Importance: Occupational therapy practitioners evaluate students’ ability to participate in school and may provide services to improve learning, academic performance, and participation.

Objective: To examine the effectiveness of interventions within the scope of occupational therapy practice to improve academic participation of children and youth ages 5–21 yr.

Data Sources: We searched MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane databases for articles published from 2000 to 2017 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Study Selection and Data Collection: Within the scope of occupational therapy practice and focused on children ages 5–21 yr.

Findings: Forty-six studies were included, based on three themes: (1) interventions to support participation and learning in the classroom; (2) interventions to support motivation and participation in literacy, including combined reading, written expression, and comprehension; and (3) interventions to support handwriting. Low strength of evidence supports the use of weighted vests and stability balls, and moderate strength of evidence supports the use of yoga to enhance educational participation. Moderate strength of evidence supports the use of creative activities, parent-mediated interventions, and peer-supported interventions to enhance literacy participation. Strong evidence supports therapeutic practice for handwriting intervention, and low strength of evidence supports various handwriting programs as replacement or additional instructional strategies to enhance handwriting abilities.

Conclusions and Relevance: More rigorous studies are needed that are conducted by occupational therapy practitioners in school-based settings and that use measures of participation and academic outcomes.

What This Article Adds: This systematic review provides occupational therapy practitioners with evidence on the use of activity-based and occupation-centered interventions to increase children’s participation and learning in school.

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