Exploring the Role & Identifying Opportunities for Occupational Therapy for Children Who Have Experienced Adverse Childhood Experiences Scoping Review
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Keywords
Childhood trauma, Occupational Therapy Practitioners, Trauma Informed
Abstract
Introduction: Adverse childhood experiences (ACEs) affect roughly 64% of Americans and are linked to negative outcomes, including higher risks of substance abuse and criminal justice involvement. Occupational therapy practitioners (OTPs) can support children impacted by ACEs to enhance quality of life (QoL) and well-being. However, evidence for effective occupational therapy (OT) interventions in this population remains limited and often vague. The scoping review investigates: what OT interventions are used to improve QoL and well-being for children 3-17 years old who have experienced one or more ACEs?
Methods A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, searching APA PsycINFO, MEDLINE, CINAHL, Psychology & Behavioral Sciences, Health Source, and SocINDEX. Included studies were in English, focused on children with 1 or more ACEs, involved OT in interprofessional care, and described specified interventions. Articles lacking intervention details or focusing on medication, academics, or non-OT professions were excluded. Relevant articles were reviewed, and a thematic analysis was conducted to synthesize data.
Results: Of 978 articles retrieved, 613 were screened, 16 underwent full-text review, and nine met inclusion criteria. Through thematic analysis, common interventions included self-regulation (n=8), sensory interventions (n=7), therapeutic use of self (TUoS) (n=7), play (n=6), and social participation and relationships (n=8). Other interventions addressed ADLs (n=3), leisure (n=3), IADLs (n=2), cognition (n=1), and others (n=2). Overall, OT interventions correlated with a positive impact on QoL and overall well-being (n=7).
Conclusions: Occupational therapy interventions emphasizing self-regulation, social participation, and positive TUoS support QoL and wellbeing in children affected by ACEs, potentially mitigating risks for negative life outcomes. OTPs should further examine the specificity of interventions to better inform practice, with increased emphasis on early identification and timely intervention.
References
2. LifeStance Health. The 4 types of trauma responses. May 5, 2025. https://lifestance.com/blog/four-types-trauma-response/
3. The National Child Traumatic Stress Network. Complex trauma. n.d. https://www.nctsn.org/what-is-child-trauma/trauma-types/complex-trauma/effects
4. Felitti V, Anda R, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many leading causes of death in adults: the adverse childhood experiences study. Am J Prev Med. 1998;14(4):245-258. Doi: 10.1016/s0749-3797(98)00017-8.
5. Fraser K, MacKenzie D, Vernel J. What is the current state of occupational therapy practice with children & adolescent with complex trauma? Occup Ther Ment Health. 2019;35(4):317-338. Doi: 10.1080/0164212X.2019.1652132.
6. Jones M, Pierce H, Chapple C. Early adverse childhood experiences and self-control development among youth in fragile families. Youth Soc. 2022;54(5):806-832. Doi: 10.1177/0044118X21996378.
7. Howard ARH, Lynch A, Call C, Cross D. Sensory processing in children with a history of maltreatment: an occupational therapy perspective. Vulnerable Children Youth Stud. 2020;15(1):60-67. Doi: 10.1080/17450128.2019.1687963.
8. Perez N, Jennings W, Baglivio M. A path to serious, violent, chronic delinquency: the harmful aftermath of adverse childhood experiences. Crime Delinq. 2018;64(1):3-35. Doi: 10.1177/0011128716684806.
9. Cleveland Clinic. Adverse childhood experiences (ACEs). n.d. Updated April 4, 2023. https://my.clevelandclinic.org/health/symptoms/24875-adverse-childhood-experiences-ace
10. Kerker B, Zhang J, Nadeem E, et al. Adverse childhood experiences and mental health, chronic medical conditions, and development in young children. Acad Pediatr. 2015;15(5):510-517. Doi: 10.1016/j.acap.2015.05.005.
11. World Federation of Occupational Therapy. About occupational therapy. 2024. https://wfot.org/about/about-occupational-therapy
12. American Occupational Therapy Association. Occupational therapy practice framework: domain and process (4th ed.). Am J Occup Ther. 2020;74(Supplement 2):7412410010p1-7412410010p87. Doi: 10.5014/ajot.2020.74S2001.
13. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(71):1-9. Doi: 10.1136/bmj.n71.
14. Moretti L, Elleman B. Exploring the Role and Identifying Opportunities for Occupational Therapy for Children Who Have Experienced Adverse Childhood Experiences (ACEs): A Scoping Review Protocol. Open Science Protocol. April 19, 2024. https://osf.io/n26eg/?view_only=d26d90da820142adb6628ccb87ed29a9
15. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan – a web and mobile app for systematic reviews. 2016;5(210). Doi: 10.1186/s13643-016-0384-4.
16. Mason J, Stagnitti K. Occupational therapists’ practice with complex trauma: a profile. Aust Occup Ther J. 2022;70:190-201. Doi: 10.1111/1440-1630.12846.
17. Purvis K, McKenzie B, Cross D, Razuri E. A spontaneous emergence of attachment behavior in at-risk children and a correlation with sensory deficits. J of Adolesc Psychiatric Nursing. 2013;26;165-172. Doi: 10.1111/jcap.12041.
18. Sanders H, Sears A, Apodaca J. Sensory-focused play & attachment: interdisciplinary collaboration in treatment foster care. SIS Quart Pract Connect. 2016;1(1):2-4.
19. Shea C, Jackson N, Sordille M. Shared concepts guiding the practice of a community occupational therapy program serving youth with psychosocial challenges. Open J Occup Ther. 2023;11(2):1-17. Doi: 10.15453/2168-6408.1997.
20. Walker P, Gee B, Leonard S. Occupational therapy’s psychosocial role for young children transitioning out of foster care. Open J Occupational Ther. 2022;10(3). Doi: 10.1543/2168-6408.2003.
21. Walsh-Garcia S, Cremin K, Spirtos M. An exploration of occupational therapy practices with children and adolescents experiencing complex trauma: an irish perspective. Occup Ther Ment Health. 2023;40(4):391-413. Doi: 10.1080/0164212X.2023.2283500.
22. Warner E, Koomar J, Lary B. Can the body change the score? Application of sensory modulation principles in the treatment of traumatized adolescents in residential settings. J Fam Violence. 2013;28:729-738. Doi: 10.1007/s10896-013-9535-8.
23. Wilburn V, Huber M, Senter D, Stoll H. Considerations for occupational therapists in developing community-level interventions for youth with high adverse childhood experiences (aces). Open J Occup Ther. 2022;10(1). Doi: 10.15453/2168-6408.1800.
24. The Theraplay Institute. What is theraplay? https://theraplay.org/what-is-theraplay/
25. Butler Center for Research. Moving to trauma responsive care. April 2021. https://www.hazeldenbettyford.org/research-studies/addiction-research/trauma-responsive-care
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Copyright, 2026 by the authors. This work is licensed under the Creative Commons Attribution 4.0 International License.