Therapy and Developmental Services for Children in Japan
Two Ways to Get Therapy in Japan
If your child has a disability or developmental delay in Japan, therapy and developmental support are available through two separate systems. Understanding the difference between them is one of the most important things a parent can know, because each system is accessed differently, covered differently, and offers different types of support.
Track 1: The Welfare System (Fukushi / 福祉)
This is the disability welfare service track. Under this system, your child attends a jidou hattatsu shien jigyousho (児童発達支援事業所), an early childhood developmental support facility, where they receive group or individual developmental support. The focus is broad: daily living skills, social skills, communication, sensory processing, motor development, and play-based learning. Sessions are typically led by childcare specialists (hoikushi / 保育士), child instructors (jidou shidouin / 児童指導員), and in some facilities, therapists.
To access this track, your child needs a tsuusho jukyuusha shou (通所受給者証), the service authorization recipient certificate issued by your municipality. See the article “The Tsuusho Jukyuusha Shou” on this site for the full process.
Track 2: The Medical System (Iryou / 医療)
This is the hospital and clinic track. Under this system, your child sees licensed rehabilitation therapists at a medical institution. A doctor writes a rehabilitation prescription, and your child receives individual therapy sessions covered by Japan’s national health insurance (kenko hoken / 健康保険). The standard copayment for children’s medical care is typically low and in many municipalities is further reduced or free through the kodomo iryouhi josei (子ども医療費助成), the children’s medical fee subsidy.
This track provides specialized, clinician-led therapy: occupational therapy, physical therapy, and speech-language therapy. These are the same professions that exist internationally, with licensed practitioners.
The Three Main Therapy Professions
Rigaku Ryouhoushi (理学療法士) / Physical Therapist (PT)
Physical therapists work on gross motor skills, balance, posture, walking, and physical movement. For children with conditions like cerebral palsy, muscular disorders, or motor delays, a PT helps build strength, coordination, and mobility. Sessions may include exercises, stretching, balance activities, and practice with assistive equipment.
Sagyou Ryouhoushi (作業療法士) / Occupational Therapist (OT)
Occupational therapists focus on fine motor skills, sensory processing, self-care skills (eating, dressing, toileting), handwriting, and the ability to participate in daily activities. For children with autism, developmental coordination disorder, or intellectual disabilities, OT often addresses sensory sensitivities, hand-eye coordination, and the practical skills needed for school and daily life.
Gengo Choukaku Shi (言語聴覚士) / Speech-Language-Hearing Therapist (ST)
Speech-language-hearing therapists work on communication, speech production, language comprehension, social communication, feeding and swallowing difficulties, and hearing-related issues. For children who are nonspeaking, have delayed speech, or struggle with language, an ST provides targeted therapy to build communication skills. This may include work on articulation, vocabulary, sentence building, pragmatic language, and alternative communication strategies.
Where to Get Therapy
1. Jidou Hattatsu Shien Jigyousho (児童発達支援事業所)
Track: Welfare
Ages: Birth to school entry (generally 0 to 6)
These are community-based developmental support facilities. There are thousands across Japan. Each facility has its own approach, some focusing on group activities and social skill development, others offering more individualized therapy-style sessions. Some have OTs, PTs, or STs on staff; many do not and instead focus on developmental play, structured activities, and daily living skill practice led by childcare specialists.
The government’s guidelines identify five domains of support that these facilities should address: health and daily living, motor and sensory development, cognition and behavior, language and communication, and relationships and social skills.
2. Jidou Hattatsu Shien Sentaa (児童発達支援センター)
Track: Welfare (hub facility)
Ages: Birth to school entry
These are the larger, more established centers that serve as regional hubs for children’s developmental support. They are more likely to have therapists (OT, PT, ST) on staff, and they also play a coordination role, providing guidance and training to smaller facilities in the area.
Since April 2024, under the revised jidou fukushi hou (児童福祉法, Child Welfare Act), the former distinction between “welfare-type” (fukushi gata / 福祉型) and “medical-type” (iryou gata / 医療型) centers has been unified into a single category. This change was made so that children with all types of disabilities can access support at their nearest center, regardless of whether the center was previously classified as welfare-type or medical-type.
3. Hospitals and Clinics with Pediatric Rehabilitation
Track: Medical
Ages: All ages
Medical rehabilitation is provided at hospitals, clinics, and rehabilitation centers that have a pediatric rehabilitation department (shouni rihabiriteshon ka / 小児リハビリテーション科). You need a doctor’s referral and a rehabilitation prescription (rihabiriteshon shohousho / リハビリテーション処方箋) to access these services. Sessions are conducted one-on-one with a licensed therapist.
Not all hospitals offer pediatric rehabilitation. Availability varies significantly by area, and wait times for an initial appointment can be long (months in some regions). Ask your pediatrician or your local health center for a referral.
4. Home-Visit Developmental Support (Kyotaku Houmon Gata Jidou Hattatsu Shien / 居宅訪問型児童発達支援)
Track: Welfare
Ages: Birth to school entry
For children who cannot attend a facility due to severe disability or medical fragility, a therapist or developmental specialist visits the child at home and provides one-on-one developmental support. This service requires a tsuusho jukyuusha shou (通所受給者証).
5. Nursery and School Visit Support (Hoikusho Tou Houmon Shien / 保育所等訪問支援)
Track: Welfare
Ages: Preschool and school age
A specialist visits your child’s nursery, kindergarten, or school to observe, advise staff, and help create an environment where your child can participate more fully. This service is especially helpful for supporting your child’s inclusion in a regular educational setting. It also requires a tsuusho jukyuusha shou (通所受給者証).
6. Private Therapy (Jihi / 自費)
Track: Self-pay
Some families also use private, self-pay therapy services. These are not covered by insurance or welfare subsidies and can be expensive, but they may offer shorter wait times or specialized approaches not available through the public system. This is less common but worth knowing about as an option.
Can My Child Use Both Tracks?
Yes. Many children use both systems at the same time. For example, a child might attend a jidou hattatsu shien jigyousho (児童発達支援事業所) three times a week for developmental play and social skill groups (welfare track), while also seeing a speech therapist at a hospital once a week (medical track). The two systems are separate and do not conflict with each other.
In fact, many jidou hattatsu shien jigyousho do not have licensed therapists on staff. If your child needs specialized OT, PT, or speech therapy, you may need to access those through the medical track separately.
How Much Does It Cost?
Welfare Track
Services accessed through the tsuusho jukyuusha shou (通所受給者証) have income-based monthly copayment caps. For preschool-age children (ages 3 to 5), services are completely free under the government’s muryouka (無償化, free early childhood education and care) policy. See the article on the Tsuusho Jukyuusha Shou on this site for details on cost tiers.
Medical Track
Hospital-based rehabilitation is covered by health insurance. The standard copayment for children varies by age and municipality. Many municipalities offer a children’s medical fee subsidy (kodomo iryouhi josei / 子ども医療費助成) that reduces or eliminates the copayment entirely, often up to age 15 or even 18. Check with your municipality for your local rules.
Practical Tips
- Start early. Research consistently shows that early intervention leads to better outcomes. If your child has a developmental concern, do not wait for a formal diagnosis to begin exploring services.
- Visit multiple jidou hattatsu shien jigyousho before choosing one. Each facility has its own atmosphere, approach, and staff. Ask about staff qualifications, group sizes, and what a typical session looks like.
- If your child needs specialized therapy (OT, PT, or speech therapy), ask whether the jidou hattatsu shien facility has those professionals on staff. If not, you will likely need to access medical rehabilitation at a hospital separately.
- Ask your pediatrician for a rehabilitation referral early. Hospital-based therapy often has long wait lists, so getting on the list early is important.
- You can search for jidou hattatsu shien providers in your area using the WAMNET provider search, a government-affiliated service directory.
- Some children benefit most from a combination of welfare-track group programs and medical-track individual therapy. Talk to your child’s doctor and consultation support specialist about what combination makes sense.
- Keep a record of your child’s progress. Having notes on what your child can do and what they are working on helps you communicate effectively with both welfare and medical providers.
- Ask about parent training programs. Some jidou hattatsu shien sentaa (児童発達支援センター) offer parent programs (pearento toreeningu / ペアレントトレーニング) that teach you strategies to support your child’s development at home.
- Ask about hoikusho tou houmon shien (保育所等訪問支援). This service sends a specialist to your child’s school or daycare to help teachers understand your child and create better accommodations. Many families do not know this option exists.
Key Terms
| Japanese Term | English |
| 児童発達支援 (jidou hattatsu shien) | Early childhood developmental support |
| 児童発達支援事業所 (jidou hattatsu shien jigyousho) | Developmental support facility |
| 児童発達支援センター (jidou hattatsu shien sentaa) | Developmental support center (hub) |
| 理学療法士 (rigaku ryouhoushi) | Physical therapist (PT) |
| 作業療法士 (sagyou ryouhoushi) | Occupational therapist (OT) |
| 言語聴覚士 (gengo choukaku shi) | Speech-language-hearing therapist (ST) |
| リハビリテーション (rihabiriteshon) | Rehabilitation |
| 健康保険 (kenko hoken) | National health insurance |
| 子ども医療費助成 (kodomo iryouhi josei) | Children’s medical fee subsidy |
| 保育士 (hoikushi) | Childcare specialist / nursery teacher |
| 療育 (ryouiku) | Therapeutic education / developmental care |
| 居宅訪問型児童発達支援 (kyotaku houmon gata jidou hattatsu shien) | Home-visit child developmental support |
| 保育所等訪問支援 (hoikusho tou houmon shien) | Nursery/school visit support |
| 無償化 (muryouka) | Free early childhood education and care policy |
| ペアレントトレーニング (pearento toreeningu) | Parent training program |
Useful Resources
- Children and Families Agency (CFA): Disability Child Support Policies (障害児支援施策)
https://www.cfa.go.jp/policies/shougaijishien/shisaku
- CFA: April 2024 Service Fee Reform and Center Unification (令和6年度障害福祉サービス等報酬改定)
https://www.cfa.go.jp/policies/shougaijishien/shisaku/hoshukaitei
- MHLW: Jidou Hattatsu Shien Guidelines (児童発達支援ガイドライン, PDF)
- MHLW: Disability Welfare Service User Fees (障害者の利用者負担)
https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/hukushi_kaigo/shougaishahukushi/service/hutan1.html
- National Rehabilitation Center: Developmental Disabilities Information and Support Center (発達障害情報・支援センター)
- National Rehabilitation Center: WHO Collaborating Centre (English leaflet, PDF)
https://www.rehab.go.jp/english/whoclbc/pdf/eng-leaflet.pdf
- WAMNET: Service Provider Search (障害福祉サービス等情報検索)
