This systematic review aimed to synthesize the best available research evidence regarding the effectiveness of school-based occupational therapy interventions on school skills and abilities among children with ADHD (attention deficit hyperactivity disorder) and ASD (autism spectrum disorder). The review was conducted according to JBI (Joanna Briggs Institute) guidelines . A three-step search strategy was conducted from five electronic databases (CINAHL, PubMed, OTDBASE, Google Scholar, and Oula-Finna) in January 2022. This review considered randomized and quasi-randomized studies that evaluated school-based occupational therapy interventions for children on school skills and abilities, specifically outcomes of social interaction and process skills, and cognitive abilities. This review includes thirteen studies with a total sample size of 375 participants. Results are divided into two categories: school-based occupational interventions for children with ADHD (three studies) and school-based occupational interventions for children with ASD (ten studies). Results from school-based occupational therapy intervention studies for children and adolescents with ADHD indicate that this group of students benefits from manualized interventions that focus on social interaction skills, process skills, and cognitive abilities. Positive responses to these outcomes were found when using interventions concerning mindfulness, weighted vests, and executive function training programs. Results from school-based occupational therapy intervention studies for children and adolescents with ASD emphasize using interventions that affect social interaction skills.