Importance: Demand is increasing for activity- and occupation-based interventions to address occupational performance and support maximal participation of children and youth.

Objective: This Practice Guideline was developed to guide decision making and support best practices in service delivery for children and youth ages 5–21 yr at home, at school, and in the community.

Method: The results from three systematic reviews (SRs) of activity- and occupation-based interventions for children and youth ages 5–21 yr were reviewed, synthesized, and translated into recommendations for education, practice, and research.

Results: One hundred eighty-five articles were included in the three SRs examining the evidence for interventions to promote activities of daily living, instrumental activities of daily living, play and leisure, and rest and sleep; to improve mental health, positive behavior, and social participation; and to enhance learning, academic achievement, and successful participation in school. The reviews provide evidence for interventions associated with typical concerns addressed by occupational therapy practitioners.

Conclusions and Recommendations: On the basis of the evidence, this guideline recommends that occupational therapy practitioners consistently collaborate with families and caregivers and provide services in the natural context of the desired occupation. The evidence also supports group service models and models that include peer mediation; these models can promote participation across areas of occupation. Skills-based training and therapeutic practice in the context of valued occupations are recommended over isolated sensorimotor approaches. Technology, manualized programs, and sports activities can be effective but should be evaluated and matched to age, diagnosis, and outcomes as guided by the evidence.

What This Article Adds: When guided by evidence, activity- and occupation-based interventions are effective in promoting participation and enhancing performance in valued occupations of children and youth ages 5–21 yr.

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