In the 2024/25 academic year, the overall attendance rate for children with Additional Support Needs (ASN) in Scotland was 88.2%, compared to 92.9% for pupils without ASN. With more inclusive practices in mainstream schools, driven by occupational therapists, this gap could be reduced – according to The Royal College of Occupational Therapists (RCOT).

According to RCOT members in Scotland, the top benefits and improvements of getting the right support from occupational therapists at the right time are:

•  Ability of caregivers/parents to support their child’s needs (95%)
• Classroom participation (92%) 
• Behaviour and emotional regulation (81%) 
• Capacity of school staff to support children and young people (79%) 
• Mental health and wellbeing, e.g. confidence, self-esteem (77%) 
• Developing the skills needed for future employment (77%)

More than half of Scottish respondents (55%) said they’re unable to provide the level or type of support children in their area need and only around three in five (58%) said their occupational therapy teams are fully staffed. A lack of capacity across services is having wide‑ranging consequences for children’s wellbeing, learning and long‑term prospects.  

“I’ve tried to not say anything on this but if everyone keeps quiet nothing will change.” ASN Education in Orkney

Occupational therapy plays a vital role in helping children participate in the classroom, develop essential life skills and manage emotions, yet nearly three-quarters of respondents based in Scotland (74%) said a shortage of occupational therapy capacity is now a major barrier to effective ASN support in their area.  

This means more children are missing out on essential support with things like learning how to do up zips, hold a pen, use a knife and fork, or go to the toilet by themselves. Children with sensory differences may not be included in classroom tasks if the lighting or sound levels haven’t been adjusted. And children who struggle with mobility may not be able to get to certain parts of their school. It means children are being left out and aren’t gaining the essential skills they need to help them throughout school and into adulthood and work.

The survey also revealed that almost nine in 10 (87%) respondents in Scotland believe earlier occupational therapy could prevent the need for a Coordinated Support Plan, either almost always or sometimes. And over four in five (81%) believe improving access to school‑based occupational therapy could reduce the number of ASN tribunals, supporting both families and overstretched local systems. This shows that having access to occupational therapy in school as early as possible could make a huge difference to families of children with ASN.

Policy and Public Affairs Lead for Scotland at the Royal College of Occupational Therapists, Katie MacGregor, said: 

‘Every child has a right to education and we know that children have the best educational outcomes when they get the right support at the right time. Our survey results show how harmful delays in occupational therapy can be for children and young people. Ahead of the election in May, this is a chance for the next Scottish government to make a real difference. 

‘Many children are struggling without support that could change their school experience. While they wait, they become anxious, fall behind and disengage from learning. Early support matters, but many occupational therapists aren’t able to see children quickly. 

‘Occupational therapists help with things like handwriting, self‑care, sensory needs and adapting classrooms. Without more workforce capacity across Scotland, children face barriers that could affect their future.’

There are currently an estimated 300-500 occupational therapists in Scotland who work with children, not all of them in schools, and there are over 2300 publicly-funded mainstream schools. There’s a desperate need for an increase in the number of occupational therapists and a shift in resources to ensure every school in Scotland has access to the support its pupils need.

Occupational therapists work across health, social care, education and private practice with adults and children of all ages who have a wide range of conditions, helping them overcome challenges completing everyday tasks or activities, also known as occupations. In schools, they help create more inclusive and accessible school environments so all children can learn, thrive and enjoy school life. By working in partnership with schools, occupational therapists can identify children’s needs early and provide timely support to stop difficulties from escalating. Taking a proactive approach enables every child to access learning and reach their potential, as children and as adults. 

RCOT is calling for every mainstream school across Scotland and the rest of the UK to have access to occupational therapy expertise and to take a whole-school approach to providing support. Occupational therapists need to be involved in the training of teachers, teaching assistants and others who work with children, to help them better understand and support all areas of children’s development. Adopting this whole-school approach and enabling school staff to identify, support and include learners with additional needs will mean occupational therapists have more time to focus on children and young people with higher support needs. To achieve this, investment in the occupational therapy workforce is essential, as well as integrated commissioning of children’s occupational therapy services. There also needs to be better integration across education, health and care to ensure children and young people get the seamless support they need to learn and thrive at school. 

For more information about the Right Support, Right Time: Unlocking the Power of OT campaign, visit: rcot.co.uk/righttimeOT  

The Royal College of Occupational Therapists (RCOT) findings are part of its UK-wide Right Support, Right Time campaign and as a response to the UK Labour Government’s White Paper SEND reform plan, Putting Children and Young People First for England. In the 2024/25 academic year, the overall attendance rate for children with SEND in England was 86.3% compared to 93.1 % for all children. 

Over 1.7 million pupils in England have special educational needs and the number is rising in every UK nation, each year.   According to our latest workforce survey, 72% of children’s OTs said the demand for OT had increased since January 2025.