The CO-OP Approach (Cognitive Orientation to daily Occupational Performance) is an occupational therapy intervention in which a child works toward goals they choose themselves, guided by a global problem-solving strategy: GOAL-PLAN-DO-CHECK. Rather than treating underlying impairments directly, the therapist uses guided discovery to help the child find and apply their own strategies, with evidence for conditions including developmental coordination disorder (DCD) and autism.
Key takeaways
- CO-OP is client-centred: the child chooses the goals, and the therapist coaches problem-solving rather than drilling skills.
- GOAL-PLAN-DO-CHECK is the global strategy children learn to apply to any task.
- The four objectives are skill acquisition, cognitive strategy use, generalisation and transfer of learning.
- Systematic reviews report positive effects on activity and participation for children with DCD and other neurodevelopmental disorders, though some evidence is early-stage.
- Self-chosen goals map directly onto NDIS goal-based planning.
What is the CO-OP Approach?
The CO-OP Approach is described in the clinical literature as "an individualized, client-centred intervention" that "engages the patient/child as an active collaborator in the therapeutic process of problem-solving" (). It was developed for children with DCD and has since been applied across several childhood-onset disabilities.
What makes CO-OP distinctive is its mechanism. It "focuses directly on skill acquisition through cognitive strategy use, without specifically addressing underlying impairments." Instead of remediating, say, balance or motor planning in the abstract, the therapist helps the child work out how to do the specific everyday task they want to do — riding a bike, doing up buttons, printing their name — and how to think their way through similar tasks in future.
How does GOAL-PLAN-DO-CHECK work?
GOAL-PLAN-DO-CHECK is the global problem-solving strategy at the heart of CO-OP. The child learns to apply four steps to any task ():
The therapist supports this through guided discovery — "facilitating clients to find their own solutions to their own problems, using questioning, coaching, working on one thing at a time" — rather than telling the child the answer. The aim is that the child internalises the strategy and can run GOAL-PLAN-DO-CHECK themselves.
What are the goals of CO-OP?
CO-OP works toward four objectives ():
- Skill acquisition — learning the specific tasks the child chose.
- Cognitive strategy use — using GOAL-PLAN-DO-CHECK and other strategies.
- Generalisation — applying skills beyond the therapy setting.
- Transfer of learning — using the strategy on new, untrained tasks.
Generalisation and transfer are what separate CO-OP from approaches that produce gains only on the practised task in the clinic room.
What is the evidence for CO-OP?
The strongest evidence is for developmental coordination disorder. A 2024 systematic review of CO-OP for children and adults with DCD selected 31 articles and reported that "findings consistently support CO-OP's effectiveness with children having DCD, yielding positive outcomes for specific measures," while also noting "the need for more rigorous research to bolster confidence in the evidence base" (). In other words: promising and consistent, but not yet backed by large definitive trials.
Across neurodevelopmental disorders more broadly, a 2023 systematic review of 20 studies — covering DCD (13 studies), autism spectrum disorder (5), ADHD (1) and learning disability (1) — concluded that "the CO-OP approach has a positive effect on children with NDDs, particularly in regard to their activities and participation," with all 19 studies measuring activity and participation outcomes showing improvement ().
For autistic children, a 2025 quasi-experimental study of 27 autistic children (aged 8–12) with co-occurring DCD found that "the CO-OP intervention effectively improved motor skills of autistic children," with significant improvements across outcome measures maintained at three-month follow-up ().
Taken together, the evidence supports CO-OP as a reasonable, goal-directed option for the right child — with appropriate clinical reasoning and honest acknowledgement that some of the research base is still developing.
How do occupational therapists apply CO-OP?
In practice, an OT using CO-OP will:
- Start with the child's goals. The child names a small number of tasks they want to be able to do. The therapist may use a structured tool to set and rate these goals.
- Coach, don't drill. Through guided discovery and questioning, the therapist helps the child apply GOAL-PLAN-DO-CHECK to each goal, working on one thing at a time.
- Build the strategy, not just the skill. The therapist makes the GOAL-PLAN-DO-CHECK strategy explicit so the child can reuse it.
- Plan for generalisation and transfer. Parents and others are brought in so the child uses the strategy at home and school, and on new tasks.
This positions the child as the problem-solver and the OT as the coach — a stance that tends to support engagement and ownership.
How does CO-OP align with NDIS goals?
CO-OP is, by design, goal-based: the child's self-chosen, functional goals are the unit of work. That fits cleanly with NDIS planning, where supports are organised around a participant's individual goals and capacity building. Because CO-OP explicitly targets generalisation and transfer, it also aligns with the NDIS emphasis on building lasting capability rather than ongoing dependence.
As always, suitability is individual. CO-OP requires a child who can engage with a cognitive, talk-based strategy, and outcomes are not guaranteed. Goals should be individualised and reviewed.
Evidence at a glance
Read the source studies directly; this summary is not individual clinical advice.
Frequently asked questions
What does CO-OP stand for?
CO-OP stands for Cognitive Orientation to daily Occupational Performance. It is a client-centred occupational therapy approach in which children work toward self-chosen goals using cognitive strategies ().
What conditions is CO-OP used for?
CO-OP was developed for developmental coordination disorder and has been applied to autism, cerebral palsy and acquired brain injury, among others. The strongest evidence base is for DCD ().
How is CO-OP different from regular skills practice?
Rather than directly remediating underlying impairments, CO-OP teaches the child a problem-solving strategy — GOAL-PLAN-DO-CHECK — and uses guided discovery so the child finds their own solutions, with a deliberate focus on generalising and transferring skills to new tasks.
Is CO-OP suitable for every child?
No single approach suits every child. CO-OP relies on a child engaging with a cognitive, talk-based strategy, so an occupational therapist will assess whether it fits a particular child and their goals. Outcomes vary and are not guaranteed.
Does CO-OP fit with NDIS goal-based planning?
Yes, conceptually. CO-OP starts from the participant's own functional goals and targets durable, transferable capability, which aligns with how NDIS plans are built around individual goals and capacity building. Funding depends on the participant's specific plan.
Working with Align Network
Align Network's use goal-directed approaches including CO-OP, and collaborate with our where communication goals intersect with daily-living goals. To discuss whether CO-OP suits a child's goals, . Speak with Align Network's speech pathology and occupational therapy team.
Contact Align Network today
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