there simply aren’t enough practitioners to deliver the services that MBS rebates are intended to support, nor is there the population volume to make it financially viable.

For example, the Independent Review into the NDIS Final Report indicated that over 33% of participants in small and medium rural towns who have been in the scheme for at least one year are not accessing any therapy supports, despite having funding for these supports [34]. Simply providing the funding for service in the absence of a strategy to increase numbers of allied health professionals is not enough.

The NDIS report [34] highlights that some rural or remote communities experience lower incomes and lower levels of education. There may be higher levels of poverty and homelessness, higher cost of living, poorer housing and health outcomes. Employment opportunities (a key enabler of control in one’s life) are generally fewer in rural and remote areas.

This suggests that it may be difficult for people in remote areas to afford the out-of-pocket costs that are associated with the MBS. For example, while the MBS might provide a $60 rebate for an allied health service, the actual cost of an assessment or therapy session can be $160 or more, leaving a significant gap fee.

In alignment with the recommendations outlined in the Consultation Report – NDIS Thin Markets Project, the government should explore alternative funding approaches under the Thriving Kids model to address thin market challenges. Options such as block funding or salaried employment for allied health professionals in rural areas could support the delivery of services that are no or low cost to patients. For remote communities it is likely that outreach models or virtual models of care will also need to be available, noting that a fully virtual model may not be clinically appropriate.

The Government could also continue to commit to strategies to expand and better distribute the allied health workforce across Australia to address critical shortages that are particularly severe in rural and remote communities. A sustainable strategy should include enlarging targeted initiatives such as selecting students from rural backgrounds, offering extended clinical placements and place-based training models in rural settings, recognising and rewarding advanced generalist skills, and providing ongoing professional development and career progression opportunities. These measures are essential to building a resilient, well-supported allied health workforce capable of meeting the diverse needs of rural and remote Australians.

Office of the National Rural Health Commissioner

References

  1. Arefadib, N. and T.G. Moore, Reporting the Health and Development of Children in Rural and Remote Australia. 2017, The Centre for Community Child Health at the Royal Children’s Hospital and the Murdoch Children’s Research Institute: Parkville, Victoria.
  2. Reimagine Australia, National Guidelines for Best Practice in Early Childhood Intervention (Early Childhood Developmental Supports). 2024, Early Childhood Intervention Australia Ltd.
  3. Healthy Trajectories Child and Youth Disability Research Hub, Best Practices in Early Childhood Intervention: Towards Effective Implementation. 2022.
  4. McLean K, et al., Screening and surveillance in early childhood health: Rapid review of evidence for effectiveness and efficiency of models. 2014, Murdoch Childrens Reserach Institute.
  5. Moore, T. and M. McDonald, Acting Early, Changing Lives: How prevention and early action saves money and improves wellbeing. Prepared for The Benevolent Society. 2013, Centre for Community Child Health at The Murdoch Childrens Research Institute and The Royal Children’s Hospital: Parkville, Victoria.
  6. Australian Institue of Health and Welfare, Rural and remote health. 2024, AIHW: Canberra.
  7. Russell, D.J., et al., Remote health: what are the problems and what can we do about them? Insights from Australia. BMC Health Services Research, 2025. 25(1): p. 641.
  8. Dew, A., et al., Addressing the barriers to accessing therapy services in rural and remote areas. Disability and Rehabilitation, 2013. 35(18): p. 1564-1570.
  9. Cumming, T., Lived experiences of seeking support for rural and remote children with developmental challenges (White Paper). 2019, Charles Sturt University: Bathurst, Australia.
  10. Gosse, G., et al., Child Development Allied Health Services in Rural and Remote Areas: A Systematic Scoping Review of Drivers, Barriers and Enabling Strategies to Delivery of Services. Australian Journal of Rural Health, 2025. 33(1): p. e70010.
  11. Hussain, R. and K. Tait, Parental perceptions of information needs and service provision for children with developmental disabilities in rural Australia. Disability and Rehabilitation, 2015. 37(18): p. 1609-1616.
  12. D’Aprano, A., et al., A scoping review of early childhood support for Aboriginal and Torres Strait Islander children living with a disability in regional, rural and remote settings. Aust J Rural Health, 2024. 32(5): p. 890-905.
  13. DiGiacomo, M., et al., Childhood disability in Aboriginal and Torres Strait Islander peoples: a literature review. International Journal for Equity in Health, 2013. 12(1): p. 7.
  14. Australian Institue of Health and Welfare. Profile of First Nations people. 2024 [cited 2025 22 September]; Available from: https://www.aihw.gov.au/reports/australias-welfare/profile-of-indigenous-australians.
  15. Department of Education, The Australian Early Development Census National Report. 2024, Department of Education: Canberra, ACT.
  16. Jones, D., et al., Improving health and education outcomes for children in remote communities: A cross-sector and developmental evaluation approach. Gateways: International Journal of Community Research and Engagement, 2015. 8(1): p. [1]-22.
  17. Nous Group, Evidence base for additional investment in rural health in Australia. 2023.
  18. Humphreys, J.S., J. Wakerman, and R. Wells, What do we mean by sustainable rural health services? Implications for rural health research. Australian Journal of Rural Health, 2006. 14(1): p. 33-35.
  19. Thomas, S.L., J. Wakerman, and J.S. Humphreys, Ensuring equity of access to primary health care in rural and remote Australia-what core services should be locally available? International journal for equity in health, 2015. 14: p. 1-8.
  20. Brown, A., et al., Investigation of primary health care service delivery models used in allied health practice in rural and remote areas of Australia: a systematic review. BMC Health Services Research, 2025. 25(1): p. 573.
  21. Wakerman, J., et al., Primary health care delivery models in rural and remote Australia: a systematic review. BMC Health Serv Res, 2008. 8: p. 276.

Office of the National Rural Health Commissioner

  1. Carey, T.A., et al., What principles should guide visiting primary health care services in rural and remote communities? Lessons from a systematic review. Australian Journal of Rural Health, 2018. 26(3): p. 146-156.
  2. Healy, L.J., G. Beccaria, and P. McIlveen, Revised model for evaluating visiting health care services in rural and remote settings. Australian Journal of Rural Health, 2021. 29(5): p. 779-788.
  3. Battye, K. and T. McTaggart, Development of a model for sustainable delivery of outreach allied health services to remote north-west Queensland, Australia. Rural and remote health, 2003. 3(4): p. 1-14.
  4. Hussain, R., et al., The Fly-in Fly-out and Drive-in Drive-out model of health care service provision for rural and remote Australia: benefits and disadvantages. Rural and Remote Health, 2015. 15(3): p. 357-363.
  5. Barry, R., et al., Factors critical for the successful delivery of telehealth to rural populations: a descriptive qualitative study. BMC Health Services Research, 2024. 24(1): p. 908.
  6. Miller, R.M., The State of Play 2025. 2025, Play Australia.
  7. Rural Doctors Association of Australia, Childcare in rural and remote Australia. 2025.
  8. Hurley, P., H. Matthews, and S. Pennicuik, Deserts and oases: How accessible is childcare? 2022, Mitchell Institute, Victoria University.
  9. The Parenthood, ‘Choiceless’: The plight of parents in accessing regional, rural and remote early learning and care. 2023.
  10. National Rural Health Commissioner, Review of rural allied health evidence to inform policy development for addressing access, distribution and quality. 2020, Commonwealth of Australia (Department of Health).
  11. Services for Australian Rural and Remote Allied Health, Services for Australian Rural and Remote Allied Health (SARRAH) 2022-23 Pre-Budget Submission. 2022.
  12. Zhao, Y., et al., Remoteness, models of primary care and inequity: Medicare under-expenditure in the Northern Territory. Australian Health Review, 2022. 46(3): p. 302-308.
  13. Commonwealth of Australia, Working together to deliver the NDIS - Independent Review into the National Disability Insurance Scheme: Final Report. 2023, Commonwealth of Australia.

Office of the National Rural Health Commissioner

Attachment A

Evidence-Based Therapies for Children with Delays in Development

This document summarises evidence supporting the effectiveness of speech pathology, occupational therapy and physiotherapy for children with delays in communication, fine motor and gross motor skills.

Speech Pathology

Speech therapy supports children in developing communication skills, including speech clarity, language comprehension and expression, social interaction, and early literacy skills

Early, targeted intervention for children with developmental language disorder (DLD) has been shown to produce meaningful improvements in key areas of language development. Evidence from randomized controlled trials highlights that intensive therapy for three- and four-year-olds can significantly enhance both expressive and receptive phonological skills, with gains sustained over time. Interventions targeting morpho-syntactic abilities also yield positive outcomes, particularly in expressive language. Although findings in other domains—such as vocabulary and inferential narrative skills—are more limited or mixed, the overall evidence supports the value of speech and language therapy in promoting communication development in children with DLD. These results reinforce the importance of implementing structured language interventions during early childhood.

Reference: Rinaldi, S., Caselli, M.C., Cofelice, V., D’Amico, S., De Cagno, A.G., Della Corte, G., Di Martino, M.V., Di Costanzo, B., Levorato, M.C., Penge, R., Rossetto, T., Sansavini, A., Vecchi, S., & Zoccolotti, P. (2021). Efficacy of the Treatment of Developmental Language Disorder: A Systematic Review. Brain Sciences, 11(3), 407. https://doi.org/10.3390/brainsci11030407

Occupational Therapy

Occupational therapy supports children in developing fine motor skills, sensory processing, and daily living abilities.

Occupation and activity-based interventions have a demonstrably positive impact on the occupational participation and performance of children aged 5 to 21. Strong evidence supports the use of these approaches to improve engagement in activities of daily living (ADLs), play, and leisure, particularly when interventions include practice across environments, coaching, and feedback. Moderate evidence also highlights the benefits of collaborative goal setting, modeling, and technology-based supports. These findings affirm the value of occupational therapy in enhancing functional outcomes and promoting meaningful participation in everyday life for children and young people

Reference: Laverdure, P., & Beisbier, S. (2021). Occupation- and activity-based interventions to improve performance of activities of daily living, play, and leisure for children and youth ages 5 to 21: A systematic review. The American Journal of Occupational Therapy, 75(1), 7501205050p1–7501205050p24. https://doi.org/10.5014/ajot.2021.039560

Physiotherapy

Physiotherapy supports children in developing gross motor skills, strength, coordination, balance, and functional mobility to enhance their physical independence and participation in everyday activities.

A recent meta-analysis confirms a strong positive impact of physiotherapy-based motor skill training on preschool children’s gross motor development. The review of 23 randomized controlled trials found that targeted exercise programs significantly improved locomotor skills, object control, and overall gross motor performance, with large to very large effect sizes (Cohen’s d ranging from 1.13 to 1.55). The findings support the integration of structured physiotherapy programs into early childhood education to promote physical competence and developmental outcomes.

Reference: Wang, X., & Zhou, B. (2024). Motor development-focused exercise training enhances gross motor skills more

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effectively than ordinary physical activity in healthy preschool children: An updated meta-analysis. Frontiers in Public Health, 12, 1414152. https://doi.org/10.3389/fpubh.2024.1414152

Multidisciplinary Therapy